Part 3

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.

SECTION V.

_Of the Secret Antimonial Medicines, and particularly of the fever-powder._

If the difficulty of conducting the operation of antimony, renders the general application of it, in regular practice, dangerous, it must, as a secret remedy, in the hands of those who have no medicinal skill, be still more pernicious. But as some secrets, now, universally extolled, are avowed, by their proprietors, to be preparations of antimony, let us next proceed to examine their claim to the high character which they have obtained. For this purpose the fever-powder may be selected, since if the impropriety and danger of its general use should be demonstrated, the arguments in favour of less celebrated secrets will not require a serious refutation.

Unpleasing as the task may be, and however odious, to some, it may render the man who undertakes it, yet the great importance of life and health requires, that the precepts of the most illustrious physicians should not pass without examination, nor secret and mysterious remedies be adopted with implicit faith.

The devout solemnity with which the fever-powder is ushered into the world, the exorcisms against detractors and malicious persecutors, and the invocation of God to support his own work, being in the usual stile of the mystical chymists, require no comment. _As there may be some_, says the Inventor, _whose lucrative views may tempt them to persecute me, and the method I propose, with all the detraction and falsehood which may be expected from self-interest and unprovoked revenge, these I shall advise to save themselves a good deal of unnecessary trouble, and to let it alone; for if it be of men it will come to nought, but if it be of God ye cannot overthrow it_[72]. When magical chymistry and superstition reigned over the dark ages of ignorance, this charm would have secured it from all enquiry. But as the sober light of religion and philosophy hath now illuminated the world, and displayed the absurdity of that servile bondage which obstructed all improvement, we may, notwithstanding this solemn prohibition, with candor and modesty, proceed to examine the real merit of this boasted arcanum.

The process for making it has been carefully concealed, while its being an antimonial preparation, hath, with industry and ostentation, been universally published. From the view which has already been given of the natural history of antimony, its analysis and chymical properties, its preparations and their medical effects, it has, I think, been clearly proved, that however efficacious it may have been in particular circumstances, and under judicious management, yet there is not, in unskilful hands, a medicine more dangerous and destructive.

By a judicious regulation of the doses of different preparations of antimony, by guarding against the pernicious effects which might arise from the virulent particles which it contains, by directing such food, drink, and medicines as may promote its salutary operation, and prohibiting those by which it might be rendered noxious; skilful and experienced physicians have been able, in singular instances, to render it a safe and efficacious remedy: but when it has been accidentally or imprudently given in too large doses[73], or joined with such food or medicines as excite its poisonous qualities[74], it has not only proved too violent in its operations, but has been productive of fatal consequences.

Had, therefore, the Inventor discovered a method of divesting this Proteus-like mineral of all pernicious qualities, and rendering it a medicine invariably safe and efficacious, however combined with other remedies, or mixed with a variety of humours, food, and drink in the stomach, his powder would have been more proper for common use, and might have been trusted, in unskilful hands, with less danger, than other antimonial preparations. But it does not in this respect lay any claim to superiority. _Supposing_, says the Inventor, _physicians perfectly well skilled in the preparation and uses of it, that knowledge will inform them, that nothing can be added to it that will in any degree increase its virtues; or rather that no addition can be made to it that will not diminish them_[75].

By this frank declaration we understand that the fever-powder retains the mutability of antimony, and is, from slight accidents, changed from a salutary medicine to a noxious substance; and hence proceeds the Inventor’s anxiety to prevent improper combinations. But the dread of dangerous consequences, or some other cause, has led him unwarily and inconsistently to depreciate his powder, and reduce it below all other antimonial preparations; for though by certain additions the virtues of antimony may be diminished, yet by others they may be improved; and this, it is probable, from the known properties of that mineral, will also hold with the fever-powder, although the contrary is here expressly asserted.

But, lest the assertion should give unfavourable impressions, it is immediately retracted; and we are told that, _occasion may sometimes occur of employing, advantageously, a regimen, or even medicine, when judgment directs and integrity presides_[76]. and again: _It sometimes happens, when little or no putrid bile is contained in the stomach, bowels, &c. &c. that the powder, though given in the largest doses, will have no sensible operation of any kind whatever. In these cases half, or a whole paper should be repeated every four or six hours. But on those occasions, it will be proper to procure two stools in twenty four hours, either by a clyster, which is the most easy way, or by giving, with every dose of the powder, from five to ten grains of rhubarb_[77]_. But in some constitutions where a putrid bile has very much abounded, and for this reason the stimulus of the medicine, added to that of the bile, has been apt to operate more than was sufficient, it has been necessary to reduce the dose so low as two or three grains_[78]: and thus, after a series of contradictions, the fever-powder, as might have been expected, is declared to require the addition of other medicines, and to be as uncertain in its operation as other antimonials.

