King of Poisons: A History of Arsenic

It may seem odd that the substance thought of as the quintessential poison has also had a long history of use as a medicine. Yet arsenic compounds have been employed as remedies in various illnesses from antiquity up to the present time.This fact is not as surprising as it might at first seem.After all, almost all medicines, even those developed in recent times, have toxic side effects, sometimes serious ones. In the sixteenth century, Paracelsus pointed out that all things are poisons in the right doses. Too much of a seemingly innocuous substance such as salt, for example, can be lethal. When Paracelsus was criticized for recommending the use of dangerous chemicals such as salts of arsenic, mercury, and lead in the treatment of disease, he responded that these substances could indeed be beneficial if administered in small, controlled doses. The difference between a medicine and a poison was a question of amount or dose.1 Paracelsus was not the first physician to employ arsenic for medicinal purposes , however. The earliest use of arsenic as a remedy goes back to ancient times and is lost to history. It was not used in its elemental form, but as one of its salts. One of the earliest references to arsenic in medicine appears in the writings attributed to the Greek physician Hippocrates (ca. 460–360 BC), often called the father of medicine. Hippocrates recommended the use of realgar and orpiment in the treatment of ulcers (sores) on the body, as did the noted Greco-Roman physician Galen in the second century AD. In his famous treatise on materia medica (medicine or drugs), Dioscorides (first century AD), aware of the astringent and corrosive properties of orpiment, advocated its use as a depilatory (hair remover). He also recommended realgar mixed with oil to destroy lice, as well as the inhalation of its vapors for 145 c h a p t e r f i v e What Kills Can Cure Arsenic in Medicine 146 KING OF POISONS chronic cough. The use of arsenic as a medicine has a long tradition in the East as well. The ancient Chinese were using orpiment and realgar to treat abscesses and skin diseases by 200 BC. Reportedly, arsenic compounds were also used in China since early times for the treatment of tuberculosis, malaria, and “female complaints.”2 Although the discovery of white arsenic is often attributed to theArab alchemist Jabir ibn Hayyan (eighth centuryAD), the compound was actually known to Greek alchemists by the early Christian era. It was readily obtained by roasting orpiment or realgar . White arsenic is quite toxic, and there does not appear to be any conclusive proof of its use in medicine before the eleventh century AD. At that time, the famous Persian physician ibn Sina, known to the West as Avicenna, recommended it (both internally and externally) for the treatment of cancer.Thereafter, salves containing arsenic were popular remedies for cancer. In general, the medieval Arabs made frequent use of arsenic ointments. Martin Levey’s translation of a medical formulary by the ninth-centuryArab physician and philosopher al-Kindī states that arsenic was used in the treatment of skin ulcers, decayed teeth, gum problems, and eye ailments.3 As R. P. Multhauf has pointed out, Arabs made significantly more use of minerals in therapeutics than ancient Greeks.This interest in the use of minerals , including arsenic, in medicine was transmitted to medieval European alchemists and medical chemists. As previously noted, however, it was Paracelsus and his followers who popularized the medicinal use of minerals such as arsenic and antimony beginning in the sixteenth century. Paracelsus believed that arsenic trioxide was effective in the treatment of cancers, Hippocrates, the “Father of Medicine,” recommended arsenic compounds for the treatment of ulcers or sores on the body. Courtesy of the National Library of Medicine. [132.148.121.6] Project MUSE (2024-05-06 07:36 GMT) WHAT KILLS CAN CURE: ARSENIC IN MEDICINE 147 wounds, and ulcers on the body, though he warned that this form of arsenic should only be used externally because of its toxicity. He also made medicinal use of a solution of potassium arsenate in alcohol that was similar to Fowler’s solution. From the sixteenth through the eighteenth centuries, arsenic compounds were used to treat a variety of diseases, including plague, malaria, ulcers, and cancer. Arsenic may also have played an indirect role in medicine by helping to control the plague in this period through its use as a...