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A CASE OF LUMINAL POISONING.
596
Clinical and
had fallen into a basket of damsons and, not being a business woman, would lose her money. She saw pistols in the hands of other patients and said that they wore leather helmets as
Laboratory Notes.
precaution against being killed. lIer intelligence, judged by the accuracy of her replies to questions, varied from hour
a
to hour. Rarely could her attention be secured. On Feb. 10th Dr. H. J. Norman saw her with me and found her depressed and anxious, readily confused, and unduly apprehensive. The next day she rushed screaming round the ward and refused to be pacified until the windows, which had been closed for the round, were reopened. On Feb. 12th she made a sudden and complete recovery and her memory for the recent and distant past was once more clear.
A CASE OF LUMINAL POISONING. BY HUNDRED
CARLILL, M.D. CAMB., M.R.C.P. LOND.,
PHYSICIAN TO WESTMINSTER HOSPITAL.
THE following case of poisoning with luminal is probably worthy of record, for the symptoms, although alarming at the time, were followed by complete recovery. A sober Nov. 24th,
of 69, in collision with a cyclist on 1924, received a blow"on the back of the head which momentarily stunned her. She found her way home and at once exhibited evidence of mental impairment. For example, she filled hot-water bottles with cold water, and next morning came downstairs with fish knives in her hair I, and proceeded to pour out tea into the milk jug. The sphincters were uncontrolled. She was admitted to hospital on Dec. 1st, garrulous, incoherent, confused, and incontinent. There was an unclean scalp wound over the occiput in the middle line. woman
Convalescence has been uninterrupted. She went to the seaside on March 5th, and recently I have had from her a grateful letter of a woman in complete possession of all her faculties. I call attention to the amount of the drugs taken, the value of faradism in treatment, and the avoidance of certification.
OF RENAL GLYCOSURIA WITH KETONURIA. A CASE
BY J. PATTERSON, M.SC., PH.D. was no evidence of fracture, intracranial haemorrhage, defect of the visual apparatus, but the left pupil was the Biochemical Department, Charing Cross Hospital.) larger than the right. There was no aphasia or paresis, and (From motor or no of the there was sensory pathsign of affection ways. The systolic and diastolic blood pressure measured WHILE the crucial means for distinguishing between 140 mm. and 80 mm. of mercury respectively. The serum diabetes mellitus and renal glycosuria lies with the and cerebro-spinal fluid were healthy. sugar-tolerance test, it is generally recognised that Dec. 24th her somewhat had abated and the By symptoms a normal to curve indicating renal She was still were controlled. confirmatory restless, garrulous, sphincters and confused. Luminal and potassium bromide in small glycosuria is a urine examination showing a fairly doses were prescribed but, inadvertently, gr. 10 of the former constant and low value for the percentage of sugar, and gr. 50 of the latter were administered daily for 12 days with the complete absence of acetone bodies. A (total luminal gr. 120, potassium bromide gr. 600). On the negative finding with regard to these latter substances twelfth day, Jan. 4th, 1925, she became stuporose and had is such an invariable result in this type of case that a recurrence of double incontinence. The pupils were much contracted and lost their reaction to light. At times there one might have assumed reasonable certainty in was a divergent squint. The pulse-rate was increased. The diagnosing diabetes wherever an obviously positive cerebro-spinal fluid was under normal pressure. The urine glucose test was accompanied by an authentic acetone contained no hematoporphyrin. After stimulation and a in the urine. In only one case of renal long delay she feebly obeyed certain instructions. Energetic glycosuria so far described (Allen, Wishart, and Smith, treatment was employed in the form of strychnine, hot have ketone bodies been detected, but then coffee by mouth and rectum, oxygen, and