Nevertheless, it is certain that in a few even very aggravated cases the purest and most vigorous antiphlogistic treatment has been resorted to with success. Dr. Roget's patient, whose case was formerly referred to for another purpose, seems to have been saved by venesection; and at all events, the amelioration effected was unequivocal. In the Medical Repository there is another good example of the beneficial effects of blood-letting carried even to a greater extent than in Roget's case;[1] and in the Medical and Physical Journal[2] a third instance will be found, which after the first twenty-four hours assumed the form of pure gastritis, and was treated as such with success. Blood-letting ought not to be practised till the poison is nearly all discharged from the stomach, because it promotes absorption by causing emptiness of the blood-vessels.
Orfila has lately advocated the use of blood-letting, on the ground that it tends to remove from the system a portion of the poison which circulates with the blood, and is the main source of danger to life. He has endeavoured to show by experiments on animals, that doses adequate to cause death may be given without this result flowing, if depletion be vigorously enforced along with other treatment. And he has related a case of recovery in the human subject under unfavourable circumstances, where blood-letting was practised five times, and on every occasion with marked relief.[3]
It is not probable that any material advantage will be derived from topical blood-letting, at least in the early stage, because if depletion is to be of use at all, it must be carried at once to a far greater extent than it is possible to attain by local evacuants. Blisters on the abdomen will prove useful auxiliaries in the advanced stage.
While many have advocated the employment of blood-letting and other antiphlogistics, and have used them with apparent advantage, Rasori was of opinion, and more recently Giacomini has strenuously maintained that the proper treatment in all cases of arsenical poisoning is the purely stimulant method. The remedy recommended by the latter is a mixture of eight ounces of beef-tea and two ounces of wine. These notions are evidently dictated by the prevailing pathological delusions of the Italian school. Although upheld in some measure by a Report of the Parisian Academy of Medicine upon some experiments by M. Rognetta on this subject,[4] Professor Orfila subsequently proved, that the practice recommended is utterly useless, if not even hurtful.[5] At the same time no one who has ever seen a case of poisoning by arsenic can doubt that it is often necessary to counteract the overwhelming languor of the circulation by the moderate use of stimulants.
Opium in repeated doses will prove useful, when the poison has been removed, and the inflammation subdued by blood-letting. And I conceive that to the form of gastritis, caused by arsenic, may be
