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A CASE OF MULTIPLE OR PERIPHERAL NEURITIS, DUE TO CHRONIC ARSENICAL POISONING.
1237
pulse was 110. and the temperature normal. For the previous few months she had, as she described, lightning-like pains down the legs, and suffered at intervals of three or four weeks from what seemed an almost typical" gastIia crisis." The pain now seemed more fixed in the soles of weight, be pulled up easily and steadily, without jerks or both feet, which were found to be completely anaesthetic to the employment of much muscular force, and might remain pricking and pinching. Sensibility was very much blunted suspended equably the whole time which mightbe required, on the dorsum of the foot, and less so up the front of without an effort on the part of the assistant. I therefore the leg; in the latter region the muscles were notably requested Messrs. Krohne and Sesemann, of Duke-street, atrophied. There was great unsteadiness of gait she Manchester-square, to fix to one of the poles of the tripod a could only maintain the upright position with some diffiby means of which the cord could be pulled culty, and swayed sensibly when the eyes were closed up and down in an equable manner, avoiding jerks, and be In attempting to walk she swayed from side to side, enade, by means of a catch, to remain in any position in the knees were bent very much, and the toes turned outwhich it might be required. The accompanying diagram wards and dropped. On being placed against the wall, with illustrates the contrivance so well that a further description the heels fixed, the toes could not be raised from the I am obliged to the makers for floor. The skin of the legs had a glossy appearance, and of it is unnecessary. carrying out this idea in a very neat manner, and I have there was some mottling. Complicated movements could used the improved apparatus for more than two months be performed with both hands, and the grasp was fairly with ease and success. ,strong. Some of the finger-joints were swollen and painful I have now made upwards of 300 suspensions in twenty- to pressure. Extreme coldness, alternating with heat, nine cases in hospital and private practice ; and, although were complained of in both feet ; these symptoms were also the time which has elapsed since this treatment was objective. Plantar reflex was abolished ; the knee-jerks inaugurated is as yet too short for a definite opinion on the were exaggerated in both legs ; and there was no anklewhole subject to be formed, I am convinced that suspension clonus. The muscles supplied by the ant nor tibial nerve has already gained a firm footing in the therapeutics of gave no reaction to faradism, and only feebly to the galvanic chronic nerve-degenerations. In, some of my cases the current; but there was no qualitative change. The eyes results have been actually brilliant, in t’,e majority they reacted to light, but did not accommodate for distance ; have been good, while in a minority no benefit has the pupils were equal and moderately contracted ; and the resulte(l. Occasional failure, however, does not detract discs seemed normal. from the value of any remedy. In addition to locomotor Static electricity by means of a Carre’s machine was ataxy and other spinal affections, chronic rheumatism tried the same day, also general electrisation by friction, and rheumatoid arthritis, and spasmodic torticollis, appear and sparks were drawn from the soles of the feeG to be favourably induenced by suspension. and atrophied muscles, the fibres contracting enerHurley-street. getically duiing the application, the procedure lasting seven minutes. This was repeated for three consecutive with the greatest relief to the pain, sensation days, A CASE OF also being most markedly improved. My patient now had MULTIPLE OR PERIPHERAL NEURITIS, DUE one of her gastric attacks, including severe pain referred to the region of the stomach, nausea (no absolute sickness), TO CHRONIC ARSENICAL POISONING.1 and extreme faintness, accompanied by a feeling of unsteadiness even when in bed, objects in the room seeming BY HENRY M’CLURE, M.D. to rise and fall before her eyes. These symptoms had quite off in two and she was able to resume the passed MULTIPLE NEURITIS maybe due to the poisons of alcohol electrical treatment.days, or other narcotics and stimulants, or to lead, arsenic, Dr. Donald Hood, who happened to be in Cromer at this ’copper, and ergot. Of these, the most familiar is that due to time, kindly saw the patient with me. Our diagnosis then alcohol or lead. Of whatever form, the neuritis presents was an obscure organic legion of the spinal cord. Strange to say, on this day the patient developed a well-marked certain characteristic symptoms. Among these, and nearly "writer’s cramp " in the right hand, with total anaesthesia. always present, are pains and abnormal sensations referred the tips of the thumb and first two fingers. After this, to various nerve distributions, described as numbness, under static electricity, we had a most encouraging and