CASE OF 
POISONING BI OIL OF CIEIPOflllJM. 
-BY- 
THOMAS R. BROWN, M. D, 
Professor of Clinical and Operative Surgery, and Diseases of the 
Genito-Urinary Organs, Colleger of Physicians 
and Surgeons, Baltimore, Md. 
Reprint from the Maryland Medical Journal for November, 1878. 
BALTIMORE: 
J H. FOSTER & CO,', STEAM PRINTERS AND PUBLISHERS, 
No 9 South Charles Street. 
—1878.— CASE OF POISONING BY OIL OF CHENOPODIUM. 
BY THOMAS R. BROWN, M. D., PROFESSOR OF CLINICAL AND OPERATIVE 
SURGERY, AND DISEASES OF THE 
ORGANS, COLLEGE OF PHYSICIANS AND 
SURGEONS. BALTIMORE, MD. 
The following history of a most interesting case of 
by wormseed oil, is submitted somewhat in detail : 
Mr. X., occupation merchant, single, age 31, was a man of 
really excellent health, though subject to what may be styled 
constant “fits” of unrest and anxiety as to some imaginary dis- 
ease, for which lie was repeatedly physicking himself. These 
medicines would be either those prescribed by a physician or 
druggist, he always reserving to himself the right which he in- 
dulged freely, of entirely altering the prescription in kind or 
quantity to such an extent as to produce effects different to what 
were intended. 
For example I have known him in one of these “fits” of de- 
pression, caused as he stated, by a serious decline in his sexual 
powers, a by no means uncommon fear with those who often, 
as he did, would test his virility, failing to get prescription from 
me, purchase from a druggist a number of those phosphorus and 
nux vomica pills prepared by Warner & Bro., of Philadelphia. 
He did not discontinue these remedies until after he had taken in 
the neighborhood of 25 dozen pills. On another occasion he 
continued the notion that he needed toning up for which he pre- 
scribed iron, that he gravely took before meals, which were almost 
invariably taken in such enormous quantities, and with such gusto 
as to make his family jocosely question the necessity for the tonic 
course that he had mapped out for himself. 
On still another occasion I met him when he told me that he 
had sent to the drug store for medicine, and that to make sure of 
the desired effect he had taken double the quantity ordered. I 
might add to these numerous illustrations of a typical “hypo” in 
the way of urged examinations of lungs, heart, belly, penis, testi- 
cles, urine, etc., but enough has been offered to show his peculi- 
arity. Now in striking contrast with all this, 1 can state that he was actually a man of good physical health, and mentally, so far 
as related to his business capacity, he compared favorably with 
most men. He had agood appetite, regular bowels, normal urine, 
a muscular development which qualified him for enduring a great 
amount of exertion in gunning, boating and playing base ball. 
On Friday September 5th, he returned from an extended and 
successful business tour through the South. Soon after his return 
he consulted me, saying that he had been feeling very badly and 
generally “ out of sorts.” With the exception of a fatigued ap- 
pearance, having been up a good part of the night, he looked as 
well as ever. Amongst other things complained of he informed 
me that he had been “ passing worms.” He seemed very positive 
about this, and I prercribed for him verbally one ounce of castor 
oil and twenty drops of turpentine. He immediately inquired of 
me if after the action of the medicine it would not be a good 
idea to “ shape off,” as he expressed it, with iron and quinine. 
To this I assented; he procured the medicine from a druggist 
near by, returned to my office, and after I had mixed it with 
whiskey he swallowed it. I remarked to him that castor oil was 
such a stinking thing that I would throw the bottle away at once, 
but, knowing his propensity as described above, I did not do this 
until I had observed from the label whether he had gotten the 
prescribed quantity of turpentine. He had ordered 30 in the 
place of 20 drops, I never thought of looking immediately 
above to note the quantity of the oil for the reason that I could 
not imagine a patient voluntarily increasing the dose of this dis- 
gusting medicine, and secondly that the quantity presented was 
evidently that or about that ordered. He remained under my 
sight for about one hour, during which time he spoke of being 
annoyed by disagreeable eructations, which made him a little 
sick. I left him, went on my rounds, and did not see him until 
6 p. M., or about seven hours after the medicine had been taken. 
