Introduction
Including C. metallicum (precipitated from solution of sulphate); C. aceticum, Cu (C2h3O2)2. H2O, verdigris; and C. sulphuricum, CuSO4 5H2O, blue vitriol.
Provings.
1. HAHNEMANN, Fragm. de Viribus. Contains 29 symptoms obtained by self from sulphate, and 38 from authors mainly from acetate.
2. IBID., Chronic Diseases, 2nd ed., part iii of original, vol. of translation. Contains also symptoms from a pathogenesis of acetate published in Archiv, iii, and rom patients taking triturated metal; while 154 of the total 397 are from authors, recording effects of various salts.
Poisonings
1. Five children ate of confectionery in which a considerable amount of copper was detected. The following symptoms appeared: – Unquenchable thirst, headache and giddiness, nausea, dryness of mouth, frequent vomiting of a fluid partly yellow-brown, partly blackish-green, severe tormina at region of navel, suppression of urine, slight tension of abdomen, which was tender on pressure, obstinate costiveness with constant tenesmus, pain in mall of back, cold extremities, cold sweat. After vomiting had somewhat subsided nervous symptoms were superadded, or which the chief were, – very severe headache, slight delirium, tearing pain in upper and convulsive movement in lower extremities (particularly calves), great exhaustion and somnolence (in 3 approaching to coma); countenance at parts red, at parts very pale. Pulse in 4 was very small, contracted, and slow; in 1, a plethoric boy, it was hard, full, and quick, with red face and dry skin. One had 6 attacks of diarrhoea, another 1 attack of vomiting of blood and mucus. All recovered, but 3 weeks later one had jaundice, and another a tertian intermittent, with periodic diarrhoea. (BEER, Oest. Med. Watch, 1842)
2. A girl, aet.24, swallowed 2 oz. of verdigris. After severe vomiting, colic, and convulsions, she died 60 hours afterwards. P. M. showed yellow colour of skin, body stiff, mouth firmly closed, eyes half shut, nails blue. In abdomen omentum inflamed, bowels coloured green, distended with air, in some places gangrenous; stomach, especially towards pylorus, green, and much inflamed, gangrenous in one spot near pylorus size of half a crown, cartilaginous contracted. Intestines filled with green excrement, here and there inflamed and gangrenous; this extended to rectum; liver in its upper thin border slightly inflamed. In thoracic cavity, diaphragm near oesophagus inflamed; lungs in their upper part posteriorly inflamed, full of blood; heart and large vessels full of clotted blood. (PYL, Sammu. v. Aufs. a d. States – arzk, viii; from Wibmer.)
3. A soldier swallowed at 4 p. m., 1 1/2 oz. verdure in 4 oz. water. Soon violent tearing pain in scrob. cordis. Brought into hospital he was delirious, had weakness and convulsions, limbs and body stiff, jaws closed. After eau sucree vomited stuff mingled with verdigris, thereafter the bad symptoms disappeared; after 3 hours complained of dysphagia, thirst, and pain in abdomen. Next day fever distended abdomen, constipation 2nd day, belly still distended, headache, heat, hard pulse, and dysphagia. 3rd days, sweat, passed urine and faeces, and was then well. (M. DUVAL, Diss. sur lass Toxicol., 1806; from Ibid.)
4. A man, aet. 44, swallowed at midnight 4 drachm verdigris in water. After 1/4 hour violent pain in belly, copious vomiting and diarrhoea lasting till 5 a. m. Brought into hospital he got gum, milk, and clysters. After 3 hours expression sad, eyes deep set, tongue moist, mouth doughy, anorexia, hawking, coppery eructations violent thirst, small regular pulse, 80. At 2:30 p. m. vomited green mass, at 4 p. m. jaundice. All night colic and vomiting, 3 stools, followed by relief an sleep. Next day skin very yellow, countenance calm, tongue, rely, mouth doughy, taste coppery; abdomen retracted, little sensitive to pressure, pulse regular, stronger, temperature normal, head heavy, slight deafness. He got Vichy water and whey and emollient clyster; during day 4 grayish stools. 3rd day, same symptoms, general malaise, intense thirst, turbid, dark red urine, with yellow sediment. 4th day, all symptoms relieved, appetite returned, only genial weakness remained. Next today jaundice gone, and he recovered. (ORFILA, Toxicology, sub voce.)
5. A soldier, aet.29, swallowed a quantity of paint containing verdigris, lay down and fell asleep, soon woke with violent pains in belly. He lay on his back with head drawn back, very restless; cried out often, but could not speak in consequence of trismus and spasm of throat; abdomen distended, painful to touch; stomach occasionally contracted; pulse small, contracted, but regular, expression anxious. Recovered after mucilaginous drinks (R. PARISE, Gaz. de Sante, 1820.)
6. A man, aet. 30, swallowed 1/4 oz. verdigris. He vomited green stuff. Complained of violent bellyache, frequent urging to stool, stomach very sensitive to touch, violent thirst. Pulse small, quick, contracted, respiration accelerated, face expressed much pain. Then there came on violent cramp in calves, both big toes were drawn tetanically towards sole with the most violent pains. He got the whites of 10 eggs and warm water. This caused renewed vomiting. In 1 hour all the symptoms had declined; there remained only great exhaustion and tendency to cramp in toes. After a restless night he was sufficiently recovered to be able to walk 6 miles. (WITTCKE, Med. Zeit. v. Ver. f. Heilk. in Preussen, vii Jahrg., No. 25, 129. 1838).
7. A man, aet. 54, took at 1 a. m. 3 to 4 gr. verdigris in coffee. After 1 hour dull pain in umbilical region, followed by nausea and vomiting of green stuff. One hour later came to hospital. Very violent pain in umbilical region, not affected by pressure, tongue green, pulse contracted, respiration accelerated. From 11 a. m., till 2 p. m., voluntary, green and fetid, liquid stools. 2nd day., free from pain, only quick pulse and red cheeks. 3rd day, bruised pain in limbs and constipation, which went off in 3 day. (RENAULDIN, Four. univ. des sc. med., xvii, part i, 118, 1820).