tingling, burning, darting, shooting, or lancinating pains. steady improvement in all the symptoms; the pain had Coldness may be complained of, referred to limited regions, quite gone, the sensation almost completely restored, the -or coldness alternating with heat. The pa ns may be general health most markedly better, complexion much referred to nerves, muscles, or joints; even symptoms clearer, and the appetite excellent. She now complained of heaviness and stillness in the legs, tisualiy referred to ataxia may be present, as "gastric mostly of aatfeeling and as if a board were tied to her feet. especially night, - crises," or as if the patient were watldng on wool. The the middle of November she had improved so much By be also senses the affected : motor, sensory may special that she could walk without help, and could raise both paralytic, ataxic, and spasmodic phenomena-- feet with the heels fixed. There was no pain, the atrophied alterations in electrical reactions ; and there may he muscles had notably grown, and to her friends she seemed and Of reflex, vaso-motor, trophic symptoms present. the objective sensory symptoms, the most important from better than she had been for a year. The power in the had also improved. All went well until Dec. 15tii, a, diagnostic point of view is tenderness of both nerves hand when there was a complete break-down, ushered in by and muscles; this is a constant and distinctive symptom. The transmission of pain pressure and temperature sensa- extreme pain and tenderness of the right foot, accomtion is delayed. Motor paralysis is, of course, a prominent panied by a distinct flush on the outer aspect. There was of feet, most marked in the right. Pain was symptom in multiple neuritis. The nerves first involved paresis in both tho left hand, with almost total anaesthesia of are the musculo-spiral and anterior tibial. The electrical present the tips of the fingers and inability to close the hand. The responses vary with the amount of inflammation and extensor of the foot were very tender, and the in nerves. of the Cases acute degeneration poisoning by sensation muscles of and deep pressure were markedly pricking arsenic followed by neuritis have been reported ; but I am not aware of any case having been published of chronic retarded on the soles and frontof the leg; above the knee sensation was normal. The muscles supplied by the poisoning by this metal producing such a result. anterior tibial nerves of both legs gave no response to My patient, a lacly aged fifty-six, married, find with a faradism and slightly exaggerated reactions to galvanism, large family, had always enjoyed excellent health tilli but no qualitative changes. The knee jerks were dimieighteen months ago. Since then she had suffered a good nished. There was also gastric pain and nausea. deal from pain, and had been treated for e;ont and rheuFor some time I had been reconsidering the diagnosis, matism. When first seen (Sept. 2?nd, I88S) she had an and now, after this hreak-down, I was convinced I had a appearance of suffering, an unhealthy, muddy-looking commultiple neuritis to de;tl with, most probably of toxic origin, the was the coated plexion, tongue thickly posteriorly, and gave a more hopeful prognosis. Alcohol and lead being appetite very bad, there was ob-itina.te constipation, the excluded, my thoughts turned to arsenic The wall papers 1 There happened to were investigated, but gave no result. Paper read before the Norwich Medico-Chirurgical Society. unbearable, even to a sound person, when protracted for five minutes. Under these circumstances, it appeared to me desirable to add to the apparatus employed a mechanical contrivance, by means of which the patient might, even if of great bodyas
winding-wheel,
of
including
1238 fession to become at once popular. Unlike cocaine, which was used universally within a few months after its first announcement, nitro-glycerine has been before the profession over thirty years, and yet, until the last few years, it was seldom or never mentioned in medical literature. In 1858 Field introduced it as a remedy in neuralgia and nervous affections. The Academy of Science of Paris in 1875 carefully investigated its physiological properties and cautioned physicians against using it in large doses. Four years later Dr. Murrell recommended its use as a successful means in the relief of the agony of neuralgia of the heart (angina pectoris). For a number of years favourable results were reported in our magazines. Gradually, as physicians became more acquainted with its effects, it was tried in other diseases, where relief was hoped for by increasing the volume of the pulse. In July, 1885, I published a brief article in the Therapeutic Gazette of Philadelphia, Penn., recommending the drug as an efficient substitute for alcohol in cases of emergency. The article was widely copied. THE LANCET suggested to physicians to investigate this new claim for the drug, and see if it could be used or recommended. Preparation and Dose.