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ACCIDENTAL INHALATION OF PETROL.
ACCIDENTAL INHALATION OF PETROL.
959
presence in such subjects of a chromogen of the is still unknown. It cannot be attributed to mere porphyrin which is converted into the photo-sensitising That the chromogen excess of neutral fats, and Vaughan Harley found that pigment by the action of light. the liquid fat consisted mainly of fatty acids. Nor is is so converted is known, as also the fact that as such it wholly due to excess of fats, which may reach a very it lacks the photo-sensitising power. high figure even in cases in which there is no oil passed apart from the feaces. The lecturer was inclined to ascribe congenital steatorrhoea to the absence of ACCIDENTAL INHALATION OF PETROL. some special pancreatic enzyme which plays an AN unusual accident was recently reported1 important part in the utilisation of fats. The second error described-viz., congenital por- from Queensland by Dr. A. W. St. Ledger. Whilst phyrinuria-was recognised as such by Hans Gunther4 attempting to clear the petrol pipe of his car a in 1911. A pigment of the porphyrin group, hitherto healthy man, aged 34. sucked a considerable amount the spirit into his mouth. As this happened spoken of as haematoporphyrin, is present in traces in of " he caught his breath " and he was quite clear that many morbid urines, but in quantities too small to influence their colour, and, in still smaller traces, in some of it was inhaled. Thirty-six hours later, on normal urine, faeces, and meconium. The excretion of admission to hospital, he complained of acute pain in red urine rich in porphyrin is met with as an acute the right hypochondrium and stated that the pain event in some patients who take sulphonal, and in started immediately after aspirating the petrol. He In adopted a position sitting up, stooping, and leaning some cases in which no such drug has been taken. other cases ’.lch urine is passed over considerable towards the right side. The respiration (35 to the periods, a.nd in others, continuously or irtermittently, minute) was short and jerky and his breath smelt from birth onwards. Such porphyrinuria with deep distinctly of petrol. There was no cyanosis or coughred urine may be regarded as a distinct morbid ing. The respiratory movement seemed inhibited phenomenon. Some 15 cases of congenital porphy- on the right side, but chest signs were very slight. The rinuria have been recorded, and in most ot them the abdomen was immobile, with rigidity and distension urinary anomaly has been associated with annual of the epigastrium, There had been no vomiting. Six eruptions of hydroa. aestivale, affecting only the parts hours after admission he commenced coughing, the exposed to light. This association was first pointed sputum being tinged with blood. The haemoptysis out by McCall Anderson in two brothers. Hans increased, and with the increase of the pulmonary SubGiinther’s case has been subjected to the most thorough signs the abdominal ones became less definite. investigation, first by Giinther himself, and later by sequently a marked pleural effusion occurred, which Hans Fischer and by 0. Schumm. Dr. Leonard Mackey after 14 days was gradually absorbed. Dr. St. Ledger and the lecturer hope to publish shortly an account of regards the haemoptysis as due to a mechanical distension of the bronchioles, brought about by a fresh case which has been under observation for some time past. The scarring which the hydroa produces sudden volatilisation of aspirated petrol. Many and the mutilations and loss of sight to which it may features of this case are obscure, but it seems likely give rise, renders congenital porphyrinuria a most that basal pneumonia must have developed on the undesirable anomaly. The deposition of porphyrin right side, with involvement of the diaphragmatic This hypothesis would account for the causes,a deep brown staining of the bones of the subjects pleura. of this anomaly, whereas the cartilages remain abdominal symptoms and would give a clue to the unstained, producing a most remarkable appearance. genesis of the pleural effusion. The case is also Hans Fischer,6 who made a thorough investigation, by puzzling in this respect that the patient did not cough chemical methods, of the pigments in the urine and on admission ; it may be that, at this stage, 36 hours faeces of Giinther’s patient, has shown that uroporphyrin after the accident, a pleural effusion had already and stercoporphyrin differ widely in chemical com- formed, interposing a water cushion between the pleurae, thereby preventing reflex position, and that both differ from the hsemato- parietal and visceral can be little doubt as to’ the There cough. but their as pleural of Nencki, differ, spectra only porphyrin Schumm has shown, in slightly altered positions of the connexion between the accident with the petrol and which followed, and the case is a saluabsorption bands. There is evidence that sterco- the symptoms to motorists who convert themselves warning tary and that uroporphyrin is porphyrin is originally formed derived from that substance, which appears to be the into impromptu pumps. chief agent in the production of hydroa in these cases. On the other hand, it is almost certain that other TUBERCULOSIS IN THE SERVICES. causes may also be at work in the production of hydroa THE paper read by Prof. S. Lyle