[Reprinted from the Boston Medical and Surgical Journal ot 
March 7, 1889.] 
ON CHRONIC ARSENIC POISONING, ESPE- 
CIALLY FROM WALL-PAPER, 
BASED ON THE ANALYSES OF TWENTY-FIVE CASES IN 
WHICH ARSENIC WAS FOUND IN THE URINE.1 
BY JAMES J. PUTNAM, M.D. 
The object of this paper is to call attention once 
more to the prevalence of poisoning from arsenical 
wall-papers, by reporting brief notes of twenty-six 
cases, which have never been published, where ar- 
senic was found in the urine. I have chosen this 
series of cases, not because they are clinically more 
striking than many others where the urine was not 
examined, but because they may be justly expected 
to carry more weight, since through the demonstra- 
tion of the arsenic one element of doubt as to the 
diagnosis is removed. 
For the notes of twepty-f our of the cases I beg to ex- 
press my sincere thanks to the following gentlemen : 
Profs. Wood, and Hills, Dr. A. M. Comey, and Mr. W. 
S. Robinson, of Harvard University, Prof. Sanger, 
Drs. S. W. Driver, S. W. Torrey, T. E. Francis, E. 
F. Cutter, A. Worcester, T. M. Rotch, P. C. Knapp, 
J. T. G. Nichols, and Prof. H. E. Hill'. 
I wish also to make a contribution toward our 
means of exact diagnosis in this obscure class of 
cases by calling special attention to one where a 
close examination showed the presence of a neuritis 
which might readily have escaped detection. 
I shall have occasion to refer frequently to a 
1 Read at the meeting of the Boston Society for Medical Improve- 
ment, February 12, 1889. 2 
series of observations by Kirchgasser (1868), partly 
because he has utilized his material in a very thor- 
ough manner, for the benefit of diagnosis, partly 
because in his cases also the diagnosis was in many 
instances controlled by an analysis of the urine. 
The time has nearly gone by when fair-minded 
persons who have taken pains to investigate the 
evidence need to be convinced that arsenical wall- 
papers and fabries may be a source of poisoning. 
The problems of chief importance at present are, 
how we may learn to recognize with greater confi- 
dence the less typical cases ; how we may persuade 
our legislators to give us due protection against 
this wide-spread public danger. The latter need 
lias recently been pointed out anew by a Avriter (Mr. 
A. W. Stokes) in the London Chemical News, to 
whose investigations attention is called in the last 
number (January, 1889) of the Therapeutic Gaz- 
ette. The author examined one hundred samples 
of Indian muslins and cretonnes, and found that 
23 per cent, contained arsenic in appreciable 
quantities, the highest percentage being twenty- 
three grains of white arsenic per "scpiare yard. 
Arsenic was also found in 10 per cent, of wall- 
papers submitted, by various manufacturers, and in 
a number of other articles of household uSe. It 
has been asserted by our chemists that the dangers 
from these sources are by no means so great as for- 
merly, but it is evident that they are still far 
from being entirely done away with. 
The symptoms which are liable to be met with 
in these cases are so thoroughly detailed in the 
admirable reports of I)rs. Draper and Wood, in 
the Massachusetts State Board of Health reports 
for 1872 and 1885, and by the writers therein 
cited, as to make it seem a needless task to call 3 
attention to the subject afresh, especially as 
might be thought unwise to separate the discus- 
sion of the symptomatology of this special form 
of arsenic poisoning from that of chronic arsenic 
poisoning in general. As a matter of fact, however, 
it is mainly from this class of cases that we prac- 
tically derive our knowledge of chronic arsenic 
poisoning, and our power of diagnosis of this 
condition is by no means perfect. Acute arseni- 
cal poisoning has long been familiar to toxicolo- 
gists, and the subacute form is usually easily 
recognized by the severe gastro-intestinal disorders, 
oedema of the eyelids, outspoken affections of the 
mucous membranes, sensory and motor paralyses, 
and the like; but in dealing with the chronic forms 
we have only the shadows of these characteristic 
symptoms to guide us, and are, moreover, likely to 
be led astray by the fact that the arsenic may only 
act by bringing out the latent weaknesses of the 
patient. For this reason, we not only need to know 
that a particular symptom may be of arsenical ori- 
gin, but also to familiarize ourselves with more re- 
fined methods of ascertaining whether it is so or not. 