-Druggists usually keep it in stock in a 10 per cent. solution, which is non-explosive. From this 10 per cent. solution they prepare a 1 per cent. solution for the use of the profession, at a cost of eight cents an ounce, which is one cent for sixty doses. It is also sold in the form of pills, perles, and triturates. The liquid form I have found the handiest, and least liable to change and become worthless. Care should be taken to keep the bottle tightly corked, or by evaporation the strength might be increased. Although nitro-glycerine is not decomposed by the acid of the stomach, yet, as nitrites as a class are to a great extent rendered inert by acids, it would be as wen not to use an acid with nitro-glycerine in the same prescription. The dose is one drop of a 1 per cent. solution. This may be taken in water into the stomach, the physician dropping ten drops into a tumbler, and adding ten teaspoonfuls of water, one teaspoonful now representing one drop of the remedy. If there is need of great haste, or if the patient cannot swallow from being unconscious, one drop can be placed within the lower lip or upon the tongue by means of a dropper or pipette, which many physicians. now carry in their case of remedies. The drug may be given hypodermically ; but so rapid is its absorption through the mucous membrane of the mouth that, unless the syringe should happen to be filled and ready for use, I doubt if any time would be gained by the use of the needle. Patients are not all alike in the amount required to produce an effect-some requiring less than one drop, others requiring three or four drops to produce the same effect ; the usual dose, however, is one drop. Patients also differ in the duration of the effect of the drug. Usually the effect lasts three or four hours, but in a few cases the effect had ceased in twenty or thirty minutes. Permit me to say here that the name nitro-glycerine is so associated in the minds of the people with dynamite and with gunpowder that in many cases where the physician has to give a name for what he prescribes it might be wisdom to call the remedy less terrorising names-glovoin, trinitrin. Physiological Effects.-Dropped on the tongue, the effect is the more rapid, as there is no dilution. By way of the Cromer, stomach, unless greatly diluted, the effect is apparent in a. few minutes, the pulse being increased from 10 to 20 beats, NITRO-GLYCERINE — A SUBSTITUTE FOR and becoming full and regular. In a few cases there is a slight headache, lasting for a few minutes. In larger doses ALCOHOL IN CASES OF EMERGENCY. the face becomes flushed, a severe headache is experienced, BY JOSEPH B. BURROUGHS, M.D., accompanied with a feeling of fulness, singing in the PRESIDENT OF ONTARIO COUNTY MEDICAL SOCIETY, NEW YORK STATE. before the eyes, and all the symptoms of ears, an increased supply of blood to the brain. On account of IN presenting to the medical profession the subject of this effect on the cerebral circulation, care should be taken the remedy to the aged, as the sudden nitro-glycerine, my object is to bring to their attention a in administering the of cerebral vessels might cause a rupture of expansion that in its effects, rapidity of action, size of dose, and drug their weakened calcareous walls. Its action on the heart is lack of taste when taken in water, cannot be surpassed. the sympathetic nervous system. The vagus nerve Greater than these properties, desirable as they are, is the through and the vaso-contractor nerves of the vaso-motor nervous additional one, that in nitro-glycerine we possess an system are depressed, partially paralysed. This allows the efficient substitute for alcohol in every case of emergency. extensive system of arterioles to dilate, and thus give room Indeed, in some cases, after alcohol had failed, nitro- within their walls for a greater amount of blood to flow. Thus this enlarged reservoir of tubes relieves the heart of glycerine succeeded. the work of forcing the current through narrow contracted History.-With so many desirable qualities, one would tubes. This and the vagus nerve being depressed permits to it needed have been introduced to the proonly suppose the heart to beat freer, fuller, and more rapidly. 2 Ann. Univers. Med. Sciences, vol. i. Antagonists.-In case of a poisonous dose of nitro-glycerine
be staying in the house a very intelligent lady, who remembered reading about two years ago some letters in The Times of cases of arsenical poisoning at Cooper’s-hill College by means of so-called Indian muslins used as curtains and draperies of the rooms. On investigation being made, it was found that the patient had been for nearly two years working with such muslins, tearing them and making them up into covers for sofa-cushions, curtains, and many kinds of art draperies, both for herself and friends. Mr. Bryans, M.B., examined for me some of the muslins, and found undoubted traces of arsenic. I communicated with Dr. Matthews, Demonstrator of Chemistry at Cooper’s-hill College, who told me there had been cases of arsenical poisoning there traced to such muslins and cretonnes. I sent this