PHYSIOLOGIC AND FUNCTIONAL ANOMALIES. 14 page

mentions the symptoms of poisoning following the application of extract

of belladonna to the scrotum. Davison reports poisoning by the

application of belladonna liniment. Jenner and Lyman also record

belladonna poisoning from external applications.

Rosenthal reports a rare case of poisoning in a child eighteen months

old who had swallowed about a teaspoonful of benzin. Fifteen minutes

later the child became unconscious. The stomach-contents, which were

promptly removed, contained flakes of bloody mucus. At the end of an

hour the radial pulse was scarcely perceptible, respiration was

somewhat increased in frequency and accompanied with a rasping sound.

The breath smelt of benzin. The child lay in quiet narcosis,

occasionally throwing itself about as if in pain. The pulse gradually

improved, profuse perspiration occurred, and normal sleep intervened.

Six hours after the poisoning the child was still stupefied. The urine

was free from albumin and sugar, and the next morning the little one

had perfectly recovered.

There is an instance mentioned of a robust youth of twenty who by a

mistake took a half ounce of cantharides. He was almost immediately

seized with violent heat in the throat and stomach, pain in the head,

and intense burning on urination. These symptoms progressively

increased, were followed by intense sickness and almost continual

vomiting. In the evening he passed great quantities of blood from the

urethra with excessive pain in the urinary tract. On the third day all

the symptoms were less violent and the vomiting had ceased. Recovery

was complete on the fifteenth day.

Digitalis has been frequently observed to produce dizziness, fainting,

disturbances of vision, vomiting, diarrhea, weakness of the pulse, and

depression of temperature. These phenomena, however, are generally

noticed after continued administration in repeated doses, the result

being doubtless due to cumulative action caused by abnormally slow

elimination by the kidneys. Traube observed the presence of

skin-affection after the use of digitalis in a case of pericarditis.

Tardieu has seen a fluid-dram of the tincture of digitalis cause

alarming symptoms in a young woman who was pregnant. He also quotes

cases of death on the tenth day from ingestion of 20 grains of the

extract, and on the fifth day from 21 grams of the infusion. Kohuhorn

mentions a death from what might be called chronic digitalis poisoning.

There is a deleterious practice of some of the Irish peasantry

connected with their belief in fairies, which consists of giving a

cachetic or rachitic child large doses of a preparation of fox-glove

(Irish--luss-more, or great herb), to drive out or kill the fairy in

the child. It was supposed to kill an unhallowed child and cure a

hallowed one. In the Hebrides, likewise, there were many cases of

similar poisoning.

Epidemics of ergotism have been recorded from time to time since the

days of Galen, and were due to poverty, wretchedness, and famine,

resulting in the feeding upon ergotized bread. According to Wood,

gangrenous ergotism, or "Ignis Sacer" of the Middle Ages, killed 40,000

persons in Southwestern France in 922 A. D., and in 1128-29, in Paris

alone, 14,000 persons perished from this malady. It is described as

commencing with itchings and formications in the feet, severe pain in

the back, contractions in the muscles, nausea, giddiness, apathy, with

abortion in pregnant women, in suckling women drying of milk, and in

maidens with amenorrhea. After some time, deep, heavy aching in the

limbs, intense feeling of coldness, with real coldness of the surfaces,

profound apathy, and a sense of utter weariness develop; then a dark

spot appears on the nose or one of the extremities, all sensibility is

lost in the affected part, the skin assumes a livid red hue, and

adynamic symptoms in severe cases deepen as the gangrene spreads, until

finally death ensues. Very generally the appetite and digestion are

preserved to the last, and not rarely there is a most ferocious hunger.

Wood also mentions a species of ergotism characterized by epileptic

paroxysms, which he calls "spasmodic ergotism." Prentiss mentions a

brunette of forty-two, under the influence of ergot, who exhibited a

peculiar depression of spirits with hysteric phenomena, although

deriving much benefit from the administration of the drug from the

hemorrhage caused by uterine fibroids. After taking ergot for three

days she felt like crying all the time, became irritable, and stayed in

bed, being all day in tears. The natural disposition of the patient was

entirely opposed to these manifestations, as she was even-tempered and

exceptionally pleasant.

In addition to the instance of the fatal ingestion of a dose of Epsom

salts already quoted, Lang mentions a woman of thirty-five who took

four ounces of this purge. She experienced burning pain in the stomach

and bowels, together with a sense of asphyxiation. There was no

purging or vomiting, but she became paralyzed and entered a state of

coma, dying fifteen minutes after ingestion.

