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cannot fail to interest those who have been taught to regard this kind of antiquarian research not as the mere pastime of learned leisure, but as throwing light upon much that concerns us all in the practical work of our daily lives, and conferring unity upon much that at first sight appears dissonant and heterogeneous; not as mere digging in a barren waste for the perishing records of the past, but rather as cultivating a fertile field richly charged with the sown seed of the future.
CASES OF ZINC POISONING.
By J. W. Von Tunzelmann, M.D.
A Sequel to Cases of Lead Poisoning from Well-water, which were reported in the January number of this Journal.
Having recently given an account of some cases of lead poisoning which occurred at Wimbledon last summer, and which were traced to contamination of well-water with lead, from the action of the water on the leaden pipe by which it was drawn from the well (owing to the peculiar condition of the water, which consisted, briefly, in the absence of carbonate of lime and the presence of traces of nitrous and nitric acid and ammonia), I have now to relate the injurious consequences which arose in one family (that in which Cases 1 and 3, there related, occurred) from drinking the water of the well after a pipe of galvanized iron (i.e. zinked iron) had been put into it in the place of the leaden one.
1.—The young lady who had suffered from diplopia (Case 1, above related) remained quite free from her trouble, after returning from a stay of two months at the Lakes, for about three months, when suddenly, in February this year, after having for two days suffered from a feeling of languor with aching in the lumbar region, the diplopia returned. On being sent for I tested the water which the family were drinking, but could not detect lead in it. A specimen was then sent to Dr. Frankland, and he reported that it was virtually free from lead, the quantity being so small that it could not be weighed. Subsequently it was found to contain "58 grains of zinc per gallon, the presence of zinc having been suspected, and attention drawn to it further by a discovery made by the young lady's mother, on inspecting the filter one day, of a scum on the water in the upper chamber of the filter; this she removed and brought to me; it had a metallic lustre, and as it promised to explain the state of things I requested that it should be sent to Dr. Frankland to be examined. He reported that it was carbonate of zinc, and that the water was, in consequence, extremely dangerous. The use of the water was, of course, immediately stopped. An oculist was consulted, who gave his opinion that the diplopia was owing to paralysis of the sixth pair of nerves, the left being more affected than the right.
The diplopia increased and decided strabismus became developed, which was not the case when the patient suffered from the effects of lead, to which the previous occurrence of diplopia was due. The left eye was more affected than the right, in consequence of which a pair of spectacles was recommended having a dark plate opposite the left eye. This was grateful to the patient, as it prevented double vision.
This patient complained also of pain in the back (lumbar region), and the urine was dark and turbid, which was unusual with her, though she had suffered in the same way when under the influence of lead last summer.
Change of air, first to the country and then to Brighton, caused a steady but very gradual improvement, and by the beginning of June the strabismus had so much diminished as to be scarcely perceptible. After that the young lady went to Scotland on a yachting expedition of about a month, and returned without wearing her spectacles, the diplopia having quite left her, and a slight amount of stiffness in the movements of the eyes only remained. Other members of the family have suffered also.
2.—A younger sister, who two years ago had suffered severely from rachialgia running into what appeared to be incipient paraplegia, which improved (though only slowly), on removal to Brighton, under Homoeopathic treatment (it took about a year to subside), and was, I have no doubt, owing to the continual influence of lead in the water, and arsenic in the paper of the dining room (a dark green flock paper, which on analysis was found to contain arsenic in considerable quantity), began to suffer at the end of December last year (i.e. about six weeks after the return of the family from the Lakes) from a return of rachialgia in an aggravated form, so that she was confined to her bed for about a month on account of the exhaustion produced by want of sleep and almost total anorexia; there was also a good deal of photophobia (without pyrexia). She improved gradually under Cimicifuga 1 and 3, chiefly, so as to be able to take carriage exercise (the water being taken all the time, not having then been suspected). She subsequently went away for a change; first to St. John's Wood and then to Brighton; returning in the beginning of June quite well, sleeping well, eating well, and able to be about all day. This improvement has continued.