gentleman some of the samples used by my patient, and he told me that he discovered arsenic in two of the samples, one of which contained a small amount, while in the other lie found arsenic in considerable quantities, and he had no hesitation in declaring the latter to be dangerous. Of course the muslins with which the patient was still surrounded were at once got rid of; but she was confined to bed for some days, being quite unable to stand. Iodides and "puralis" water were given and galvanism applied during her stay in the house. She improved gradually, and was able to get to my house in about ten days, when static electricity was again resorted to, with some further improvement ; but, the weather getting very cold, she left for Brighton at the end of January, where she was seen by Mr. Bernard Roth and Dr. Uhthoff. She remained under Dr. Uhthoffs care till the middle of March. During her stay at Brighton there was a still further improvement in her condition. Dr. Cowers saw her in London on March 20th, and by permission of Dr. Uhth.in’ I quote a portion of his letter to him : " I have seen Mrs. Hthis afternoon. There seems to me to be no reason for donbt that Dr. M’Clure’s diagnosis is correct. Peripheral neuritis certainly exits. Apart from alcohol, a mineral poison is by far the most probable cause. Spots of pigmentation of the skin is one of the characteristic effects of chronic arsenical poisoning. I have seen it several times in consequence of the long-continued administration of arsenic to prevent bromide rash in epilepsy. No other cause of these symptoms can be traced. Arsenic is the only cause which accounts for the skin pigmentation and the nervous symptoms. It does account perfectly for everything in the case. The exposure to arsenic appears ample. Thus the evidence appears to me overwhelming. Such a case is very rare. I have never seen one like it before, nor do I remember reading of one ; but such cases would probably All the cases of have been misunderstood till recently. arsenic paralysis recorded of late years have followed acute arsenical poisoning. The prospect of recovery is good." Of the usual symptoms of arsenical poisoning the following were absent: with the exception of the periodical attacks referred to, thete was no gastric pain or nausea, no irritation of the eyes, no cough or dyspncea, no typical tongue, no albuminuria, and no arsenic found in the urine. The most important point in the diagnosis as a neuritis, as pointed out by Starr,2 was the implication of the sensory afferent as well as the motor efferent nerves.
strength
by its
flashes
pulse was 110. and the temperature normal. For the previous few months she had, as she described, lightning-like pains down the legs, and suffered at intervals of three or four weeks from what seemed an almost typical" gastIia crisis." The pain now seemed more fixed in the soles of weight, be pulled up easily and steadily, without jerks or both feet, which were found to be completely anaesthetic to the employment of much muscular force, and might remain pricking and pinching. Sensibility was very much blunted suspended equably the whole time which mightbe required, on the dorsum of the foot, and less so up the front of without an effort on the part of the assistant. I therefore the leg; in the latter region the muscles were notably requested Messrs. Krohne and Sesemann, of Duke-street, atrophied. There was great unsteadiness of gait she Manchester-square, to fix to one of the poles of the tripod a could only maintain the upright position with some diffiby means of which the cord could be pulled culty, and swayed sensibly when the eyes were closed up and down in an equable manner, avoiding jerks, and be In attempting to walk she swayed from side to side, enade, by means of a catch, to remain in any position in the knees were bent very much, and the toes turned outwhich it might be required. The accompanying diagram wards and dropped. On being placed against the wall, with illustrates the contrivance so well that a further description the heels fixed, the toes could not be raised from the I am obliged to the makers for floor. The skin of the legs had a glossy appearance, and of it is unnecessary. carrying out this idea in a very neat manner, and I have there was some mottling. Complicated movements could used the improved apparatus for more than two months be performed with both hands, and the grasp was fairly with ease and success. ,strong. Some of the finger-joints were swollen and painful I have now made upwards of 300 suspensions in twenty- to pressure. Extreme coldness, alternating with heat, nine cases in hospital and private practice ; and, although were complained of in both feet ; these symptoms were also the time which has elapsed since this treatment was objective. Plantar reflex was abolished ; the knee-jerks inaugurated is as yet too short for a definite opinion on the were exaggerated in both legs ; and there was no anklewhole subject to be formed, I am convinced that suspension clonus. The muscles supplied by the ant nor