_Of the preparations of antimony, and their medical effects._
The limits to which dissertations of this kind ought to be confined will
not permit us to enter into a minute detail of the various antimonial
preparations which may be found in every dispensatory. Those in most
frequent use are calx of antimony, crocus of antimony, antimonial wine,
tartar emetic, and kermes mineral.
The virtues of calx of antimony are variously represented by different
writers, some ascribing to it the power of an excellent diaphoretic,
others asserting that it even proves violently emetic, and others,
among whom is the great Boerhaave, declaring it a mere inert earth
intirely destitute of all medicinal virtue. The College of Physicians
of London, who had formerly directed this preparation, under the title
of diaphoretic antimony, thought proper, because of the various opinions
concerning its operation, to change its name to that of calx of antimony,
till its medicinal qualities should be better ascertained[51].
These different judgments can scarce be supposed to have been delivered
by competent judges concerning the same medicine, but may be accounted
for from the different manner in which the process for making the calx
may have been conducted. The common nitre, with which it is prepared,
contains some portion of sea-salt, and when that abounds, the proportion
of nitre being less, the calx may prove an active remedy[52].
If it is not sufficiently calcined, or perfectly freed from the reguline
parts by washing, such of these as remain, may produce more sensible
effects than are to be expected when it is duly prepared, and hence
perhaps proceed the contradictory opinions of chymists and physicians
concerning this antimonial preparation.
But the assertion of its being a mere inert earth, is not well founded,
since a small dose of it sometimes produces violent effects; and it
may be reduced by fusion, with inflammable fluxes, into pure regulus.
It enters the composition of a medicine described by the judicious
Doctor Morton, with which, in three instances, he cured an obstinate
intermitting fever. In one case the disease was of two years standing,
and in all of them had resisted a diligent and skilful application of
the Peruvian bark. But these were the only opportunities he had of trying
it; for having never met with any other case in which that excellent
febrifuge disappointed his expectation, he deemed it an unpardonable
wantonness to use a precarious remedy, while he was possessed of one more
certain and efficacious[53]. It is also recommended by Van Swieten in the
peripneumony, as a deobstruent and expectorant[54].
Crocus of antimony is made by deflagrating equal parts of antimony
and nitre: it operates as a violent emetic when given from two to six
grains. A preparation of this kind, recommended to the London College of
Physicians by one of their own members, under the title of milder crocus
of antimony, as a medicine of mild operation and eminently efficacious,
was inserted in their Dispensatory; but the committee appointed to review
and correct it having had some comparative trials reported to them of
this and the common crocus, which rendered them dubious of their effects,
were induced to leave the matter to be further examined[55].
It is seldom prescribed: but an extraordinary cure is said to have been
performed by the milk of an ass that had drank water in which it was
accidently infused[56]; and from such an improbable story, an eminent
physician was induced to use the milk of a goat which drank the same kind
of water.
Antimonial wine was formerly ordered, in the London Dispensatory, to be
made, by infusing an ounce of powdered glass of antimony in two pints of
claret; and is commended by Salmon, as a strong vomit, under the name of
vinum rubellum.
The vinum benedictum is made by infusing an ounce of crocus metallorum
in a pint and an half of Spanish white wine. A third form is, to digest
two ounces of regulus of antimony in three pints of white wine. This
last preparation is declared by Salmon to be an excellent medicine in
fevers and agues, and in obstructions of the bowels, emptying them of
all evil humours. It perfectly cures the falling-sickness, convulsions,
cramps, gout, sciatica and almost all other disorders. Another tincture
of antimony is directed by the same author, and is said, on account of
its many virtues, to be a gift sent from God. It cures the plague and
all pestilential fevers. A tincture of antimony is also directed by Basil
Valentine, eight drops of which are said to be a remedy for all diseases.
The simple infusion of crocus, glass, or regulus of antimony in wine, if
not more efficacious, is at least less dangerous than those preparations
which are made by more elaborate chymical processes, since the accuracy
and attention of those who prescribe it, will not so readily be defeated
by the carelessness or ignorance of an operative chymist. But though
it may be given with greater safety than other antimonials, yet the
extravagant encomiums bestowed upon it are contradicted by the testimony
of the faithful, attentive and judicious Sydenham. That candid physician
expresses his wishes, that instead of the infusion of crocus of antimony,
we had safer vomits sufficiently efficacious. When called to infants, and
observing a vomit indicated, whereby they might have been preserved from
danger, he durst not give this infusion for fear of bad consequences. He
was cautious of giving it, even to grown people, though, when plentifully
diluted, he found no ill effect from it; but he positively declares that,
in a continued fever, it is by no means safe to give it to children under
the age of fourteen; and expects no other benefit from it, than what
might be obtained by milder emetics[57].
