PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. 13 page

in the stomach, and continued vomiting, which he declared was ten times

as distressing as the symptoms caused by the ingestion of tartar

emetic. In about ten minutes after eating the flour the itching would

be greatly intensified, especially about the head, face, and eyes, but

tormenting all parts of the body, and not to be appeased. These

symptoms continued for two days with intolerable violence, and only

declined on the third day and ceased on the tenth. In the

convalescence, the lungs were affected, he coughed, and in

expectoration raised great quantities of phlegm, and really resembled a

phthisical patient. At this time he was confined to his room with

great weakness, similar to that of a person recovering from an

asthmatic attack. The mere smell of wheat produced distressing

symptoms in a minor degree, and for this reason he could not, without

suffering, go into a mill or house where the smallest quantity of wheat

flour was kept. His condition was the same from the earliest times, and

he was laid out for dead when an infant at the breast, after being fed

with "pap" thickened with wheat flour. Overton remarks that a case of

constitutional peculiarity so little in harmony with the condition of

other men could not be received upon vague or feeble evidence, and it

is therefore stated that Waller was known to the society in which he

lived as an honest and truthful man. One of his female neighbors, not

believing in his infirmity, but considering it only a whim, put a small

quantity of flour in the soup which she gave him to eat at her table,

stating that it contained no flour, and as a consequence of the

deception he was bed-ridden for ten days with his usual symptoms. It

was also stated that Waller was never subjected to militia duty because

it was found on full examination of his infirmity that he could not

live upon the rations of a soldier, into which wheat flour enters as a

necessary ingredient. In explanation of this strange departure from the

condition of other men, Waller himself gave a reason which was deemed

equivalent in value to any of the others offered. It was as follows:

His father being a man in humble circumstances in life, at the time of

his birth had no wheat with which to make flour, although his mother

during gestation "longed" for wheat-bread. The father, being a kind

husband and responsive to the duty imposed by the condition of his

wife, procured from one of his opulent neighbors a bag of wheat and

sent it to the mill to be ground. The mother was given much uneasiness

by an unexpected delay at the mill, and by the time the flour arrived

her strong appetite for wheat-bread had in a great degree subsided.

Notwithstanding this, she caused some flour to be immediately baked

into bread and ate it, but not so freely as she had expected The bread

thus taken caused intense vomiting and made her violently and painfully

ill, after which for a considerable time she loathed bread. These facts

have been ascribed as the cause of the lamentable infirmity under which

the man labored, as no other peculiarity or impression in her gestation

was noticed. In addition it may be stated that for the purpose of

avoiding the smell of flour Waller was in the habit of carrying camphor

in his pocket and using snuff, for if he did not smell the flour,

however much might be near him, it was as harmless to him as to other

men.

The authors know of a case in which the eating of any raw fruit would

produce in a lady symptoms of asthma; cooked fruit had no such effect.

Food-Superstitions.--The superstitious abhorrence and antipathy to

various articles of food that have been prevalent from time to time in

the history of the human race are of considerable interest and well

deserve some mention here. A writer in a prominent journal has studied

this subject with the following result:--

"From the days of Adam and Eve to the present time there has been not

only forbidden fruit, but forbidden meats and vegetables. For one

reason or another people have resolutely refused to eat any and all

kinds of flesh, fish, fowl, fruits, and plants. Thus, the apple, the

pear, the strawberry, the quince, the bean, the onion, the leek, the

asparagus, the woodpecker, the pigeon, the goose, the deer, the bear,

the turtle, and the eel--these, to name only a few eatables, have been

avoided as if unwholesome or positively injurious to health and

digestion.

"As we all know, the Jews have long had an hereditary antipathy to

pork. On the other hand, swine's flesh was highly esteemed by the

ancient Greeks and Romans. This fact is revealed by the many references

to pig as a dainty bit of food. At the great festival held annually in

honor of Demeter, roast pig was the piece de resistance in the bill of

fare, because the pig was the sacred animal of Demeter. Aristophanes in

'The Frogs' makes one of the characters hint that some of the others

'smell of roast pig.' These people undoubtedly had been at the festival

(known as the Thesmophoria) and had eaten freely of roast pig, Those

who took part in another Greek mystery or festival (known as the

Eleusinia) abstained from certain food, and above all from beans.

"Again, as we all know, mice are esteemed in China and in some parts of

India. But the ancient Egyptians, Greeks, and Jews abhorred mice and

would not touch mouse-meat. Rats and field-mice were sacred in Old

Egypt, and were not to be eaten on this account. So, too, in some parts

of Greece, the mouse was the sacred animal of Apollo, and mice were fed

in his temples. The chosen people were forbidden to eat 'the weasel,

and the mouse, and the tortoise after his kind.' These came under the

designation of unclean animals, which were to be avoided.