Of such symptoms, the most convincing are perhaps 
those that can be recognized by physical examina- 
tion, such as neuritis of a sufficiently advanced 
degree to cause changes in electrical reaction, dimin- 
ution of cutaneous sensibility, impairment of motor 
power or co-ordination. Another physical sign, 
which is spoken of as important by Kirchgasser, is 
a peculiar brownin'g of the skin, especially of the face. 
This has often been described as occurring during 
the long-continued use of arsenic for medicinal pur- 
poses, but not often in connection with wall-paper 
poisoning. It probably affects other parts of the 
body quite as much as the face, It is the same 4 
writer’s opinion that a typical periodic recurrence 
of symptoms is frequently seen, suggesting the inter- 
mittence of malaria, and certain neuralgias ; and he 
also points out that shifting rheumatoid. Another 
important physical sign is albuminoia with casts and 
sometimes blood in the sediment; of this I have two 
instances to report. The other influences which 
might lead to this condition are not numerous, and 
can, after a time at least, usually be eliminated. 
In Kirchgasser’s cases this symptom was not pres- 
ent, and he says, in fact, that the urine is not char- 
acteristic, though he dwells upon the significance 
of dysuria. Both those symptoms have been noted 
by other writers, especially from poisoning with 
arseniuretted hydrogen. 
Cerebral symptoms, such as vertigo, impairment 
of memory and mental endurance, and, rarely, epi- 
leptiform seizures, are met with in cases of chronic 
arsenical as in lead poisoning, and may be suggest- 
ive if not characteristic, if other causes can be ex- 
cluded. Kirchgasser further reports, as others 
have done also, attacks of fever of low grade and 
unusual course, and this is noted in one of my cases. 
The case observed by myself is as follows : — 
The patient is a lady forty-three years of age, and of 
naturally good health and habits. She is a hard 
worker, and during the year or two previous to the 
illness now in question, suffered from time to time 
with severe colds and indigestion, which, however, 
yielded, after a while, to careful dieting and tonics. 
At the time that the symptoms began, she was in 
good condition, and had, in fact, only recently re- 
turned from a vacation. In the spring of 1887, 
shortly before going on her summer vacation, she 
moved into new lodgings, which consisted of eight 
rooms, About a month or six weeks after returning 5 
home, she began to suffer from severe pain in the 
abdomen, at the epigastrium. This pain recurred 
periodically, coming on in the morning and passing 
away in the afternoon. It was unconnected with 
any sign of digestive disorder except intestinal flat- 
ulence, and was not relieved by the most stringent 
dieting, nor by medicinal treatment; but was some- 
what relieved by a full meal. This pain remained 
without material change through the autumn, win- 
ter, and the following spring, unaccompanied at 
first by any other sign of illness, except that the 
patient felt fatigued after the attacks and Anally 
began to lose sleep and appetite. About February 
or March, 1888, she first noticed tingling in the 
fingers, lips, tongue, and a slight twitching of the 
fingers on attempting to write. The right hand 
was worse than the left. These symptoms contin- 
ued with varying intensity for many months. The 
feet were affected in a similar manner, at first in a 
less degree than the hands, but towards the end of 
June more severely. She also after a time began 
to be troubled with soreness of the hands and wrists 
on pressure, so that she dreaded to shake hands ; 
and writing, which had formerly been easy and 
habitual, became a labor from which she shrank. 
There was also lameness about the left shoulder, 
developed by any slight blow. 
The drinking water and urine were examined for 
lead, at this period, but none was found. Moderate 
pressure on the arms, as in lying on the side, and 
even at times in the back, caused a sense of formi- 
cation, so uncomfortable that she frequently re- 
frained from lying down. 
I would here remark that this “going to sleep” 
of the arms on lying down, even when the arms 
themselves are not under the body, is a familiar 6 
symptom to neurologists, and is generally attributed 
to slight neuritis, though it is not proved that this 
is always present. 
The same sensation was readily excited in the 
legs by crossing one over the other. A careful 
electrical examination made on August 4, 1888. 
showed that the minimal faradic action of some of 
the extensor muscles of the fingers, as well as of 
the opponens and flexor proprius pollicis, were less 
good for the right arm than the left, requiring the 
coils to be approximated about half a centimeter 
for that side. 