Iodin Preparations.--The eruptions following the administration of

small doses of potassium iodid are frequently noticed, and at the same

time large quantities of albumin have been seen in the urine. Potassium

iodid, although generally spoken of as a poisonous drug, by gradually

increasing the dose can be given in such enormous quantities as to be

almost beyond the bounds of credence, several drams being given at a

dose. On the other hand, eight grains have produced alarming symptoms.

In the extensive use of iodoform as a dressing instances of untoward

effects, and even fatal ones, have been noticed, the majority of them

being due to careless and injudicious application. In a French journal

there is mentioned the history of a man of twenty-five, suspected of

urethral ulceration, who submitted to the local application of one gram

of iodoform. Deep narcosis and anesthesia were induced, and two hours

after awakening his breath smelled strongly of iodoform. There are two

similar instances recorded in England.

Pope mentions two fatal cases of lead-poisoning from diachylon plaster,

self-administered for the purpose of producing abortion. Lead

water-pipes, the use of cosmetics and hair-dyes, coloring matter in

confectionery and in pastry, habitual biting of silk threads,

imperfectly burnt pottery, and cooking bread with painted wood have

been mentioned as causes of chronic lead-poisoning.

Mercury.--Armstrong mentions recovery after ingestion of 1 1/2 drams of

corrosive sublimate, and Lodge speaks of recovery after a dose

containing 100 grains of the salt. It is said that a man swallowed 80

grains of mercuric chlorid in whiskey and water, and vomited violently

about ten minutes afterward. A mixture of albumin and milk was given to

him, and in about twenty-five minutes a bolus of gold-leaf and reduced

iron; in eight days he perfectly recovered. Severe and even fatal

poisoning may result from the external application of mercury. Meeres

mentions a case in which a solution (two grains to the fluid-ounce)

applied to the head of a child of nine for the relief of tinea

tonsurans caused diarrhea, profuse salivation, marked prostration, and

finally death. Washing out the vagina with a solution of corrosive

sublimate, 1:2000, has caused severe and even fatal poisoning. Bonet

mentions death after the inunction of a mercurial ointment, and

instances of distressing salivation from such medication are quite

common. There are various dermal affections which sometimes follow the

exhibition of mercury and assume an erythematous type. The

susceptibility of some persons to calomel, the slightest dose causing

profuse salivation and painful oral symptoms, is so common that few

physicians administer mercury to their patients without some knowledge

of their susceptibility to this drug. Blundel relates a curious case

occurring in the times when mercury was given in great quantities, in

which to relieve obstinate constipation a half ounce of crude mercury

was administered and repeated in twelve hours. Scores of globules of

mercury soon appeared over a vesicated surface, the result of a

previous blister applied to the epigastric region. Blundel, not

satisfied with the actuality of the phenomena, submitted his case to

Dr. Lister, who, after careful examination, pronounced the globules

metallic.

Oils.--Mauvezin tells of the ingestion of three drams of croton oil by

a child of six, followed by vomiting and rapid recovery. There was no

diarrhea in this case. Wood quotes Cowan in mentioning the case of a

child of four, who in two days recovered from a teaspoonful of croton

oil taken on a full stomach. Adams saw recovery in an adult after

ingestion of the same amount. There is recorded an instance of a woman

who took about an ounce, and, emesis being produced three-quarters of

an hour afterward by mustard, she finally recovered. There is a record

in which so small a dose as three minims is supposed to have killed a

child of thirteen months. According to Wood, Giacomini mentions a case

in which 24 grains of the drug proved fatal in as many hours.

Castor oil is usually considered a harmless drug, but the castor bean,

from which it is derived, contains a poisonous acrid principle, three

such beans having sufficed to produce death in a man. Doubtless some of

the instances in which castor oil has produced symptoms similar to

cholera are the results of the administration of contaminated oil.

