ON A CASE OF POISONING WITH BICHROMATE OF POTASH.

496

tough fibrous tissue. Its inner surface was rough, and in sstomach, with a glow of heat all over the body, and this general appearance was not unlike the mucous membranewas followed by a cold sweat. Next he became sick, and of the stomach in a case of araenic-poisoning ; in colour it vnmited freely. He then uffered from agonising pain in The opening of communication under thethe was dark purple. 1 epigastric region, with giddiness, specks before the crural arch, between the two portions of the sac, was wide eyes, < and loss of power of the legs. (He had complete power < his arms ) HIs thirst was intense, and he aptly expressed enough to admit four fiogels or a small hand, and the interior ot surface of the abdominal sac was felt to be similar to thatIhimself, "that he felt as if he could diink the sea dry." of the scrotal sac. The source of the haemorrhage was sought Lastly, he complained of severe rigors, with coldness of the for in vain. whole body, more especially of the extremities. The patient having regained strength, and the parts The patient was carried into the hospital at ten minutes to i o’clock (nearly two hours after swallowing the poison), looking sufficiently healthy, he was, on March 28tb, againseven placed under chloroform, and the redundant portion of theand on examination I found the pupils slightly dilated, the scrotal integument, together with the whole of the sac wall face pale and extremely cold, and the pulse feeble and below Poupart’s ligament, were excised. As the testicle had fluttering. There was no vomiting then ; but he complained atrophied to a mere nodule, it also was removed. The of intense pain over the region of the stomach, and a feeling wound was then closed with silver sutures, the drainage- nf great depression. No cramps or diarrhoea were present. tube of the abdominal sac being brought out at its upper There was a degree of stupor, but he answered questions angle. From thit time the patient made an uninterrupted fairly well. Sensibility to touch and pain was well marked. Treat7nent.-This consisted in giving a full dose of sal. recovery; the scrotal wound healed readily, while the upper cavity, which for a time discharged freely, gradually phate of zinc, and washing out the stomach with tepid water contracted, and by degrees pushed out the drainage-tube. by means of the stomach-pump till the fluid was colourless. He was discharged well on May 12th, returning to his As the pulse threatened to fail, I injected subcutaneously former avocation of cart driver. I have since had an oppor- twenty minims of sulphuric ether, which was followed by tunitv of seeing him. The scrotum is of natural size, while a marked improvement. The patient was covered with the abdominal sac is apparently obliterated, and the sinus plenty of warm blankets, and hot bottles were applied to the feet and side?. A mustard poultice was applied over quite closed. I think this case is worthy of publication, both from its the stomach, which gave great relif. I next tried the rarity and on account of the success of the treatment administration of some tepid coffee well diluted with adopted. I have never seen or heard of a similar case milk and plenty of brown sugar. This was rejected at in this country, where hvdrocele and hsematocele are so once; but some milk well mixed with a good quantity of common. Professor G. M. Humphry mentions a case of lime water and ten grains of subnitrate of bismuth were "abdominal" hydrocele in his article in the "System of retained. Barley water was given as a drink, and the Surgery."1 Nothing further has been added to this by Mr. patient was ordered milk diet with lime-water. He slept Jacobson in the third edition. J. Rocbard records an instance fairly well that night, and in the morning every symptom of " abdominalhaematoeele complicated with hernia.3 had disappeared, except a slight soreness of the mouth. Beyond these cases I can find no reference to the subject. Diet was strictly attended to as usual. The patient made a The liability, after a cursory examination only, to mistake perfect recovery without a single bad symptom. the present case for one of retention of urine was natural Remarks. - (1) The first svmptom-viz., the lightness in enough, and forms an interesting feature of it. As regards the head, apparently a tendency to syncope-took place