Antimony, Arsenic

Anomalies and Curiosities of Medicine
by George M. Gould, M.D., Walter L. Pyle, M.D.

(Page 26 of 44)

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 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.