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ON A SINGULAR CASE OF POISONING BY ARSENICAL PAPER.
but momentary consciousness, and he could give no account of and became so painful that eating, or even speaking, could himself. The skin was red and burning, in parts perspiring; scarcely be indulged in. breathing quick and irregular; the eye a little fiery; conjuncThinking it depended on some gastric irritation, I treated tiva partially injected; pupil large, feebly sensible to the him accordingly, together with the local use of chlorate of stimulus of light; pulse quick, of small volume, with a degree potass as a lotion. No improvement being exhibited after of muscular tremor. Subjected to the same treatment of cold several days, and finding that he wore two false teeth, I had water, &c., as in the other cases. In half an hour he became them removed, and although the gold appeared quite pure, it
partially conscious, and at nine P.M., two hours from admis- struck me that some galvanic action was going on in the mouth, sion, sensibility was completely restored, the eye sensitive, which acted on the copper of the alloy and produced the effects. pulse of improved volume, with disposition to sleep. The Five days after the removal of the teeth, my patient called on treatment for the night consisted in a blister to the nape of the me, well, with the exception of the largest ulcer having not neck, with a diaphoretic draught; and on the following morn- quite healed. I was taking credit to myself for sagacity in thus discovering ing he awoke comparatively well, the blister discharging, little or no headache, and the pulse of fair volume. Had no return the cause, when, a few days after, he returned, with the mouth of alarming symptom, but, like the other cases, he has re- in a far worse state than ever; all the old ulcers had remained in a weak state, requiring a tonic treatment and atten- opened, several new ones formed, the lips were much swollen, tion to the liver, which organ is sluggish. He is unable to bear and there was profuse ptyalism. He had not taken a dose of an Indian sun, and his removal to a colder climate is essential. mercury for some years. I was totally at a loss both as to the Remarks.-The issue of the above cases is suggestive of a few cause and the treatment to pursue, but adopted palliative reobservations which may not be altogether devoid of interest, or medies for some time without effect. Things were in this uneven utility, upon a very serious affection common enough in satisfactory state, when, happening one evening to go into his, India, and which during the past summer has appeared in shop, I perceived, on entering, a most unpleasant smell. AskEngland, one or more cases of coup de soleil being recorded in ing my patient the cause, he told me that it was produced whenever he lit the gas-jet by which he worked, as the heat the weekly return of mortality in London. The symptoms on admission will be found to have varied caused a smell from the varnish covering his paper shade. somewhat in the individual cases, though not, perhaps, more This drew my attention to the shade in question, and, noticing than would be dependent upon constitutional peculiarity. In its colour, (a bright green,) the thought instantly occurred to all, the redness and almost pungent heat of skin (so character- me that here perhaps was the fons et origo mali. I took it istic of the affection, as distinguishing it from other cerebral away with me, applied Reinsch’s test, and obtained immediate diseases) were present, though varying in intensity; in all, proof of the presence of arsenic (aceto-arsenite of copper.) To there was the quick, feeble, and almost running pulse; and in be brief, I left off all treatment, the patient discontinued the all, complete insensibility, not apparently the result of pressure use of the shade, and complete recovery ensued, though not till, inducing coma, as in apoplexy, but consequent upon dimi- after the lapse of nearly three weeks. Remarks.-This case is interesting in connexion with the nished or suspended nervous power; this view being borne out by the speedy return to consciousness, and the fact of the pa- subject of arsenical paper-hangings, about which there has tients at the end of twelve hours on the following morning been so much excitement. Ic is certain that, while much truth being comparatively well, with a steady pulse of moderate was elicited in the controversy, there was a great deal of error volume, instead of a slow and laboured one, with, perhaps, superadded. Several articles were published to prove that the paralysis or other symptom of severe organic lesion in the great arsenic contained in the paper was volatilized by the heat of nervous centres. This leads to the condition of the brain in the gas in a room, the authors not remembering or not knowconnexion with the above symptoms, which may, I think, very ing that a temperature considerably above that of boiling water fairly be considered as one of want of blood in the organ, or ofwas necessary to produce this result. The rational conclusion temporary congestion only, the result of diminished nervous! finally arrived at was, that the symptoms suffered by theenergy, and deficiency of tone in the bloodvessels to enable patients were caused by the mechanical separation of the green them to carry on the circulation, owing to the shock received colour, and its subsequent inhalation or absorption. In this by the brain from the immediate effect of the sun’s rays. With case, however, was shown the effect of its actual volatilization, this view, then, the treatment adopted would appear to be and the short time necessary to produce serious symptoms. correct; whilst the result of the cases and the subsequent de- My patient had used the shade but a few days before he bility support the non-depletion, in contradistinction to both began to suffer, and the period in which he so much improved general and topical bleeding, as recommended by some old and was an interval during which he had not worked by gaslight; but it should be observed that the temperature of the shade even by some later writers. Two other points may be worthy of remark : First, the action was elevated to a very high degree, and that, when working, .