The untoward effects of opium and its derivatives are quite numerous

Gaubius treated an old woman in whom, after three days, a single grain

of opium produced a general desquamation of the epidermis; this

peculiarity was not accidental, as it was verified on several other

occasions. Hargens speaks of a woman in whom the slightest bit of opium

in any form produced considerable salivation. Gastric disturbances are

quite common, severe vomiting being produced by minimum doses; not

infrequently, intense mental confusion, vertigo, and headache, lasting

hours and even days, sometimes referable to the frontal region and

sometimes to the occipital, are seen in certain nervous individuals

after a dose of from 1/4 to 5/6 gr. of opium. These symptoms were

familiar to the ancient physicians, and, according to Lewin, Tralles

reports an observation with reference to this in a man, and says

regarding it in rather unclassical Latin: "... per multos dies

ponderosissimum caput circumgestasse." Convulsions are said to be

observed after medicinal doses of opium. Albers states that twitching

in the tendons tremors of the hands, and even paralysis, have been

noticed after the ingestion of opium in even ordinary doses. The

"pruritus opii," so familiar to physicians, is spoken of in the older

writings. Dioscorides, Paulus Aegineta, and nearly all the writers of

the last century describe this symptom as an annoying and unbearable

affection. In some instances the ingestion of opium provokes an

eruption in the form of small, isolated red spots, which, in their

general character, resemble roseola. Rieken remarks that when these

spots spread over all the body they present a scarlatiniform

appearance, and he adds that even the mucous membranes of the mouth and

throat may be attacked with erethematous inflammation. Behrend

observed an opium exanthem, which was attended by intolerable itching,

after the exhibition of a quarter of a grain. It was seen on the chest,

on the inner surfaces of the arms, on the flexor surfaces of the

forearms and wrists, on the thighs, and posterior and inner surfaces of

the legs, terminating at the ankles in a stripe-like discoloration

about the breadth of three fingers. It consisted of closely disposed

papules of the size of a pin-head, and several days after the

disappearance of the eruption a fine, bran-like desquamation of the

epidermis ensued. Brand has also seen an eruption on the trunk and

flexor surfaces, accompanied with fever, from the ingestion of opium.

Billroth mentions the case of a lady in whom appeared a feeling of

anxiety, nausea, and vomiting after ingestion of a small fraction of a

grain of opium; she would rather endure her intense pain than suffer

the untoward action of the drug. According to Lewin, Brochin reported a

case in which the idiosyncrasy to morphin was so great that 1/25 of a

grain of the drug administered hypodermically caused irregularity of

the respiration, suspension of the heart-beat, and profound narcosis.

According to the same authority, Wernich has called attention to

paresthesia of the sense of taste after the employment of morphin,

which, according to his observation, is particularly prone to supervene

in patients who are much reduced and in persons otherwise healthy who

have suffered from prolonged inanition. These effects are probably due

to a central excitation of a similar nature to that produced by

santonin. Persons thus attacked complain, shortly after the injection,

of an intensely sour or bitter taste, which for the most part ceases

after elimination of the morphin. Von Graefe and Sommerfrodt speak of a

spasm of accommodation occurring after ingestion of medicinal doses of

morphin. There are several cases on record in which death has been

produced in an adult by the use of 1/2 to 1/6 grain of morphin.

According to Wood, the maximum doses from which recovery has occurred

without emesis are 55 grains of solid opium, and six ounces of

laudanum. According to the same authority, in 1854 there was a case in

which a babe one day old was killed by one minim of laudanum, and in

another case a few drops of paregoric proved fatal to a child of nine

months. Doubtful instances of death from opium are given, one in an

adult female after 30 grains of Dover's powder given in divided doses,

and another after a dose of 1/4 grain of morphin. Yavorski cites a

rather remarkable instance of morphin-poisoning with recovery: a female

took 30 grains of acetate of morphin, and as it did not act quickly

enough she took an additional dose of 1/2 ounce of laudanum. After this

she slept a few hours, and awoke complaining of being ill. Yavorski saw

her about an hour later, and by producing emesis, and giving coffee,

atropin, and tincture of musk, he saved her life. Pyle describes a

pugilist of twenty-two who, in a fit of despondency after a debauch (in

which he had taken repeated doses of morphin sulphate), took with

suicidal intent three teaspoonfuls of morphin; after rigorous treatment

he revived and was discharged on the next day perfectly well.

Potassium permanganate was used in this case. Chaffee speaks of

recovery after the ingestion of 18 grains of morphin without vomiting.

In chronic opium eating the amount of this drug which can be ingested

with safety assumes astounding proportions. In his "Confessions" De

Quincey remarks: "Strange as it may sound, I had a little before this

time descended suddenly and without considerable effort from 320 grains

of opium (8000 drops of laudanum) per day to 40 grains, or 1/8 part.

Instantaneously, and as if by magic, the cloud of profoundest

melancholy which rested on my brain, like some black vapors that I have

seen roll away from the summits of the mountains, drew off in one

day,--passed off with its murky banners as simultaneously as a ship

that has been stranded and is floated off by a spring-tide--

'That moveth altogether if it move at all.'

