Page images
PDF
EPUB

good results have been reported, and it will be proper to add that failure to accomplish any great good, has often been met, and sometimes fears of having done harm even, entertained.

It would not be doing full justice to the recuperative powers of nature, should omission be made of the fact, that she oftentimes accomplishes most signal cures in this disease wholly unaided by art. A case which was supposed to be hopeless, was some years since admitted to the Buffalo General Hospital. The young man was paralyzed in the lower extremities, and nearly helpless; was examined, observed and pitied, but no attempt was made at cure, either by myself or my colleagues. Various expedients were at different times proposed, but none adopted. The curve was in the upper dorsal region and the deformity great. Nature at length commenced to repair or to adapt to existing conditions, and the young man now walks without cane or crutch, and attends to the usual duty of a grocery clerk with acceptable ability. He was an inmate of the hospital two years or more, and finally discharged himself for more lucrative employment, an illustrative example of the influence of time in effecting cures, which had treatment-mechanical support, for instance, been applied, would have been regarded as signal triumphs of art.

ART. IV-A Case of Acute Poisoning by Arsenic, ending in recovery. BY J. R. LOTHROP, M, D.

It will assist a clear understanding of the following details of the case, to relate the facts which led to a suspicion of poisoning by arsenic. A boy in the employ of a farmer, an inmate of his family, was known to have bought arsenic. On the morning of Wednesday, August 16th, the wife and a son of the farmer breakfasted together. Both were soon attacked with vomiting. The wife died that night with symptoms of poisoning by arsenic, the At noon son, though made quite sick, recovered by afternoon. the farmer, a physician called to attend the wife, and a little daughter whose case is related below, dined together, and were all soon after attacked with vomiting. In the case of the little girl the The others soon symptoms were serious and long continued.

recovered and felt no ill effects. Upon examination Dr. Hadley found arsenic in the liver of the wife, thus establishing the fact of

poisoning by arsenic.

On Wednesday, August 16th, in the evening I was called to see a case of suspected poisoning. The patient was a girl of about ten years of age. The following facts were made known to me when I first saw her. In the morning she went from her home, at her grandmother's, to her father's farm, a few miles out of the city, dined and returned in the afternoon about 5 o'clock. Soon after her return she was attacked with vomiting, which continued at short intervals. She stated that she was taken sick soon after eating her dinner and vomited several times before her return. From something which was said about arsenic having been bought the day before by a boy at the farm, the family became fearful that she was poisoned. When I first saw her she was lying upon a couch, apparently well, with no heat of skin or increase of pulse. Soon after she vomited with considerable retching and ejected a small quantity of watery liquid, appearing after it was over as comfortable as before. This was repeated in a short time, perhaps fifteen or twenty minutes. The vomiting was not preceded by much nausea. She would appear free from it till just before vomiting occurred, then she would complain of being sick and immediately vomit.

1

A mustard emetic had been given before I saw her, and she was allowed to drink water freely. As soon as it could be procured, the hydrated sesquioxyde of iron was freely given and frequently repeated, with a liberal allowance of water. The vomiting continued at short intervals till nearly midnight, when the intervals became longer, and towards morning it ceased, and the patient slept. At 6 A. M. Thursday, the trouble seemed over, and I began to feel that there would be no return. I then ordered powdered magnesia to be given, with the intent to clear the intestines of whatever they might contain, of iron and arsenic, and to forestall all danger of fresh absorption. Very soon after the magnesia was given vomiting began anew, and continued till the next day, Friday, when about noon it ceased entirely. As soon as the vomiting was renewed the iron was again given, and its administration kept up till noon of that day, Thursday. At that time it was dis

continued, as it seemed probable that the limit of its usefulness as an antidote had been reached, and its further use was more likely to irritate the stomach than to be attended with benefit. The giving of magnesia was then resumed mainly for the purpose of acting upon the intestines to expel the iron and arsenic which might be in them. For though it might be supposed that but little iron would pass the pylosus during the continued vomiting, in fact, a considerable quantity did pass, and was afterwards expelled; and as to arsenic, though it was probably taken in solution and would not therefore, if let alone, be likely to be found undissolved in the intestines, if the iron had the power to render it insoluble it would be found there with it and be expelled at the same time. The magnesia in fine powder was given in milk, and though apparently all vomited, yet enough passed into the bowels to produce after a time, aided by an enema, a pretty free evacuation of their contents. Magnesia was given frequently till late in the evening and then discontinued.