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of the stream of cold water upon the head, which was at once to) his mouth and nostrils were within two inches’ distance of it. I have been induced to offer this case for publication by way excite the nervous system, raise the pulse, and induce forcible contraction of the voluntary muscles; but if continued too long; of caution against the present general use of this paper as a pro. at one time, it was followed by diminution of volume in the tection to the eyes from the glare of lamps, the purpose of all pulse and marked depression. The other point is, the absolute others to which it is least adapted, as affording the most favournecessity for the removal of a patient to a colder climate wheni able opportunity for the sublimation of the poison; for, cononce he has been the subject of this very fatal affection. Ini sidering the powerful effect of arsenic on mucous surfaces, it is two out of the three cases here recorded, the men had beeni obvious that too much care cannot be exercised to avoid such attacked during the previous year, and afterwards allowed to injurious exposure to its influence. remain in the country, only to suffer again, very probably even1 Charles-street, Jan. 1860. to the sacrifice of their life; whereas, in ordinary or mild cases, there is no reason why a soldier should not afterwards effec ALLEGED FAILURE OF CEREBRAL AUSCULTATION.tively perform his duties in a colder climate, ensuring thus his Some American and German physicians-notably Dr. Fisher, own life and a very considerable saving to the Government. of Boston, and Drs. Whitney and Hennig, of Leipsic-had. Gorruchpore, Nov. 1859. published some remarkable researches on the results of auscultation of the head. They concluded that, by the interpretation ON A SINGULAR CASE OF POISONING BY of certain sounds, assumed to be physiological or pathological according to observed conditions, valuable deductions might be. ARSENICAL PAPER. drawn, as from the auscultation of the chest. If these researches had been confirmed, a new system of semeiology would BY R. BIGGS, ESQ., M.R.C.S., &c., Bath. he established for cerebral affections. M. Roger reports the result of his experimental investigation of this subject: his I WAS lately consulted by a watchmaker for a very trouble- conclusions are wholly negative. He affirms that neither in some and irritable condition of the mucous membrane of the meningitis, nor effusions, nor in any other cerebral affection, mouth, from which he had been suffering for some time. On are any fixed pathological sounds induced; and he concludes. the head is thus far an useless proexamination, I discovered several small superficial ulcers ex- that the auscultation of He suggests one application only, as the result of ceeding. the inner surface of each in size lip, varying tending along careful study of a large number of cases: it is to the defrom mere specks, the largest being about one-twelfth of an very tection of the anæmic bruit which accompanies rachitis in the inch in diameter. The smarting and annoyance were intolera- infant. It is difl’icult to listen to the neck in the infant ; easy Lle. and much increased in the evenin. when the lips swelled at the fontanelles.
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partially conscious, and at nine P.M., two hours from admis- struck me that some galvanic action was going on in the mouth, sion, sensibility was completely restored, the eye sensitive, which acted on the copper of the alloy and produced the effects. pulse of improved volume, with disposition to sleep. The Five days after the removal of the teeth, my patient called on treatment for the night consisted in a blister to the nape of the me, well, with the exception of the largest ulcer having not neck, with a diaphoretic draught; and on the following morn- quite healed. I was taking credit to myself for sagacity in thus discovering ing he awoke comparatively well, the blister discharging, little or no headache, and the pulse of fair volume. Had no return the cause, when, a few days after, he returned, with the mouth of alarming symptom, but, like the other cases, he has re- in a far worse state than ever; all the old ulcers had remained in a weak state, requiring a tonic treatment and atten- opened, several new ones formed, the lips were much swollen, tion to the liver, which organ is sluggish. He is unable to bear and there was profuse ptyalism. He had not taken a dose of an Indian sun, and his removal to a colder climate is essential. mercury for some years. I was totally at a loss both as to the Remarks.-The issue of the above cases is suggestive of a few cause and the treatment to pursue, but adopted palliative reobservations which may not be altogether devoid of interest, or medies for some time without effect. Things were in this uneven utility, upon a very serious affection common enough in satisfactory state, when, happening one evening to go into his, India, and which during the past summer has appeared in shop, I perceived, on entering, a most unpleasant smell. AskEngland, one or more cases of coup de soleil being recorded in ing my patient the cause, he told me that it was produced whenever he lit the gas-jet by which he worked, as the heat the weekly return of mortality in London. The symptoms on admission will be found to have varied caused a smell from the varnish covering his paper shade. somewhat in the individual cases, though not, perhaps, more This drew my attention to the shade in question, and, noticing than would be dependent upon constitutional peculiarity. In its colour, (a bright green,) the thought instantly occurred to all, the redness and almost pungent heat of skin (so character- me that here perhaps was the fons et origo mali. I took it istic of the affection, as distinguishing it from other cerebral away with me, applied Reinsch’s test, and obtained immediate diseases) were present, though varying in intensity; in all, proof of the presence of arsenic (aceto-arsenite of copper.) To there was the quick, feeble, and almost running pulse; and in be brief, I left off all treatment, the patient discontinued the all, complete insensibility, not apparently the result of pressure use of the shade, and complete recovery ensued, though not till, inducing coma, as in apoplexy, but consequent upon dimi- after the lapse of nearly three weeks. Remarks.