His first remark was that “ that infernal medicine had not moved 
his bowels, but had made him deathly sick.” He had been to 
witness a game of base ball, and while on the grounds he retired 
several times behind the benches and made unsuccessful attempts 
to vomit himself by using his finger. As just stated his chief and only complaint on his return was the great nausea. I gave him 
one-twelth of a grain of calomel to be repeated every half hour, 
the explanation for the unusual effect of the oil which I offered 
was that for some reason it had been retained in his stomach and 
that the nausea had been kept up by the constant eructations. My 
engagements kept me from seeing him until ten o’clock, four 
hours after. I found that he had remained in his dining room 
with a cousin during this interval, playing cards. The latter on 
my arrival, at once asked what my patient had taked as in addi- 
tion to the sick stomach he observed that there was such difficulty 
in walking as to make him stagger like a drunken man and to 
require assistance in getting him to the water closet, situated in 
the story above, where I found him feeling, as he said, better after his 
bowels had begun to move slightly. When he descended to the din- 
ing room his behavior was simply such as might be explained by 
a severe attack of stomachic vertigo, and he looked badly, having 
a good deal of pallor, and was manifestly anxious. He retired 
early, having failed as was his custom to close the windows and 
lower the gas light. 
The next morning, Saturday September 6th, he did not join 
his family at breakfast, which did not occasion surprise, as he had 
already announced his intention of getting rested and taking three 
days holiday after his labors. Soon after his breakfast hour I 
entered his room and found him sleeping as quietly and sweetly 
as possible. In the course of two hours I again called at his bed- 
room when he was still sleeping as before. This time, after a 
more careful scrutiny of himself and his apartment, I discovered 
that he had vomited freely over the sheet and especially on the 
floor. The vomit consisted of particles of meat and bread, the 
constituents of the breakfast taken the day before. Not only 
what had been ejected but the entire chamber was strongly 
scented with the unmistakable odor of wormseed. 
It was evident that he had retired in great confusion and haste, 
a box of cigars, which he had brought to his room the night 
before, had been thrown at a table and was found on the floor, 
with the lid open and the contents partly emptied. He was lying 
on his back partly covered with a thin spread,' and so eager had he been to reach the bed that he had not put on his night shirt. 
His pulse, respiration, physiognomy, and skin were perfectly 
natural. I left the room without rousing him, but did not begin 
my rounds until I had visited my office for the purpose of con- 
sulting Stille, Ringer, Taylor and Orfila, not to mention a number 
of other works that could in any way enlighten me, as to 
symptoms of poisoning from Wormseed. Besides the known 
fact of the danger from an overdose no information was obtained. 
I returned to my patient at about 4-30 p. m. of the same day, and 
found him precisely as I had left him, still soundly asleep. With- 
out much difficulty, by calling and shaking him slightly, he awoke 
to perfect consciousness, and at once began to call my attention to 
the vomiting that had taken place during the night. On question- 
ing him he placed his hand to his ear and indicated that he could 
scarcely hear a word I would speak. He was much surprised at 
the length of his sleep and the hour of the day. I asked him 
where he had gotten wormseed medicine and he denied having 
taken any. I assured him that the odor had charged the matter 
he had vomited and that he must have taken some. He again 
denied having had any. After directing him to get up and dress 
himself I left the room. I returned in less than one hour to find 
him again asleep on the bed and all dressed excepting as to his 
coat. He had buttoned his gaiters, prepared a clean shirt which 
required him to transfer the buttons, bent his collar, in short had 
attired himself in his accustomed manner. I easily roused him, 
he still showing marked deafness, took him by the arm and es- 
corted him to the dining room, his gait being only a little 
unsteady but none of the staggering nor the anxious pallor of the 
night before was observed. He saluted his sister and her baby 
in a very cheerful way and immediately asked for food. Whilst 
waiting he commented upon his mysterious attack, and stated 
that with the exception of his deafness to the sounds of the voice, 
but exquisite sensitiveness to the sounds of passing vehicles and 
the cracking of ice by the waiteress, and an annoying buzzing in 
his ears, he felt as well as he ever did in his life. In great doubt, 
under necessity, I was obliged to leave him for my office near by 
where he soon joined me. For a short time I was engaged in my private office and left the patient in the waiting room. When 
seen again he had fallen soundly asleep. As soon as practicable 
I roused him, took him by the arm and walked him in the open 
air for about one-half of a mile. His intellection was clear, his 
gait steady and nothing unusual was observed but his deafness to 
my voice, and a painful sensitiveness to the sounds made bv 
passing wagons. He remarked as each vehicle rolled by that it 
sounded like the roaring of immense cannons right into his ear. 