faradism. The 1919,1) luminal and bromide were cancelled. For a few days the only at the time the patient was admitted to periods of mental alertness increased in length but on each hospital, for when placed on full diet the acetone occasion she relapsed rapidly into stupor. Her conversation test immediately became negative. It would seem, therefore, to be of interest to supply showed extreme confusion of thought. The tendon and superficial reflexes were unaffected throughout. By Jan. 10th a few details pertaining to a case which was quite the urgent symptoms were relieved and the sphincters once exceptional- in that the urinary examination was more under control. The systolic blood pressure measured to the findings based on 120 mm. of mercury. The pupils remained unequal and apparently contradictory blood analysis. reacted to light very sluggishly. Then followed a period Clinical Record. of four weeks in which she was greatly confused. On Jan. 19th, for example, her answers to questions were as follow. The patient, a man aged 42, was admitted to hospital with Year ?-March. Age ?-59. Year of birth ?-1956. Age ? a history suggestive of pulmonary tuberculosis and diabetes. -Westerham. War’?-China versus Chilians. Her handHistory.-In 1911 he underwent an operation for gastric and her She writing was illegible composition grotesque. at which time he was discoveied to have sugar in the ulcer, knew not where or who she was. She expressed a fear of urine and was evidently regarded as diabetic. Later, he being killed by a firing party, and she said that her sister attended a hospital as an out-patient for six months, being told to diet carefully. Towards the end of 1918 he developed a bad cough, afterwards began to have night-sweats, and also brought up dark-coloured sputum. He had dyspnoea, 16. Beurnier and Clapier: Bull. Soc. de l’Ouest Africain, on exertion and suffered from loss of strength. Going before 1923. Oct. 21st, a medical board, he was X rayed and phthisis suspected, 17. Baermann : Arch. für Schiffs- und Trop.-Hyg., 1923, p. 229. but shortly afterwards the cough improved and the night18. Tanon and Jamot : Rev. de Méd. et d’Hyg. Trop., 1924, p. 18. sweats ceased. During the last six months preceding admis19. Waldorp : Biologie Médicale, 1924, No. 7, p. 363. 20. Sabrazes: Sciences Médicales, 1924, No. 31, p. 482. sion, dry red rashes appeared on the left thigh, both forearms, 21. Fontanel : Soc. Méd. des Hôp. de Lyon, June 3rd, 1924. and scrotum. He had been thereupon examined at a skin 22. Couvy : Bull. Soc. de Path. Exot., 1924, p. 533. hospital, where it was believed his skin disease was related 23. Couvy : Ibid., 1924, No. 7, p. 531. to a diabetic condition. 24. Couvy : Ibid., 1924, p. 530. No evidence of active pulmonary tuberculosis being found, 25. Cot : Biologic Médicale, 1924, No. 7, p. 353. a brief inquiry into his " diabetic " condition was instituted, 26. Ravaut: Collection Horizon, Masson, 1918, &c. 27. Marchoux : Bull. Soc. Path. Exot., 1923, No. 2, p. 79. with the results recorded below. 28. Delanoe : Maroc Médical, 1923, No. 17, p. 110 ; Soc. Path. There or
reaction
Exot., 1923, p. 119. 29. Leger and Nogue : Bull. Soc. Path. Exot., 1923, No. 7, p. 537.
30. Fontanel : Soc. Méd. des Hôp. de Lyon, June 3rd, 1924. 31. Rubenthaler and Jansion : Paris Médical, 1924, No. 23,
. 538.
32. Leon Bernard and Thomas : Bull. Acad. de Méd., June 24th, 1924. 33. Petzetakis: Presse Médicale, 1925, No. 19, p. 299. 34. Marchoux : Paris Médical, 1924, No. 47, p. 421. 35 and 36. Marchoux : Bull. Soc. Path. Exot., 1923, p. 325. 37. Valenti and Tomaselli : Il Policlinico, 1924, fasc. 36, p. 1159. 38. Marchoux and Cohen: Soc. do Biologie, 1925, xcii., 132. 39. Marchoux : Comptes Rendus de l’Acad. d. Sciences, 1925,
clxxx., 617.
Chemical Findings.
1. On full diet.-Sugar and acetone constantly present in the urine, former identified as glucose in the form of phenylglucosazone ; amount varying from 0-5 to 3 per cent. ; latter confirmed by Lieben and by Gunning tests after distillation.
Blood-sugar. ,
29/1/25 30/1/25 31/1/25
......
......
......
.
Nitro-prusside test. +
0-091 0-085 0-090
......