But the obsolete opinions of the universal efficacy of antimonial wine,
although expressly contradicted by the chaster judgement of Sydenham,
were again revived in their full force by Dr. Huxham. In the year 1737
he recommended the vinum benedictum, in a manner that might rather
have been expected from the mystical chymists, in times of ignorance
and superstition, than from an able and experienced physician, in a
liberal and enlightened age[58]. As he had obtained much influence and
authority in his profession, his earnest recommendation could not fail
widely to extend the use of this medicine in regular practice; and when
further experience induced him to speak of it in more moderate terms,
and physicians to look out for less precarious remedies, a new and
infallible antimonial medicine, known by the name of the fever-powder,
was published, which brought us again back to the abuse of antimonial
preparations, which had already been often exploded.
That which next became fashionable, as having the greatest supposed
resemblance, in its operation, to the celebrated fever-powder, was
tartar emetic. It is prepared by boiling equal quantities of washed
crocus of antimony and crystals of tartar in water. This, as being
soluble in liquids, is said to be less precarious in its effects than
the other solid preparations; yet the strength of it greatly depends
upon the manner of conducting the process, for some of the tartar, in
the ordinary method, will be apt to shoot by itself, retaining little
of the crocus. Some have therefore advised, as soon as the solution is
filtered, to carry the evaporation much further than is usually done, if
not to the total exhalation of the liquor[59]. Its effects, however, are
uncertain, six or eight grains sometimes proving a mild emetic; though
in other cases, I have seen half a grain operate so severely as to bring
on violent convulsions, and Newman has known three or four grains prove
mortal.
Fatal consequences have also happened from want of attention to the
different methods of preparing this medicine. A Dutch physician, being
accustomed to an emetic tartar made with salt of tartar, which was given
in doses of ten, twelve, or fifteen grains, prescribed a like dose from a
German shop, by which the patient vomited to death[60].
Kermes mineral, a preparation similar to golden sulphur of antimony, has
been vended as a quack medicine in France and Germany, under the title of
Mineral Centaury, Kermes or Alkermes Mineral, or Poudre des Chartreu, and
in England by that of Wilson’s Panacæa, and Russel’s Powder.
The king of France was at length persuaded by M. Dodart, his first
physician, to purchase it from M. La Ligerie, a surgeon at Paris, and it
was made publick in the year 1720: but, like all other catholicons, has
lost its consequence since the secret has been divulged, and the medicine
found to be a well-known preparation described by Glauber,[61] and the
elder Lemery.[62]
How long this medicine was used by the mystical chymists cannot be known,
since they seldom communicated any of their processes excepting for a
valuable consideration, and under the strictest obligation to secresy.
But Cristopher Farnner, who was a humble retainer of Glauber’s, on the
small stock of chymical knowledge which he had gleaned from him and from
a servant whom he seduced to betray his master and discover his secrets,
attempted to become his rival, and set the process for making the golden
sulphur of antimony to sale, at the price of thirty rixdollars. Glauber,
incensed at his treachery, published his own improved method of preparing
this medicine, which he calls a Panacea of common antimony, and it has
since under different names, and with some variation, been transcribed
into most of the chymical books[63].
According to Geoffroy, as well as the earlier chymists, it was esteemed
an universal medicine. It sometimes vomits, often purges, and generally
operates by sweat and urine; in a word, says this celebrated writer, it
promotes the feveral evacutions, according to the different channels by
which nature may be disposed to throw of the vitiated humours.
It is recommended in the small-pox and measles, in obstinate autumnal
intermittents, in spitting of blood, and other pulmonary complaints, in
chronic diseases arising from obstructions in the bowels, in dropsies and
in the bloody-flux. It is made by boiling antimony repeatedly in water,
with a certain proportion of alcaline salt, and owes its virtues to a
portion of regulus being rendered soluble in water[64].
But this manner of preparing it is condemned by Hoffman; who affirms,
that the reguline or arsenical parts are not sufficiently sheathed by the
sulphureous, as appears from many circumstances which he mentions, but
especially from its violent emetic quality. He recommends a different
process, by which he supposes the sulphur to be so blended with the
reguline, or arsenical particles as to render it a mild and effectual
diaphoretic.
The fate of antimony and its preparations has been as various as the
reports concerning their efficacy are contradictory. They have been
ranked among the wonders of the world, and their virtues extolled
beyond all probability. They have again been proscribed as baneful, and
prohibited under the severest penalties.
Those who used antimony in Rome were sent to the gallies. It was
prohibited in France by an edict of parliament in 1566; and in 1609 a
physician was expelled the faculty of Paris for prescribing it. The
edict was repealed in 1650, and it was again received into the number
of purgatives; but this having been found inconvenient or dangerous,
its general use was prohibited by a new edict in 1668, and it was only
permitted to be prescribed by Doctors of the faculty.
