Lectures on Certain Views on the Nature and Treatment of Phthisis Pulmonalis

E. Smith
1857 BMJ (Clinical Research Edition)  
BRITISH MEDICAL JOURNAL.] ORIGINAL OOMMUNICATIONS. [MARCH 7, 1857. frequently come before us, are those of artificers who are employed with lead in some form or other, most commonly as the acetate or vhite-lead, and thus receive the poison in small quantities, gradually absorbed, into the system. Painters necessarily are mnost liable to suffer in this way; the facility and rapility with which the system becomes affected depends upon a variety of circumstances; the vigour of the patient's
more » ... he patient's constitution, his habits of cleanliness, the purity of the atmosphere in which he habitually works. The most rapid case of satut-rine initoxication that has occurred in our own experience, was in ai iani not generally employed in this way, who for three days wvas e1ngagaedl in applyinlg a new process to the fastening of a roof, in wlhihli red lead was employed; during the whole time he was in a confinie(d localitv and forced to respire the fumes of the lead, anid at the endl of the three days gave unequivocal signs of lead-poisoning. The blue line which was shown by D-. BuIton to frinige the gums of persons poisoned by lead, and possibly dependent upon the formation in the system of a sulplhuret, is anl almost invariable characteristic of the affection, yet cases do occur where after exposure to the poisonous influence, symptoms are manifested which resemble lead-poisoning, and yield to the iodide, though the blue line is absent. Of the rapid actiol of iodide of potassium in saturnine neuralgia, the folilowin are inistances. CASIE. George C., aged 27, a painter, had colic two months previouis to coming-ulnlder my case. He then had been affected with it for six days, and was slightly jaundiced. His belly wvas lhard, biit towards night it became. as "' hard as a stone." There was n1o tendtlerness. A slight blue line was seen to edge the gumIS. Sept. 15th. The following vmedicine was ordered: g Potass. iodidi gr. v; liquoris opii nlx; misture campb. gi. The pain etased two days after commencing the meclicine. The liquior opiiwas then omitted. On Sept. 26th, it is stated that the colic is mluch better; that there is still occasional pain in the upper left abdomen; that the blue line continues. I then gave hinti ten grains of iodide of potassium, and three weeks later thlere hadl been no return of pain. Trhe following is asimilar instance. CASE. Thomas L., aged 28, painter, had neiver had colic or dropped hanids, till a fortnight before coming un(ler treatment lie was attacked with severe and constant pain about the navel; the parts were tender; sense of nausea: uline highcoloured; bowels costive. A trace of blue line round several teetlh. Ptulse 72, normal. Good appetite. Dec. 1%2th. The following pills were ordered to be taken eveiy niglht at bed time. R Piluhe colocynthidis comp. gr. x; olei crotonis gtt. i. Three days later, the pain is stated to be less; the bowels lhad been mtioved twice each day. The iodide of potassium was now adnmi,iistered in five-grain doses, and three days after the pain had left him, an-d though under treatment for other affections, for above twvo montlhs, the pain did not return. The iodide wvas continued for some timiie, and when discharged cured, the gums were restored to their normal condition. MIany interesting questions are connected with the action of iodide of potassium in cases of miietallic poisoning; not the least imnportant being the mode in which the metal is eliminated. That it passes off bv the uirine has been demonstrated; buT it is miianifestly eliminated by other channels, because, at timIles, during its administration in undoubted cases of leadpoisoniing, while the patient is rapidly recovering, the lead cannot be detected in the urine. We must then assume that it passes off by the bowels, after being set free by the antidote. Nor is the dletection of the lead itself in the urine so easy a process; it does nIot occur in the form of an ordinary salt, but appears to enter into a very intimate combination with the organiic matter of the urine, which must be destroyed before the coimmon tests serve to demonstrate it. In an tayiological point of view, the. study of lead-poisoning is extremiely interesting, as it gives rise to the most varied forms of nervouis disease, in all of whicb an accurate diagnosis is the mniore importanit, as the proper remedy will rarely fail to establish a curl, that remnedy being iodide of potassium. Thus epil psy, ahiuost always a disease with a doubtful prognosis, appeai-s to lose tlhis characttelr wvhen we trace it to lead-poisoningy; for the causte may be removed, and with it the demoniac seizlures lilkvewise disappear. Steel and quinine, our ordinary ainerbos in neuralgic atffetions, fail us in lead-poisoning; but we al-c snrt of allaying the pain as soon as we know that it is a case for iodide of potassium. There is anotlher mettal which, to the disgrace of our profes-sion, has long been employed to poison our fellow-men, under the protection of the fegis of science, but which now appears to be placed under such restrictions as to render it truly a remedial agent: we allude to mercury. This drug also, in its poisonous effects, finds a powerful annd certain antidote in iodide of potassium. The latter searches it out in its various combinations with the organic constituents ofthe body, and, after more or less resistance, effectually expels it. Some pain most generally results from the mercury being first set free; and even salivation, which had subsided, may thus be again excited; but, in salivation itself, we know of no more effectual remedy, besides the exhibition of local astringents (upon which, however, we would not lay much stress), than the iodide. We will close this paper by quioting a case in illustration of its efficacy under these circumstances. James C., a painter, who had generally enjoyed goocl health, had been taking flowers of sulphur during the preceding summer, to counteract the effects of the lead paint wvith which he worked, but had never had the colic or dropped hands. Two weeks previously, his face began to swell. At first there was sore throat; then the gums swelled; and the teeth, which previously had been sound, became quite pulpy. The gums, at the time of consultation, were invisible, from the tumefaction of the adjoining parts. There was a decided miercurial fcmtor, and the man bore the stamp of a man who was salivated; still he denied having taken any mercurial, and ascribed his affection to using a vinegar and rye gargle, and to working in a damp place. However, I prescribed-R Potassii iodidi gr. iv; infusi cascarillk 5j. M. Fiat haustus ter die sumendus. Sumat olei ricini 3ss omni mane. Habeat decocti querc'us Oj pro gargarismate. At the next visit, he, on repeated questioning, admitted having been in the habit of occasionally taking some pills prescribed for him by a physician a long time ago, and which contained some hydrargyrum cum creta. The treatment was steadily persevered in, and the improvement was satisfactory. In the third week, the report is, "1 Doing well; teeth recover. ing their normal appearance, but still loose, though less than they were; there was a blue ring round the gums." He now returned to work; the mercurial fetor soon entirely disappeared; and in another month he was able to masticate. In conclusion, allow me once more to revert to a remark made at the earlier part of my paper, that my intention has not been to exhaust the subject, as I lknow full well that much more might be said upon the action of iodide of potassium in other maladies than those named. My desire has been to submit for your consideration some of the opinions which practical experience has induced me to form relative to the drug we have considered, and to elicit from the stores of your own observation further illustrations in regard to its use and effects.
doi:10.1136/bmj.s4-1.10.194 fatcat:vujb5upmcbgl5mhbablydhxxtq