On returning to my office he spoke, for the first time, of a slight 
uneasiness in his belly and made an ineffectual attempt to vomit. 
During our walk I again inquired about the taking of wormseed 
medicine. I could not abandon the idea that anything but this 
drug could produce the odor encountered in his room. He 
again as before, denied having taken any. 
After our walk he went to his home accompanied by myself, 
when I suggested to himself and sister a game of casino for the 
purpose of keeping him awake. He played with his usual clever- 
ness and nothing unusual occurred until between ten and eleven 
o’clock when his sister played in violation of the rule by attempt- 
ing to “ build from the table,” He instantly, sooner than myself, 
detected the false play and offered interruption but could not 
command the words to complete his sentence. After a vain 
effort, made for about one-half of a minute, he appealed to me 
in gesture if he was not right. In this he was clearly aphasic. 
The games having been finished I was left to watch him during 
the night. During the night the deafness and roaring in his ears 
continued. His temperature was taken and found normal as were 
his pulse, respiration, and physiognomy. There was some thirst. 
His speech was as good as ever, as shown by the anxiously clear 
and direct questions which he repeatedly made as to the “mean- 
ing of all this.” He walked in a perfectly steady manner and the 
steadiness of his gait was especially noticeable as he gave chase 
to a rat that suddenly appeared in the room. He took during 
the night a few doses of a mixture containing about two drops 
of laudanum and whiskey, given as stimulants. Towards morn- 
ing his drowsiness returned and he slept naturally for about two 
hours. I left him until eleven o’clock of that same (Sunday) morning. During my absence, he was constantly attended by 
some member of his family and while in conversation with his 
sister, he for the first time admitted to his sister having taken 
some wormseed oil. When again seen by me he was wide awake 
lying on his bed and smoking a cigar, but disinclined to converse. 
His manner in smoking was peculiar. He would scarcely light 
the cigar before he would lay it down and take a fresh one, 
arguing clearly some perversion in his taste. This was kept up 
until interdicted and by the afternoon his mantel piece was strewn 
with cigars only slightly used. From 12 o’clock to his dinner 
hour—1-30, he remained in his room either on his bed or sitting 
up. Tho’ relations remained constantly by his side, he showed 
not the least disposition to engage in conversation. To one of his 
attendants he again showed signs of distinct aphasia. He clearly 
wanted him to get or do something for him, but could not make 
himself understood. His friend replied by writing on paper 
“ Don’t understand” at the same time handing him the paper and 
pencil with which to make known his wish. After holding them 
in his hand, in a pensive state for some minutes with a sort of a 
flourish, he wrote in a perfectly distinct hand “The paper mu,” 
waited awhile and then with a painful expression of the realiza- 
tion of his difficulty returned the materials and laid down. I 
then repeated the attempt by asking him what medicine he had 
bought while away from home. After similar preliminaries as 
before he only managed to write two letters “ Th.” In reply to 
my question as to how he felt he responded “ I feel all right.” 
The latter, like the other words were written in a perfectly distinct 
manner. 
I prescribed for him small doses of bromide and iodide of 
potash. During all this time his deafness as described, was pro- 
gressive and became so pronounced as to make it impossible to 
talk to him. Still there was the same kind of sensitiveness to 
other sounds. For example when the tea bell rang, tho’ he was 
in the third story, three flights from where the sound came, he 
without notice from members of his family to their utter astonish- 
ment got up and walked as deliberately as ever into the dining 
room. He did not seem to know his accustomed seat and sat at the wrong place. During the afternoon his aphasia was complete 
so that he no longer found it possible to express his ideas to any 
one which seemed to amuse him very much as he laughed hearti- 
ly over it. Iiis behavior all of this time deserves comment. 
Whatever he did he would keep repeating it for a considerable 
time. When I entered the room he rose shook me cordially and 
firmly by the hand, and then took his seat. In about a minute 
he arose solemnly came forward and again shook hands with me 
so that by twenty minutes he had shaken hands with me as many 
times. He then began to wash his hands and tho’ the basin con- 
tained no water he went through the form of using soap and 
wiping with the towel as often as a dozen times in one hour. 
Many acts of similar import might be offered, some of which I 
observed and others were described by members of his family. 
He urinated normally during the day and the water as seen by 
me looked natural. 