-This case is interesting in connexion with the nished or suspended nervous power; this view being borne out by the speedy return to consciousness, and the fact of the pa- subject of arsenical paper-hangings, about which there has tients at the end of twelve hours on the following morning been so much excitement. Ic is certain that, while much truth being comparatively well, with a steady pulse of moderate was elicited in the controversy, there was a great deal of error volume, instead of a slow and laboured one, with, perhaps, superadded. Several articles were published to prove that the paralysis or other symptom of severe organic lesion in the great arsenic contained in the paper was volatilized by the heat of nervous centres. This leads to the condition of the brain in the gas in a room, the authors not remembering or not knowconnexion with the above symptoms, which may, I think, very ing that a temperature considerably above that of boiling water fairly be considered as one of want of blood in the organ, or ofwas necessary to produce this result. The rational conclusion temporary congestion only, the result of diminished nervous! finally arrived at was, that the symptoms suffered by theenergy, and deficiency of tone in the bloodvessels to enable patients were caused by the mechanical separation of the green them to carry on the circulation, owing to the shock received colour, and its subsequent inhalation or absorption. In this by the brain from the immediate effect of the sun’s rays. With case, however, was shown the effect of its actual volatilization, this view, then, the treatment adopted would appear to be and the short time necessary to produce serious symptoms. correct; whilst the result of the cases and the subsequent de- My patient had used the shade but a few days before he bility support the non-depletion, in contradistinction to both began to suffer, and the period in which he so much improved general and topical bleeding, as recommended by some old and was an interval during which he had not worked by gaslight; but it should be observed that the temperature of the shade even by some later writers. Two other points may be worthy of remark : First, the action was elevated to a very high degree, and that, when working, .
.
of the stream of cold water upon the head, which was at once to) his mouth and nostrils were within two inches’ distance of it. I have been induced to offer this case for publication by way excite the nervous system, raise the pulse, and induce forcible contraction of the voluntary muscles; but if continued too long; of caution against the present general use of this paper as a pro. at one time, it was followed by diminution of volume in the tection to the eyes from the glare of lamps, the purpose of all pulse and marked depression. The other point is, the absolute others to which it is least adapted, as affording the most favournecessity for the removal of a patient to a colder climate wheni able opportunity for the sublimation of the poison; for, cononce he has been the subject of this very fatal affection. Ini sidering the powerful effect of arsenic on mucous surfaces, it is two out of the three cases here recorded, the men had beeni obvious that too much care cannot be exercised to avoid such attacked during the previous year, and afterwards allowed to injurious exposure to its influence. remain in the country, only to suffer again, very probably even1 Charles-street, Jan. 1860. to the sacrifice of their life; whereas, in ordinary or mild cases, there is no reason why a soldier should not afterwards effec ALLEGED FAILURE OF CEREBRAL AUSCULTATION.tively perform his duties in a colder climate, ensuring thus his Some American and German physicians-notably Dr. Fisher, own life and a very considerable saving to the Government. of Boston, and Drs. Whitney and Hennig, of Leipsic-had. Gorruchpore, Nov. 1859. published some remarkable researches on the results of auscultation of the head. They concluded that, by the interpretation ON A SINGULAR CASE OF POISONING BY of certain sounds, assumed to be physiological or pathological according to observed conditions, valuable deductions might be. ARSENICAL PAPER. drawn, as from the auscultation of the chest. If these researches had been confirmed, a new system of semeiology would BY R. BIGGS, ESQ., M.R.C.S., &c., Bath. he established for cerebral affections. M. Roger reports the result of his experimental investigation of this subject: his I WAS lately consulted by a watchmaker for a very trouble- conclusions are wholly negative. He affirms that neither in some and irritable condition of the mucous membrane of the meningitis, nor effusions, nor in any other cerebral affection, mouth, from which he had been suffering for some time. On are any fixed pathological sounds induced; and he concludes. the head is thus far an useless proexamination, I discovered several small superficial ulcers ex- that the auscultation of He suggests one application only, as the result of ceeding. the inner surface of each in size lip, varying tending along careful study of a large number of cases: it is to the defrom mere specks, the largest being about one-twelfth of an very tection of the anæmic bruit which accompanies rachitis in the inch in diameter. The smarting and annoyance were intolera- infant. It is difl’icult to listen to the neck in the infant ; easy Lle. and much increased in the evenin. when the lips swelled at the fontanelles.
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