1728 CLINICAL NOTES.

which a woman, aged 37 years, took 30 grains of acetate ofmorphia, a fact which was not discovered until three hoursafterwards. Four injections of atropine, each of one-fortiethof a grain, were given, but the recovery of the patientwas attributed to the prolonged use of oxygen gas withartificial respiration, all natural respiratory movements

having ceased for several hours. Mr. Percy Pope 2 records acase of recovery in a girl, aged 19 years, after a hypodermicinjection of 12 grains of morphia. The treatment con-sisted in the administration of four grains of atropine indoses of one-twentieth of a grain at short intervals during12 hours and in artificial respiration, strong coffee, and

attempts to rouse the patient. Cruse describes the case ofan infant, one week old, who was accidentally poisoned bya grain of morphine. The comatose condition that resultedremained unaffected by various treatments for several hoursuntil a quarter of a grain of atropine was administered andthe dose repeated after an interval of half an hour. Recoverywas complete in 38 hours and no unpleasant symptomsattended the administration of such large doses of atropine.From the marked improvement in my patient I should beinclined to regard atropine as a valuable remedy in opium-poisoning ; but there appears to be one difficulty, and thatis to know when the limit of safety has been reached withregard to the amount of atropine to be used. The action ofmorphia and atropine is not exactly antagonistic, the formeracting centrally and the latter peripherally. According toDr. J. Dixon Mann, " Morphia slows the heart’s action

by excitation of the vagus at its origin in the brain ;atropine quickens the heart by paralysing the termina-tions of the vagi and the inhibitory ganglia in the heart....... Opium acting centrally contracts the pupils ; atropineparalyses the terminals of the oculo-motor nerves. Opiumcauses sweating by stimulating the central nerve apparatusconcerned ; atropine arrests it by paralysing the nerve ter-minals in the sweat glands." Ultimately, however, theeffects of the two poisons become mutual, both paralysing themotor and sensory nerves, atropine especially paralysing theheart and opium the respiratory apparatus. Some caution,therefore, is required in using the antidote. Dr. A. P. Luffrecommends that it be given in frequently repeated dosesuntil half a grain has been given, and this should provide afair margin of safety. My patient took about four and one-third grains of morphia which is not a very large dose, andone-eighth of a grain of atropine was given as an antidote,which, I believe, contributed largely to his recovery. Thereis one point that is rather impressed on the mind in con-sidering this question and that is that however large the doseof opium or morphia may be there need be no despair, withthe help of atropine, oxygen, and artificial respiration, of

rescuing from death the person poisoned even after the

poison has become thoroughly absorbed.Maidstone.

Clinical Notes:MEDICAL, SURGICAL, OBSTETRICAL, AND

THERAPEUTICAL.

A CASE OF ARSENICAL BEER POISONING.

BY J. HAROLD BAILEY, M.B. VICT.

ON Oct. 9th, 1900, I was called in to attend a married

woman, aged 41 years, residing in Pendleton, she havingslipped and sprained her left ankle. Rest and the applica-tion of lead and opium lotion to the injured joint wereprescribed. The swelling around the joint subsided and thepain, which was severe, abated somewhat, but at the endof a week the patient began to complain of pains andtingling in the left foot, and she was unable to stand

upright and was obliged to remain altogether in bed.

Cramps in the calves of both legs were next complained of,and the feet and legs became exceedingly painful to pressureon any part of them ; she also complained of the weightof the bed-clothes and of being unable to sleep at nightowing to the intensity of the pains. After anotherweek the patient noticed that her hands were becoming

2 THE LANCET, March 17th, 1894, p. 669.

affected, saying that they felt numb to the touch, thoughpainful sensations like "pins and needles" were present.She could not use her hands, moving the fingers with diffi-culty. Her appetite began to fail, the tongue became slightlycoated, and vomiting of yellowish bile occasionally occurred.Before being confined to bed the patient had been accustomedto have beer for supper and she admitted having taken a glassor two since. Hearing late on Nov. 20th that Dr. E. S.

Reynolds had detected arsenic in beer in Manchester I calledat the patient’s house on the morning of Nov. 21st and sentout for a jug of the beer which she was in the habit of

drinking ; this was obtained from the shop whence she hadbeen getting her beer, and on its being analysed byMr. William Kirkby, F.L.S., of Owens College, it wasfound to contain 0’14 grain per gallon of As406’ A

sample of urine from the patient failed to show thepresence of arsenic, though in the case of another

patient of mine who had drunk the same beer and wassuffering from symptoms of arsenical poisoning the urineshowed a faint trace of arsenic. The condition of thepatient became gradually worse, the weakness of the limbsincreasing, and there being in addition considerable generalwasting. On making a detailed examination on Nov. 29ththe following state of affairs was noticed. The patient lay onher right side in a drowsy, heavy condition, with the eyeshalf open and the knees drawn up. She opened her eyesslowly when asked to do so. She could recognise me, men-tioning my name. She complained of her head, saying thatit felt as though drums were playing in the street.Dark brownish pigmentation of the skin was presenton the neck, the axillae, the abdomen, the thighs,and the legs. There was flaky desquamation of theskin over the lower part of the abdomen. Over the calvesof the legs the skin was roughened and desquama-ting. The legs and hands could be moved slightlywithout the patient being roused, but on making moreextended movements she complained of pain. The left footwas dropped and the skin was thickened ; on the right footkeratosis was well marked, especially over the heel. The

patellar reflex was absent on both sides. The tongue wasred and moist, the pupils reacted readily to light, the eyeswere somewhat watery, but there was no nasal discharge.The heart sounds were regular but feeble, the first sound washardly to be detected. The pulse was 100 per minute andexceedingly feeble. The respirations were 24 per minute;there was slight movement of the diaphragm. The chestmoved as a whole without much lateral expansion. The

temperature was normal. During the five days ending onDec. 4th the patient’s condition remained much the samethough more nourishment was taken and the comatose statewas not so well marked.Pendleton.

SYMPTOMS OF ARSENICAL POISONING PRODUCEDIN A YOUNG CHILD BY DRINKING BEER.

BY JOHN BROWN, M.D. VICT., D.P.H.,MEDICAL OFFICER OF HEALTH OF BACUP.

I DURING the recent epidemic of peripheral neuritis, nowproved to have arisen from the drinking of arsenicated beer,I have seen no reference to any cases observed in very youngchildren. Such must be of very rare occurrence, as it is tobe hoped that parents do not generally allow young children,to drink beer. Moreover, if a case occurred in a child itwould most probably not be easily detected, as it is a condi-tion one would hardly expect in a young child. On Nov. 27tb,,however, whilst attending a patient affected with peripheralneuritis my suspicions were aroused to the case which I nowrecord, and I was led to suspect that the child was sufferingfrom arsenical beer poisoning by the fact that the father hadperipheral neuritis. Dr. Kelynack, to whom, with Mr.

Kirkby, is due the credit of being the first to announce tothe profession the true source of the arsenic, very kindlycame to Bacup to see the patient with me. He went overthe case very thoroughly and expressed his opinion that itwas undoubtedly a distinct but mild case of peripheralneuritis due to arsenical beer. The case being unique Ihave made a few notes briefly recording the more importantfeatures.The patient was a bonny-looking little girl, aged two years.

She had been unwell for some days, suffering from pains i&bgr;’