8. A lady, aet.67, her daughter, aet.39, a maidservant, aet 22, ate a fricassee of fowls that had been cooked in a badly- tinned copper pan with water boiled in a copper pot. E. and night, mother and daughter had violent retching, contraction and dryness of mouth, thirst, violent pains in epigastrium, and colic followed by several watery whitish stools. Next morning these symptoms continued, and, in the case of the daughter, became so bad that she had continued anxiety, general convulsions, painful and hard swelling of abdominal parietes, and repeated faintings. The mother had coppery eructations, violent colic with urging to stool, and liquid greenish stools. – February 2nd, evening, mother had much heat and dryness of mouth and intestines, metallic styptic taste, painful feeling in epigastrium, frequent colics and repeated greenish direct stools painful distension of abdomen, anxiety, general prostration, palpitation of heart, weak and irregular pulse. The maidservant a the same symptoms, but stronger pulse, more violent colics and more frequent diarrhoea of the same character. The daughter suffered in the same way; she had coppery eructations, intolerable pain in epigastrium and abdomen without diarrhoea, bad headache, faintings, cold sweat and a contracted, small, irregular pulse. They all recovered by taking walnutwood charcoal. (BERTRAND, Rec. period de a Soc. de Med., lii, pt. 4, 363. 1815.)
9. A large party (50) became ill after taking sausages fried in lard that had acquired a green color from having been kept for 2 days in a copper vessel. Thirty-one of these cases were observed. Traces of copper were found in their urine. Three of them were taken ill in the night with extremely violent colicky, cutting pains, which caused constriction of abdomen, severe headache, cold skin; soon afterwards violent vomiting of green, bilious masses and from 10 to 20 loose stools. Next day weakness, prostration, 3 to 5 diarrhoeic stools; the following day they were well. The remaining 28 were attacked 2,3, or 4 day later. Those first affected showed chiefly symptoms of the digestive organs; those later affected had more symptoms of the nervous system. In the former the symptoms commenced with colicky pains across abdomen, not much aggravated by pressure; many had great sensitiveness of epigastrium and a constant burning pain, or feeling of internal heat, nausea, in some repeated vomiting of yellowish-green mucus; most had constipation; tongue in some red, in others moist with white or yellow fur, great thirst, no appetite, severe pain in frontal region, with pale, collapsed features; skin warm and dry; pulse moderately quick, or normal, soft. After 1 to 2 day. – genially after taking medicine- diarrhoea with remission in of the colic, the abdomen became lax, the vomiting ceased, and the nervous symptoms appeared. Those later attacked were in the first days quite well, and then they gradually complained of increasing weakness and prostration in limbs, with vertigo, heaviness and pain in head, anorexia, constipation in limbs, with vertigo, heaviness and pain in head, anorexia, constipation; occasional transient slight drawing pains in abdomen, collapsed features, staggering. In this period the symptoms assumed a typhoid character; great confusion of head, such intense vertigo they could not sit up in bed, sometimes headache, restless sleep disturbed by dreams, sometimes slight delirium or constant stupor, in some increased to a completely comatose state; in others complete sleeplessness, pale face, with expression of great prostration or stupidity, eyes deep set and dull, pupils dilated, feeling of extreme prostration and weakness, in some amounting to fainting; tongue in the milder cases moist and pale, or only red at borders, in most red, dry, rough, pupils dilated, thirst great no appetite, even loathing of food; abdomen soft, painless, only a few slight colicky pain; stool-generally after medicine-diarrhoeic, skin warm, often covered with profuse sweat, pulse slightly accelerated, small and weak, urine turbid and jumentous. These symptoms lasted from 6 to 10 days., and went off gradually. The last symptoms to leave were the vertigo and confusion, the weakness continued still longer. One case terminated fatally; this was a girl, aet. 4. On the 3rd evening after the dinner she complained of headache, and looked weak and dejected. That night and the next she had constant vomiting, first of what she had eaten, then of a greenish-yellow slimy fluid. Next day she was extremely weak and exhausted, face pale and fallen in, skin soft and cool, pulse small and weak but not quick, tongue moist, with white fur and red borders, abdomen soft and painless, constipation. Very frequent vomiting generally after drinking anything. The 6th day same state, with still greater exhaustion, pulse scarcely perceptible, cold clammy sweat, petechiae on skin, especially on chest and arms brown furred tongue, abdomen tympanitic. On this and previous day frequent epistaxis; intellect not disturbed. Died in evening P. M., – Cerebral membranes normal, cerebral substance somewhat drier and firmer than usual; lungs healthy, a bronchial gland swollen and tuberculous. Heart normal, in both ventricles soft coagula. Stomach empty, its m. m. very red in patches; intestines pale, the solitary and Peyer’s gland rather swollen, the mesenteric glands swollen. (LANGENBER Deutsche Klinik, No.39,418,1851.)
10. A lady and her 4 daughter partook of soup cooked in a copper vessel. After 2 hours all five were attacked with violent and horrible pains in stomach, followed by violent convulsions affecting chiefly the abdomen and extremities. They then screamed
loudly, like howling or the croaking of fronts. They raised themselves up in bed, and their movement should not be restrained by strong attendants. Their reason was quite deranged, they appeared frightened and endeavored to escape, their eyes sparkled and seemed to be coming out of their head. They had a wild look. The attacks were so frequent as to be almost continuous. When one was attacked, as soon as the others heard her screams they became furious and were attacked in the same way. Th mother and youngest daughter recovered nearly completely, but their abdomen remained painful, hard, and tense, their stomach remained weak, and they had constant pains between the shoulders, in elbows, hough, etc. with relaxed state of all limbs. Their look is distraught, but their intellect and speech normal. But they are still subject to fits, which come on quite unexpectedly. (COSNIER, four. de Med., iii, part 4,263. 1755.)