Cummins before aestivale, which is by no means always associated with porphyrinuria. The experiments of Hausmann7 on the Naval, Military, and Air Force Group of the white mice, and that of Meyer Betz 8 upon himself,Society of M.O.H. and reported in THE LANCET of show conclusively that the presence of porphyrins in April 29th, should help to focus attention on a subject the organism produces a remarkable degree of photo- which has not in the past been treated with the sensitivity, and the same is true of the natural metabolic consideration it deserves. Before 1914, when only a porphyrins. A white mouse injected subcutaneously small fraction of the general population was required with 0-02 g. of haematoporphyrin dies in a few hours if by the navy and army, there was comparatively difficulty in filling the services with perfectly exposed to bright light, and in subdued light acquires a chronic light disease, whereas the animal if kept in fit males, and the problem of the unfit was left almost the dark after the injection takes no harm, and after in its entirety to the civil authorities. But when the the lapse of a few weeks spent in darkness may be assistance of almost every young adult male and exposed to light with impunity. An intravenous female in the country was required, the health of injection of 0-2 g. rendered Meyer Betz sensitive to the nation’s raw material became of vital importance to the services. It is to be hoped that this lesson of light for several months. That the hydroa of a congenital porphyrinuric is due the war will not be forgotten, and that the cooperation to the presence of porphyrin, and especially of sterco- it forced on the services and the civil authorities will porphyrin in his tissues cannot be doubted. On the other continue indefinitely. As Prof. Cummins pointed out, hand, the fact that in some cases both the porphyrinuria the army provides wonderful research material, but and hydroa appear to result from exposure to light, in the past full use of this material has not been made. presents a difficulty which calls for further investiga- The lacune in our knowledge are, indeed, almost tion. Possibly the explanation will be found in the innumerable, and for want of full and accurate information the leader of a campaign against tuber4 Deutches Archiv f. klin. Med., 1911, cv., 89. culosis is at present in the position of a general whose 5 British Journal of Dermatology, 1898, x., 1. knowledge of the country in which he is operating 6 Münchener med. Wochenschrift, 1916, lxiii., 377. 7 Biochemische Zeitschrift, 1911, xxx., 276. 1 The Medical Journal of Australia, March 18th, 1922. 8 Deutsche Archiv f. klin. Med., 1913, cxii., 476.
from the mere excretion of faeces rich in fatty substances,
little
959
presence in such subjects of a chromogen of the is still unknown. It cannot be attributed to mere porphyrin which is converted into the photo-sensitising That the chromogen excess of neutral fats, and Vaughan Harley found that pigment by the action of light. the liquid fat consisted mainly of fatty acids. Nor is is so converted is known, as also the fact that as such it wholly due to excess of fats, which may reach a very it lacks the photo-sensitising power. high figure even in cases in which there is no oil passed apart from the feaces. The lecturer was inclined to ascribe congenital steatorrhoea to the absence of ACCIDENTAL INHALATION OF PETROL. some special pancreatic enzyme which plays an AN unusual accident was recently reported1 important part in the utilisation of fats. The second error described-viz., congenital por- from Queensland by Dr. A. W. St. Ledger. Whilst phyrinuria-was recognised as such by Hans Gunther4 attempting to clear the petrol pipe of his car a in 1911. A pigment of the porphyrin group, hitherto healthy man, aged 34. sucked a considerable amount the spirit into his mouth. As this happened spoken of as haematoporphyrin, is present in traces in of " he caught his breath " and he was quite clear that many morbid urines, but in quantities too small to influence their colour, and, in still smaller traces, in some of it was inhaled. Thirty-six hours later, on normal urine, faeces, and meconium. The excretion of admission to hospital, he complained of acute pain in red urine rich in porphyrin is met with as an acute the right hypochondrium and stated that the pain event in some patients who take sulphonal, and in started immediately after aspirating the petrol. He In adopted a position sitting up, stooping, and leaning some cases in which no such drug has been taken. other cases ’.lch urine is passed over considerable towards the right side. The respiration (35 to the periods, a.nd in others, continuously or irtermittently, minute) was short and jerky and his breath smelt from birth onwards. Such porphyrinuria with deep distinctly of petrol. There was no cyanosis or coughred urine may be regarded as a distinct morbid ing. The respiratory movement seemed inhibited phenomenon. Some 15 cases of congenital porphy- on the right side, but chest signs were very slight. The rinuria have been recorded, and in most ot them the abdomen was immobile, with rigidity and distension urinary anomaly has been associated with annual of the epigastrium, There had been no vomiting. Six eruptions of hydroa. aestivale, affecting only the parts hours after admission he commenced coughing, the exposed to