In regard to all antidotes for arsenic, it must be observed, that they can seldom be otherwise employed than in unfavourable circumstances. If, as most generally happens, the poison has been taken some time before medical aid is obtained, its powder is diffused over the surface of the stomach, adheres with tenacity to the villous coat, and excites the secretion of tough mucus, through which it is with difficulty reached by any antidote possessing a chemical action with it. In all cases, therefore, it is advisable to promote vomiting occasionally, if not already full and free, so as to aid the stomach in clearing itself of the secreted mucus.
If the existence of a chemical antidote for arsenic be doubtful, much less is there any one known of that rarer denomination which operates by exciting in the system a action contrary to that established by the poison.
A good deal, however, may be done by general medical treatment to improve the chance of recovery. If vomiting should be delayed, as often happens, for half an hour or more, advantage ought to be taken of the opportunity to administer an emetic of the sulphate of zinc, with the view of withdrawing the powder in mass before it is diffused over the stomach; and for the same purpose milk should be drunk both before and after vomiting has begun, as it appears to be the best substance for enveloping the powder, and so procuring its discharge. The patient should never be allowed to exhaust his strength in retching without a little milk or other fluid in his stomach to act on. At the same time, there is probably some justice in the opinion expressed by a late writer on this subject, that large draughts of diluents are injurious; and that, unless the stomach is allowed to contract fully and frequently on itself, it cannot discharge from its surface the mucous secretion, in which the powder of arsenic is in general closely enveloped.[1] The stomach-pump, although it has been applied to cases of poisoning with arsenic, does not possess any advantage whatever over emetics or the natural efforts of nature, and is less effectual in expelling the mucus which envelopes the poison. Even emetics are unnecessary, when full vomiting is caused by the poison itself. If milk in sufficient quantity cannot be procured, strong farinaceous decoctions will probably prove useful.
Supposing the poison to have been removed from the stomach, or that the patient has been put on the course which appears best fitted to accomplish that end,—two objects remain to be accomplished, namely, to allay the inflammation of the alimentary canal, and to support the system under that extraordinary depression which it undergoes in the generality of cases. Were it not for the latter of these objects, the treatment would be both obvious and frequently successful. But it is highly probable that the active remedies, to which the physician trusts in internal inflammations generally, and which are urgently called for by the inflammation caused by arsenic, cannot be enforced with the requisite vigour, on account of the remote depressing effects also produced by this poison on the body.
- ↑ Mr. Kerr in Edin. Med. and Surg. Journal, xxxvi. 97.
