Say the word arsenic and most people think "deadly poison."  Arsenic was the poison of choice for murderers up through the latter part of the nineteenth century, and it is still used for homicides up to  the present time.  It may, therefore, seem surprising that arsenic was also used extensively as a medicine for centuries, and was even consumed by many people as a health tonic or for cosmetic purposes.  A particularly interesting case in point is the arsenic eaters of Styria.
         

In 1851, the medical world learned of the practice of arsenic eating among peasants in Styria (now a region of Austria) through an article in a Viennese medical journal.   The author was a Swiss physician, naturalist, and traveler named Johann Jakob von Tschudi.  According to Tschudi the stimulus for his 1851 paper was a trial involving a poisoning case that had recently taken place in the town of Cilli, part of the Austrian empire.  During the trial, the question was raised as to whether or not a certain military officer was a "toxicophagus."  Tschudi explained that since the "toxicophagi" were "more or less unknown to the medical public, I have thought it my duty to publish some information and observations on the subject."
 
These so-called toxicophagi were a group of peasants in Styria and Lower Austria who were in the habit of eating arsenic.  They ate the arsenic either to acquire a fresh complexion and appearance of flourishing health or to facilitate respiration when walking or working in the mountainous terrain of the area.  These toxicophagi began by taking a small piece of the arsenic, about the size of a lentil (less than half a grain) several times a week.  Over time, they gradually increased the dose as the smaller quantity loses its effect.  Tschudi gives an example of a man of about sixty years of age who had increased the dose over time to about four grains (enough to kill most people).

The toxicophagi became dependent on the arsenic, and suffered  ill consequences if they ceased using it.  The symptoms of withdrawal included anxiety, indigestion, loss of appetite, vomiting, constipation and spasmodic pain.  Although arsenic eaters appeared to develop a certain tolerance for the poison, and many showed no signs of chronic poisoning, Tschudi pointed out that the number of deaths from abuse of arsenic was not trifling.
              
Translated into English and French and published in several medical journals, Tschudi’s article caught the attention of the broader English-speaking public through an article in Chambers Journal in 1856 and through James Johnston's popular 1855 book, The Chemistry of Popular Life.  The interest generated by the article and the doubts expressed about the arsenic eaters in several English medical journals led Tschudi to publish an additional paper on the subject in 1853, expanding upon his earlier observations.

 Many medical writers, especially in Britain, at first tended be skeptical of Tschudi's account of the toxicophagi.  In 1856, Physician W. B. Kesteven translated Tschudi's article, and then attacked it and the accounts based on it.  He argued that much of the evidence for arsenic eating was based on hearsay, rather than on any systematic observation of the so-called arsenic eaters over an extended period of time.  He criticized those who wrote these accounts as either not being medically-trained (such as the chemist Johnston) or not having substantial clinical experience (such as von Tschudi, whom he characterized as more of a traveler than a doctor).  Kesteven also pointed out that the substance ingested by the Styrian peasants had not undergone chemical analysis to confirm that it was indeed arsenic.  

 The debate over the arsenic eaters continued, however, and several individuals attempted to obtain further evidence of the practice.  Henry Enfield Roscoe, professor of chemistry at Owens University in Manchester, published a paper on arsenic-eating in 1862.   Roscoe communicated with seventeen physicians in Styria, all of whom agreed that it was generally believed that some people there consumed arsenic regularly in substantial quantities without apparent harm.  These physicians also provided information on cases of arsenic eating which they had personally observed or which had been related to them by "trustworthy persons."  One physician, for example, described a case of a man who consumed a total of 10 grains (at least twice the normal lethal dose) over two days and still appeared to be in good health.    One of Roscoe’s correspondents also provided a sample of a substance consumed by an arsenic eater; chemical analysis had confirmed that this was white arsenic.  Roscoe affirmed "That arsenious acid [white arsenic] is taken regularly into the system, by certain persons in Styria, in quantities usually supposed sufficient to produce immediate death."

The Scottish physician Craig Maclagan also traveled to Styria with a colleague to investigate the subject.  He later published his results in the Edinburgh Medical Journal in 1864.  While in Styria, Maclagan, along with a Dr. Knappe, watched two arsenic eaters consume what would normally be lethal doses of the chemical.  Neither man showed any ill effects from the arsenic on the following day.

