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40 JANUARY, 1929,

pot roast and a muslin nightshirt will ac

complish the same lifesaving functions.

Why should the people who cannot or

will not pay for the most expert and valuable professional services feel that ~ h e y have a right to demand them, "without

money and without price," direct from the

overworked doctor, when something less

expensive would, in most instances, meet

their needs equally well and can, as a rule,

be obtained thru the same channels as other

charity service.

A M E R ~ C A N MEDIClNE

Oh, there is plenty of nutritious food for

thought in this question of whether we will

!cow-tow to a string of supercilious "pa.

trons" who condescendingly slip us a"gratuity" or "honorarium," now and then,

out of the goodness of their hearts; or stand

up like honest, square-dealing b u s i ~ e s s men

and prepare to sell our "customers" good

"goods," at fair prices, and frankly discuss

and demand our pay for them, promptly

and in full.

14th and Sheridan Road.

Chronic Poisoning by an Irritant Contained in Cooking

Utensils and Tap WaterBY

LElO SPIRA, M.D.,· M.RiC.S. (Elng.), I.R.C.P. (Lon.), L.M.S.S.A. (Lon.)

London, Eng.

In a previous article entitled "Some Skin

Manifestations and Their Relation to the

Disturbance of the Gastrointestinal Tract"

(AMERICAN MEDICINE, November, 1928)

it was shown that such dermatoses as

cheiropompholyx, dysidrosis, dhqbie itch,

dermatitis herpetiformis, baker's itch, etc.,

are conditions which have a close relation

ship with disturbances of the alimentarytract. The gastrointestinaL symptoms' are

the primary, the skin affections the second

ary manifestations o t poisoning by an irri

tant which finds its way ~ n t o the body by

the tnouth it), the fi17st irIstance. Treatment

,of the gastrointestinal tract by an effective

~ b s o r b e n t (e.g.) charcoal), followed by an

aperient and at the smile time cutting off

the source of poison results invariably in

the disappearance 6f all the s y ~ p ~ o m s , in

dudingthe derrnatoses. It was klso shown

that the irritant was· contained', in cooking

utensils and' tap 'water and the conclusion

was; therefore, drawn that if must be a:

metallic constituent of the alloy of which

the cheap cooking utensils and water pipes

were made. This conclusion was strength

ened by the fact that lead was found in the

excreta of many, and tin in those of a few

of the patients suffering from the symptom

complex. No suggestion was made that all

the symptoms could be attributed to the

action of lead, there being no evidence thatthis metal ever produces any changes in the

skin. It may, however, be reasonably sug

gested that constipation, which is the out

standing symptom, so prevqlent among the

English population is caused by it. Stress

was' also laid 011 the fact that in producing

the symptom complex another chemical

factor besides lead plays an important part.

This factor in its action is closely similar

to arsenic and belongs probably to the

arsenic group of metals. Arsenic itself was

looked for but not found in .some of the

cases' which were under discussion. There

is In'the whole. complex one symptom only

, II

tl



AMERICAN MEorcrNE .oRIGINAL ARTICLES JANUARY, 1929 41

which makes an exception to the recognized

disturbances produced by arsenic, i.e.) con

:stipation. In this respect the action of the

substance similar to arsenic might be com-

lllicated by that of lead, or else it may be

that the action of the irritant contained in

tap water is specific and produces symp

toms common to both lead and arsenic.

In the previous article only a few out

standing symptoms affecting the gastroin

testinal tract were Inentioned and it was

shown that they improved rapidly with

charcoal andan

aperient.It

is proposedfirst to discuss all the symptoms as they

have been observed to occur in patients in

this country during the last six years. They

affect the popUlation in much graver degree

than on the Continent. In fact it has been

observed that those patients who left Eng

land temporarily to live abroad improved in

health rapidly even without any medical at

tention and on the other hand people withprevious perfect health ,who came to live in

London complained of bad health a few

months or even weeks after their arrival in

this country.

The first obvious change presented on ex

amination concerns the condition of the

l11outh. The tongue loses the natural aspect

of a flesh-colored moist smooth surface

with the papillre foliatre only slightly ele

vated. 'There appears a thick white or dirty

grey fur, and the papillre foliatre become

vividly red and enlarged. The patients at

tribute this condition of the tongue at first

to a slight attack of indigestion caused some

time previously by some article of food.

The changed appearance of the tongue per

sists and different methods 'of treatment,

dietetic as well as mechanical, fail to re

move the fur. The only method which

temporarily restores the normal aspect ap

pears to be scraping the surface of the

tongue with a soft tooth brush dipped in

bicarbonate of soda. Its action seems to

be rather chemically neutralizing than me

chanical. Scraping the tongue with a denti

frice contatntng magnesium carbonate

makes the fur appear more pronounced.