Now, then, I was again happy; I took only a thousand drops of Laudanum

per day, and what was that? A latter spring had come to close up the

season of youth; my brain performed its functions as healthily as ever

before; I read Kant again, and again I understood him, or fancied that

I did." There have been many authors who, in condemning De Quincey for

unjustly throwing about the opium habit a halo of literary beauty which

has tempted many to destruction, absolutely deny the truth of his

statements. No one has any stable reason on which to found denial of De

Quincey's statements as to the magnitude of the doses he was able to

take; and his frankness and truthfulness is equal to that of any of his

detractors. William Rosse Cobbe, in a volume entitled "Dr. Judas, or

Portrayal of the Opium Habit," gives with great frankness of confession

and considerable purity of diction a record of his own experiences with

the drug. One entire chapter of Mr. Cobb's book and several portions of

other chapters are devoted to showing that De Quincey was wrong in some

of his statements, but notwithstanding his criticism of De Quincey, Mr.

Cobbe seems to have experienced the same adventures in his dreams,

showing, after all, that De Quincey knew the effects of opium even if

he seemed to idealize it. According to Mr. Cobbe, there are in the

United States upward of two millions of victims of enslaving drugs

entirely exclusive of alcohol. Cobbe mentions several instances in

which De Quincey's dose of 320 grains of opium daily has been

surpassed. One man, a resident of Southern Illinois, consumed 1072

grains a day; another in the same State contented himself with 1685

grains daily; and still another is given whose daily consumption

amounted to 2345 grains per day. In all cases of laudanum-takers it is

probable that analysis of the commercial laudanum taken would show the

amount of opium to be greatly below that of the official proportion,

and little faith can be put in the records of large amounts of opium

taken when the deduction has been made from the laudanum used. Dealers

soon begin to know opium victims, and find them ready dupes for

adulteration. According to Lewin, Samter mentions a case of

morphin-habit which was continued for three years, during which, in a

period of about three, hundred and twenty-three days, upward of 2 1/2

ounces of morphin was taken daily. According to the same authority,

Eder reports still larger doses. In the case observed by him the

patient took laudanum for six years in increasing doses up to one ounce

per day; for eighteen months, pure opium, commencing with 15 grains and

increasing to 2 1/4 drams daily; and for eighteen months morphin, in

commencing quantities of six grains, which were later increased to 40

grains a day. When deprived of their accustomed dose of morphin the

sufferings which these patients experience are terrific, and they

pursue all sorts of deceptions to enable them to get their enslaving

drug. Patients have been known to conceal tubes in their mouths, and

even swallow them, and the authors know of a fatal instance in which a

tube of hypodermic tablets of the drug was found concealed in the

rectum.

The administration of such an inert substance as the infusion of

orange-peel has been sufficient to invariably produce nervous

excitement in a patient afflicted with carcinoma.

Sonnenschein refers to a case of an infant of five weeks who died from

the effects of one phosphorous match head containing only 1/100 grain

of phosphorus. There are certain people who by reason of a special

susceptibility cannot tolerate phosphorus, and the exhibition of it

causes in them nausea, oppression, and a feeling of pain in the

epigastric region, tormina and tenesmus, accompanied with diarrhea, and

in rare cases jaundice, sometimes lasting several months. In such

persons 1/30 grain is capable of causing the foregoing symptoms. In

1882 a man was admitted to Guy's Hospital, London, after he had taken

half of a sixpenny pot of phosphorous paste in whiskey, and was

subsequently discharged completely recovered.

A peculiar feature of phosphorus-poisoning is necrosis of the jaw. This

affection was first noticed in 1838, soon after the introduction of the

manufacture of phosphorous matches. In late years, owing to the

introduction of precautions in their manufacture, the disease has

become much less common. The tipping of the match sticks is

accomplished by dipping their ends in a warm solution of a composition

of phosphorus, chlorate of potassium, with particles of ground flint to

assist friction, some coloring agent, and Irish glue. From the contents

of the dipping-pans fumes constantly arise into the faces of the

workmen and dippers, and in cutting the sticks and packing the matches

the hands are constantly in contact with phosphorus. The region chiefly

affected in this poisoning is the jaw-bone, but the inflammation may

spread to the adjoining bones and involve the vomer, the zygoma, the

body of the spheroid bone, and the basilar process of the occipital

bone. It is supposed that conditions in which the periosteum is exposed

are favorable to the progress of the disease, and, according to Hirt,

workmen with diseased teeth are affected three times as readily as

those with healthy teeth, and are therefore carefully excluded from

some of the factories in America.

Prentiss of Washington, D.C., in 1881 reported a remarkable case of

pilocarpin idiosyncrasy in a blonde of twenty-five. He was consulted by

the patient for constipation. Later on symptoms of cystitis developed,

and an ultimate diagnosis of pyelitis of the right kidney was made.

