1921 Journal of the American Medical Association  
which had troubled him continuously since the preceding January. The itching was so intense that he found it necessary frequently to stop all work, and to obtain momentary relief by scratching. He had tried various local and internal remedies without relief. Physical Examination.-The head, thorax and abdomen were negative. The skin about the genital region was reddened, thickened and rough. There were no edema and eruption. The urine was negative for albumin and sugar. Treatment and
more » ... ent and Result.-Since the usual methods of treat¬ ment gave only momentary relief, it was decided to discover and remove the etiologic factor if possible. Skin tests were made with the proteins of all the foods eaten during a period of one month. There was a + + reac¬ tion to pork, with doubtful reactions to potato and milk. Pork was eliminated from the diet. In seven days, the pruritus disappeared and has not returned during the last six months. Case 2.-History.-H. B., farmer, white, aged 25, consulted me, Oct. 5, 1920, complaining of intense itching over the entire body, of five weeks' duration. He had consulted several physi¬ cians who had prescribed the usual local and systemic remedies without result. The family and personal histories were nega¬ tive for asthma and allied conditions. Physical Examination.-This was negative except for a slight roughening of the skin and a few excoriations caused by scratching. Treatment and Results.-Skin tests were made, using the proteins of buckwheat, milk, egg, pork, coffee, corn, tomato and chicken. There was a + H-h reaction to potato and a + reaction to buckwheat. The elimination of potato and buckwheat from the diet for nine days gave complete relief for five days, when potatoes were again eaten. The itching recurred in two days. Potato was again eliminated from the diet, with complete relief. There has been no recurrence of symptoms in three months. aged 66, a painter, who had formerly been in excellent health, felt slightly constipated and at 8 a. m. took from a marked bottle about an ounce of what he thought was a proprietary saline cathartic. Within fifteen minutes, he was seized with violent epigastric cramps, accompanied by attacks of retching and vomiting, coming on at from five to ten minute intervals. A physician was called, who made a diagnosis of acute indigestion and ordered milk of magnesia. At 10: 15 a. m. I was hurriedly called. When I arrived the patient's pulse was weak, the extremities were cold and clammy, there was cold sweat on the forehead and cyanosis. At five minute intervals he would cry out that he was strangling or choking, and he almost strangled when a little whisky was administered. The lips were slightly cyanotic. At inter¬ vals of a few minutes he cried out with pain in the epigas¬ trium and then immediately after he would grasp his throat and complain of difficulty in swallowing, of choking and strangling. Notwithstanding active, hypodermic stimulation (V20 grain of strychnin and 2 c.c. of camphor in oil), he died in one of these paroxysms one hour after my arrival. There was no lead line on the gums or other symptoms present or past to suggest lead colic. Necropsy was advised and permitted by the family. The bettle, one-half filled wkh the powder taken by Mr. K., was saved. Necropsy, performed at 4 p. m. by my associate, Dr. L. H. Fuson, revealed nothing abnormal. Chemical analysis of the contents of the stomach demonstrated the presence of IV2 ounces of borax. The bottle contained pure borax. comment At the coroner's inquest it was shown that the deceased's mother-in-law, about 80 years of age, had filled the empty saline bottle with borax without informing the family or changing the label, and that it had been placed on the medi¬ cine shelf by another member of the family who thought it was a bottle of saline laxative. The coroner's jury returned a verdict of accidental borax poisoning. CONCLUSIONS This was a cleancut case of borax poisoning, conforming in every respect to the clinical picture. The necropsy findings were otherwise practically negative, for the cause of sudden death and the etiology of the poison¬ ing were demonstrated beyond peradventure. This case demonstrated that borax is a potent poison when taken in large quantities. It should be labeled poison, and should not be used carelessly without a definite understand¬ ing that it has fixed toxicologie properties. boy, aged 13, rated as a first year high school student in a private school, became ill during the early part of January, 1920, with paratyphoid. While convalescing he was brought in contact with a case of measles. Shortly after this he also developed measles, and had apparently recovered from this when he complained of a severe pain in the left ear. His physician within a few hours called in consultation an aurist. An acute suppurative otitis media of the left side was diagnosed, and an incision of the drum performed. Irrigation with boric acid solution was made every three hours. On the fourth and fifth days the patient became nervous and restless, and suffered somewhat from insomnia. His temperature range was from 100 to 102.5 F. February 18, I was asked by Dr. Alexander Schmitt to see the patient. His temperature at this time was 103 F. He was extremely nervous, apprehensive and rather septic in appear¬ ance. The right ear was perfectly normal. From the left ear came a profuse yellow discharge of pulsating character. It was difficult to keep the canal wiped. The incision made previously appeared to be extensive, and afforded all the drainage possible. At this time slight tenderness was elicited directly over the mastoid antrum. A smear was taken and later reported as. showing a pneumococcus. A specimen of urine was negative for albumin and sugar. The nurse was instructed to irrigate the ear every hour with boric acid solution, and even at intervals during the night. The patient was seen daily and the canal cleansed. In spite of the utmost care the discharge remained, pulsating and very profuse, although there was no sagging of the drum. The insomnia persisted. On the 21st and the next two days the temperature' range was from 100 to 105 F. The tenderness had increased over the mastoid, extending well over the temporal and zygomatic regions, but none over the tip. Any increased tenderness over the meningeal area is significant of operative interference, especially with a ten day history of aural discharge. At this time a simple mastoid operation was advised. The same day a roentgenogram was taken at St. Luke's Hospital. This revealed an increased cloudiness of the left side and a most unusual extensive pneumatic mastoid bone. The cells were extremely high over the zygoma and temporal plate ; the tenderness corresponded exactly to the location of these cells. Read before the
doi:10.1001/jama.1921.92630060030011a fatcat:bmqhreyd4jcmflah7xojd525nq