Later on, in much advanced cases, deep

fissures appear on the surface and constitute

the condition of superficial glossitis. The

tongue becomes indented by the teeth, raw

and excoriated.

In acute exacerbations the whole mucous

membrane of the mouth is involved and

presents the complete picture of stomatitis.

Herpetic ulcers develop and the gums ap

pear red and swollen with pus collecting

under them and thus a condition of severe

gingivitis closely similar to, i f not identical

with, alveolar pyorrhea is established.

In the meantime the initial gastroin

testinal symptoms, first overlooked or

attributed to some acute attack of indiges

tion or "gastric flu," are progressingsteadily towards a chronic c o n d i t i ~ n in spite

of careful dieting. Tqe appetite is consid

erably impaired or entirely lost and there is

retching during or after meals, with, in

some cases, a distressing hiccough. Attacks

of nausea set in ftnd in more advanced

stages also vomiting of every kind of food

soon after taking it. Severe flatulence is

invariably present combined with co1,ickypain and it assumes sometimes such propor

tions as to suggest the possibility of an

"acute abdomen." Constipation makes the

patient a victim to e v e r - i n c r e a s i ~ g doses of

an aperient. All these symptoms persist in

spite of a most carefully composed diet.

A most illustrative Case of this kind is

the following: A middle-aged woman

complained of the typical symptom complex

in a rather serious degree. The condition

of the patient became steadily worse in

spite of treatment directed against different

symptoms dominating the picture in a man-



42 JANUARY, 1929 ORIGINAL "oA.RTICLES AMERICAN MEDICINE

ner varying in intensity at different times

and she was recommended to have a few

teeth extracted with a view to checking the

absorption of toxins ascribed to the severe

pyorrhea and general stomatitis. Her faceassumed a distinctly mask-like expression

and she complained of" having lost all sensa

tion in the nose and mouth. The orbicu

laris oris muscle was paralyzed and the lips

could hardly be separated voluntarily. In

spite of extraction of some teeth the gen

eral condition of the patient, as well as that

'Of the mouth, got worse and energetic treat

ment on the lines indicated against the systemic poisoning, i. e.) charcoal, aperient and

cutting off the source of poison was com-

menced. This resulted in the most striking

disappearance of all the symptoms includ

ing the pyorrhea and muscular paralysis

within a fortnight.

Pyorrhea then appears to be, quite in ac-

cordance with the theory of many writers,only one of the manifestations of a systemic

poisoning originating in the gastrointestinal

tract and the infection caused by spirochete

and other organisms found sometimes in

the pus under the gums is of a secondary

nature. Only in this way can the fact be

explained that the appearance of this affec

tion among patients on the Continent within

relatively recent times seems to coincidewith the introduction of cheap aluminum

utensils into the households, whereas the

poison contained in these and in tap water

causes the teeth of the English population

t'O be proverbially bad. A patient with

previous perfect health while living on the

Continent, suffered from gastrointestinal

symptoms, rashes and pyorrhea within astay of only six months in London. Cases

are known in which death was attributed to

t'Oxic absorption from decayed teeth and

pyorrhea.

Generalized pruritus, often more serious

locally in many cases in such parts of the

body as the perianal region, scrotum, VUlva

and under the breasts, bouts of urticaria

and herpetiform eruptions appear aftermeals and are obviously of gastrointestinal

origin.

The condition is frequently accompanied

by raised temperature quite in accordance

with the well-known fact that poisoning by

a metal of the arsenic group produces a

febrile gastroenteritis.

Further investigations might show

whether some of the organic lesions of thealimentary tract can be produced by the

irritant in question. It is a well-established

fact that in the etiology of diver.ticulitis for

example, to which much attention has been

drawn of late, apart from mechanical and

bacterial causes, a chronic poisoning by a

chemical substance (e.g., merc1:1ry) appears

to be an important factor. I t is certainly a

striking feature that diverticultis seems to

be 011 the increase.

There is clinical evidence to show that

the poison contained in cheap cooking u t e n ~ sils and tap water is readily absorbed from

the gastrointestinal tract into the .general

circulation. Pruritus and the various

dermatoses caused in this way were d e ~

scribed fully in the previous article. Theabsorption of the irritant also gives rise to

catarrh of mucous membranes producing

conjunctivitis, frequent attacks of "C0l111n'On

cold" with pharyngitis, bouts of frequent

vehement sneezing and intense itching in

the nose. It was observed in many cases

that administration of charcoal for relief

of the gastrointestinal symptoms improved

at the same time th'Ose of the "C0l1ll110n

cold."