The figures are as follows : — 
K. L. 
FI. prop, pol 12. 12.5 
Opp. pol 11.5 11.9 
Ext. Ion. ind. 10.8 11.2' 
Ext. com. dig 10.S 10.8 
Ext. min. dig 1.. 10.8 11.2 
Ext. carpi uln 11. 10.0 
The results of this examination were essentially 
the same with that of a previous examination of 
the date of July 16th, and at that time a similar, 
slight, but definite difference of reaction to the 
galvanic current, in favor of the left side, had also 
been made out. When stronger currents were used 
it was found that while the extensor muscles of the 
left forearm responded strongly, so that the hand 
and fingers were raised in the usual manner, those 
of the right arm did not contract with correspond- 
ing vigor, their contraction being readily overcome 
by that of the flexor muscles, though the latter were 
stimulated only by the current transmitted through 
the thickness of the arm, so that when the electrode 
was placed over the extensors, and strong currents 
applied, the hand was flexed instead of being ex- 
tended. This was confirmed by repeated trials. 
The difference in reaction between the two arms 7 
was not due to greater electrical resistance on the 
right side, as was shown by galvanometric tests. 
The grasp of both hands was feeble, that of the 
left especially so. The dynamometer figures were, 
K. 5; L. 17, whereas they might have been expected 
to be at least 11. 40 to 50 ; L. 30 to 40. 
On hyperextension of the hand and fingers, with 
the fingers spread, there was a marked tremor of 
both hands ; but while the left hand could be held 
extended by a strong effort, the right began almost 
immediately to droop, and reached the plane of the 
forearm after thirty or forty seconds. I consider 
this to be a sign of real value in estimating slight 
failure in efficiency of the extensor muscles, not 
severe enough to betray itself in the ordinary use 
of the hands. 
The sensibility of the tips of the fingers of the 
right hand, as compared with the left, was found 
slightly but markedly diminished, on careful test- 
ing, as regards touch and temperature and estima- 
tion of the compass points (K. 3-16, L. 2-16). 
In the early part of July the wall-papers were 
examined by l)r. A. M. Comey, of Harvard Univer- 
sity, and a large quantity of arsenic was found in 
two of them, which covered the walls of tl r 'e rooms. 
The largest quantity was in the room used by the 
patient as a bedroom. Early in August the urine 
was also analyzed, and Dr. Comey reported that it 
contained as' large an amount of arsenic as he had 
ever found in a urine analysis. 
Almost immediately after this (in July) the pa- 
tient moved to new lodgings, and for safety’s sake 
the paper on the patient’s bedroom was examined 
for arsenic. The patient is away all day long, and 
is practically never in any other room except the 
parlor, where she sits a few hours in the evening 8 
five days in the week. A large amount of arsenic 
was found in the bedroom paper, and the room was 
repapered in October, but unfortunately the new 
paper was put on over the old. For a few weeks 
before this change was made the patient had had 
less pain and discomfort in the arms, perhaps as a 
result of leaving her former lodgings, but from this 
time forward her improvement in every respect was 
almost continuous, although on one occasion, during 
a visit away from home, the pain in the stomach 
returned. 
During the entire present winter she has re- 
mained (except for an occasional twinge) free from 
the pain in the stomach which had followed her so 
long and so continuously. For a long time, however, 
and until four or five weeks ago, she suffered from 
constant nightmares and slept restlessly and poorly. 
In November the urine Avas examined for the sec- 
ond time, and arsenic was still found in considerable 
quantity, though not so much as before. 
I advised her to have both papers removed from 
the wall, and asked her before doing so to have a 
third analysis of the urine made, in order to see 
whether the arsenic found the second time was 
probably due to the underlying paper, or was an 
indication that the elimination from the previous 
poisoning was not complete. 
This has been done, with the result that a very 
large amount has been found to be still present. 
The idea naturally suggests itself that she is getting- 
arsenic from some other source, but if so I have 
been unable to find it. Her household effects are 
very limited, and of the few articles in her pos- 
session which might be suspected, I have had a 
dress and a curtain analyzed, and pieces of two 
carpets, as well as the paint of the room in which 9 
she works, with the result that all of them were 
found innocent. 
One other symptom remains to be mentioned, 
though I am not prepared to assert that it is attribu- 
table to the arsenic. 
Namely, during last autumn, at about the time 
of the repapering of the bedroom, and while the 
gastralgia was abating, the patient began to suffer 
from a typical convulsive spasm of the left facial 
muscles, which at times was severe, and this has 
continued, with a few weeks’ intermission, up to 
the present time I shall bring forward evidence 
to show that the action of arsenic may probably be 
concentrated in one part of the body, apparently 
causing, or helping to cause, localized and unsym- 
metrical signs of disease, but in the present case 
the patient remembers having noticed a very slight 
twitching about the left eye and left angle of the 
mouth shortly before she moved into the first lodg- 
ings, at a time when she is not known to have been 
exposed to arsenic, and doubt is thus thrown on the 
propriety of referring the spasm to arsenical poi- 
soning, though the patient herself considers the 
former attack to have been of a different nature 
from this. Except for this facial spasm the patient 
is now apparently in good health. 