11. A lady partook of some food seasoned with pepper which had been pulverized in a mortar which had been used for pounding blue vitriol and not properly cleansed. She complained of colic and anxiety, woke at midnight feeling a if stiff all over, hands, cold, face swollen, red, with large drops of perspiration on it, eyes straining and dim, tongue swollen, stiff, and as if paralysed, pulse full and hard, breathing short and laboured. An emetic was administered. After vomiting several times she complained of dreadful burning and cutting in abdomen, precordial anxiety and throbbing and roaring in head; extreme want of power of collecting thoughts, she spoke much nonsense. She got milk to drink; At 4 a. m., fell asleep and woke somewhat relieved and could think better, but next day could not hold up her head nor stand on her feet, and felt burning, cutting pains in bowels. It was the 3rd on before she old go about alone. (WILLICH, Baldinger’s neues Mag. f. Aerzte, vii, part 2, 118.)
12. May 22nd, at 5 p. m., I was called in haste to see the family of Mr.B–. Finding 5 or 6 patients ill, with vomiting and other violent symptoms, I at once inquired what articles had been eaten at dinner. at once inquired what articles had been eaten at dinner. Was informed that nothing more than usual was taken except a dessert of cream-puffs, which had been purchased of a confectioner that day. It was afterwards fully proven, as then suspected, that these cream – puffs had been cooked in proven, as then suspected, that these cream – puffs had been cooked in a copper kettle not thoroughly cleansed. In all there were over 30 persons affected by eating them; all violently, in the same manner, and with no perceptible difference in those who had eaten but a part of one. Mr. B-’ family dined at 2 p. m. The poison manifested itself in the younger children as early as 3:30, but by 6 p. m. all were suffering violently, except 2 young ladies who had eaten the dessert, and who escaped with only a taste of copper in the mouth and some pain in the lips. The symptoms of the other 12 were as follows: – Violent vomiting of greenish water, coming on suddenly, and attended by copious greenish diarrhoea, and violent pain in bowels; feeling as if intestines were drawn into knots, in most cases continuous, in some paroxysmal, with inclination to draw knees up, and press hard upon bowels. With 3 of them this vomiting and diarrhoea became bloody, excessively bloody in one instance, though these 3 had but little pain in bowels, and much more cramping in limbs. In 2 cases (children) stools were involuntary during collapse; one of them bloody, the other not. The majority of them had involuntary passage of urine. The vomiting was attended in each case by burning nausea arising from stomach to throat. Even the children complained of this. After the above symptoms had continued for from 30 to 60 morning, they sank into a semi- unconscious state, voice very faint, eyes half open, fixed, glassy, not sensitive to light, pulse very weak, in some quickened, in others slow, difficult to arouse, and when aroused, complaining of cold and of violent pain in the abdomen, the older being aroused by nausea to vomit, the younger vomiting without arousing, frequent singultus, often loud enough to be heard all over the house, the patients being unconscious. In one case the vomiting was followed immediately by a succession of sharp cramping spasms in the chest, causing the young lady to scream out. During this collapse the patients were covered with a cold clammy sweat especially on the forehead, but would lie quietly, only moaning-cheeks and eyes sunken, bluish hue of face, and lower jaw hanging down. This stage lasted from 1 to 3 hours, and was followed by reaction; the patients still complaining, however, of occasional severe pain in bowels, and vomiting. Now thirst appeared, and a I permitted ice,they ate it continually without any bad effects, though the stomach ejected everything else. It did not allay the vomiting, however. As the pulse rose and they became warm, violent cramping, paroxysmal, in the calves appeared – in two cases drawing one limb sideways and backwards, but always relieved by rubbing. They opened their eyes, the body became warm, and they rested quietly, but not asleep. Throughout the whole attack, with the exception of the lady who had the spans of the chest, there was not the least restless-they seeming too weak to move a finger. From this time the danger seemed to have passed, though some of th symptoms remained for several day, as, for example, taste of copper; occasional cramp in bowels; in one case, vomiting of what had been eaten for breakfast, though at no other time; weakness and pain (aching) in limbs; no movement of bowels (in any) for 6 or 7 day; very great desire for acids, they want nothing else; and, of course, great exhaustion. There was one characteristic symptom experienced by every one, from commencement of attack to time of collapse, namely, severe pressing pain from temples in a straight line to angles of lower jaw, as if a stick or splint were on each side, crushing face inwards. Equally marked was the burning and nausea arising from stomach to throat. One adult lady had, when first attacked, an uncontrollable desire for camphor, to which she had always heretofore, been peculiarly average. The collapse in this same lady lasted for several hours, and she say that the only thing she remembers during that time is an imaginary slight of her physician. The severe symptoms seem to have all passed off in about 10 day, leaving the patients in their usual health again. (C. W.BREYFOGLE, M. D., Med. Inv., viii, 481.)
13. Woman, aet.18, was brought into hospital January 24th, having swallowed solution of sulphate on 18th. In 5 morning she had vomited, and then took slat and water, which promoted the vomiting considerably; throat became very painful and felt burnt, and abdomen was swollen tender, and painful. She passed a good night, but next day had constant pain in region of stomach, and vomited everything, solid and liquid; there was also some diarrhoea. The vomiting diarrhoea and abdominal pain continued till day or admission, when she was suffering chiefly from exhaustion; she had some pain in abdomen, and unpleasant coppery taste in mouth, nausea without vomiting, and diarrhoea; tongue white and furred; general exsanguined state of surface; pulse 150. After treatment, she lost by 27th all pain save headache, and recovered appetite. (TODD, Lancet, 1841-2, ii, 145.)