Apart from the cutaneous lesions de

scribed in the previous article keratosis of

the.palmsand soles and so-called "chil-



AMERICAN MEDICINE ORIGINAL ARTICLES JANUARY, 1929 43

blains" on the fingers and "soft corns" be

tween the toes are met. with quite frequently.

From the fact that in several cases death

was attributed to a chronic disease of the

skin, e.g., baker's itch, it must be con

cluded that such dermatoses are only the

external manifestation of a systemic dis

ease of a most serious nature. The finger

nails become brittle, lose their luster and

appear opaque while longitudinal striation

in various degrees is usually present. The

brittleness and striation of the finger nails

disappear during the period in which thepatients adhere strictly to the prescribed

regime but recur when this is omitted. The

hair frequently falls out in these cases.

It is evident that the irritant being ab

sorbed into the general circulation must

necessarily do considerable damage to the

kidneys. Albuminuria with the presence of

red blood cells in the urine is quite a com

mon occmrence in the symptom complex.I t was shown that besides lead present in

several cases the existence of another irri

tant plays the more important part in pro

ducing symptoms. It is, therefore, not sur

prising to find low blood-pressure much

more often than high blood-pressure in

these cases and this is an expression of

myocardial degeneration resulting from

prolonged action of this other irritant. A

systolic blood-pressure of between 80 and

110 m111. Hg. is in my experience a very

common occurrence in this country among

middle-aged and even older patients.

Giddiness and excessive perspiration

were observed in many cases and anemia is

a regular occurrence.

Such is the picture of poisoning after ithas lasted for years. Very frequently the

patients give a history of having suffered

from stomach trouble since childhood,

"cramps" and constipation being the chief

complaint which they can remember.

Since the poison has been found to be

contained in tap water, it would be reason

ably expected that every person living in

London would be affected and probably

even in the whole country as the water

supply is nearly everywhere uniform and

conveyed by the same means. As a matter

of fact it was sho:wn that a very large pro

portion of the popUlation in this country is

suffering from gastrointestinal symptoms;

the remainder who apparently do not com-

plain of any obvious disease may be com

pared to those "arsenic eaters" who havinggot used to the poison taken in minute doses

since childhood are not affected e:ven by big

doses accumulated in the body.

One case observed in this country appears

to be of considerable interest. A woman,

aged 26, who had always been in perfect

health while living on the Continent and

for a few years in ~ o n d o n , had two normal

confinements but began to suffer eight daysbefore termination of her third pregnancy

from a "cold" with sneezing cough and

headache. Later her only complaint was

intense headache with a normal tempera

ture. By the next day she began to be

comatose with severe acetonnria, a small

amount of albumen in urine, a fair number

of hyaline and granular casts with a few

blood fells and some reducing substance

which was not glucose. Toxemia of preg

nancy was diagnosed and Cresarean section

performed. The patient died the next day

from paralysis of respiratory center, the

temperature rising to about 105 0 before

death. Subsequent laboratory investiga

tions of a preserved sample of her urine re

vealed the presence of lead but 110 arsenic.

The child born by Cresarean section

showed two days after birth twitching of

the right wrist and round the eyes and

mouth. The temperature was 103.6°.

Meconium was hard and urine contained



44 .T,\NUARY, 1929 ORIGINAL ARTICLES AMERICAN MEDICIl-lll

traces of albumen and minute but definite

trace of lead. On the fourth day a rash

appeared first on the forehead consisting

partly of papules but mostly of vesicleswhich spread not very markedly over trunk

and on to the sides of the fingers. Peeling

also commenced. Slight rectal hemorrhage

occurred. Treatment c o ~ s i s t e d of the ad

ministration of Magn. sulph. and the child

recovered after a few weeks sufficiently well

to be taken abroad where it has enjoyed

perfect health for the last three years.

the irritant contained in water is not of

mineral rather than metallic nature. That

this disease is caused by water becomes evi-

dent when the "enema rash" is kept inmind, an exanthem produced by the appli

cation of a simple enema of tap water with

out the addition of any irritating substance.

It appears within 24 hours from the appli

cation of the enema first on the legs and

arms spreading rapidly all over the body as

a rash which causes severe pruritus and is

of a pink color not unlike that of measles.

It will be well to examine now the question how far animals are affected by the

irritant. While thoro investigation must

be left to veterinary surgeons, a disease

~ a y be mentioned which affects dogs and

roani fests itself in formation of abscesses

between the toes. It should also be remem

bered that dogs, including those which are

kept clean, are frequevtly found to lick

their paws and other parts apparently be

·cause they itch. This leads one strongly to

"Suppose that dogs too suffer from this

symptom identical with dhobie itch, etc., in

human beings as one of the several mani

festations of the poisoning. .