tibial nerve has already gained a firm footing in the therapeutics of gave no reaction to faradism, and only feebly to the galvanic chronic nerve-degenerations. In, some of my cases the current; but there was no qualitative change. The eyes results have been actually brilliant, in t’,e majority they reacted to light, but did not accommodate for distance ; have been good, while in a minority no benefit has the pupils were equal and moderately contracted ; and the resulte(l. Occasional failure, however, does not detract discs seemed normal. from the value of any remedy. In addition to locomotor Static electricity by means of a Carre’s machine was ataxy and other spinal affections, chronic rheumatism tried the same day, also general electrisation by friction, and rheumatoid arthritis, and spasmodic torticollis, appear and sparks were drawn from the soles of the feeG to be favourably induenced by suspension. and atrophied muscles, the fibres contracting enerHurley-street. getically duiing the application, the procedure lasting seven minutes. This was repeated for three consecutive with the greatest relief to the pain, sensation days, A CASE OF also being most markedly improved. My patient now had MULTIPLE OR PERIPHERAL NEURITIS, DUE one of her gastric attacks, including severe pain referred to the region of the stomach, nausea (no absolute sickness), TO CHRONIC ARSENICAL POISONING.1 and extreme faintness, accompanied by a feeling of unsteadiness even when in bed, objects in the room seeming BY HENRY M’CLURE, M.D. to rise and fall before her eyes. These symptoms had quite off in two and she was able to resume the passed MULTIPLE NEURITIS maybe due to the poisons of alcohol electrical treatment.days, or other narcotics and stimulants, or to lead, arsenic, Dr. Donald Hood, who happened to be in Cromer at this ’copper, and ergot. Of these, the most familiar is that due to time, kindly saw the patient with me. Our diagnosis then alcohol or lead. Of whatever form, the neuritis presents was an obscure organic legion of the spinal cord. Strange to say, on this day the patient developed a well-marked certain characteristic symptoms. Among these, and nearly "writer’s cramp " in the right hand, with total anaesthesia. always present, are pains and abnormal sensations referred the tips of the thumb and first two fingers. After this, to various nerve distributions, described as numbness, under static electricity, we had a most encouraging and tingling, burning, darting, shooting, or lancinating pains. steady improvement in all the symptoms; the pain had Coldness may be complained of, referred to limited regions, quite gone, the sensation almost completely restored, the -or coldness alternating with heat. The pa ns may be general health most markedly better, complexion much referred to nerves, muscles, or joints; even symptoms clearer, and the appetite excellent. She now complained of heaviness and stillness in the legs, tisualiy referred to ataxia may be present, as "gastric mostly of aatfeeling and as if a board were tied to her feet. especially night, - crises," or as if the patient were watldng on wool. The the middle of November she had improved so much By be also senses the affected : motor, sensory may special that she could walk without help, and could raise both paralytic, ataxic, and spasmodic phenomena-- feet with the heels fixed. There was no pain, the atrophied alterations in electrical reactions ; and there may he muscles had notably grown, and to her friends she seemed and Of reflex, vaso-motor, trophic symptoms present. the objective sensory symptoms, the most important from better than she had been for a year. The power in the had also improved. All went well until Dec. 15tii, a, diagnostic point of view is tenderness of both nerves hand when there was a complete break-down, ushered in by and muscles; this is a constant and distinctive symptom. The transmission of pain pressure and temperature sensa- extreme pain and tenderness of the right foot, accomtion is delayed. Motor paralysis is, of course, a prominent panied by a distinct flush on the outer aspect. There was of feet, most marked in the right. Pain was symptom in multiple neuritis. The nerves first involved paresis in both tho left hand, with almost total anaesthesia of are the musculo-spiral and anterior tibial. The electrical present the tips of the fingers and inability to close the hand. The responses vary with the amount of inflammation and extensor of the foot were very tender, and the in nerves. of the Cases acute degeneration poisoning by sensation muscles of and deep pressure were markedly pricking arsenic followed by neuritis have been reported ; but I am not aware of any case having been published of chronic retarded on the soles and frontof the leg; above the knee sensation was normal. The muscles supplied by the poisoning by this metal producing such a result. anterior tibial nerves of both legs gave no response to My patient, a lacly aged fifty-six, married, find with a faradism and slightly exaggerated reactions to