14. Woman, aet.28, swallowed, October 20th, large dose of verdigris. Very shortly afterwards she was seized with great anxiety, vomiting, acute pains and swelling of abdomen, sensation of burning heat in throat, coldness and severe cramp in extremities, oppressed pulse, swelling of face, sparkling eyes. Had an emetic. On 21st, at 2 a. m., deglutition very painful; hardness and swelling of neck; abdomen tympanitic, and painful on least pressure; countenance heavy; face flushed, pulse oppressed. Deglutition became more painful during day; mucous membrane of mouth altered in appearance in several places; stiffness and swelling of neck notably increased; face and eyelids swollen and red, eyes prominent; abdomen flattened, but extremely sensitive, and rectum so painful that she could not bear an injection. On 22nd, tendency to coma was observed. Face was pale; lips swollen; gums ulcerated; copious discharge of viscid saliva. Neck had become softer, and man ecchymosed spots wear observed on it. Copious stool, first since poisoning; some blood which was drawn showed inflammatory coat. She had several spasmodic fits. On 23rd, a quantity of viscid glairy matter was vomited, of greenish colour and tinged with blood; she suffered also occasionally from spasmodic attacks. On 24th, epistaxis and general cramps came on and stool and urine were completely suppressed. P. M., whole body became cold, and convulsions supervened, which lasted till evening but abated on occurrence of free evacuations by stool and urine. On 25th, she was somewhat better and able to pronounce a few words. On 26th, ulcers of mouth began to heal. On 27th, she vomited some greenish, glairy matters, but from this date gradually amended, though complaining occasionally of epigastric uneasiness. (GUILLO, Journ, des Conn. Med. Chir., 1843).
15. a. August 25th, 1783, a lady, aet.17, ate 3 or 4 oz. of pickled sapphire which had become impregnated with copper. Being very thirsty soon after, she drank about 1/2 pint of vinegar. In evening she complained of pain in stomach, and perceived a rash upon hands and chest. She went to bed early, feeling indisposed, and slept little during night. Rash almost entirely disappeared before noon of 26th. She was troubled at times with shooting pains over whole body, particularly on right side, and was dejected, restless, and very thirsty. On 27th, pain and thirst continued she had longing for acids, and was much troubled with flatulence. Pulse was frequent and small; tongue covered with white fur; and she passed several day without a stool. During operation of a laxative pain removed from right side to left, and she felt a great and universal soreness. On 20th, symptoms continued without abatement. On 29th, pain in side became extremely violent; in evening, however, it was alleviated, and never afterwards returned with much severity. On 30th (morning) sickness came on; she vomited at intervals during day, a hiccup usually preceding retchings. The vomit was not offensive, consisting chiefly of the liquids swallowed. Retchings were incessant on morning of 31st.; a quantity of sapphire was thrown up; all discharges were of green colour, very offensive, and tasting of copper to patient. Hiccup was frequent, and always occasioned vomiting.
15 b. The above history was given by her medical attendant. When Dr. Percival saw her the discharges by stool and vomiting were extremely offensive, latter of dusky green colour, and acid to patient’s taste, though not perceptibly so to nostrils of bystanders. Stomach was enormously distended with wind, and exquisitely tender to touch; hiccupings almost incessant; pulse quick, tremulous, and irregular. After treatment symptoms abated, but in 24 house vomiting recurred, with great inquietude; extremities became cold; pulse weak and fluttering; countenance ghastly; and the expired early on morning of September 3rd. Body was opened same day. There was about a quart of brown, fetid liquor in stomach; internal coat was inflamed and gangrenous, particularly about cardia and pylorus; and this appearance
extended some way down duodenum. (PERCIVAL, Trans. Roy. Coll. of Phys., iii, 90)
16. Five persons partook of a pudding containing verdigris. Two women became sick in 15 morning. The most prominent symptoms were severe headache, and (subsequently) vomiting and purging. After these had in measure subsided tympanites supervened, which in one woman was very distressing, her abdomen becoming tense as a drum, but it soon subsided. Associated wit the above was coppery taste in mouth; and they were followed by very numbness of legs and arms, accompanied with great trembling, especially of hands, which incapacitated them from holding anything with safety. A girl of the was not attacked till next day, when similar symptoms came on but less severally. The nurse, an old person, was not affected till 3rd day; but her convalescence was slower than that of the others. (ARMSTRONG, Medical Times, x, 495).
17. A lady drank water from a copper kettle, in which analysis proved presence of metal. She came under treatment December 20th, 1858, suffering from slight sore-throat, total loss of appetite, restlessness, great thirst and other feverish symptoms, sickness, and considerable enlargement and hardness of right cervical glands. Had observed the swellings for some day. Treatment seemed useless and symptoms increased; she took to her bed, vomited every kind of food about 20 morning after taking it, suffered greatly with tenesmus, with scanty, dark, pulpy motions, urine scanty, skin clammy, pale, and doughy-looking. Pulse was quick and thready; abdomen slightly tender over its whole surface; mouth sore, with little blisters on mucous membrane; face swelled and pasty; expression anxious and state of exhaustion extreme. The cause of the mischief (the poisoned water) being removed, she vomited but once after; the tenesmus ceased; the swelling of the glands, which had leveled the neck with the jaw, slowly subsided, as did the soreness of mouth and other symptoms; and by beginning of February recovery was complete, though she remained weak until the middle of March, During recovery stomach remained sensitive and impatient of any but the most bland and simple milk diet; and the effects of some articles of food were curious, acids of any sort, fruit, etc. giving the tingling sensation of a galvanic current to the mouth and teeth. (AMYOT, Med. Times nd Gaz., 1859, i, 265).