1 Arch. Int. Med., xxiv., 523
+ +
Clinical and
had fallen into a basket of damsons and, not being a business woman, would lose her money. She saw pistols in the hands of other patients and said that they wore leather helmets as
Laboratory Notes.
precaution against being killed. lIer intelligence, judged by the accuracy of her replies to questions, varied from hour
a
to hour. Rarely could her attention be secured. On Feb. 10th Dr. H. J. Norman saw her with me and found her depressed and anxious, readily confused, and unduly apprehensive. The next day she rushed screaming round the ward and refused to be pacified until the windows, which had been closed for the round, were reopened. On Feb. 12th she made a sudden and complete recovery and her memory for the recent and distant past was once more clear.
A CASE OF LUMINAL POISONING. BY HUNDRED
CARLILL, M.D. CAMB., M.R.C.P. LOND.,
PHYSICIAN TO WESTMINSTER HOSPITAL.
THE following case of poisoning with luminal is probably worthy of record, for the symptoms, although alarming at the time, were followed by complete recovery. A sober Nov. 24th,
of 69, in collision with a cyclist on 1924, received a blow"on the back of the head which momentarily stunned her. She found her way home and at once exhibited evidence of mental impairment. For example, she filled hot-water bottles with cold water, and next morning came downstairs with fish knives in her hair I, and proceeded to pour out tea into the milk jug. The sphincters were uncontrolled. She was admitted to hospital on Dec. 1st, garrulous, incoherent, confused, and incontinent. There was an unclean scalp wound over the occiput in the middle line. woman
Convalescence has been uninterrupted. She went to the seaside on March 5th, and recently I have had from her a grateful letter of a woman in complete possession of all her faculties. I call attention to the amount of the drugs taken, the value of faradism in treatment, and the avoidance of certification.
OF RENAL GLYCOSURIA WITH KETONURIA. A CASE
BY J. PATTERSON, M.SC., PH.D. was no evidence of fracture, intracranial haemorrhage, defect of the visual apparatus, but the left pupil was the Biochemical Department, Charing Cross Hospital.) larger than the right. There was no aphasia or paresis, and (From motor or no of the there was sensory pathsign of affection ways. The systolic and diastolic blood pressure measured WHILE the crucial means for distinguishing between 140 mm. and 80 mm. of mercury respectively. The serum diabetes mellitus and renal glycosuria lies with the and cerebro-spinal fluid were healthy. sugar-tolerance test, it is generally recognised that Dec. 24th her somewhat had abated and the By symptoms a normal to curve indicating renal She was still were controlled. confirmatory restless, garrulous, sphincters and confused. Luminal and potassium bromide in small glycosuria is a urine examination showing a fairly doses were prescribed but, inadvertently, gr. 10 of the former constant and low value for the percentage of sugar, and gr. 50 of the latter were administered daily for 12 days with the complete absence of acetone bodies. A (total luminal gr. 120, potassium bromide gr. 600). On the negative finding with regard to these latter substances twelfth day, Jan. 4th, 1925, she became stuporose and had is such an invariable result in this type of case that a recurrence of double incontinence. The pupils were much contracted and lost their reaction to light. At times there one might have assumed reasonable certainty in was a divergent squint. The pulse-rate was increased. The diagnosing diabetes wherever an obviously positive cerebro-spinal fluid was under normal pressure. The urine glucose test was accompanied by an authentic acetone contained no hematoporphyrin. After stimulation and a in the urine. In only one case of renal long delay she feebly obeyed certain instructions. Energetic glycosuria so far described (Allen, Wishart, and Smith, treatment was employed in the form of strychnine, hot have ketone bodies been detected, but then coffee by mouth and rectum, oxygen, and faradism. The 1919,1) luminal and bromide were