The figures for the dynamometer test are now 
E. 35; IT 35. 
The points that seem to me chiefly important in 
this case are that, in spite of the absence of any 
material disorders of the general nutrition, or the 
digestion, the attacks of gastralgia recurred daily, 
and at the same hour, for almost a year; and, still 
more, that definite signs of loss of muscular strength, 
affecting the extremities the most, and both flexor 
and extensor muscles, impairment of cutaneous sen- 10 
sibility, and changes in the electrical reactions were 
found on careful examination, though the patient 
had not been incapacitated for work, and her symp- 
toms were such as might easily have been attributed 
to simple nervous weakness. 
With regard to the diagnosis, the absence, so far 
as is known, of other causes of generalized neuritis; 
or of any history of previous attacks of gastralgia 
or analogous nervous symptoms; and the improve- 
ment when the patient was removed from exposure 
to the worst arsenical paper, together with the find- 
ing of arsenic in the urine, warrants us in looking 
upon arsenical poisoning as the most probable origin 
of her illness. The continued presence of arsenic 
in the urine renders it probable that the poison is 
still given off in spite of the overlying paper, or 
comes also from the other papers which have not 
been analyzed.2 
The remainder of the twenty-five unpublished 
cases in which arsenic was found in the urine are 
in outline as follows : — 
Case 1 was reported to me by Drs. A. Worcester, 
and E. C. Cutler, of Waltham, the analyses being 
made by Prof. Hill, of Cambridge. The patient 
was a woman, thirty years of age, whose health had 
previously been good. The symptoms were briefly 
as follows: indigestion of several years’ standing; 
debility, especially for a few weeks each spring and 
fall, after house-cleaning; in March, 1887, tonsillitis 
for two months following; coated tongue, salivation, 
with swelling of the sublingual and submaxillary 
glands, increased by mastication; nausea; loss of 
flesh, but no headache or diarrhoea. Arsenic poison- 
ing was suspected, mainly on account of the saliva- 
tion, and the patient was sent away from home for 
* Since this period the patient has had a short illness, in which 
the gastralgia returned lor a time. 11 
a few days, during which the gastric symptoms, 
salivation and swelling of the glands, became worse. 
The urine was examined and 0.02 mg. to the litre 
found. The wall-papers were also examined with 
the following result: — 
Sitting-room trace. 
Bedroom 0.002 milligrammes to square meter. 
Hall 0.027 
Spare room 0.420 “ “ 
Curtains trace. 
The spare-room was almost constantly kept open, 
though rarely used. The patient remembered having- 
felt worse at one time after sleeping there for a few 
weeks, and that room had always been included in 
the house-cleaning. The case finally ended in re- 
covery, but not until the patient had made a pro- 
longed stay away from home, and all the articles 
containing even a trace of arsenic had been removed. 
The salivary symptoms remained troublesome the 
longest. 
Case 2. Husband of the above. His symptoms 
also consisted in salivation, with swelling of the 
glands ; and he eventually recovered. 
This is one of those interesting pairs of cases 
sometimes met with where a similar exposure gives 
rise to similar symptoms, the diagnostic value of 
which is thereby materially increased. They are 
also interesting on account of the prominence of 
the salivary symptoms, and because in the first 
case the symptoms continued to grow worse for a 
time after removal from exposure, and because a 
susceptibility to even traces of arsenic seemed to 
be gradually established. 
Hos. 3 and 4 are two interesting cases, also of 
husband and wife, reported by Dr. S. W. Torrey, of 
Beverly, the analyses being made by Prof. Wood. 
Here again both patients presented essentially similar 
symptoms. In the case of the wife these symptoms 12 
consisted in long-continued muscular pains, espe- 
cially in the shoulders and arms, of increasing 
severity, together with insomnia, prostration, and 
with some impairment of the digestion, but without 
diarrhoea, or disease of the superficial mucous mem- 
branes. In the case of the husband, prostration, 
insomnia, and indigestion were also present, and 
the tongue showed the silvery coat so often alluded 
to by other observers. Arsenic was found in quite 
a number of fabrics and papers, mostly in small 
amounts, but in a dress and in the frieze of the 
sitting-room in a large amount. 