18. A man, aet. 26, placed some copper coins in vinegar, and allowed them to remain there for a week. He drank the vinegar about 4 p. m. October 25th, 1828. At 7 he was found stretched
senseless on floor, and was immediately brought to the Hotel Dieu. On admission all muscles were agitated with violent convulsions, limbs remaining rigid in intervals. There was much difficulty in supporting patient. Teeth were firmly closed; breathing short; pulse hard, small, and very slow; stomach tender on pressure, which produced violent convulsions. Warm water forced down throat, and tickling pharynx and uvula with a feather, had no effect. He drank in intervals between convulsions, and in 1/4 hour came to himself in some degree, and explained cause of poisoning. White of eggs in water was given; convulsions ceased at once, but hiccup continued during part of night. In morning, pulse was large, slow, intermitting; belly contracted, hard, and very sensitive all over to slightest pressure; slight convulsions in limbs; general lowness, taciturnity, and pallor; pupils dilated; tongue soft, moist and pale. In evening, worse; extreme agitation, with colic, dyspnoea, hiccup, and a hard and contracted pulse. Urine scanty and scanty and scalding; hard stool after a third clyster. N. bad. 27th. – Much better pulse soft; no abdominal pain; urine free, an a liquid stool passed with clyster. In 10 days, digestive functions were re-established, and all bad symptoms disappeared. His moral condition, however, had not improved; he still continued taciturn, immobile, with pale countenance and dry hot skin, sleeping but little. (Lond. Med. Gaz., iv, 155)
19. A lady was in the habit of using injections from a brass syringe which proved to be coated internally with verdigris. She suffered on one occasion from vomiting and purging, attended with some griping, and colicky pains in stomach and bowels, and sense of constriction in throat. Stools were copious, watery, and dark; urine scanty; thirst urgent; pulse small and irregular; surface cold and bathed in perspiration; great prostration of strength. She suffered more or less in the same way every time she used the instrument. (Lancet, 1869, ii, 426.)
20. a. Dr. J. P. SIMON inhaled vapour of a hot aqueous solution of sulphate, and dipped hands in it. “I began, ” he writes, to feel uneasiness between shoulders, with headache, shivering and occasional pain in epigastric region. I became pale, and had vertigo with prostration of strength and dim sight; papillae of tongue became tumefied and horribly annoying. I first thought I had scalded my tongue with hot broth; but the symptoms increased, tongue became ulcerated in centre and considerably swollen on each side, and it was furred as if spermaceti ointment had been spread over it; fauces also became tumefied and inflamed, while roof of mouth was studded with spots a in measles, with swollen gums and slight ptyalism.
20 b. “I was obliged to discontinue my experiments. After a time I renewed them, though I had often had a copperish, cold, subside taste, particularly on opening my mouth to inhale fresh air, and although after having washed my hands the water would become blue from the sulphate absorbed into the system. I dissolved 2 or 3 lbs. of the sulphate in the usual way, and on the 2nd days of experiment began to feel headache and uneasiness about fauces and soft palate. There was considerable itchiness and sudden feeling as if I was going to faint. I looked in my mouth, and saw as well as felt that the symptoms were fast returning. ” (The Chemist, 1840, p. 380.)
21. Mr. B- placed 1/4 oz. of verdigris in. a pot, and two leaves of false goldleaf (copper in left) in another, poured upon each about a spoonful of nitric acid, and stirred very assiduously. Soon afterwards he felt burning pain in right ring finger; this increased every moment, and affected whole hand with burning pain and swelling, which soon subsided, but then flew into left hand, and a few morning afterwards into insides of legs, as if scalding water had been thrown on them. His stockings being immediately pulled off, there appeared a great many red spots, as large as sixpences, somewhat raised above skin, and all covered with very small blisters. In about 2 hours accident I first saw him; he was very uneasy, complaining of pain and great anxiety at pit of stomach, as if a burning hot iron were laid upon it. Pulse was regular but slower and weaker than natural; he had nausea, and complained of a very coppery taste and smell. I ordered some alkaline volatile medicine, and to drink small sack whey. He vomited once and had 4 to 5 stools, and then his stomach grew easy; but the scene soon began again with lancing pain in left eye. He was kept in a sweat, by which he found some ease at night; but whenever the sweating lessened the burning pains returned in broad flakes, changing from one part of the body to the other, with shootings, sometimes in eye, sometimes along penis. Pulse same. In several places spots similar to those of legs came out. On 3rd day, after sleeping well, pulse was better, and he continued easy till about 11 a. m., when the burning pains returned, shooting from place to place, but always superficial. Rubbing part affected gave ease; and when sweating ceased, and burnings and shootings became insufferable, I put him into a bath of hot water with some wood ashes, which gave him great relief. This p. m. he felt violent burning pain in this great toes, and sometimes in this left hand, with shootings up to the shoulder. Once he cried out in great pain that his shoulder was burst, for he felt something fly out with a sort of explosion; but I found nothing particular on examining the part. He observed when the flaky burnings began they were as if they kindled from a point, and flashed, like lightning. He was very often tormented with such pains at pit of stomach; and this evening had shooting through back with pain in belly. He complained of a strong sulphurous suffocating smell, though his breathing seemed easy, and his lungs in no way affected. In night he was seized with great pain about heart, and cried out violently that his heart was on fire; but after taking a dose of nervine medicine, and being put into the bath, he was soon easy. Pulse was not disturbed during the attack but remained slower and softer than usual. 4th day, he complained most of toes, and now and then of burning pains in forehead. 5th and 6th day, same as regard toes (left); but in evening pains in stomach returned, which lanced to left side, with dartings inwardly. 7th day, nothing particular except his feeling, with sharp pains, a spark (as he called it) to fly out of his right cheek, as on shoulder previously, but less sharply. No pain there before it, but after it a soreness lasting some day. 9th day, he began to get out of bed, but was often seized with glowing pains, suddenly, affecting different parts of body, seldom continuing an hour in one part. He continued to be troubled with these in less degree for a long time.