"But people have abstained from eating kinds of flesh which could not

be called unclean. For example, the people of Thebes, as Herodotus

tells us, abstained from sheep. Then, the ancients used to abstain from

certain vegetables. In his 'Roman Questions' Plutarch asks: 'Why do the

Latins abstain strictly from the flesh of the woodpecker?' In order to

answer Plutarch's question correctly it is necessary to have some idea

of the peculiar custom and belief called 'totemism.' There is a stage

of society in which people claim descent from and kinship with beasts,

birds, vegetables, and other objects. This object, which is a 'totem,'

or family mark, they religiously abstain from eating. The members of

the tribe are divided into clans or stocks, each of which takes the

name of some animal, plant, or object, as the bear, the buffalo, the

woodpecker, the asparagus, and so forth. No member of the bear family

would dare to eat bear-meat, but he has no objection to eating buffalo

steak. Even the marriage law is based on this belief, and no man whose

family name is Wolf may marry a woman whose family name is also Wolf.

"In a general way it may be said that almost all our food prohibitions

spring from the extraordinary custom generally called totemism. Mr.

Swan, who was missionary for many years in the Congo Free State, thus

describes the custom: 'If I were to ask the Yeke people why they do not

eat zebra flesh, they would reply, 'Chijila,' i.e., 'It is a thing to

which we have an antipathy;' or better, 'It is one of the things which

our fathers taught us not to eat.' So it seems the word 'Bashilang'

means 'the people who have an antipathy to the leopard;' the

'Bashilamba,' 'those who have an antipathy to the dog,' and the

'Bashilanzefu,' 'those who have an antipathy to the elephant.' In other

words, the members of these stocks refuse to eat their totems, the

zebra, the leopard, or the elephant, from which they take their names.

"The survival of antipathy to certain foods was found among people as

highly civilized as the Egyptians, the Greeks, and the Romans. Quite a

list of animals whose flesh was forbidden might be drawn up. For

example, in Old Egypt the sheep could not be eaten in Thebes, nor the

goat in Mendes, nor the cat in Bubastis, nor the crocodile at Ombos,

nor the rat, which was sacred to Ra, the sun-god. However, the people

of one place had no scruples about eating the forbidden food of another

place. And this often led to religious disputes.

"Among the vegetables avoided as food by the Egyptians may be mentioned

the onion, the garlic, and the leek. Lucian says that the inhabitants

of Pelusium adored the onion. According to Pliny the Egyptians relished

the leek and the onion. Juvenal exclaims: 'Surely a very religious

nation, and a blessed place, where every garden is overrun with gods!'

The survivals of totemism among the ancient Greeks are very

interesting. Families named after animals and plants were not uncommon.

One Athenian gens, the Ioxidae, had for its ancestral plant the

asparagus. One Roman gens, the Piceni, took a woodpecker for its totem,

and every member of this family refused, of course, to eat the flesh of

the woodpecker. In the same way as the nations of the Congo Free State,

the Latins had an antipathy to certain kinds of food. However, an

animal or plant forbidden in one place was eaten without any

compunction in another place. 'These local rites in Roman times,' says

Mr. Lang, 'caused civil brawls, for the customs of one town naturally

seemed blasphemous to neighbors with a different sacred animal. Thus

when the people of dog-town were feeding on the fish called

oxyrrhyncus, the citizens of the town which revered the oxyrrhyncus

began to eat dogs. Hence arose a riot.' The antipathy of the Jews to

pork has given rise to quite different explanations. The custom is

probably a relic of totemistic belief. That the unclean

animals--animals not to be eaten--such as the pig, the mouse, and the

weasel, were originally totems of the children of Israel, Professor

Robertson Smith believes is shown by various passages in the Old

Testament.

"When animals and plants ceased to be held sacred they were endowed

with sundry magical or mystic properties. The apple has been supposed

to possess peculiar virtues, especially in the way of health. 'The

relation of the apple to health,' says Mr. Conway, 'is traceable to

Arabia. Sometimes it is regarded as a bane. In Hessia it is said an

apple must not be eaten on New Year's Day, as it will produce an

abscess. But generally it is curative. In Pomerania it is eaten on

Easter morning against fevers; in Westphalia (mixed with saffron)

against jaundice; while in Silesia an apple is scraped from top to

stalk to cure diarrhea, and upward to cure costiveness.' According to

an old English fancy, if any one who is suffering from a wound in the

head should eat strawberries it will lead to fatal results. In the

South of England the folk say that the devil puts his cloven foot upon

the blackberries on Michaelmas Day, and hence none should be gathered

or eaten after that day. On the other hand, in Scotland the peasants

say that the devil throws his cloak over the blackberries and makes

them unwholesome after that day, while in Ireland he is said to stamp

on the berries. Even that humble plant, the cabbage, has been invested

with some mystery. It was said that the fairies were fond of its

leaves, and rode to their midnight dances on cabbage-stalks. The German

women used to say that 'Babies come out of the cabbage-heads.' The

Irish peasant ties a cabbage-leaf around the neck for sore throat.