After removal of the papers and fabrics (except 
one carpet), and a vacation in the woods, the patient 
improved, but on his return relapsed and was at- 
tacked, in addition to the other symptoms, with 
acute catarrh of the pharynx and middle ears. 
Here, also, a susceptibility to arsenic seemed to 
have been established, which, possibly, was greater 
from the fact that the patient had previously been 
poisoned. 
Cases 5 and 6 were reported by Dr. Francis, of 
Brookline, the analyses being made, as in the last 
cases, by Dr. Wood. Neither case presented un- 
equivocal signs, one of them being that of an infant, 
previously healthy, who refused food without ap- 
parent cause; and the other that of a young lady, 
who became extremely anaemic, and suffered from 
repeated attacks of diarrhoea, all symptoms disap- 
pearing promptly on removal from exposure, and 
taking tonic treatment. 
Cases 6 and 7 were again husband and wife, and 
were reported to me by Dr. Comey, who made the 
analyses, and was in position to know all the facts 
with accuracy. One of the cases in particular, that 
of the husband, a gentleman of fifty, and of natur- 
ally good health, was remarkably interesting. 13 
The symptoms included temporary impairment 
of memory, and mental vigor, albuminuria with 
casts and blood, and a prolonged painful affection of 
one foot, attended with excessive local coldness and 
pallor, and a sense of numbness, for which no cause 
could be found, but which improved under massage, 
and like the other symptoms, eventually passed 
away after removal of the patient from exposure to 
the arsenical paper. Not having seen the case my- 
self, I do not feel at liberty confidently to refer 
this curious symptom to the source of the arsenic, 
but it is probable that, so far as the unsymmetrical 
position of the lesion is concerned, arsenic might 
have been the cause, or partial cause. 
Dr. Comey’s case is also important from the fact 
that arsenic continued to be eliminated in the urine, 
though in diminishing quantity, for nearly seven 
months after removal of the papers, while at the 
same time the steady decrease, and eventual com- 
plete disappearance, of the symptoms gave good 
grounds for thinking that the real source had been 
found. The objectionable papers, which were two 
in number, and were superposed one over the other, 
were, most of the time, covered in with a third, 
which was free from arsenic. The innermost paper 
contained fifteen grains per square meter. Cases 
where poisoning has apparently occurred under 
these circumstances have repeatedly been reported, 
and strongly support the view that the arsenic 
sometimes makes its way into the room in a volatile 
form. The most recent experiments of Hamberg, 
who has long investigated this question, would 
seem to show that this vapor is not arsenuretted 
hydrogen to any great extent, while the investiga- 
tions of Selmi, and others, referred to by Stevenson, 
of Guy’s Hospital, in the British Medical Journal 
for 1888, page 1220, suggest that the dangerous 14 
compound may be one of the extremely poisonous 
“ arsines ” which are formed in the presence of 
decaying organic matter. 
Cases 8 and 9 were contributed by Mr. W. S. 
Robinson, assistant in the chemical department at 
Cambridge, who made the analyses, as well as by 
Dr. E. C. Leach, in whose family they occurred, and 
by Dr. Knapp, who examined one of the patients. 
Characteristic symptoms were present in only one 
of the cases, that of a child, who presented ataxia, 
now a recognized symptom of neuritis. This affec- 
ted especially the right side, and was associated 
with numbness, prickling of all four extremities, 
and also extreme nervous irritability. The other 
case, that of the mother, was also interesting be- 
cause of a long-continued pain in the eyes not 
attended by any material amount of inflammation. 
The patient was for a time under the care of Dr. 
Hasket Derby for this symptom, and T should judge 
that he considered it of the nature of simple asthen- 
opia, This view is perhaps strengthened by the 
fact that it recurred several times while the patient 
was away from home, though the tendency to it 
eventually passed nearly away. On the other hand, 
this also was one of the cases in which arsenic con- 
tinued to be found in the urine, for many months 
after the suspected papers had been removed, either 
because elimination was delayed, or because all the 
sources of poisoning were not found. The amount 
of arsenic found in the worst paper was twenty 
grains per square yard, but this paper was covered 
by another which was free from arsenic. A 
recurrence or outbreak of symptoms after re- 
moval from exposure is not an uncommon event 
in the history of arsenical poisoning from what- 
ever source. The characteristic paralyses, for 
example, sometimes appear days, weeks, and even 15 
months after a single large close, or a number of 
smaller doses, have been taken. 
