BY M. J. RHEES, M.D., MOUNT HOLLY, N. J.

The following instances of the formidable effects of the mineral poisons, are reported from memory; the only record made of them having been left in California, where the cases occurred. It is much to be regretted that I cannot refer to them, as it is impossible after so great a lapse of time to remember dates and the remedies used. The first was a case of Gangroenopsis. Sometime in February, 1852, a gentleman called on me and desired me to visit his child, a boy of 9 years of age. 1 received the following account of the case: The boy had always been delicate, pale and thin. About three weeks previously, he had been attacked with languor, headache, slight diarrhea and fever. An allopathic physician was called in, who pronounced the disease bilious fever. He was a western man and administered large doses of medicines. For a week or more before I was called, it was supposed that Calomel had been administered for the purpose of producing salivation. Three days before my visit, salivation commenced, with the peculiar mercurial fetor, accompanied by an intense and extensive swelling of the left cheek. This swelling was pronounced erysipelas by the physicians, (two were attending at that time,) the circumference of the swelling was painted with solution of Nitrate of Silver, and the day before I saw the patient, it was decided that he could not live three days, and that further treatment was useless.

I found him in a state of complete prostration, pulse feeble and 120, constant thirst, no appetite, diarrhea of dark green, almost black, and very offensive feces, but not very frequent; tongue and mouth covered with dark coating, teeth heavily coated with black sordes, strong mercurial fetor with copious discharge of discolored saliva. The whole of the left side of the face, but especially the cheek, was excessively tumefied. The surface of this swelling was pale, cool, puffy and glazed. I was informed that the child had been seriously afflicted with cancrum oris in former years. From all that I could learn, I presumed that the case had been one of typhoid fever, which diagnosis was subsequently confirmed by the occurrence of three well marked cases of the disease in the same family. To the best of my recollection, it was on the third day after my first visit, that a dark livid spot appeared in the middle of the cheek. This gradually extended until it involved the whole cheek, and in a few days a distinct line of demarcation was established. The stench of the gangrenous tissues together with the mercurial fetor, was extremely offensive. The atmosphere of the room was kept as pure as possible by admitting the external air and by the use of Chloride of lime, and the putrefying parts were bathed from time to time with sweet oil in which a small proportion of Kreosote had been incorporated. The whole cheek was covered with a bread and milk poultice to promote the separation of the dead tissues and a weak solution of brandy and water was administered internally as a stimulant, and at the same time Arsenicum and China with other remedies, were administered as they seemed to be indicated. Portions of the decaying mass were removed with the knife as fast as it was prudent to do so, care being taken not to injure any living tissue. At the end of three weeks, the whole of the slough had separated and was removed, with the exception of a small portion of the masseter muscle under the zygomatic arch, which also came away subsequently. At the time of the child's death, which occurred in about four weeks from the time I was called, the entire margin of the wound was clean and healthy, but showed no disposition to throw out granulations. It extended from the angle of the mouth, (which was carried away leaving the lips separated,) along the Bide of the nose close to the internal angle of the eye, around the inferior margin of the orbit, leaving the orbicularis palpebrarum muscle uninjured, up to the articulation of the malar bone with the frontal bone, from that point down to the articulation of the malar and temporal bones, and thence along the ramus and body of the inferior maxillary bone to the vicinity of the mental foramen and up to the place of starting. All the bones included in this space were dead and black. The teeth of the affected side all came away early after mortification set in. It seems to me probable that the bones first lost their vitality and all the soft parts attached to them sloughed off as a necessary consequence. Just previous to death there were some evidences of an effort on the part of nature to cast off the superior maxillary bone from its attachment to the nasal bone, but she was unequal to the task and life passed away quietly and almost imperceptibly.

The second case was one of

Arsenical Poisoning. I was summoned in great haste to visit a young man aged about 20 years, and found him just recovering from a serious attack of syncope. I learned that he had been suffering for a day or two with violent fever, vomiting of bilious matter and other symptoms which induced me to think that he was laboring under one of the violent forms of bilious fever which prevail in that climate. But there was a complication which I could not understand, as it could not be referred to the effect of the fever. It was an extensive tumefaction of the right cheek, with violent pain in the whole of that side of the face, and smooth, shining, scarlet redness of the skin over the swelling. I battled with the symptoms to the best of my ability and succeeded in reducing the fever and the inflammation in the face, but the pain continued. In the course of a week after the attack commenced, the right arm became intensely tumefied from the elbow to the wrist, and was very painful. In my intercourse with the patient, I learned that a short time before he was taken sick, he had consulted a dentist in regard to a large cavity in the second superior molar tooth. The nerve being exposed, the dentist introduced Arsenic to destroy it, previous to filling the cavity. This seemed to throw some light on the case, and was sufficient in my opinion to account for all the phenomena.

In the course of two or three weeks, there were evidences of a considerable collection of pus in the arm, and I introduced a lancet near the posterior surface of the ulna just above the wrist. A very copious discharge of thick yellow pus followed, and on introducing a common silver probe into the incision, I could distinctly feel it grating on the denuded surface of the bone as far as the length of the probe permitted me to explore. Contrary to my expectation the arm got well speedily after this, and there was no subsequent trouble with it, although the bone was so extensively denuded of periosteum. The superior teeth of the affected side now began to loosen and were removed with the fingers in the following succession — the first molar, the second molar, the bicuspid and lastly the canine. An abscess pointed over the canine eminence and on being: opened discharged freely, and continued to discharge a sanious pus for several weeks afterwards. Subsequently, a large portion of the alveolar process of the superior maxilla became detached and was removed, and in the course of four or five months from the time he was attacked, the patient regained his usual health.

To this I may add an experience of my own, which, though not so serious, served to show the danger connected with the use of Arsenic for destroying exposed dental pulp.

Last spring I went to a dentist for the purpose of having a large cavity filled, in the second inferior molar of the left side. It was so sensitive that the operation could not be borne, and the dentist wished to introduce Arsenic; but remembering my California case, I objected, and he inserted instead, tincture of galls and myrrh. After a reasonable time had elapsed it was found that no effect had been produced by this application, and as the dentist assured me that he had used the Arsenic in hundreds of cases without any evil affects, I consented to have it applied. In about one hour a severe dull aching pain commenced in the tooth, extending to all the teeth of that side, attended with nervousness and general discomfort. I was told that this pain would continue not more than twenty-four hours; but instead of ceasing at that time, it increased and continued to torment me for nearly two weeks. The tooth seemed longer than natural, was somewhat loosened, and very sensitive to pressure, and to cold water. In about a month after the application of the Arsenic, a portion of the alveolar process came away from the outer side of the tooth, and it gradually became firm in its socket, and was afterwards filled without pain.

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