According to Gerarde, the Spartans ate watercress with their bread,

firmly believing that it increased their wit and wisdom. The old

proverb is, 'Eat cress to learn more wit.'

"There is another phase to food-superstitions, and that is the theory

that the qualities of the eaten pass into the eater. Mr. Tylor refers

to the habit of the Dyak young men in abstaining from deer-meat lest it

should make them timid, while the warriors of some South American

tribes eat the meat of tigers, stags, and boars for courage and speed.

He mentions the story of an English gentleman at Shanghai who at the

time of the Taeping attack met his Chinese servant carrying home the

heart of a rebel, which he intended to eat to make him brave. There is

a certain amount of truth in the theory that the quality of food does

affect the mind and body. Buckle in his 'History of Civilization' took

this view, and tried to prove that the character of a people depends on

their diet."

Idiosyncrasies to Drugs.--In the absorption and the assimilation of

drugs idiosyncrasies are often noted; in fact, they are so common that

we can almost say that no one drug acts in the same degree or manner on

different individuals. In some instances the untoward action assumes

such a serious aspect as to render extreme caution necessary in the

administration of the most inert substances. A medicine ordinarily so

bland as cod-liver oil may give rise to disagreeable eruptions.

Christison speaks of a boy ten years old who was said to have been

killed by the ingestion of two ounces of Epsom salts without inducing

purgation; yet this common purge is universally used without the

slightest fear or caution. On the other hand, the extreme tolerance

exhibited by certain individuals to certain drugs offers a new phase of

this subject. There are well-authenticated cases on record in which

death has been caused in children by the ingestion of a small fraction

of a grain of opium. While exhibiting especial tolerance from peculiar

disposition and long habit, Thomas De Quincey, the celebrated English

litterateur, makes a statement in his "Confessions" that with impunity

he took as much as 320 grains of opium a day, and was accustomed at one

period of his life to call every day for "a glass of laudanum negus,

warm, and without sugar," to use his own expression, after the manner a

toper would call for a "hot-Scotch."

The individuality noted in the assimilation and the ingestion of drugs

is functional as well as anatomic. Numerous cases have been seen by all

physicians. The severe toxic symptoms from a whiff of cocain-spray, the

acute distress from the tenth of a grain of morphin, the gastric crises

and profuse urticarial eruptions following a single dose of

quinin,--all are proofs of it. The "personal equation" is one of the

most important factors in therapeutics, reminding us of the old rule,

"Treat the patient, not the disease."

The idiosyncrasy may be either temporary or permanent, and there are

many conditions that influence it. The time and place of

administration; the degree of pathologic lesion in the subject; the

difference in the physiologic capability of individual organs of

similar nature in the same body; the degree of human vitality

influencing absorption and resistance; the peculiar epochs of life; the

element of habituation, and the grade and strength of the drug,

influencing its virtue,--all have an important bearing on untoward

action and tolerance of poisons.

It is not in the province of this work to discuss at length the

explanations offered for these individual idiosyncrasies. Many authors

have done so, and Lewin has devoted a whole volume to this subject, of

which, fortunately, an English translation has been made by Mulheron,

and to these the interested reader is referred for further information.

In the following lines examples of idiosyncrasy to the most common

remedial substances will be cited, taking the drugs up alphabetically.

Acids.--Ordinarily speaking, the effect of boric acid in medicinal

doses on the human system is nil, an exceptionally large quantity

causing diuresis. Binswanger, according to Lewin, took eight gm. in two

doses within an hour, which was followed by nausea, vomiting, and a

feeling of pressure and fulness of the stomach which continued several

hours. Molodenkow mentions two fatal cases from the external employment

of boric acid as an antiseptic. In one case the pleural cavity was

washed out with a five per cent solution of boric acid and was followed

by distressing symptoms, vomiting, weak pulse, erythema, and death on

the third day. In the second case, in a youth of sixteen, death

occurred after washing out a deep abscess of the nates with the same

solution. The autopsy revealed no change or signs indicative of the

cause of death. Hogner mentions two instances of death from the

employment of 2 1/2 per cent solution of boric acid in washing out a

dilated stomach The symptoms were quite similar to those mentioned by

Molodenkow.