Cases 10 to 15 were contributed by Dr. Driver, 
of Cambridge, and Prof. Sanger. 
Nos. 10 and 11 were two typical examples of the 
more usual form of poisoning, the symptoms con- 
sisting in impaired health for two years, then marked 
irritation of the eyes and throat, diarrhoea, and 
insomnia, all ending eventually in recovery. It is 
interesting that the urine of one of the patients, 
who stayed at home most of the time, contained 
twice as much arsenic as that of the other, her 
sister, who spent half of her time away, at work, 
the exposure being otherwise the same. The 
amounts were, respectively, 0.068, and 0.028 per 
litre. 
Case 12 was interesting from the fact that here, 
also, there were periodic attacks of gastralgia, 
occurring, this time, at night, but in addition, occa- 
sional outbreaks of colic and diarrhoea. Insomnia 
and debility were also present. There were no 
other especially characteristic symptoms. The 
urine contained 0.01 mg. per litre. 
In Case 13 arsenic was twice found in the urine, 
but it was difficult to say what symptoms, if any, 
were to be attributed to its influence. The case was 
one of severe and painful inflammation in the 
abdominal cavity, with constipation and loss of 
strength. It is, however, interesting to note that 
the only wall-paper was in the parlor. The family 
sat here a good deal, and it was so placed that the 
warm air, rising from this part of the house, could 
circulate freely through the chambers, which were 
not themselves papered. The parlor paper con- 
tained nine grains of arsenic to the square yard. 
The amount in the urine was, at the first analysis, 
0.016; at the second, just one month later, 0.002 
per litre. 16 
Case 14, the patient being a lady of fifty-eight, 
showed, besides the more common symptoms of 
impaired nutrition and digestion, numbness of the 
hands at times, and weakness in walking. In the 
presence of these symptoms it is fair to suspect 
that a searching physical examination of the mus- 
cles, and of the sensibility of the skin, might have 
justified a diagnosis of neuritis. Without that, 
the numbness of the hands at least can only be 
counted as a corroborative symptom. The source 
of the arsenic was not traced out, but the patient 
improved on leaving home, and relapsed on her 
return. The amount of arsenic in the urine was 
0.005 per litre. 
In Case 15 the patient suffered from “ epileptic 
vertigo,’5 which was not, however, attributed to the 
arsenic. She had also obscure digestive and nervous 
symptoms. The suspected paper was not removed, 
and the patient did not recover. The amount found 
in the urine was 0.005 per litre. 
In Case 16 a variety of serious symptoms were 
present referable to the nervous system and general 
nutrition, but Bright’s disease was present, and for 
this reason it would not have been thought worth 
while to report this case, but that it is a question 
to be investigated whether arsenic may not occasion- 
ally set up a chronic nephritis. The quantity found 
in the urine was also relatively large, 0.055 per litre. 
The source of the arsenic was not discovered. 
Case 17 was that of a school teacher, thirty-six 
years old, and in a rather nervous and debilitated 
state through her work, without, at first, any dis- 
tinctly characteristic signs of arsenic poisoning. 
During the summer months immediately following 
this period she spent more of her time out of doors, 
and also changed her room, and seemed on the high 
road to recovery. In Oct. she returned to her former 17 
room, and immediately her old symptoms came back, 
and she was obliged to keep her bed, suffering from 
ringing in the ears, sleeplessness, attacks of colic 
at night followed by diarrhoea, bad taste in the 
mouth, flatulent dyspepsia, irritation of the eyes 
and throat, and numbness of the hands. On account 
of the character of the symptoms, and because they 
became worse after the house was closed for a time, 
and the furnace lighted, arsenic was suspected and 
sought for. The paper in the room was found to 
contain only a trace, but a frieze twenty inches wide, 
and extending through three stories, gave fifteen 
grains to the square yard, and it was observed that 
the hallway formed a sort of shaft through which 
the heated air was conducted to the patient’s bed- 
room, which was protected only by a portiere, with 
an open space at the top. Furthermore, a small 
trunk-room, the door of which opened next to hers, 
and which was used, with its windows open, to ven- 
tilate her room, had an old paper, with border and 
figures of paris green. The urine contained 0.018 
mg. of arsenic to the litre. The paper has been 
removed, and the patient’s gastric symptoms and 
sleeplessness are much relieved, though she is still 
under treatment. 
Cases 18 and 19 were communicated by Dr. T. M. 