The opinions of different authors on this subject have not been more
various than those of the same person at different times. In the year
1737 Dr. Huxham asserts, without reserve, that no medicine is more safe
or more efficacious than Vinum Benedictum, which, from a supposition
of its possessing all the powers of this mineral, he calls essence of
antimony[65]. But after almost twenty years further experience, he
declares, whoever would give antimony with safety and success, should be
well acquainted with its analysis and component principles, and should
know what different combinations, preparations, and doses, will effect,
otherwise it may prove a poison instead of a remedy[66].
From what has already been advanced, it will not be difficult to account
for these contradictory reports. Different specimens of antimony when dug
out of the mines are not made up of the same component parts; and it is
so changed by fusion, that different pieces of the same lump are not of
equal virtue[67]. There are few antimonial preparations which may not
be made by various processes, none of which can be conducted with such
accuracy as uniformly to produce a medicine of invariable strength, and
their operation is rendered yet more precarious by their combination with
a variety of humours, food, drink and medicines in the stomach.
But since no judgment can be formed from the opposite and contradictory
opinions of others, it may now be proper to mention the result of my own
experience and observation. In one instance, I have seen a dangerous
pleuritic fever, of seven days standing, accompanied with an incessant
cough, a hard, full, quick pulse, laborious breathing, and violent pain
in the breast, perfectly cured in a few hours by the use of antimonial
wine[68].
A dropsy of two years standing, occasioned by a tedious remitting fever,
and accompanied with an obstruction in the liver, which had withstood
the diligent application of a variety of medicines, under the direction
of several skilful practitioners, was cured in a few days by a medicine
which owed its efficacy to tartar emetic[69].
An obstinate dysentery, which had long resisted many other methods of
cure, was perfectly removed by two doses of the vitrum antimonii ceratum.
Encouraged by these signal instances of the efficacy of antimonial
medicines, and by the universal prejudice in their favour, I have used
them in many thousand cases, but never, even in slighter diseases with
the same success. When given with much attention and caution, they have
generally failed where milder medicines have proved effectual, and in
some instances they have been prejudicial.
In a recent dropsy and visceral obstructions occasioned by a remitting
fever, tartar emetic was prescribed not only without success, but with
an apparent aggravation of the symptoms, which were afterwards perfectly
removed by the use of Peruvian bark, snake-root and rhubarb[70].
I have been desired to visit children and some grown persons in fevers,
attended with convulsions, which were, with good reason, attributed to
the misapplication of antimonials, and in one case an imprudent use of
them was judged to be the cause of death.
Though it is asserted that antimonial preparations may be so directed as
to vomit, purge, or sweat according to the intention of the prescriber,
yet those who have had much experience will not obstinately defend the
assertion, since nothing perhaps is more difficult than to foretel
their effects when administered alone. If they are combined with other
medicines their operation may be more certainly directed, since by opium
they may be determined to the skin, by senna or manna they may be carried
off by the intestines, and by an addition of ipecacuan or oxymel of
squills they may be rendered emetic.
But much prudence and skill are requisite in conducting the operation
of these compound medicines. For tho’ no danger were to be apprehended
from joining antimonials with emetics or purgatives, yet, by unskilful
combinations, the peculiar efficacy of antimony may be destroyed; and
by opiates those virulent particles may be retained, and prove noxious,
which would have been carried off, without any other inconvenience than
what might arise from the violence of their operation.
Upon the whole, the evidence in favour of antimony and its preparations
is too slight to justify the exaggerated encomiums with which it has been
extolled: it contains in its crude state, and in all its preparations,
such virulent particles as may, by slight accidents, become poisonous in
the stomach: well-attested instances of remarkable cures performed by
it are few; cases in which it has failed or been prejudicial, numerous;
the reports of chymists and physicians concerning it are various and
contradictory; its effects are precarious, and more skill, experience
and attention requisite to conduct its operation than are to be expected
among the generality, even of regular practitioners[71]. It is therefore
very improper for common use; and as there is no certain rule to direct
the management of it, every physician must form his judgment by comparing
his own observations with the opposite and contradictory assertions of
others.
It would be imprudent to reprobate a medicine which, in some instances,
has certainly performed such cures as are seldom obtained by milder
methods. No bounds are to be fixed to discreet and experienced
practitioners, who, on mature deliberation, may determine the propriety
of hazarding, in particular circumstances, a violent and precarious
remedy, and can conduct its operation with skill and sagacity. Yet the
present indiscriminate use of antimony, which is now grown up into a
fashion too formidable to be attacked with much hope of success, must,
after a candid and impartial examination, be condemned as pernicious.