Patient recovered health and strength, yet after this was often subject to nervous ailments, and became sensibly affected not only by smell of paints, but even handling of some kinds of metallic inodorous bodies gave him anxiety, tremors, faintings, and many other uneasy symptoms. (MOUNSEY, Phill. Trans., i, 19).
22. C. S.-,aet.18, a copper-plate printer, was admitted July 3rd, complaining of severe colic. He stated that while sitting reading on the previous evening he was suddenly attacked with acute pain in abdomen; he felt “just as if someone had struck him violently in the belly. ” The pain, which he described as a “dead pain, increasing every now and then, ” had lasted 14 hours; it was increased by pressure,; bowels acting; felt very sick. Had peculiar sallow, almost clay-coloured complexion, and anxious expression; lips livid and eyes sunken; tongue tolerably clean, but round gums is characteristic purple line of copper poisoning. He has been a copper-plate printer for 2 years; in cleaning the plates he inhaled a good deal of greenish dust-like verdigris. He had two similar attacks before this; the 1st, in October, lasted a fortnight, the other, a month ago, lasted 3 days. 7th. – Better; no more colic, only a little pain when bowels act (from medicine); face less sallow and anxious looking; purple line well marked. 10th. – Looks still better. On 14th dismissed cured, but line on gums still distinct. (HARLEY, Lancet, 1863, ii, 129.)
23. A patient came under my care with a dark green line on edge of gums, and a similar stain along at least half of each tooth. He was a coppersmith. His general symptoms, which were of a chronic character, were vertigo, gastrodynia, flatulence, dyspnoea, frequent vomiting, some degree of wasting, and a peculiar coppery taste; tongue moist and flabby, pulse hard and full. The workmen in the factory (15 besides himself) all complained of lassitude and giddiness, and a disinclination when not at work to take exercise or to go about. Some were exceedingly thin and pallid. All had a greenish stain on their teeth, varying from a light bright green to a dark greenish brown. Their perspiration had a bluish green tinge. (CLAPTON, Med. Times and Gaz., 1868, i, 658.)
24. A man,aet.33, employed at copper-smelting works, was admitted September 7th with circumscribed pain in epigastric region, frequent vomiting (especially after food), occasional haematemesis, loss of appetite, soreness of gums (which had a slight blue line apparent), and looseness of teeth. Had been ill for 6 months, and this was 2nd attack within 15 months. Has got much thinner, looks haggard, and feels very depressed. Under treatment he gradually improved, and was discharged convalescent in a fortnight. (Two other precisely similar cases follow.) (CAMERON, Ibid., 1870, i, 581.)
25. A man, aet.27, arrived in Boston November, 1855, and engaged himself to a coppersmith. About middle of March, 1856, he first noticed deviation from his uniformly good state of health; but some time previously he had occasionally noticed peculiarly sweetish taste in mouth, and slight constriction in fauces, with sense of nausea. Symptoms of which he now complained were, peculiar sense of weight, weakness and oppression in epigastric region, disagreeable and nauseous taste in mouth, failure of appetite, constipation, ultimately becoming very obstinate, general languor and prostration. These symptoms were soon followed by cardialgia, morbid sensibility of epigastrium and hypochondria, sinking, disposition to remove some offending substance from stomach (without nausea), and epigastric palpitation. These were soon followed by neuralgic pains in various parts of body, paroxysms varying in intensity and duration, more persistent in head and hips than elsewhere; great weakness of hips and lower extremities; giddiness; numbness of different parts of arms and legs, which under certain circumstances was attended by intense pricking pains in various parts of body; peculiar sensation of right hand and forearm, consisting in sense of constriction and of great increase of size, it seeming to him at times to be larger than his whole body, and its motions not fully under the control of his will; also a difficulty in urinating, consisting in a painful inability, requiring considerable time and effort to relieve the bladder; shortness of breath; occasional paroxysms of coughing unattended with any physical signs of disease of lungs; great wakefulness; profuse night sweats; rapid emaciation; and great depression of spirits. When first seen (May 17th) he presented no striking indications of illness except some pallor and thinness of face, but he detailed the above symptoms. Tongue was coated with a light brown or cream-coloured fur, except edges and tip, which were clean and of pale red colour, whole tongue being moist. Gums were lax and spongy for about 3/16 in. from teeth through nearly whole extent; he had occasionally spit blood from mouth, especially on rising in morning. Pupils abnormally, dilated, insensible to strong light. Pulse 58 – 62, moderately full and regular, but weak. The sponge gums were so retracted from teeth as to leave a narrow bevelled surface through their whole extent, and on this was a delicate shade of red purple. (SALTER, Bost. Med. and Surg. journ., iv, 121.)
26. The watch manufacturers at Besancon, who continually handle gold and copper, are very liable to phthisis. The symptoms the men suffer form are, – paroxysms of fear, pulse frequent, skin hot, throat dry; most of them complain of pain in epigastrium, in region of kidneys, and in head; many suffer from indigestion and diarrhoea; and others have feeling of constriction and acute pain in throat. Teeth are in all such cases coloured more or less green and almost bronzed. These symptoms are especially striking in the apprentices, who are almost exclusively occupied in filling copper. In many cases the symptoms take a severe form; acute colics, fever, burning thirst, vomiting, diarrhoea or obstinate costiveness, are observed. Nutrition also is mostly impaired, muscles are badly developed, complexion haggard, look miserable.
The continual absorption of small doses of C., and its local and direct action, the frequent repetition of toxic and febrile symptoms, and the cachexia at last produced by it, are the causes of the prevalence of consumption among these men. (PERRON, Med. Times and Gaz., 1861, ii, 488.)
27. Copper produces in the worker in it a form of enteritis, of which the chief symptom is a colic with remissions. The workman bends himself double to relieve it; the belly is tender on pressure; there is headache and inclination to vomit, diarrhoea or constipation; vomit consists of bilious fluid, first stools are often green; fever is frequent, there is often lassitude. (BLANDET, Gaz. Med, 1845.)