To what degree cattle are afflicted with

alimentary trouble was revealed by statistics

'showing that 75 per cent. of the total veteri

nary bills of· farmers in Bedfordsh,ire are

attributable to indigestion of cows. j t was

oObserved that the condition of patients suf

fering from the different· dermatoses under

·discussion and gastrointestinal symptoms

were aggravated among others by consump

tion of meat, especially the fat parts of it.

This is apparently the cause of the derma

toses being sometimes attributed to con

'sumption of bacon.

Should further investigations in the

direction indicated show that the affections

of both human beings and animals a.re iden

tical then the question will arise whether

The symptom complex does not result

from the taking in of the poison by the

mouth for a 'period extending only over

days or weeks. It runs a chronic course

from the beginning, only minute traces of

the poison being taken daily, not sufficient

to' produce an acute intoxication. After a

sufficiently long time the cumulative action

of the irritant produces the well-established

chronic condition with acute exacerbations

of the poisoning, the outcome of which de-

pends on the rapidity and energy applied to

the elimination of the poison. The appear

ance of the different symptoms is then

merely a question of degree and is regu

lated by intake of, and elimination of the

poison from, the body.

The opinion has been frequently expressedthat the dertX!atoses and especially the

pruritis get more pronounced at night be-

cause of the warmth produced by the

blankets in bed. It certainly has often

been observed that besides pruritus several

of the other syinptoms show in a more

marked degree at night, e.g.} flatulence,

colicky pain, twitching of the legs, etc., and

this fact must be rather attributed to the

main meal being taken in .the evening, which

is the direct cause of these symptoms.

Whereas dhobie itch is at its height in the

late night hours the condition of the eczema

on the hands (cheiropompholyx) appears



AMERICAN MEDICINE ORIGINAL ARTICLES JANUARY, 1929

fully developed early in the morning, being

in direct relation to the main meal taken

the previous evening.

It is a known fact that the urine of patients suffering from chronic arsenical

. . , . Tl .pOlsonlllg may contam sugar. . le lmpor-

tance of the regularity with which a slight

reduction of Fehling's solution occurs in

patients suffering from the symptom com

plex is obvious. It led in several cases to a

hasty cliagnosis of diabetes with which it

certainly has some common features. Thereduction, however, disappears with treat

ment directed against the poisoning but is

not influenced by regulating the carbohy

drate metabolism. In the investigations

care was taken to exclude those who were

suffering from true diabetes.

The pathologic condition with the several

symptoms as described in this and the previ-0us article was observed on patients in daily

practice. Several important examinations,

physiologic and chemical, could obviously

in these circumstances not be performed.

Whereas it is belie:ved that the description

of the symptom complex is complete from a

clinical point of view, it remains to find out

the exact nature of the irritant in questioncontained in tap water and cheap aluminulU

utensils. It is evident that this can only be

ascertained by close cooperation of the

clinician and toxicologist.

Pasteur and His Discoveries

BY

CHARLES O'GRADY, B.Sc., M.D.

Cbarleston, W. Va.

Louis Pasteur was bom at Dole, Decem

ber 27. 1822. He was the son of Jean

Joseph Pasteur and Jeanne ROCl4i, and was

the third child born to them. Pasteur's

father had been a soldier under the Emperor

Napoleon, and served three years in the

Third Regiment and was finally promoted

to Sergeant Major and made a Knight of

the Legion of Honor,

A fter his discharge from the army came,

on the return of the Royalists to power, he

settled down to follow his former trade,

which was that of tanner. In a short time

he moved his family to the town of Arbois,

In this town was where Louis Pasteur grew

to manhood, and where he received his first

schooling. He was sent to the primary

school attached to Arbois College, and later,

when attending the regular classes in col

lege, was known as a good, average pupil.

He was able to take several prizes without

much difficulty.

He had one friend in Arbois College,

Prof. Romanet, who had a decisive influ

ence on the mind and heart of Pasteur.

Remanet was first to, discover the hidden

spark in his pupil. He saw that he worked

hard and carefully-so carefully that he

was considered slow, and tMt he never

made a statement unless sure of it, altho

he had a vivid imagination.

This care and caution in Pasteur was a

characteristic. of him thrtt liie, and was thereason of his friend's belief that he would

succeed at anything he tried. Prof. Ronianet

inspired him with the idea of entering the

Ecole Normale in Paris. Pasteur's first

trip to Paris, when he was fifteen, was not

to last long as he had to return home after

two months from homesickness.

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