DISEASE FROM POTASSA BICHROMATE.
Of late years, since bichromate of potassa has been used so largely in the arts, certain remarkable affections have been ob served as occurring from it. They have been presented under two conditions, namely, during the manufacture of the salt itself, and during the use of it, in the form of solution, in water.
The first observer who specially detected disease arising from the bichromate, was a French physician, Dr. Becourt. By an acci dent Becourt met with a man who was engaged in a manufactory of bichromate of potassa, and who was suffering from a peculiar kind of ulceration in the face. The case was studied by &court in consultation with the distinguished hygienist, Chevalier, and they both came to the conclusion that the bichromate of was probably the cause of the disease. They failed to obtain from the man, however, any such particulars as they could con sider satisfactory; they therefore looked in other directions for more knowledge. After a time they obtained from the director of a manufactory at Graville the information that many of the workers in the manufactory were subject to a peculiar form of ulceration.
In transforming neutral chromate of potassa, by means of chromic acid, into bichromate, the vapor arising carries with it an infinity of pulverized molecules of the product which spread through the workshop. A cloud of particles is easily visible in a ray of sunlight. The particles, if inspired abundantly, give to the palate a bitter and disagreeable taste; but, as saliva is profusely produced, the chromate is thrown off and has not time to inflict injury.
If, instead of breathing by the mouth, which for long periods of time seems impossible, the particles are drawn in by the nose, great irritation of the delicate membrane lining the nose is pro duced, there is a violent sensation of pricking, suffusion of tears, and irresistible sneezing. There follows upon this ulceration of the septum of the nose, the partition that divides the nostrils, and ultimately the septum is destroyed altogether and lost. Upon this the symptoms cease, and the workmen, as a rule, continue steadily at their employment without further suffering.
Chevalier and Bocourt are of opinion that this process of ul ceration of the nose is not produced in those men who take snuff.
The same observers noticed that if the skin of the body be it may be exposed to a strong and even to a heated so lution of the bichromate, or may remain for many hours in actual contact with the salt itself without any bad effect. But if the skin be torn, or abraded, or cut, and the salt be left in contact with the wound, the caustic action is so intense that severe inflammation follows with decomposition of the living tissue. The caustic action is so great it does not cease until it has penetrated to a bone. The pain of the ulceration is excessively severe. They also observed that when a moist surface of the body is exposed in creases or folds to this salt, a peculiar irritability and itching is set up. This is unattended by ulceration if the part be not abraded by rubbing, but, under abrasion, a troublesome and very painful ulceration occurs.
M. Clouet, a manufacturer of bichromate of potassa at Havre, has added to the above facts others which are of great importance in their practical bearing. lie shows that the inferior animals suf fer from the effects of the bichromate as severely as man. Horses employed in the manufactory, and which walk over the salt, are attacked in the feet; the hoof falls off, and the ulceration extends to the upper part of the leg. In one instance of this kind, recorded by Chevalier and B6court, a horse was at tacked in one of its hind feet, and was quite disabled. The ulcer ation extended through the limbs and through nearly half the body of the animal, and death occurred within a month of the commencement of the malady. Both legs on the affected side were entirely ulcerated. It was as if the decomposition, when it had commenced, went on indefinitely as a veritable metamorphosis of the skin and flesh altogether, analagous to a fermentative action. Dogs and cats and rats were discovered, in the manufactory, suf fering in a similar manner.
Bichromate of potassa taken internally by the mouth is a pur gative, and in large doses of from fifteen to twenty grains is poi sonous. It causes severe colic and purging, but no vomiting. M. Clouet, to whom we are so much indebted for information on this subject, and who first made observations respecting the in ternal action of the bichromate, states that in one manufactory workmen inflicted the foolish and practical joke of putting bichromate of potassa into a barrel of cider belonging to certain of their fellow-workmen. The cider was rendered of a dirk color, but, notwithstanding, the workmen drank of it, and were all af fected with severe colic and diarrhoea, from which, happily, they recovered.
I have been unable to trace ulceration from the bichromate in England. But amongst English operatives I have recently ob served a series of facts illustrative of the action of a watery solu tion of the bichromate on the skin. In that part of the autotype process in which a solution of bichromate, containing from three to five per cent. of the salt, is employed, some of the workers with the solution are affected by an irritation which extends over those parts of the hands and arms that are exposed to the irritant. There is at first a redness, erythema, over the parts affected, which is followed by a considerable amount of irritation, with raised spots, ending in a reddish, scaly exfoliation of the upper skin, very much like what we have already studied under the head of pityriasis rubra. The eruption passes away in a few weeks after the bands and arms are no longer exposed to the solution, and the disease never extends deeply unless there be a sore or wound of the skin. Some workmen suffer much more severely than others, and are much longer before they make a recovery. A few escape altogether, and that even though their skin be of delicate texture.