the origin of the abdominal sac, the very unsatisfactory fifteen minutes after he had swallowed the poison. (2) Had history of the double tumour leaves us more or less in the it not been that vomiting occurred in his lodgings, which dark. In the absence of anv better explanation I am content happened about twenty minutes after he had taken the to accept that offered by Professor Humphry-namely, the poison, and that the patient had taken food about an hour persistence, unclosed except at its upper part, of the funicu- and a half before he entered the works, the effects might lar portion of the peritoneal pouch which accompanied the have been much more disastrous. (3) Although a good testicle in its descent. The gradual distension of the scrotal quantity of the poison was found in his stomach, yet the sac caused the canal to yield where it passed through the rapid evacuation of its contents, together with the applicaabdominal wall, and finally to dilate into a large pouch tion of tepid water, along with milk, lime-water, and bisbehind. The patient, however, adhered to his original muth, tended to soothe the mucous membrane and diminish statement, that up to a year before his admission to hospital the chance of inflammatory action. The application of the he had no swelling of either the scrotum or cord, nor had he mustard externally had also a beneficial effect in the same sustained any injury of the parts. Still, long experience direction. (4) Over two drachms, according to the patient’s has taught us that the histories of their diseases given by account, must have been swallowed, and, by a rough analysis our hospital patients are, as a rule, more or less incomplete of the stomach’s contents, I estimated that it contained or untrustworthy. nearly one drachm of the bichromate. (I made the patient I shall be glad to learnwhether readers of THE LANCET have select a piece of the bichromate, which he thought was met with cases at all similar to this, and, if so, whether they exactly the same size as that which he swallowed, and then can throw any further light on its mode of origin and progress. I weighed it, and found it over two drachms.) No trace of Bombay. the poison was found in the urine with the ordinary tests for its detection-viz., nitrate of silver=red, acetate of lead=yellow, H2S=dingy green. ON A CASE OF As bichromate of potash poisoning is of somewhat rare POISONING WITH BICHROMATE OF POTASH. occurrence, perhaps a brief summary of the leading symptoms of a few cases recently recorded, comparing these with those BY EDWARD ORR MACNIVEN, M.B., C.M. ED., of the case just described, might be interesting. HOUSE-PHYSICIAN IN THE GLASGOW ROYAL INFIRMARY. CASE 1 (recorded by Dr. M’Lacblan).—Accidental poisonB. D-, twenty-two years of age, a workman in Mr. ing, in which three drachms were taken dissolved in water, and the first appeared a quarter of an hour after Carlyle’s chrome work?, was admitted under Dr. Maclaren administrationsymptom :-Symptoms : Excessive vomiting, purging, in the Glasgow Royal Infirmary on Dec. 10th, 1882, suffer- violent abdominal pains, with cramps in the legs; coldness ing from the effects of swallowing a quantity of bichromate of the surface of the body. Hands shrivelled, wrinkled, and of potash. dusky, like a person in the advanced stage of cholera; face lips dusky, with yellowness of the conjunctiva; ; excesHistory.-The patient, a fairly muscular man, in a fit of and sive thirst, feebleness of the pulse, hurried respiration; went to the chrome works about five o’clock on jealousy suppression of the urine; soreness of the mouth; mental Sunday evening and swallowed a lump of chrome (the faculties unimpaired. Resembling the case I have described purified salt) in the solid form. He then returned to his in the following symptoms : Vomiting; abdominal having which is about minutes’ walk fifteen from the lodging, works. As soon as he reached his room he experienced the pains ; excessive thirst; coldness of the surface of the body; of the pulse ; soreness of the mouth. Differs from following symptoms:-The first thing he noticed was a feebleness it in the (1) following symptoms being absent: Tendencv to in the lightness in the head, then a sensation of great heat syncope, with giddiness ; specks before the eyes, with slight dilatation of the pupils ; degree of stupor ; loss cf power ot 1 Vol. v., p. 85, second edition. ’