Rotch, and are of interest from the fact that one 
of the patients, a child’s nurse forty years of age 
was found to be suffering from a parenchymatous 
nephritis of very subacute character, at the same 
time that the other patient, the child himself, 
showed the general and mucous membrane symp- 
toms of arsenical poisoning, both illnesses being 
traceable, in all appearance, to a certain paper. The 
child was, later, attacked with scarlet fever, and 
was isolated with his nurse in another room. The 
fever ran its usual course, without complications, 18 
and the nurse rapidly recovered. The urine of both 
was found by Dr. Hills to contain arsenic before 
the removal, and none afterward. 
Cases 20 to 24 were contributed by Dr. Nichols, 
of Cambridge, the analyses having been made by 
Prof. Hill. In the hrst case, that of a girl ten 
years of age, there were, besides sore throat, cough, 
and general debility with anaemia, frequent attacks 
of feverishness, — a symptom spoken of in the early 
part of this paper, as of occasional occurrence and 
somewhat characteristic. The patient improved 
during an absence, relapsed on returning home, and 
eventually recovered. In the second case, that of a 
boy four years old, the symptoms were not espe- 
cially characteristic. The third case, or, rather, 
group of cases, was that of a mother and two chil- 
dren, live and four years old respectively. The 
symptoms were general in character, consisting in 
debility, indigestion, sore throat, cough, broken 
sleep. “ Several of the wall-papers were moder- 
ately arsenical. In the girl’s bedroom was a plain 
blue border about six inches wide, which contained 
nine grains of arsenic to the square yard.” 
There was marked improvement in the condition 
of the family after removal of the papers. 
In the fourth set of cases, also a whole family, 
the mother and two or more children, were involved. 
The symptoms concerned the digestion and mucous 
membranes of the eyes and throat; and, in addi- 
tion the mother suffered from palpitation and 
irregular action of the heart. Several papers were 
moderately arsenical, and that of the dining room 
contained more than ten grains to the square yard. 
Improvement began, in every case, on the removal 
of the papers. 
The facts of interest brought forward by these 
cases have for the most part been noted in passing. 19 
The analysis of the papers and urine were sug- 
gested as a rule either by prudence or remembrance 
of former experiences, or by the concurrence or 
unusual course of symptoms otherwise familiar; in 
a few cases by characteristic individual symptoms, 
the nature of the urinary sediment, profuse saliva- 
tion with glandular inflammation, neuritis, attacks 
of feverishness, but in some of the cases the con- 
spicuous absence of characteristic signs suggests that 
a routine examination might bring some interesting 
facts to light as to the frequency with which 
arsenic is absorbed under these conditions. In 
many cases, no doubt, it does no harm; in others it 
may only increase the general liability to disease. 
None of the reporters speak of the discoloration 
of the skin, nor of painful micturition, or distinctly 
periodic symptoms, except that nightly attacks of 
gastralgia were noted in Case 12, but possibly these 
symptoms were not sufficiently sought for. Notwith- 
standing the diagnostic value of a urine-analysis in 
suspected cases, it is not to be forgotten that a failure 
to find arsenic in this way is not apositive proof that 
it is not present in the body, since, as Taylor and 
others have shown, arsenic may be excreted only in- 
termittently by the kidneys, and even in acute fatal 
cases the urine has been found to be free. Kirchgasser 
(iloc. cit.) reports a case where, after a failure to find 
arsenic in the urine at the end of six weeks after 
cessation of the exposure, he waited two weeks 
more, and then collected ten pounds of faeces, and 
in this way obtained abundant evidence that arsenic 
was still being given off. 
Potassic iodide is supposed to favbr the excre- 
tion of arsenic by the kidneys, but if this is true it 
would seem that it must be by increasing the secre- 
tion only, for it is difficult to see on what other 
principle the drug should act, and perhaps for this 20 
purpose other drugs would answer as well or better. 
One other observation of Kirchgasser’s is worthy 
of note as concerning the differential diagnosis, 
namely, that he has seen an increase, instead of a 
falling off, of fat and weight, as a result of expos- 
ure to arsenical wall-papers, in the interval be- 
tween two outbreaks of symptoms. This result is 
well known to attend the use of arsenic in large 
but noil-poisonous doses. 