Serious symptoms are sometimes produced from the absorp tion of cyanide of potassium by those who are engaged at work where solutions of this substance are employed. The danger af fects those, specially, who are engaged in photography. It seems to arise from direct absorption of the poison by the skin, but only when the skin is wounded, abraded, or chapped. My attention was first called to this subject by a photographer, who consulted me for a series of symptoms with which I was not familiar, and which could not be accounted for by any evidence leading to the suspicion of organic nervous disease. The symptoms only came on when he was at his work, but they lasted for some hours after he had left his work. I suspected they might be due to the in haling of the vapors which are present in the working-room of the photographer; but this theory was excluded by the fact that he had worked for many years in the same place without being affected, and that none of the workmen who were in the room with him were similarly affected.
These circumstances led me to look out for local absorption by the skin. I found that the hands of the man were severely chapped, and that they had been so on every occasion when the phenomena recurred; for the phenomena were repeated many times before their cause was discovered. I was now on the right track, and by directing him to give up that part of the employ ment which involved exposure of his chapped hands to the solu tion, the patient experienced a quick cessation of his symptoms, and recovered from them without any recurrence.
The symptoms are exceedingly characteristic; they begin with vertigo. A sense of giddiness is gradually developed, with a sen sation as if all objects were passing in a circle, and then as if the body of the affected person were turning round. At times there is a further sensation of falling, as though, of necessity, the body must pitch forward, and as if the lower limbs were unable to sup port the weight of the body. These symptoms may last for some hours, and if they are not exceedingly severe they will subside when the work of the day is over, and will not recur until the re sumption of labor on the following day. They may be entirely misunderstood, and indeed often are misunderstood. In their lighter manifestations they are attributed to biliousness, or to in digestion. When they become more severe another symptom is added; the giddiness or vertigo is attended with nausea and faint ness, so that it is impossible to go on with the work. But even from this more extreme condition recovery is rapid after exposure to the cause ceases.
Under still further exposure the body becomes cold, and an extreme shivering takes place, which is succeeded by a prostration that altogether incapacitates from work, and is connected with a series of new nervous phenomena of serious moment. The first of these nervous signs is double vision; the patient, that is to say, in looking at a single object sees it as if it were two objects, or as if both eyes were separately discerning the one thing.
Finally, there are muscular tremors which are altogether be yond the control of the will. The tremors do not amount to spasms of the muscles, but they are sufficiently active to cause in voluntary movements of the limbs, and they are attended with occasional starts and twitchings. The temperature of the body is lowered, the appetite is greatly reduced, the secretions are con fined, the face is pale, the action of the heart is quick, weak, and irregular, and the sense of exhaustion urgent. The mind through out is unaffected, but there is, perhaps, an unnatural tendency to sleep.
The poison being soluble finds its way out of the system with moderate rapidity, and thereupon all the severer symptoms are removed, but some remain for several weeks. The strength re turns but slowly; dyspepsia continues as a very troublesome symp tom; amemia is a marked condition; and, the blood, which has been rendered very fluid, escapes too freely from wounded surfaces.
Some examples of poisoning by the local absorption of cyanide of potassium have been recorded, in which symptoms still more alarming than any I have seen have followed upon the accident. One remarkable case of this kind is given by Dr. Davanne. A gentleman who had stained his hand with nitrate of silver en deavored to remove the stain by rubbing it very freely with cya nide of potassium. In this process lie slid under the nail of one of his fingers a small portion of the cyanide salt. At first he did not notice what had happened, but in a little time he felt a severe pain in the part, which after a few minutes was followed by an intense vertigo, so that all objects appeared to be moving around him. To relieve himself, promptly, he conceived the idea of washing the part freely with vinegar. The vertigo now increased, was accompanied by shiverings, extreme pallor, complete loss of sight, and entire prostration; even the power of speech was lost, but the intelligence was, throughout, preserved. The limbs were very cold, and as the sight returned the phenomena of double vision were manifested. These alarming symptoms were not altogether removed within a period of ten hours, but recovery ultimately took place.