"

Mentioned in the Sydeuham Sargery for 1861, p. 312. 2

Sxiety’3 YdM-b3ok

of Medicine and

1

Glaqgow Medical Journal, July, 1881, p.

31.

497 the legs; and in (2) the following symptoms

being present: hurried respiration ; peculiar hands, with yellowness of the con-

3

kerb. She was stunned for a few moments, but recovered, and afterwards went her full time and had a fairly good labour. Some days after her confinement, however, she had an attack of what her medical attendant termed "inflammation of the womb," which laid her up for three weeks. Two months subsequently she had rheumatic fever, and kept her bed for seven weeks. About a year after the fall, when three months advanced in her eighth pregnancy, she noticed on her left side a perfectly movable swelling the size of an orange, and complained of a dragging pain in that side. She aborted at the fifth month, and was attended bya midwife, the abortion being followed by another severe attack of "inflammation." Two and a half years ago she completed her ninth pregnancy, and had a lingering labour. After her delivery her medical attendant found a large swelling in the left side, and diagnosed " an abdominal tumour of doubtful nature."She was told to go to some hospital for further advice, and attended for seventeen months as an out-patient at different London hospitals, but the abdominal condition seems to have been overlooked. In Aprillast, when three months gone in her tenth pregnancy, the pain in her left side became so bad that she fainted on several occasions, and at last took to her bed. During the next four months her suffelings increased to such an extent that she could not lie down in any position, but had to be propped up in bed, or in a chair, in order to procure sleep. She was prematurely confined of a living child at the middle of the seventh month, after a painful and tedious labour extending over two days. Her confinement was followed by increased pain in the left side, which continued to within a week of the operation. She tells me, and her statement is confirmed by her medical attendant, that in her last two pregnancies the child lay in the right side, but more particularly so in the last, when the womb was pushed completely to the right of the navel ; and after delivery a distinct hollow could be felt and seen on the right side, whilst the swelling in the left remained almost unaltered. After her last confinement, the tumour began to grow rapidly, and she lost much flesh. Her appetite failed, and her spirits became depressed. Menorrhagia and metrorrbagia were frequent symptoms, and she complned of pressure over the bladder, with difficulty in mic urition. Tne constant pain and 103s of sleep badeduced her to such an extent that walking was out of the qutstion, and the slightest exertion produced giddiness and faii3tnesq. I first saw her io January, 1883. She was then pale and much emaciated, her features were drawn and pinched, and she seemed too feeble to stand. She complained of a ci’ stant dragging and tearing pain in her left nde, wi ich prevented her lying down, and kept htr awake at night. Further examination showed her abdomen to be irregu’a’ly enlarged, and very tender. There was dulness over the front, and resonance in the flanks. Fluctuation could be detected in parts, and aortic impulse was perceptible. The tumour was movable, and seemed pretty solid. On vaginal examination the uterus was found to be enlarged and anteverted, the os was patulous, and the sound passed two inches and a half. The diagnosis was "a multilocular tumour of the left ovary with little fluid." The patient being in such a wretched state of health, I determined to wait till after her next period, and put her on a course of iron, and gave her carbonate of lithia iu five-grain doses three tims a day, to correct the urine, which was thick and loaded with urates. She rapidly improved under this treatment, but the tumour gained in size. Accordingly, on Feb. 6th, 1883, I performed ovariotomy. The patient being chloroformed, I opened the abdomen under carbolic spray, and found the tumour free from adhesions on the right side, but on the left there were several from the abdominal wall, and in long thin hands front a portion of the intestine had become attached to the tumour by a thin band which required ligaturing. The contents of the tumour being too thick to pass through the trocar, it was withdrawn, and introducing my hand, I broke down several secondary cysts, but in the end had to enlarge the incision before the mass could be extracted. The right ovary, being enlarged and cystic, was also removed, and the peritoneal cavity well i-ponged out. The wound was closed with carbolised silk ligatures and dressed with antiseptic gauze. The tumour weighed over twelve

4

pounds.

Suppression of urine ; purging ; condition of the face

and

juactivse.