These contradictions are suspicious, but if the efficacy of the medicine is confirmed by authentic facts, the Inventor may still be intitled to our confidence; and for this purpose some cases are related in which it was successfully used: the first is that of Mrs. Morton, on which it is remarked, that _many gentlewomen were present during her whole disorder, saw her take the medicine, observed the effects, and are ready to give their testimony to the truth of what has been asserted_. From what has been advanced on this subject, it clearly appears, that the operation of antimony is precarious, and its effects uncertain. Not only the most skilful physicians have given various and contradictory opinions concerning it, but the judgment of the same person has varied at different times[79]: it is not therefore to be expected, that a fact, which has not yet been agreed upon by the most intelligent and attentive practitioners, should be ascertained by these charitable _gentlewomen_, who, however sincere and humane their intentions might be, cannot be supposed to have any pretensions to that critical and discriminating skill which is necessary to determine a question so intricate. The Inventor therefore, in offering to the publick a proof so incompetent, must have relied on that credulity which, though generally abused, is still continued.

But though the cases had been attested by competent judges, yet the inferences in favour of the powder are not warranted by the circumstances related. Thus Mr. French of St. Albans street, late Surgeon of his Majesty’s ship the Levant, “_having given tartar emetic and other medicines unsuccessfully, prescribed the powder on the fourth day of the fever: it was continued on the fifth, and on the evening of that day, the fever being entirely removed, on account of the lowness and weakness of the patient, a drachm of bark was given every hour in a glass of Madeira_[80].” The misrepresentation, in this case, is evident, since the cure must be attributed, by candid and intelligent judges, not to the powder, but to the bark and Madeira; and the slovenliness of the deception is an insult to the credulity of the publick, as this is perhaps the only instance in which it has been pretended, on account of lowness and weakness, to give every hour a drachm of bark in a glass of Madeira.

These are not the only circumstances in which the evidence is deceitful; successful cases are industriously published, while those ending fatally are carefully concealed. The medicine is frequently given in slight disorders which could not, even by improper management, be rendered dangerous, and when the sick recover, its praise is loudly proclaimed.

Those who use it often become insensibly interested in advancing its reputation, and are not only incompetent judges, but partial in their testimony. Thus some who, with horror and remorse have applied for assistance, accusing themselves of murder, and vowing, for ever, to renounce quackery, have afterwards triumphed and assumed the credit of cures of which they had absolutely despaired, though the sick were, by other means, rescued from the danger incurred by the severe operation of this violent remedy; while others, shocked by the fatal consequences of their facility and misplaced confidence, wish to banish it for ever from their remembrance. The cases must therefore be dismissed as insufficient to justify the claim of infallibility to this antimonial preparation.

A proof of its salutary influence is attempted to be drawn from the bills of mortality. Fewer having, on an average, died in the space of thirteen years, from the year one thousand seven hundred and fifty, to the year one thousand seven hundred and sixty-three, than in the preceding thirteen years; this decrease in the funerals amounting to sixty-two thousand, two-hundred and sixty-six, is attributed to the fever-powder[81].

It might with some plausibility be objected, that the bills of mortality being collected from the reports of incompetent judges, cannot be admitted as proper evidence of the fact; but as no extraordinary skill seems necessary for the employment, and as the bills cannot be supposed to be made up with any partial intention, this argument must be admitted; and if the deaths, by fevers, shall be found to have decreased, in so great proportion, since the powder has been in general use, its reputation will be established by the most desirable evidence.

In collecting this proof, the whole circle of disorders, accidents and casualties has been calculated, though the powder was then only recommended for fevers. It has, indeed, been since extended to other diseases, but our examination shall be restricted to fevers, during the period to which the Inventor refers.

Though some of the cases which he relates happened in the year one thousand seven hundred and forty-one, yet the medicine was not much known till one thousand seven hundred and fifty, the æra from which its auspicious influence on the bills of mortality is dated. But antimonial medicines were more in fashion before the powder came into general use, than at any future time. Dr. Huxham having, in the year one thousand seven hundred and thirty-seven, recommended, in the highest strain of panegyric, the vinum benedictum, it was universally adopted, though expressly condemned by the Inventor of the fever-powder. _Great numbers_, says he, _of those whose employment it is to attend the sick, cunningly exhibited to their patients something, which they asserted was like the fever-powder, and would do as well. I leave it to the relations of those who took the something, to judge the consequence, for I suppose few or none of them who were thus treated survive_[82].