light. This association was first pointed sputum being tinged with blood. The haemoptysis out by McCall Anderson in two brothers. Hans increased, and with the increase of the pulmonary SubGiinther’s case has been subjected to the most thorough signs the abdominal ones became less definite. investigation, first by Giinther himself, and later by sequently a marked pleural effusion occurred, which Hans Fischer and by 0. Schumm. Dr. Leonard Mackey after 14 days was gradually absorbed. Dr. St. Ledger and the lecturer hope to publish shortly an account of regards the haemoptysis as due to a mechanical distension of the bronchioles, brought about by a fresh case which has been under observation for some time past. The scarring which the hydroa produces sudden volatilisation of aspirated petrol. Many and the mutilations and loss of sight to which it may features of this case are obscure, but it seems likely give rise, renders congenital porphyrinuria a most that basal pneumonia must have developed on the undesirable anomaly. The deposition of porphyrin right side, with involvement of the diaphragmatic This hypothesis would account for the causes,a deep brown staining of the bones of the subjects pleura. of this anomaly, whereas the cartilages remain abdominal symptoms and would give a clue to the unstained, producing a most remarkable appearance. genesis of the pleural effusion. The case is also Hans Fischer,6 who made a thorough investigation, by puzzling in this respect that the patient did not cough chemical methods, of the pigments in the urine and on admission ; it may be that, at this stage, 36 hours faeces of Giinther’s patient, has shown that uroporphyrin after the accident, a pleural effusion had already and stercoporphyrin differ widely in chemical com- formed, interposing a water cushion between the pleurae, thereby preventing reflex position, and that both differ from the hsemato- parietal and visceral can be little doubt as to’ the There cough. but their as pleural of Nencki, differ, spectra only porphyrin Schumm has shown, in slightly altered positions of the connexion between the accident with the petrol and which followed, and the case is a saluabsorption bands. There is evidence that sterco- the symptoms to motorists who convert themselves warning tary and that uroporphyrin is porphyrin is originally formed derived from that substance, which appears to be the into impromptu pumps. chief agent in the production of hydroa in these cases. On the other hand, it is almost certain that other TUBERCULOSIS IN THE SERVICES. causes may also be at work in the production of hydroa THE paper read by Prof. S. Lyle Cummins before aestivale, which is by no means always associated with porphyrinuria. The experiments of Hausmann7 on the Naval, Military, and Air Force Group of the white mice, and that of Meyer Betz 8 upon himself,Society of M.O.H. and reported in THE LANCET of show conclusively that the presence of porphyrins in April 29th, should help to focus attention on a subject the organism produces a remarkable degree of photo- which has not in the past been treated with the sensitivity, and the same is true of the natural metabolic consideration it deserves. Before 1914, when only a porphyrins. A white mouse injected subcutaneously small fraction of the general population was required with 0-02 g. of haematoporphyrin dies in a few hours if by the navy and army, there was comparatively difficulty in filling the services with perfectly exposed to bright light, and in subdued light acquires a chronic light disease, whereas the animal if kept in fit males, and the problem of the unfit was left almost the dark after the injection takes no harm, and after in its entirety to the civil authorities. But when the the lapse of a few weeks spent in darkness may be assistance of almost every young adult male and exposed to light with impunity. An intravenous female in the country was required, the health of injection of 0-2 g. rendered Meyer Betz sensitive to the nation’s raw material became of vital importance to the services. It is to be hoped that this lesson of light for several months. That the hydroa of a congenital porphyrinuric is due the war will not be forgotten, and that the cooperation to the presence of porphyrin, and especially of sterco- it forced on the services and the civil authorities will porphyrin in his tissues cannot be doubted. On the other continue indefinitely. As Prof. Cummins pointed out, hand, the fact that in some cases both the porphyrinuria the army provides wonderful research material, but and hydroa appear to result from exposure to light, in the past full use of this material has not been made. presents a difficulty which calls for further investiga- The lacune in our knowledge are, indeed, almost tion. Possibly the explanation will be found in the innumerable, and for want of full and accurate information the leader of a campaign against tuber4 Deutches Archiv f. klin. Med., 1911, cv., 89. culosis is at present in the position of a general whose 5 British Journal of Dermatology, 1898, x., 1. knowledge of the country in which he is operating 6 Münchener med. Wochenschrift, 1916, lxiii., 377. 7 Biochemische Zeitschrift, 1911, xxx., 276. 1 The Medical Journal of Australia, March 18th, 1922. 8 Deutsche Archiv f. klin. Med., 1913, cxii., 476.
from the mere excretion of faeces rich in fatty substances,
little