CASE 2 (recorded by Dr. R. Archer Warwick).—Intentional poisoning, in which a lump of chrome about half an ounce in weight was taken, and the first symptom appeared in one or two minutes after administration :-Symptoms resembling the case I have described : Pain in the stomach and b3ck; giddiness and vomiting, with violent retching ; lo-s of power of the legs; feebleness of the pulse, and clammy perspiration. Differing from it: Purging, with blood m the stools. CASE 3 (recorded by Dr. McCrorie).3-Symptoms resemb)in.;: Vomiting; dilatation of the pupils ; feebleness of the p’))t.e; tenderness of the abdomen ; coldness of the surface nf the body, with clammy perspiration. Differing : Purg-

ing ; difficult, wheezing respiration. CASE 4 (recorded by Dr. Dunbar Walker).4—Accidental

poisoning, in which

one

drachm

was

taken dissolved in

water, and the firat symptom appeared in five minutes after

adm’nistratiou. Symptoms resembling : Sickness ; tendency t) syucope; coldness of the body ; pain in the abdomen; feebleness of the pulse. Differing : Purging. Judging, therefore, from the cases just mentioned, and from those of an earlier dates the symptoms produced with bichromate of potash are those of an irritant poison, and may be described as follows :1. General or usual symptoms : Abdominal pains ; vomiting; purging; cramps in the legs; feebleness of the pulse; coldness of the surface of the body, with clammy perspiration ; soreness of the mouth and throat and excessive thirst. 2. Remote symptoms : Tendency to syncope, with giddiness; specks before the eyes, dilatation of the pupils, and yellowness of the conjunctivæ; suppression of urine; stupor; hurried or diflicult respiration ; loss of power of the legs. The accurate experiments on dogs with this substance, performed by Professor Gmelin of Tübingen,6 are also worthy of note, as illustrating the valuable information to be derived from such investigations. Lastly, the local effects on workmen who use the bichromate of potash in dyeing, as described by Drs. Duncan7 and Eadie8 of Glasgow, are of great practical interest, and illustrate the caustic action of this poison. It seems that on those workmen who have the slightest abrasion of the skin the poison acts as a caustic, producing a tough slough, followed by an ulcer with hardened cup-like border. These sores may gradually extend deeper and deeper, until they eat their way into the bone, and sometimes they actually make their way through the arm or hand altogetber. Attacks of conjunctivitis are also of not uncommon occur. rence. These observations I can fully confirm. Glasgow. CASE OF

CYSTIC TUMOUR OF LEFT OVARY EXISTING DURING SEVERAL PREGNANCIES ; REMOVAL OF BOTH

BY A C.

OVARIES,

WITH

RECOVERY.

BUTLER-SMYTHE, M.R.C.P., F.R.C.S. ED.,

SURGEON TO THE FARRINGDON GENERAL DISPENSARY AND TO THE HOSPITAL FOR WOMEN, VINCENT-SQUARE.

MRS. W-, aged thirty-three, married fifreen years, has had eight children (one premature at the end of the seventh month) and two abortions. The catarnenia appeared at the age of thirteen, and up to the year 1877 she bad always had good health. There is no history of tumour in her family. She states that five years ago, when about months gone with her seventh child, she was coming Victoria station and slipped on some orange-peel and fell, striking the left side of her abdomen against the

seven

out of the

2

THE

LANCET, January 31st, 1880, p. 167. Glasgow Medical Joumal, May, 1881, p. 378. THE LANCET, September 27th, 1879, p. 464. Taylor’s Merlical Jurisprudence, p. 127; Woodttiftu and Tidy’s

Hanrip-brok, p.

172.

Christison xx.

ï

on Poisins, 2nd erlit.. p. 444; Blllletins des Sc:ences 188. (From the Heidelberg Edinburgh Medical and Surgical JuurnMJ. xxvi, 133.

8 Guy’s Forensic -"1ed,c ne, p.

510.

stretching

The patient made a good recovery. On the third day she passed her water voluntarily, and both pulse and temperature were normal. On the seventh the sutures were removed, when the wound was found to be quite closed. On the eleventh day the bowels acted, and before the end of the