Although some skepticism remained, the medical and scientific literature of the late nineteenth and early twentieth centuries suggests that many, if not most, physicians and chemists came to accept the validity of the accounts of the Styrian arsenic eaters.  In 1905,  Henry Roscoe firmly repeated his belief that there were well-authenticated cases of arsenic eaters.  An article in the British Medical Journal in 1901 claimed that: "It is a matter of common knowledge that arsenic and its salts exhibited for a time in small doses establish a tolerance, and the arsenic eaters of the Austrian Tyrol are the classical proofs of the fact." 

The publicity given to this practice helped to popularize the use of arsenic in medicines and cosmetics from the middle of the nineteenth century.  Arsenic had long been used in medicine, going back to antiquity, and was finding widespread use by the eighteenth century.  Arsenic preparations were taken both externally and internally.  Of the various solutions of arsenic compounds,  the most important was Fowler's Solution, introduced by English physician Thomas Fowler in 1786.  Fowler's solution quickly achieved widespread popularity in medicine.  While used for numerous conditions, it was especially valued for its tonic and stimulant properties.

The story of the Styrian arsenic eaters gave physicians a new rationale for various medicinal uses of arsenic preparations such as Fowler's solution.  Arsenic had not been used much for cosmetic purposes before the mid-nineteenth century, but, after the discovery of the arsenic eaters, it became a popular beauty treatment.  The romantic account of the effects of arsenic on Styrian women in James Johnston's previously-mentioned popular work, The Chemistry of Common Life, no doubt contributed to this trend.  Johnston wrote:

“But the Styrian peasant-girl, stirred by an unconsciously growing attachment - confiding scarcely to herself her feelings, and taking counsel of her inherited wisdom only - really adds, by the use of hidri [arsenic], to the natural graces of her filling and rounding form, paints with brighter hues her blushing cheeks and tempting lips, and imparts a new and winning lustre to her sparkling eye.  Every one sees and admires the reality of her growing beauty: the young men sound her praises, and become suppliants for her favour.  She triumphs over the affections of all, and compels the chosen one to her feet.

Thus even cruel arsenic, so often the minister of crime and the parent of sorrow, bears a blessed jewel in its forehead, and, as a love-awakener, becomes at times the harbinger of happiness, the soother of ardent longings, the bestower of contentment and peace!”

What woman could resist such an appeal?  Reports of the “clear and blooming complexions” and full rounded figures of the young Styrian peasant women led to widespread use of arsenic as a cosmetic in many countries.  The arsenic was taken in various forms.  Women often drank Fowler’s solution or used it as a cosmetic wash.  Many new products were introduced on to the market.  For example, Sulphide of Arsenicum was advertised as a skin remedy and “the sure way to a better complexion.”  Dr. Simms’ Arsenic Complexion Wafers and Dr. Campbell’s Arsenic Complexion Wafers were popular, as were arsenical soaps.  In general, however, these arsenical wafers and soaps contained very little arsenic, which was undoubtedly a good thing. 

Arsenic eating continued to be of interest into the 20th century, when more scientific efforts to examine this folk practice were undertaken, especially by the practitioners of the relatively new discipline of experimental pharmacology.   Many investigators carried out animal experiments that called into question the idea that an organism can develop a tolerance to arsenic.  They argued that most likely the Styrians had consumed arsenic compounds in a relatively coarse form that was only poorly absorbed, and therefore did not suffer serious or fatal consequences.  The tide turned against the concept of arsenic tolerance in the first few decades of the 20th century.

More recent studies, however, have provided stronger evidence for the development of tolerance to arsenic in certain animals and even in human cells, although the nature and mechanism of such tolerance is not completely understood.  Some plants have also been shown to be unusually tolerant to arsenic.  In 2001, T. W. Gebel claimed that the development of an elevated tolerance to the acute toxicology of  arsenic in humans should be acquirable, and cited some studies supporting the development of arsenic tolerance in humans and other organisms.  He went on to caution, however, that the question had to be examined in more detail in order to definitively settle the issue.  As chemist William Cullen wrote in his book on arsenic:

"Because the number of arsenic eaters in Styria was relatively small, and because they were very secretive about their habit, it was difficult to unequivocally prove their existence.  Nevertheless, there is a considerable body of scientific evidence that Styrian peasants did deliberately ingest poisonous arsenic trioxide."

This article was excerpted from Dr. Parascandola's book King of Poisons: A History of Arsenic (Dulles, VA: Potomac Books, 2012), available at a discount online from Amazon or Barnes and Noble.