Up to this time, late Thursday evening, with the exception stated above, vomiting had persisted at frequent intervals, the intervals being seldom over half an hour, and often but fifteen minutes. It had continued then for more than twenty-four hours. At first, though there was almost no distress, even' with considerable retching, as it went on both increased, and the patient began to complain of pain and soreness, and at times there were streaks of blood in the liquid ejected. There was no tenderness upon pressure, and the abdomen was much retracted. No attempt had as yet been made to restrain the vomiting; inasmuch as it had appeared salutary, and had not been attended with so much discomfort or general disturbance as to demand interference. Now, however, the general disturbance was considerable; there was much heat of skin, a rapid and irregular pulse, having increased till it counted one hundred and twenty per minute, and in addition to the distress spoken of, the patient was excited, restless and thirsty, calling for water, and seeking relief from the heat of skin by frequent bathing. Deeming it proper to attempt to restrain the vomiting, I gave, by the mouth, an eighth of a grain of morphine, and repeated it every half hour, three or four times. The effect of this was seemingly to make the vomiting more frequent, and a

failure to control the other symptoms. I then made a subcutaneous injection of morphine, using a quarter of a grain. This was followed by a decided improvement. In two hours I repeated the injection, using half a grain. After this still more improvement was manifest. The vomiting did not cease, but the intervals were greatly prolonged, the retching was much moderated, and the distress removed. After midnight, when the last injection was made, the patient slept somewhat, was much more quiet and comfortable, and the pulse became slower, being reduced to about one hundred per minute. During the forenoon of the next day, Friday, although she vomited occasionally, she had no pain, and was inclined to sleep, being drowsy and delirious. About noon, as the

effect of the narcotic had worn off, I made another injection, using one-third of a grain. Soon after this was given vomiting ceased, and by evening the little patient appeared bright and natural; seemingly well. She slept well the night following, and during the next day was ready to take light food and able to run about. Such in considerable detail is the history of a case which I watched with great interest. Evidently the quantity of arsenic absorbed was small as there was no purging, and there was no very marked prostration, nothing approximating the collapse seen in fatal cases. Yet there was enough to peril life and to create some doubt as to the result. The symptoms were most intense during the time within which severe cases end fatally, for death occurs generally in such within forty-eight, and may take place in a few hours. There was no irritation of the urinary passage or strangury, though the urine was scanty. An eruption of rather dark spots on the face was noticed, but it was not looked for on the body. The heat of skin was somewhat variable, coming in flashes, and there were slight spasmodic movements. The tongue became furred and red at the tip and sides, but not dry or fissured. The thirst was great, and not easily satisfied, as water was soon rejected. The symptoms continued through forty-eight hours. The books speak of a burning as of a consuming fire, and excruciating pain, but it is probable that an intense distress and restlessness such as we see in cholera, will more often be observed, though the act of vomiting itself may become for the time painful. Vomiting.-Arsenic is said to cause vomiting by acting as an

irritant to the stomach. Yet it causes it as certainly when introduced into the system in any other way. Irritation cannot be the whole of its action in producing vomiting, and in fact is probably but a small part of it. The signs of irritation are not very apparent after death. Traces of inflammation of the stomach must be very rarely observed, or in fact any traces. The softening of the mucous membrane so often mentioned is probably more due to the action of the gastric fluid, after death, as it is found in the stomach in large quantity usually in fatal cases, and the fluid vomited is often sour to the smell and probably taste, is in fact largely the gastric juice the stomach being excited to secretion, either in consequence of prolonged vomiting, by no means uncommon, or because there is an attempt at elimination. The same may be said of the purging. The copious evacuations may be an effort to eliminate the poison, rather than a consequence of its action as an irritant. The cases in which a large quantity of arsenic is probably taken with food, and afterwards rejected by vomiting without causing any very great disturbance, hardly more than would be caused by an ordinary emetic, seem to be exceptions. If the vomiting is not merely mechanical in such cases, but is the result of absorption, how is it that they will get off with just that amount which will vomit, but not dangerously poison? Many persons partake of the same poisoned substance, yet one only dies, and the rest are not seriously affected. The difference probably is in the quantity of food taken, and the state of the arsenic. Arsenic taken unsolved into the stomach is more likely to cause serious if not fatal effects than when in solution. Some of it adheres in masses to the stomach, and is therefore not expelled with the food. The chances of absorption are much greater then, than when it is in solution and mixed with food, for only that small amount which comes in contact with the stomach walls is absorbed, an amount in many cases just sufficient to disturb the system to vomiting, and thus ensure safety. But again the quantity of food tąken still further affects it, so that the less food taken the greater the danger. Something like this will account for the differences in cases where the poison has been taken under circumstances which seem to make it certain that all will be affected alike. When masses cling to the stomach absorption goes on for a time

« PreviousContinue »