The something, it is well known, was essence of antimony or tartar emetic, medicines under the direction of prudent practitioners, similar in their operation and in their effects, not only to each other, but also to the fever-powder; and though the Inventor has perhaps too much indulged his indignation against his competitors in the antimonial trade, yet his general position, concerning the fatal consequences of the universal administration of antimonial medicines, is well supported by the evidence to which he has appealed, the bills of mortality having greatly increased during the prevalence of that practice.

The numbers of those who died of fevers from the year one thousand seven hundred and thirty-eight, to one thousand seven hundred and fifty, including a series of thirteen years, is fifty-five thousand four hundred and ninety, and those in a like series of years, immediately succeeding, is thirty-six thousand three hundred and seventy-two; consequently nineteen thousand one hundred and eighteen fewer have died in the latter than in the former period, and this has, with some appearance of justice, been urged as a proof of the efficacy of the fever-powder.

But if this decrease in the funerals were actually owing to that medicine, it should have been still more observable in the last ten years, when the powder has been more universally used. But, in that period, thirty-five thousand four hundred and ninety-four have died, and consequently, the number of deaths, by fevers, have increased eight thousand seven hundred and eighty; and if inflammation, rash, and sore-throat, which were included in the former calculations, are added, the number will amount, nearly, to ten thousand, and therefore, on an average, _one thousand, or near one-third_ more have died, of fevers, _every year_, in the last ten years, while the medicine has been universally used, than in the thirteen immediately preceding. The proof, therefore, from the bills of mortality is fatal to the fame of the fever-powder, and the decrease in the funerals during the thirteen years to which the Inventor appeals for the success of his antimonial powder, must be attributed to the desertion of the antimonial practice, and not to its prevalence.

But an appeal to the sum-total of the funerals, to prove the efficacy of the fever-powder, is unfair and inconclusive, since a great number of deaths happen from disorders, accidents and casualties with which it cannot possibly have any connection. That it might have a fair trial, our calculation has been restricted to fevers; and if the other diseases, in which it is recommended, had been included, the evidence would have been still more unfavourable.

Another argument in favour of the powder is, _if it had not been attended with general success, it could not, amidst the opposition of Physicians, have grown into reputation_. But transitions, from the highest approbation of antimony, to the absolute condemnation of it, have been so frequent, and are so familiar to those acquainted with its history, that no conclusion can be drawn from its casual reputation, or transitory condemnation; and since, in the course of our enquiry, no advantage has been taken of the penal laws enacted against its use, nor of the public edicts by which it has been prohibited, neither can any concession be made on account of the transient applause, _artfully_, obtained to some of its preparations.

As to the opposition of physicians, the Inventor, indeed, that the prophecy with which he set out might be fulfilled[83], complains, that all laws human and divine, have been trampled upon in opposing him; that he has been persecuted with _malice, rancour, virulence, detraction and unprovoked revenge_, and that his enemies have not only sacrificed _candour, honour, truth and reputation_, but even the _lives_ committed to their care, in order to discredit his boasted arcanum[84].

Were we not witnesses of his triumph, we should naturally conclude that he had suffered as a martyr in the cause of truth and humanity. Yet we find, in his Dissertation, many cases in which the powder was given under the sanction of eminent physicians, and these, too, produced by the author, in proof of its efficacy; though by his own account of the medicine, it is of all others the most improper to be used without an accurate knowledge of its composition, and cannot therefore be prescribed by physicians on any justifiable principles; although they may, from facility or complaisance, yield to the importunity and prejudice of the sick or their relations, and assent, even against their better judgement, to its administration.

_When the fever-powder is given_, says the Inventor, _no other medicine should be taken either with it, or during the course of it. For want of this caution many have perished. For it may be depended upon, that in the state of credit in which it has at present the honour of standing amongst many of the medicinal worthies, nothing is meant by any addition, but to counteract or discredit the powder at the expence of the patient’s life. It is usual for them to say, that they are acquainted with the preparation of the medicine, or that they cannot use a medicine that they do not know, just as either favours the present intention and purpose. Now let us suppose they do not know it, which is very true; by what conjuration, magic, or inspiration are they taught a method of improving, by adding something to a medicine, of which they are so totally ignorant, that they choose to suffer their friends to perish rather than employ it_[85].

It may be left to the Author to explain how those physicians, who do not use the powder, _kill_ their friends, by adding something to counteract or discredit it, while from his own declaration, we may fairly conclude that those who _do use it_, must, in _his_ opinion, be destitute either of judgment or integrity. _For supposing them_, says he, _perfectly well skilled in the preparation and uses of it, their behaviour is, for this very reason, abundantly more infamous. For the same knowledge would inform them, that no addition can be made to it that will not diminish its virtues_[86].