galvanism, large family, had always enjoyed excellent health tilli but no qualitative changes. The knee jerks were dimieighteen months ago. Since then she had suffered a good nished. There was also gastric pain and nausea. deal from pain, and had been treated for e;ont and rheuFor some time I had been reconsidering the diagnosis, matism. When first seen (Sept. 2?nd, I88S) she had an and now, after this hreak-down, I was convinced I had a appearance of suffering, an unhealthy, muddy-looking commultiple neuritis to de;tl with, most probably of toxic origin, the was the coated plexion, tongue thickly posteriorly, and gave a more hopeful prognosis. Alcohol and lead being appetite very bad, there was ob-itina.te constipation, the excluded, my thoughts turned to arsenic The wall papers 1 There happened to were investigated, but gave no result. Paper read before the Norwich Medico-Chirurgical Society. unbearable, even to a sound person, when protracted for five minutes. Under these circumstances, it appeared to me desirable to add to the apparatus employed a mechanical contrivance, by means of which the patient might, even if of great bodyas
winding-wheel,
of
including
1238 fession to become at once popular. Unlike cocaine, which was used universally within a few months after its first announcement, nitro-glycerine has been before the profession over thirty years, and yet, until the last few years, it was seldom or never mentioned in medical literature. In 1858 Field introduced it as a remedy in neuralgia and nervous affections. The Academy of Science of Paris in 1875 carefully investigated its physiological properties and cautioned physicians against using it in large doses. Four years later Dr. Murrell recommended its use as a successful means in the relief of the agony of neuralgia of the heart (angina pectoris). For a number of years favourable results were reported in our magazines. Gradually, as physicians became more acquainted with its effects, it was tried in other diseases, where relief was hoped for by increasing the volume of the pulse. In July, 1885, I published a brief article in the Therapeutic Gazette of Philadelphia, Penn., recommending the drug as an efficient substitute for alcohol in cases of emergency. The article was widely copied. THE LANCET suggested to physicians to investigate this new claim for the drug, and see if it could be used or recommended. Preparation and Dose.-Druggists usually keep it in stock in a 10 per cent. solution, which is non-explosive. From this 10 per cent. solution they prepare a 1 per cent. solution for the use of the profession, at a cost of eight cents an ounce, which is one cent for sixty doses. It is also sold in the form of pills, perles, and triturates. The liquid form I have found the handiest, and least liable to change and become worthless. Care should be taken to keep the bottle tightly corked, or by evaporation the strength might be increased. Although nitro-glycerine is not decomposed by the acid of the stomach, yet, as nitrites as a class are to a great extent rendered inert by acids, it would be as wen not to use an acid with nitro-glycerine in the same prescription. The dose is one drop of a 1 per cent. solution. This may be taken in water into the stomach, the physician dropping ten drops into a tumbler, and adding ten teaspoonfuls of water, one teaspoonful now representing one drop of the remedy. If there is need of great haste, or if the patient cannot swallow from being unconscious, one drop can be placed within the lower lip or upon the tongue by means of a dropper or pipette, which many physicians. now carry in their case of remedies. The drug may be given hypodermically ; but so rapid is its absorption through the mucous membrane of the mouth that, unless the syringe should happen to be filled and ready for use, I doubt if any time would be gained by the use of the needle. Patients are not all alike in the amount required to produce an effect-some requiring less than one drop, others requiring three or four drops to produce the same effect ; the usual dose, however, is one drop. Patients also differ in the duration of the effect of the drug. Usually the effect lasts three or four hours, but in a few cases the effect had ceased in twenty or thirty minutes. Permit me to say here that the name nitro-glycerine is so associated in the minds of the people with dynamite and with gunpowder that in many cases where the physician has to give a name for what he prescribes it might be wisdom to call the remedy less terrorising names-glovoin, trinitrin. Physiological Effects.