cancelled. For a few days the only at the time the patient was admitted to periods of mental alertness increased in length but on each hospital, for when placed on full diet the acetone occasion she relapsed rapidly into stupor. Her conversation test immediately became negative. It would seem, therefore, to be of interest to supply showed extreme confusion of thought. The tendon and superficial reflexes were unaffected throughout. By Jan. 10th a few details pertaining to a case which was quite the urgent symptoms were relieved and the sphincters once exceptional- in that the urinary examination was more under control. The systolic blood pressure measured to the findings based on 120 mm. of mercury. The pupils remained unequal and apparently contradictory blood analysis. reacted to light very sluggishly. Then followed a period Clinical Record. of four weeks in which she was greatly confused. On Jan. 19th, for example, her answers to questions were as follow. The patient, a man aged 42, was admitted to hospital with Year ?-March. Age ?-59. Year of birth ?-1956. Age ? a history suggestive of pulmonary tuberculosis and diabetes. -Westerham. War’?-China versus Chilians. Her handHistory.-In 1911 he underwent an operation for gastric and her She writing was illegible composition grotesque. at which time he was discoveied to have sugar in the ulcer, knew not where or who she was. She expressed a fear of urine and was evidently regarded as diabetic. Later, he being killed by a firing party, and she said that her sister attended a hospital as an out-patient for six months, being told to diet carefully. Towards the end of 1918 he developed a bad cough, afterwards began to have night-sweats, and also brought up dark-coloured sputum. He had dyspnoea, 16. Beurnier and Clapier: Bull. Soc. de l’Ouest Africain, on exertion and suffered from loss of strength. Going before 1923. Oct. 21st, a medical board, he was X rayed and phthisis suspected, 17. Baermann : Arch. für Schiffs- und Trop.-Hyg., 1923, p. 229. but shortly afterwards the cough improved and the night18. Tanon and Jamot : Rev. de Méd. et d’Hyg. Trop., 1924, p. 18. sweats ceased. During the last six months preceding admis19. Waldorp : Biologie Médicale, 1924, No. 7, p. 363. 20. Sabrazes: Sciences Médicales, 1924, No. 31, p. 482. sion, dry red rashes appeared on the left thigh, both forearms, 21. Fontanel : Soc. Méd. des Hôp. de Lyon, June 3rd, 1924. and scrotum. He had been thereupon examined at a skin 22. Couvy : Bull. Soc. de Path. Exot., 1924, p. 533. hospital, where it was believed his skin disease was related 23. Couvy : Ibid., 1924, No. 7, p. 531. to a diabetic condition. 24. Couvy : Ibid., 1924, p. 530. No evidence of active pulmonary tuberculosis being found, 25. Cot : Biologic Médicale, 1924, No. 7, p. 353. a brief inquiry into his " diabetic " condition was instituted, 26. Ravaut: Collection Horizon, Masson, 1918, &c. 27. Marchoux : Bull. Soc. Path. Exot., 1923, No. 2, p. 79. with the results recorded below. 28. Delanoe : Maroc Médical, 1923, No. 17, p. 110 ; Soc. Path. There or
reaction
Exot., 1923, p. 119. 29. Leger and Nogue : Bull. Soc. Path. Exot., 1923, No. 7, p. 537.
30. Fontanel : Soc. Méd. des Hôp. de Lyon, June 3rd, 1924. 31. Rubenthaler and Jansion : Paris Médical, 1924, No. 23,
. 538.
32. Leon Bernard and Thomas : Bull. Acad. de Méd., June 24th, 1924. 33. Petzetakis: Presse Médicale, 1925, No. 19, p. 299. 34. Marchoux : Paris Médical, 1924, No. 47, p. 421. 35 and 36. Marchoux : Bull. Soc. Path. Exot., 1923, p. 325. 37. Valenti and Tomaselli : Il Policlinico, 1924, fasc. 36, p. 1159. 38. Marchoux and Cohen: Soc. do Biologie, 1925, xcii., 132. 39. Marchoux : Comptes Rendus de l’Acad. d. Sciences, 1925,
clxxx., 617.
Chemical Findings.
1. On full diet.-Sugar and acetone constantly present in the urine, former identified as glucose in the form of phenylglucosazone ; amount varying from 0-5 to 3 per cent. ; latter confirmed by Lieben and by Gunning tests after distillation.
Blood-sugar. ,
29/1/25 30/1/25 31/1/25
......
......
......
.
Nitro-prusside test. +
0-091 0-085 0-090
......
1 Arch. Int. Med., xxiv., 523
+ +