With regard to the electrical examinations of 
suspected cases. I would only say that the electrical 
reactions of neuritis are reported as usually dimin- 
ished to both currents, but sometimes normal, and 
sometimes even exaggerated. Of these changes, 
the exaggeration is probably temporary, though 
characteristic when present. The diminution to 
both currents is more common, but might easily 
escape attention unless carefully sought for, and it 
may precede any apparent loss of strength. With 
regard to the alleged finding of truly normal reac- 
tions in cases of neuritis where there is diminished 
motor power, I feel rather sceptical, and doubt 
whether the examination was made with sufficient 
care. The reactions in affections attended by even 
such slight disorders of the nutrition as cases of 
the so-called writer’s cramp present, are rarely 
normal, though they would no doubt be called so, 
if close study had not shown that slight changes in 
one direction or the other can almost invariably be 
detected. 
It will be interesting to investigate briefly, 
among these twenty-two cases where arsenic was 
found in the urine, for any facts of special interest 
as to the source from which it was derived. 
In three cases the whole or main source was ap- 
parently an arsenical paper covered in by another 
free from arsenic. This condition of affairs has 21 
now been reported too often to be attributed to 
coincidence. 
Kircligasser found it in several of his cases where 
arsenic was present in the urine. 
A layer of varnish, paper, or paint gives tempo- 
rary, though perhaps only relative, protection ; but 
cracks, erosion, and dampness soon seem to make 
this inadequate, especially, no doubt, if the quan- 
tity in the underlying paper is large, as in Dr. 
Comey’s case, where it amounted to fifteen grains 
per square yard. 
Arsenical friezes seem to have been dangerous 
neighbors in two cases. In more than half the cases 
the arsenical paper was wholly or mainly in bed- 
rooms. In two cases the worst paper was not that 
of the bedroom, and in one it was in a spare room 
but little used by the family, though its door was 
open and it was included in the spring cleaning, at 
which time there was exacerbation of symptoms. 
In Dr. Torrey’s case not only the papers, but a 
dress and a number of fabrics, were found to con- 
tain arsenic. 
Finally , I desire to present a few facts tending to 
show that under certain as yet undetermined con- 
ditions the elimination of arsenic may not go on 
so rapidly as is usually the case. If this is true, 
it may explain the occasional delay in the outbreak 
of symptoms. 
The time usually considered sufficient for the 
complete elimination of arsenic is twelve to twenty 
days, but some chemists place the extreme limit, in 
the case of man, at six weeks, and traces have been 
found in the tissues of animals after forty days. 
The subject seems to me of so much importance, 
with relation to the occasional late appearance and 
long continuance of certain symptoms of poisoning, 
that I venture to offer a few facts to show that 
elimination may sometimes be delayed. 22 
Even Taylor (“ On Poisons”), while asserting the 
general principle of rapid elimination, admits by 
inference that the process may be delayed if the 
eliminating organs are working as they should. 
1. Two cases have already been reported (Cases 
6 and 8) where the elimination was apparently 
going on for seven to nine months after cessation 
of the exposure, though it must be admitted that 
this class of cases is not suitable for conclusively 
settling such a point. The steady improvement 
and eventual recovery of the patient seemed to 
indicate that the real cause had been fonnd, but it 
is possible that absorption went on for a time from 
the accumulations in the air of the house, or in the 
form of dust. 
2. A similar case to these, with elimination con- 
tinning for three months, is given by Kjellberg.3 
3. A case of poisoning from medicinal doses is 
cited in a paper previously published by myself,4 
where the arsenic did not disappear from the urine 
for nearly fifty days. 
4. A case is reported above (Kirchgasser) showing 
that the faeces may contain arsenic after elimina- 
tion by the kidney has ceased. 
5. The most important case is one given by Gibb 
in the Transactions of the Pathological Society of 
London,5 where traces of arsenic were found in the 
liver and bones six months after cessation of a long 
course of medicinal treatment which had led to 
paralysis and eventually to death. 
One reason, perhaps, that it has been so strongly 
asserted that arsenic does not accumulate is that 
it has been supposed that arsenic did not form 
definite compounds with the albuminoid tissues of 
sHygeia, 1S81, cited in Virchow, and Hirsch’s J. her., 1S82, i. 398. 
4 Boston IVted. and Snrg. Join-., 1888, vol. ii. p. 1. 
s See the Boston Med. and Surg. Jour., 1888, ii. p. 1. 23 
the body. This view is, however, disproved by the 
recent experiments of Dogiel, the last series of 
which are reported in the Transactions of the In* 
ternational Congress at Copenhagen in 1884. 
CUPPLES & HURD, THE ALGONQUIN PRESS, BOSTON.