In recent years the medical profession has become well aware that in

its application to wounds it is possible for carbolic acid or phenol to

exercise exceedingly deleterious and even fatal consequences. In the

earlier days of antisepsis, when operators and patients were exposed

for some time to an atmosphere saturated with carbolic spray, toxic

symptoms were occasionally noticed. Von Langenbeck spoke of severe

carbolic-acid intoxication in a boy in whom carbolic paste had been

used in the treatment of abscesses. The same author reports two

instances of death following the employment of dry carbolized dressings

after slight operations. Kohler mentions the death of a man suffering

from scabies who had applied externally a solution containing about a

half ounce of phenol. Rose spoke of gangrene of the finger after the

application of carbolized cotton to a wound thereon. In some cases

phenol acts with a rapidity equal to any poison. Taylor speaks of a man

who fell unconscious ten seconds after an ounce of phenol had been

ingested, and in three minutes was dead. There is recorded an account

of a man of sixty-four who was killed by a solution containing slightly

over a dram of phenol. A half ounce has frequently caused death;

smaller quantities have been followed by distressing symptoms, such as

intoxication (which Olshausen has noticed to follow irrigation of the

uterus), delirium, singultus, nausea, rigors, cephalalgia, tinnitus

aurium, and anasarca. Hind mentions recovery after the ingestion of

nearly six ounces of crude phenol of 14 per cent strength. There was a

case at the Liverpool Northern Hospital in which recovery took place

after the ingestion with suicidal intent of four ounces of crude

carbolic acid. Quoted by Lewin, Busch accurately describes a case which

may be mentioned as characteristic of the symptoms of carbolism. A boy,

suffering from abscess under the trochanter, was operated on for its

relief. During the few minutes occupied by the operation he was kept

under a two per cent carbolic spray, and the wound was afterward

dressed with carbolic gauze. The day following the operation he was

seized with vomiting, which was attributed to the chloroform used as an

anesthetic. On the following morning the bandages were removed under

the carbolic spray; during the day there was nausea, in the evening

there was collapse, and carbolic acid was detected in the urine. The

pulse became small and frequent and the temperature sank to 35.5

degrees C. The frequent vomiting made it impossible to administer

remedies by the stomach, and, in spite of hypodermic injections and

external application of analeptics, the boy died fifty hours after

operation.

Recovery has followed the ingestion of an ounce of officinal

hydrochloric acid. Black mentions a man of thirty-nine who recovered

after swallowing 1 1/2 ounces of commercial hydrochloric acid. Johnson

reports a case of poisoning from a dram of hydrochloric acid.

Tracheotomy was performed, but death resulted.

Burman mentions recovery after the ingestion of a dram of dilute

hydrocyanic acid of Scheele's strength (2.4 am. of the acid). In this

instance insensibility did not ensue until two minutes after taking the

poison, the retarded digestion being the means of saving life.

Quoting Taafe, in 1862 Taylor speaks of the case of a man who swallowed

the greater part of a solution containing an ounce of potassium cyanid.

In a few minutes the man was found insensible in the street, breathing

stertorously, and in ten minutes after the ingestion of the drug the

stomach-pump was applied. In two hours vomiting began, and thereafter

recovery was rapid.

Mitscherlich speaks of erosion of the gums and tongue with hemorrhage

at the slightest provocation, following the long administration of

dilute nitric acid. This was possibly due to the local action.

According to Taylor, the smallest quantity of oxalic acid causing death

is one dram. Ellis describes a woman of fifty who swallowed an ounce of

oxalic acid in beer. In thirty minutes she complained of a burning pain

in the stomach and was rolling about in agony. Chalk and water was

immediately given to her and she recovered. Woodman reports recovery

after taking 1/2 ounce of oxalic acid.

Salicylic acid in medicinal doses frequently causes untoward symptoms,

such as dizziness, transient delirium, diminution of vision, headache,

and profuse perspiration; petechial eruptions and intense gastric

symptoms have also been noticed.

Sulphuric acid causes death from its corrosive action, and when taken

in excessive quantities it produces great gastric disturbance; however,

there are persons addicted to taking oil of vitriol without any

apparent untoward effect. There is mentioned a boot-maker who

constantly took 1/2 ounce of the strong acid in a tumbler of water,

saying that it relieved his dyspepsia and kept his bowels open.