I joined the patient at his tea for the purpose of watching what 
up to this time had been to me an unsolved mystery. He ap- 
peared to relish his food, taking singly tea and bread. Towards 
the close of the meal while grasping a fragment of bread, there 
was a distinct spasm of the right fore-arm and hand. His fingers 
were firmly clenched, and his hand forcibly flexed on the fore-arm. 
He was assisted to his room, his walk entirely natural and when 
being placed on his bed he showed some resistance in striking at 
me. He at once commenced to groan, draw himself up, and 
tossed from side to side of the bed, suggesting abdominal distress. 
An enema of soap and water, about one quart, was given, follow- 
ed by a free involuntary movement. 
He soon became unconscious, and from his movements in bed 
it was clear that he was paralyzed in right arm. This member 
was dragged helplessly after him, as my attention was first called 
to it by a looker on. He remained in a stupor without stertor, 
with a pulse of seventy, temperature and skin normal, all of Sun- 
day night. On Monday he was seen with me by Prof. Latimer 
who agreed as to the evidences of cerebral pressure. There con- 
tinued impairment of motion and sensation of the right side 
together with insensibility to touch of the right eye ball. To- wards the evening of Monday September 8th, his temperature 
began to rise, and by Tuesday evening the thermometer registered 
one hundred and four in the axilla. For the pyrexia hypodermic 
injections of quinine were given in large doses. All during 
Monday there were frequent twitching and stiffness of the right 
limbs, which yielded to inhalations of chloroform. These cul- 
minated in a unilateral convulsion at daylight Tuesday morning. 
At about noon Monday he passed, as he continued to do to the 
end except when drawn off, a large quantity of his urine 
involuntarily in bed. A microscopic and chemical examination 
of the urine showed nothing of especial significance. Its odor 
color and general properties were such as are met with in cases 
of high temperature. On Tuesday afternoon the heavy breathing, 
with flapping of the cheeks, of apoplexy appeared There was 
also a more or less constant regurgitation of yellow frothy mate- 
rial from the mouth, which like the emanations from his skin 
smelled of wormseed. The accumulations of this material would 
at times be so profuse as to embarass respiration. During one 
of these attacks of dyspnoea, and while in a drenching sweat, 
which suggested the approach of dissolution, he was gently 
turned in bed, immediately a general convulsion markedly opis- 
thotonic appeared, lasting about two minutes, despite the use of 
chloroform. By this time a decided icterus appeared, which had 
been only noticed the day before. With the exception of dis- 
tressing rattling which kept up through the night of Tuesday, 
associated with profuse sweating, nothing worthy of note occurred. 
He died about eight o’clock on the morning of September ioth, 
five days from the beginning of his illness in profound coma and 
with a high temperature in his axilla. His yellowness at the end 
was so marked as to make it very difficult for me to discredit a ru- 
mor, that already had become current, that my patient had yellow 
fever. Unfortunately no post mortem was obtained. Immediately 
after death I examined his body and found a threatening bed sore 
over the sacrum, notably on the left side. The excessive heat 
continued for some hours after death. There was no rigor mortis. 
Decomposition set in so early as to necessitate a hasty funeral. 
The history of the origin, of this case continued to be uncertain until the day before his death, when on visiting the drug store 
where my patient had purchased his medicines, I learned for the 
first time that he had changed my prescription for one ounce of 
castor oil to about one ounce and a-half of wormseed oil, this 
being the whole of the druggist’s supply. To this the turpen- 
tine was added. Had I been in the habit of directing worm- 
seed oil, I might have thought that it had been taken under 
a misapprehension. It is the case however that only during my 
service at the Baltimore Special Dispensary, where this was the 
chief ingredient of a favorite worm mixture, did I ever administer 
it. I do not remember a single instance in private practice where 
this remedy has been prescribed by me. No matter as to this I 
have learned a lesson about ordering physic verbally. 
One of the many points of interest in connection with this case 
was the clearly defined aphasia. Why the centre of speech, 
wherever and whatever this may be should have been elected, as it 
were, as the chief seat of the attack, is a profound mystery. By 
referring to page 311 of the London Lancet, for this year, it can 
be seen that Dr. Lawson, in his article on the effects of hyoscy- 
amine upon himself states, among many other symptoms, that 
“after sleep there still remained incoherence and aphasia. 
My excuse for this detailed report, lies in the fact that in no 
work on materia medica, practice nor forensic medicine which I 
have consulted, which includes almost every modern work 
(English), have I yet met with a single case of fatal poisoning from 
wormseed oil. Since the occurrence I have heard of others, 
and I have therefore determined to place mine on record.