28. J. MD -, aet.17, had been employed for 2 1/2 year in a Venetian blind manufactory to mix “Olympian green” – which is carbonate of copper – with turpentine, and to remove the paint from old blinds with sand -paper. His skin has a pale chlorotic look, and the gums round the incisors, canines, and bicuspids, especially of lower jaw, are a bright maroon colour. The gums are somewhat retracted and slightly ulcerated. There is great emaciation and weakness but no local palsy. For last 6 mos. he has only had one stool a week, and has been seized every 3 or 4 day with fits of fierce pain round navel, relieved b pressure and disappearing by stool. With the pain in loathing of food and occasional vomiting. He is distressed with a constant cough, but there is no evidence of tubercular or other disease in lungs. He suffers much from chilliness, almost amounting to ague fits, which sitting by the fire does not relieve, but it brings on weakening sweats. (MAPOTHER, Med., Press and circular, 1870, i, 465.).
29. MAISONNEUVE states that working in pure metallic copper without heat causes no bad symptoms; but in heated rooms particles of oxide and cupric salts in the air may cause disturbance. The symptoms he has observed are,- very intense dyspnoea with laryngeal and bronchial spasm; colic, which may be accompanied by vomiting or diarrhoea; pain in upper and middle abdominal region increased by pressure, sometimes limited to pit of stomach, sometimes a little lower down; occasionally some fever. The attack is genially over by the next morning, rarely extending over 2 or 3 day (Arch. de Medicine Navale, January., 1865.)
30. From chronic poisoning with C. SCHOLITZER reports complete lameness of right hand; right arms inconstant pronation, hand bent at right table to arm, thumbs drawn into palm, fingers flexed; motion of elbow remains good, but in hand, especially in joints of fingers, extension is impossible and flexion only partial; upper extremities much emaciated, right more than left right hand nothing but skin and bone. (Deutsche Klin., 1859, p. 194).
31. Some people on board the “Vestal”had been taken suddenly ill. On 6th one man was seized in an instant with dulness, stupidity, and headache; he fell down and struggled so hard that it required six men to hold him; he shortly became delirious and behaved in the most extravagant manner. On 7th several more men were seized, and on 8th to the number of 16 more. They are all at times outrageous and mad, they snap with their teeth at those who hold them and struggle very much. On fancies himself a captain and gives orders accordingly; a second calls out, “Ground ivy to sell; ” a third, “Old chairs to mend; ” one spits in your face and laugh; on is very merry an sings; his neighbor is surly and ill-natured; and another mopes in a corner, stupid and insensible. They all have their lucid intervals, and they complain of pains in the bones and of headache. Pulse during the fit is full, quick, and strong; then sweat breaks out and it becomes soft; their eyes appear red and inflamed; their looks are wild, their speech incoherent; they sleep little. None complain of gripes and few of nausea. At the first several vomited, but no immediate relief followed. The people are chiefly seized after dinner. The whole recovered in 2 or 3 days. Dr. R – attributes these attacks to the copper vessels used in cooking their food. A few months afterwards the like malady prevailed in the “Adventure” and was attended by the same odd symptoms. The copper vessels were found to be very foul, and on remedying that fault the disease stopped and about 15 who were seized with it recovered. (RAMSAY, Med. Obs. and Eng., ii, I.).
Experiments on animals.
I. Having tied the oesophagus of a healthy pigeon I injected 0.1 grm. of neutral acetate into crop, dissolved in 2 grm. of water. In few morning began violent oft-repeated retchings, and shivering all over body; soon after greenish-grey faeces passed; next straining to vomit, then more green faeces, quick respiration, growing constantly louder; violent shivering and wavering of whole body, till, in a few morning more, bird collapse; opened and shut mouth continually, with very laborious breathing; then died. P. M. – The crop, which contained some grains of tartar, had a blue fluid in it; a thin membrane of a greenish blue was easily drawn off from the under lying muscular coat; oesophagus coloured blue outside, and in glandular stomach there was a bluish-green greasy mass; intestines much reddened, vessels strongly injected, showing themselves dichotomous, on some spots red is dark lower intestines filled up with white greasy mass; kidneys distend with blood; liver brownish-red, very full of blood, as also lungs; spinal cord was affected, – at least hyperaemia of its sheath is unmistakable. A second pigeon which had 0.5 grm., exhibited similar symptoms. (KOCK, N. Z. f. h. Kl., xvii, Nos. 20, 21.)
2. Into another pigeon 1 grm. of same was injected in 15 grm. of water. Shortly commenced efforts at vomiting and convulsions, soon followed by actual vomiting. Breathing was quickened and distressed, audible; faeces as before; bird shivered, on ground, and jerked wings (apparently in convulsions); eyes were fixed, and head often quivered; 2 hours after administration, quite exhausted from want of breath, and shivering, it let its head sink and died. P. M. – Crop,
oesophagus, and stomach as in 1st case; m. m. of intestines quite eroded and soften, peeling off in bluish – green bits, especially in duodenum. Kidneys and liver hyperaemia; peritoneal coat of both greenish. Bronchial tubes look green, as well as their continuations in the lungs; inner surface of larynx much eroded, with bluish membrane sticking to walls. Blood-vessels of brain exhibited much blood, brain itself normal. Investing membrane of cord less full of blood than in others. Fluid dark red blood in heart. (Ibid.)