Antimony.--It is recorded that 3/4 grain of tartar emetic has caused

death in a child and two grains in an adult. Falot reports three cases

in which after small doses of tartar emetic there occurred vomiting,

delirium, spasms, and such depression of vitality that only the

energetic use of stimulants saved life. Beau mentions death following

the administration of two doses of 1 1/2 gr. of tartar emetic.

Preparations of antimony in an ointment applied locally have caused

necrosis, particularly of the cranium, and Hebra has long since

denounced the use of tartar emetic ointment in affections of the scalp.

Carpenter mentions recovery after ingestion of two drams of tartar

emetic. Behrends describes a case of catalepsy with mania, in which a

dose of 40 gr. of tartar emetic was tolerated, and Morgagni speaks of a

man who swallowed two drams, immediately vomited, and recovered.

Instances like the last, in which an excessive amount of a poison by

its sudden emetic action induces vomiting before there is absorption of

a sufficient quantity to cause death, are sometimes noticed. McCreery

mentions a case of accidental poisoning with half an ounce of tartar

emetic successfully treated with green tea and tannin. Mason reports

recovery after taking 80 gr. of tartar emetic.

Arsenic.--The sources of arsenical poisoning are so curious as to

deserve mention. Confectionery, wall-paper, dyes, and the like are

examples. In other cases we note money-counting, the colored candles of

a Christmas tree, paper collars, ball-wreaths of artificial flowers,

ball-dresses made of green tarlatan, playing cards, hat-lining, and

fly-papers.

Bazin has reported a case in which erythematous pustules appeared after

the exhibition during fifteen days of the 5/6 gr. of arsenic. Macnal

speaks of an eruption similar to that of measles in a patient to whom

he had given but three drops of Fowler's solution for the short period

of three days. Pareira says that in a gouty patient for whom he

prescribed 1/6 gr. of potassium arseniate daily, on the third day there

appeared a bright red eruption of the face, neck, upper part of the

trunk and flexor surfaces of the joints, and an edematous condition of

the eyelids. The symptoms were preceded by restlessness, headache, and

heat of the skin, and subsided gradually after the second or third day,

desquamation continuing for nearly two months. After they had subsided

entirely, the exhibition of arsenic again aroused them, and this time

they were accompanied by salivation. Charcot and other French authors

have noticed the frequent occurrence of suspension of the sexual

instinct during the administration of Fowler's solution. Jackson speaks

of recovery after the ingestion of two ounces of arsenic by the early

employment of an emetic. Walsh reports a case in which 600 gr. of

arsenic were taken without injury. The remarkable tolerance of arsenic

eaters is well known. Taylor asserts that the smallest lethal dose of

arsenic has been two gr., but Tardieu mentions an instance in which ten

cgm. (1 1/2 gr.) has caused death. Mackenzie speaks of a man who

swallowed a large quantity of arsenic in lumps, and received no

treatment for sixteen hours, but recovered. It is added that from two

masses passed by the anus 105 gr. of arsenic were obtained.

In speaking of the tolerance of belladonna, in 1859 Fuller mentioned a

child of fourteen who in eighteen days took 37 grains of atropin; a

child of ten who took seven grains of extract of belladonna daily, or

more than two ounces in twenty-six days; and a man who took 64 grains

of the extract of belladonna daily, and from whose urine enough atropin

was extracted to kill two white mice and to narcotize two others. Bader

has observed grave symptoms following the employment of a vaginal

suppository containing three grains of the extract of belladonna. The

dermal manifestations, such as urticaria and eruptions resembling the

exanthem of scarlatina, are too well known to need mention here. An

enema containing 80 grains of belladonna root has been followed in five

hours by death, and Taylor has mentioned recovery after the ingestion

of three drams of belladonna. In 1864 Chambers reported to the Lancet

the recovery of a child of four years who took a solution containing

1/2 grain of the alkaloid. In some cases the idiosyncrasy to belladonna

is so marked that violent symptoms follow the application of the

ordinary belladonna plaster. Maddox describes a ease of poisoning in a

music teacher by the belladonna plaster of a reputable maker. She had

obscure eye-symptoms, and her color-sensations were abnormal. Locomotor

equilibration was also affected. Golden mentions two cases in which the

application of belladonna ointment to the breasts caused suppression of

the secretion of milk. Goodwin relates the history of a case in which

an infant was poisoned by a belladonna plaster applied to its mother's

breast and died within twenty-four hours after the first application of

the plaster. In 1881 Betancourt spoke of an instance of inherited

susceptibility to belladonna, in which the external application of the

ointment produced all the symptoms of belladonna poisoning. Cooper

Date: 2014-12-29; view: 678