S.—The mother of these two young ladies has been suffering almost the whole time since their return from the North from pain in the lumbar region of the spine, as well as in the region of both kidneys, and latterly also from giddiness and anorexia, with nausea and vomiting occasionally, also a good deal of griping pain at times in the abdomen, with tendency to diarrhoea. The urine, which was dark and somewhat turbid, deposited a large sediment, composed of urate of ammonia, with a few crystals of oxalate of lime and a few cells of renal epithelium; at times a pellicle formed on its surface after standing (Carbonate of Zinc ?). A specimen was examined on April 25th; colour rather dark amber, somewhat turbid, but comes clear on boiling; odour after standing from the previous evening (in a corked bottle) sickening and whey-like, causing a suspicion of the presence of sugar; reaction acid, sp. gr. 1023, no albumen; sugar distinctly present, though in small quantity, by Moore's and Trommer's tests; deposit, on standing two hours, about one fifth; composition on microscopic examination, as above stated.
This lady improved steadily under Lachesis 6 and Nux vom. 3, which relieved the giddiness; and subsequently Phosph. acid 1, five drops four times a day, which removed the anorexia, and greatly diminished the renal distress in about three weeks. She has continued to improve since then, and is only reminded of her former trouble by a tendency to pain in the back.
Remarks.—The distinct development of strabismus, in Case 1, is of interest in connexion with the benefit derived from Zinc in infantile convulsions, according to Drs. Teste and Madden (see Hughes' Pharmacodynamics, second edition); and as the strabismus of delicate children, often the only distinct ailment, is one of the bugbears of medical practice, even under Homoeopathic treatment, it may be found of value in this affection.
The severe and constant rachialgia of Case 2, so severe as to cause almost total sleeplessness at night, followed by heaviness in the morning, and photophobia (without fever) during the day, and also almost complete anorexia, allies itself to the severe cephalagia, which is a well-known pathogenetic effect of Zinc, and which has been frequently relieved by it. Aching in the spine with sleeplessness is so often a prominent cause of distress in hysterical ailments, that Zinc promises to be of use in this condition.
The presence of sugar in the urine, in Case 3, is of interest, and though at present (at least to my knowledge) a solitary instance of its production by Zinc in small but continued doses, it may add another remedy to our list for treating diabetes.
Dr. Frankland has informed me that the water of Loch Katrine has just been found to act on galvanized iron in the same manner as the water of the well in question.
HAHNEMANN'S PATHOGENESIS OF FERRUM.
[dr. Cooper's paper in our last number has again drawn attention to the dynamic actions of Iron, as distinct from those uses of it which are classed as "chalybeate." For the foundation of the former we should naturally look to Hahnemann's proving; but for English readers this is practically non-existent, having been omitted (we suppose from accident) by Dr. Hempel in his translation. It has therefore been thought well to present the following rendering, which is made from the second volume of the third edition of the Reine Arzneimittelle.hre.
Hahnemann has been unusually communicative in this instance as to the authors he has cited. To Ritter, to Schmidtmilller, to Zacchiroli, and to Scherer, he has appended notes, on the first appearance of their names, specifying the dose and preparation of Iron with which the symptoms were obtained. The first and last of these we have been able to consult, and have annotated their observations when necessary, embodying the imformation afforded by the originals. Of the other authors cited, we have not been able to obtain the work of Nebel and Wepfer; Harcke's contributions to vol. xxv of Hufeland's Journal have no mention of Iron, and we cannot find Lentin's two symptoms, at p. 75 of his Beitrage, though he is there speaking of the use of chalybeate baths in various diseases.]
We take soft iron filings, reduce them to a powder by triturating them sufficiently in a cast-iron mortar, sift through linen, and of the dust-like powder so obtained (called in the Pharmacopoeias Ferrum pulveratum) we take one grain, which, as directed in the case of Arsenic, we bring by means of trituration for three hours with milksugar to the millionth or third potency, and then by means of 27 dilution bottles to the thirtieth potency.