-Dropped on the tongue, the effect is the more rapid, as there is no dilution. By way of the Cromer, stomach, unless greatly diluted, the effect is apparent in a. few minutes, the pulse being increased from 10 to 20 beats, NITRO-GLYCERINE — A SUBSTITUTE FOR and becoming full and regular. In a few cases there is a slight headache, lasting for a few minutes. In larger doses ALCOHOL IN CASES OF EMERGENCY. the face becomes flushed, a severe headache is experienced, BY JOSEPH B. BURROUGHS, M.D., accompanied with a feeling of fulness, singing in the PRESIDENT OF ONTARIO COUNTY MEDICAL SOCIETY, NEW YORK STATE. before the eyes, and all the symptoms of ears, an increased supply of blood to the brain. On account of IN presenting to the medical profession the subject of this effect on the cerebral circulation, care should be taken the remedy to the aged, as the sudden nitro-glycerine, my object is to bring to their attention a in administering the of cerebral vessels might cause a rupture of expansion that in its effects, rapidity of action, size of dose, and drug their weakened calcareous walls. Its action on the heart is lack of taste when taken in water, cannot be surpassed. the sympathetic nervous system. The vagus nerve Greater than these properties, desirable as they are, is the through and the vaso-contractor nerves of the vaso-motor nervous additional one, that in nitro-glycerine we possess an system are depressed, partially paralysed. This allows the efficient substitute for alcohol in every case of emergency. extensive system of arterioles to dilate, and thus give room Indeed, in some cases, after alcohol had failed, nitro- within their walls for a greater amount of blood to flow. Thus this enlarged reservoir of tubes relieves the heart of glycerine succeeded. the work of forcing the current through narrow contracted History.-With so many desirable qualities, one would tubes. This and the vagus nerve being depressed permits to it needed have been introduced to the proonly suppose the heart to beat freer, fuller, and more rapidly. 2 Ann. Univers. Med. Sciences, vol. i. Antagonists.-In case of a poisonous dose of nitro-glycerine
be staying in the house a very intelligent lady, who remembered reading about two years ago some letters in The Times of cases of arsenical poisoning at Cooper’s-hill College by means of so-called Indian muslins used as curtains and draperies of the rooms. On investigation being made, it was found that the patient had been for nearly two years working with such muslins, tearing them and making them up into covers for sofa-cushions, curtains, and many kinds of art draperies, both for herself and friends. Mr. Bryans, M.B., examined for me some of the muslins, and found undoubted traces of arsenic. I communicated with Dr. Matthews, Demonstrator of Chemistry at Cooper’s-hill College, who told me there had been cases of arsenical poisoning there traced to such muslins and cretonnes. I sent this gentleman some of the samples used by my patient, and he told me that he discovered arsenic in two of the samples, one of which contained a small amount, while in the other lie found arsenic in considerable quantities, and he had no hesitation in declaring the latter to be dangerous. Of course the muslins with which the patient was still surrounded were at once got rid of; but she was confined to bed for some days, being quite unable to stand. Iodides and "puralis" water were given and galvanism applied during her stay in the house. She improved gradually, and was able to get to my house in about ten days, when static electricity was again resorted to, with some further improvement ; but, the weather getting very cold, she left for Brighton at the end of January, where she was seen by Mr. Bernard Roth and Dr. Uhthoff. She remained under Dr. Uhthoffs care till the middle of March. During her stay at Brighton there was a still further improvement in her condition. Dr. Cowers saw her in London on March 20th, and by permission of Dr. Uhth.in’ I quote a portion of his letter to him : " I have seen Mrs. Hthis afternoon. There seems to me to be no reason for donbt that Dr. M’Clure’s diagnosis is correct. Peripheral neuritis certainly exits. Apart from alcohol, a mineral poison is by far the most probable cause. Spots of pigmentation of the skin is one of the characteristic effects of chronic arsenical poisoning. I have seen it several times in consequence of the long-continued administration of arsenic to prevent bromide rash in epilepsy. No other cause of these symptoms can be traced. Arsenic is the only cause which accounts for the skin pigmentation and the nervous symptoms. It does account perfectly for everything in the case. The exposure to arsenic appears ample. Thus the evidence appears to me overwhelming. Such a case is very rare. I have never seen one like it before, nor do I remember reading of one ; but such cases would probably All the cases of have been misunderstood till recently. arsenic paralysis recorded of late years have followed acute arsenical poisoning. The prospect of recovery is good." Of the usual symptoms of arsenical poisoning the following were absent: with the exception of the periodical attacks referred to, thete was no gastric pain or nausea, no irritation of the eyes, no cough or dyspncea, no typical tongue, no albuminuria, and no arsenic found in the urine. The most important point in the diagnosis as a neuritis, as pointed out by Starr,2 was the implication of the sensory afferent as well as the motor efferent nerves.
strength
by its
flashes