3. Another pigeon had 2 grm. in 18 grm. of water. After 5 morning breathing at once became difficult, so that whole body began to shiver; this grew worse and worse and bird seemed anxious to vomit, but did not succeed. Hard faeces then passed. It seemed catching at air, eyelids opened wide, with pupils fixed and motionless. The whole body shivered; convulsive twitching of muscles was perceptible, and also alternate dilatation and contraction o pupils; respiration kept getting weaker, muscles seemed quite paralysed. Pigeon fell on its side, and soon died. P. M.- Throat somewhat reddened, contained mucus; no alteration of m. m. of alimentary canal, but intestines covered internally with numerous dichotomized vessels. Kidneys, spleen, and liver full of dark blood, as also heart and lungs. Membranes of brain covered with vessels tolerably full; on cutting through brain specks of blood are seen, and sheaths of cord also contain much blood. (Ibid.)
4. a. A rabbit received subcutaneously 0.06 grm. in 6 grm. of water for 5 days, and 1 1/2 grm for 6 days more, without any symptoms. From 12th to 15th day 3 ctgrm. Animal has lost it sprightliness; it steps slowly and with difficulty, generally remaining sitting in one place, and seem to have lost appetite, while it drinks more. From 16th – 22nd day 6 ctgrm. Its pace becomes still more difficult, almost dragging hind feet; daily amount of urine diminished, and traces of copper discovered in it by testing; much thirst and sleepiness; sudden starting and shivering all over. For 2 days 12 ctgrm. daily. Extreme languor and emaciation; 2 boils; right hind foot drawn up spasmodically, left dragging behind; traces of albumen in urine, which is scanty. On 25th day 18th ctgrm Walking very wearisome; left fore foot drawn inwards and disabled; total loss of appetite; shivering all over; head always moving from before backwards; breathing very quick; faeces no loner compact and globular, but soft and long; albuminous urine. On 26th day 24 ctgrm. Animal lay prone; head sinks, but is raised now and then, only to fall back again; respiration very rapid, mechanical convulsive gasping; constant jerking and shivering of while body; eyes closed; no ruined. On 27th day I found it lying dead in same position only rather turned to right, in a semi-fluid green pus, which it had probably thrown up, whilst hind legs and belly were wet with liquid faeces.
4 b. P. M.- Muscles anaemic and thin; lungs hyperaemic in slight degree;heart full of clotted blood, with septum of left ventricle four times as thick as right; liver very large, full of blood, and very firm; gall bladder full and dark green; scalpel, in dividing liver, gave sensation as of being met with some resistance, with crackling feeling as if it were cutting through a number of slender threads. Stomach and intestines natural. Spleen small, very hyperaemic, and shaped like a leech; kidneys externally pretty large, not particularly full of blood when cut; under microscope urinary canals were filled with immense quantity of small granules, which was fattily-degenerated epithelium detached from canals. Members of cord somewhat hyperaemic, those of brain normal. (Ibid.)
5. A second rabbit was treated similarly, receiving on 20th day 24 ctgrm. Symptoms as before; want of breath now clearly indicated; thorax rises and falls so fast that it looks like a shivering of the whole body; head is raised and falls again to ground; right fore foot is stretched forwards; animal falls prone, rocks from side to side, and dies on left. amidst frequent jerkings. P. M. – Muscles as in first case; lungs in lower lobes normal, in upper externally dark red, almost brown; when cut through a little blood issued, but more froth and serous fluid; heart, in both ventricles and auricles, contained congested black blood, septum of left ventricle and auricles, contained congested black blood, septum of left ventricle notably thicker than that of right. Vessels of retina much injected. Stomach and intestines normal; liver, not particularly large or hyperaemic, showed as in first case, scalpel meeting with resistance in cutting it, with crepitation, so that organ must be considered “granulated; ” spleen somewhat larger than in first case. Membranes of cord were here also hyperaemic, and cord itself on section showed insignificant specks of blood. Kidneys somewhat large, but on section not so pale as in former case; still there was some evidence of fatty degeneration of cells in urinary canals. (Ibid.)
6. a. The general effect of C. is, as Orifla, Blake and Neebe found, especially exerted upon the muscles of the trunk and heat. Harnack obtained the following results from the introduction into the body of a double salt, the nitrate of copper oxide and of sodium, – this salt being chosen because it does not produce clotting of the blood in the vessels. In frogs subcutaneous injection of 0.0005 to 0.007 grm. was followed in a few hour by muscular paralysis preceded by trembling. Muscular irritability was entirely lost without rigor mortis setting in. In warm-blooded animals there is unsteadiness in gait, weakness, and finally complete paralysis. The pulsations of the heart and the respiratory movements become extraordinarily weak and slow, as if about to cease entirely; the pupils become dilated. Although direct muscular irritability; is destroyed, yet sensation and the functions of the central nervous system remain undiminished until death. Rabbits die after the subcutaneous injection of 0.5 grm, dogs from 0.4 grm; but when injected direct into blood, former die from 0.01 to 0.015 grm., latter from 0.025 grm. It is a curious fact, that whether the doubles salt or the albuminate were used, it was observed that even when injected directly into the (jugular) vein it was hours before the physiological effect manifested itself.
6 b. Since the direct introduction of this drug into the blood of dogs caused no vomiting, while the introduction of even small doses by the stomach did excite it (Dlitzky, Harnack), it seems probable that the emesis is the reflex result of the irritation of the nerves of the m. m. of the stomach. (NOTHNAGEL and ROSSBACH, op. cit., sub voce.)
7. Lauder Brunton and West (Barth. Hosp. Reports, 1876) have experimented to ascertain whether cupric salt cause vomiting by irritation of the stomach or of the vomitive centre in the medulla. Into the jugular vein of cats they injected a neutral albuminate (which would not cause coagulation of blood), and retching and vomiting followed. Previous section of the vagi did not prevent the retching, but it did prevent evacuation of the stomach, and after section of the vagi and the splanchnic nerves neither retching nor vomiting occurred; hence they concluded that these symptoms depend upon gastro-intestinal irritation, not upon a direct excitement of the central organs. (PHILLIPS, op. cit., sub voce.).