Uremic symptoms were avoided by the constant use of pilocarpin. Between

December 16, 1880, and February 22, 1881, the patient had 22 sweats

from pilocarpin. The action usually lasted from two to six hours, and

quite a large dose was at length necessary. The idiosyncrasy noted was

found in the hair, which at first was quite light, afterward

chestnut-brown, and May 1, 1881, almost pure black. The growth of the

hair became more vigorous and thicker than formerly, and as its color

darkened it became coarser in proportion. In March, 1889, Prentiss saw

his patient, and at that time her hair was dark brown, having returned

to that color from black. Prentiss also reported the following case a

as adding another to the evidence that jaborandi will produce the

effect mentioned under favorable circumstances: Mrs. L., aged

seventy-two years, was suffering from Bright's disease (contracted

kidney). Her hair and eyebrows had been snow-white for twenty years.

She suffered greatly from itching of the skin, due to the uremia of the

kidney-disease; the skin was harsh and dry. For this symptom fluid

extract of jaborandi was prescribed with the effect of relieving the

itching. It was taken in doses of 20 or 30 drops several times a day,

from October, 1886, to February, 1888. During the fall of 1887 it was

noticed by the nurse that the eyebrows were growing darker, and that

the hair of the head was darker in patches. These patches and the

eyebrows continued to become darker, until at the time of her death

they were quite black, the black tufts on the head presenting a very

curious appearance among the silver-white hairs surrounding them.

Quinin being such a universally used drug, numerous instances of

idiosyncrasy and intolerance have been recorded. Chevalier mentions

that through contact of the drug workmen in the manufacture of quinin

are liable to an affection of the skin which manifests itself in a

vesicular, papular, or pustular eruption on different parts of the

body. Vepan mentions a lady who took 1 1/2 grains and afterward 2 1/2

grains of quinin for neuralgia, and two days afterward her body was

covered with purpuric spots, which disappeared in the course of nine

days but reappeared after the administration of the drug was resumed.

Lewin says that in this case the severity of the eruption was in

accordance with the size of the dose, and during its existence there

was bleeding at the gums; he adds that Gouchet also noticed an eruption

of this kind in a lady who after taking quinin expectorated blood. The

petechiae were profusely spread over the entire body, and they

disappeared after the suspension of the drug. Dauboeuf, Garraway,

Hemming, Skinner, and Cobner mention roseola and scarlatiniform

erythema after minute doses of quinin. In nearly all these cases the

accompanying symptoms were different. Heusinger speaks of a lady who,

after taking 1/2 grain of quinin, experienced headache, nausea, intense

burning, and edema, together with nodular erythema on the eyelids,

cheeks, and portion of the forehead. At another time 1 1/2 grains of

the drug gave rise to herpetic vesicles on the cheeks, followed by

branny desquamation on elimination of the drug. In other patients

intense itching is experienced after the ingestion of quinin. Peters

cites an instance of a woman of sixty-five who, after taking one grain

of quinin, invariably exhibited after an hour a temperature of from 104

degrees to 105 degrees F., accelerated pulse, rigors, slight delirium,

thirst, and all the appearances of ill-defined fever, which would pass

off in from twelve to twenty-four hours. Peters witnessed this

idiosyncrasy several times and believed it to be permanent. The most

unpleasant of the untoward symptoms of quinin exhibition are the

disturbances of the organs of special sense. Photophobia, and even

transient amblyopia, have been observed to follow small doses. In the

examination of cases of the untoward effects of quinin upon the eye,

Knapp of New York found the power of sight diminished in various

degrees, and rarely amaurosis and immobility of the pupils. According

to Lewin, the perceptions of color and light are always diminished, and

although the disorder may last for some time the prognosis is

favorable. The varieties of the disturbances of the functions of the

ear range from tinnitus aurium to congestion causing complete deafness.

The gastro-intestinal and genito-urinary tracts are especially disposed

to untoward action by quinin. There is a case recorded in which, after

the slightest dose of quinin, tingling and burning at the meatus

urinarius were experienced. According to Lewin, there is mentioned in

the case reported by Gauchet a symptom quite unique in the literature

of quinin, viz., hemoptysis. Simon de Ronchard first noted the

occurrence of several cases of hemoptysis following the administration

of doses of eight grains daily. In the persons thus attacked the lungs

and heart were healthy. Hemoptysis promptly ceased with the suspension

of the drug. When it was renewed, blood again appeared in the sputa.

Taussig mentions a curious mistake, in which an ounce of quinin

sulphate was administered to a patient at one dose; the only symptoms

noticed were a stuporous condition and complete deafness. No antidote

was given, and the patient perfectly recovered in a week. In malarious

countries, and particularly in the malarial fevers of the late war,

enormous quantities of quinin were frequently given. In fact, at the

Date: 2014-12-29; view: 775