AMER~CAN MEDIClNE
40 JANUARY, 1929,
pot roast and a muslin nightshirt will ac-
complish the same lifesaving functions.
Why should the people who cannot or
will not pay for the most expert and valu-
able professional services feel that ~hey
have a right to demand them, "without
money and without price," direct from the
overworked doctor, when something less
expensive would, in most instances, meet
their needs equally well and can, as a rule,
be obtained thru the same channels as other
charity service.
Chronic Poisoning by an Irritant Contained in Cooking
Utensils and Tap Water
BY
LElO SPIRA, M.D.,· M.RiC.S. (Elng.), I.R.C.P. (Lon.), L.M.S.S.A. (Lon.)
London, Eng.
In a previous article entitled "Some Skin
Manifestations and Their Relation to the
Disturbance of the Gastrointestinal Tract"
(AMERICAN MEDICINE, November, 1928)
it was shown that such dermatoses as
cheiropompholyx, dysidrosis, dhqbie itch,
dermatitis herpetiformis, baker's itch, etc.,
are conditions which have a close relation-
ship with disturbances of the alimentary
tract. The gastrointestinaL symptoms' are
the primary, the skin affections the second-
ary manifestations ot poisoning by an irri-
tant which finds its way ~nto the body by
the tnouth it), the fi17st irIstance. Treatment
,of the gastrointestinal tract by an effective
~bsorbent (e.g.) charcoal), followed by an
aperient and at the smile time cutting off
the source of poison results invariably in
the disappearance 6f all the sy~p~oms, in-
dudingthe derrnatoses. It was klso shown
that the irritant was· contained', in cooking
utensils and' tap 'water and the conclusion
was; therefore, drawn that if must be a:
Oh, there is plenty of nutritious food for
thought in this question of whether we will
!cow-tow to a string of supercilious "pa.
trons" who condescendingly slip us a
"gratuity" or "honorarium," now and then,
out of the goodness of their hearts; or stand
up like honest, square-dealing busi~ess men
and prepare to sell our "customers" good
"goods," at fair prices, and frankly discuss
and demand our pay for them, promptly
and in full.
14th and Sheridan Road. , II
a
tl
metallic constituent of the alloy of which
the cheap cooking utensils and water pipes
were made. This conclusion was strength-
ened by the fact that lead was found in the
excreta of many, and tin in those of a few
of the patients suffering from the symptom
complex. No suggestion was made that all
the symptoms could be attributed to the
action of lead, there being no evidence that
this metal ever produces any changes in the
skin. It may, however, be reasonably sug-
gested that constipation, which is the out-
standing symptom, so prevqlent among the
English population is caused by it. Stress
was' also laid 011 the fact that in producing
the symptom complex another chemical
factor besides lead plays an important part.
This factor in its action is closely similar
to arsenic and belongs probably to the
arsenic group of metals. Arsenic itself was
looked for but not found in .some of the
cases' which were under discussion. There
is In'the whole. complex one symptom only
 AMERICAN MEorcrNE .oRIGINAL ARTICLES
which makes an exception to the recognized
disturbances produced by arsenic, i.e.) con-
:stipation. In this respect the action of the
substance similar to arsenic might be com-
lllicated by that of lead, or else it may be
that the action of the irritant contained in
tap water is specific and produces symp-
toms common to both lead and arsenic.
In the previous article only a few out-
standing symptoms affecting the gastroin-
testinal tract were Inentioned and it was
shown that they improved rapidly with
charcoal and an aperient. It is proposed
first to discuss all the symptoms as they
have been observed to occur in patients in
this country during the last six years. They
affect the popUlation in much graver degree
than on the Continent. In fact it has been
observed that those patients who left Eng-
land temporarily to live abroad improved in
health rapidly even without any medical at-
tention and on the other hand people with
previous perfect health ,who came to live in
London complained of bad health a few
months or even weeks after their arrival in
this country.
The first obvious change presented on ex-
amination concerns the condition of the
l11outh. The tongue loses the natural aspect
of a flesh-colored moist smooth surface
with the papillre foliatre only slightly ele-
vated. 'There appears a thick white or dirty
grey fur, and the papillre foliatre become
vividly red and enlarged. The patients at-
tribute this condition of the tongue at first
to a slight attack of indigestion caused some
time previously by some article of food.
The changed appearance of the tongue per-
sists and different methods 'of treatment,
dietetic as well as mechanical, fail to re-
move the fur. The only method which
temporarily restores the normal aspect ap-
pears to be scraping the surface of the
tongue with a soft tooth brush dipped in
JANUARY, 1929 41
bicarbonate of soda. Its action seems to
be rather chemically neutralizing than me-
chanical. Scraping the tongue with a denti-
frice contatntng magnesium carbonate
makes the fur appear more pronounced.
Later on, in much advanced cases, deep
fissures appear on the surface and constitute
the condition of superficial glossitis. The
tongue becomes indented by the teeth, raw
and excoriated.
In acute exacerbations the whole mucous
membrane of the mouth is involved and
presents the complete picture of stomatitis.
Herpetic ulcers develop and the gums ap-
pear red and swollen with pus collecting
under them and thus a condition of severe
gingivitis closely similar to, if not identical
with, alveolar pyorrhea is established.
In the meantime the initial gastroin-
testinal symptoms, first overlooked or
attributed to some acute attack of indiges-
tion or "gastric flu," are progressing
steadily towards a chronic conditi~n in spite
of careful dieting. Tqe appetite is consid-
erably impaired or entirely lost and there is
retching during or after meals, with, in
some cases, a distressing hiccough. Attacks
of nausea set in ftnd in more advanced
stages also vomiting of every kind of food
soon after taking it. Severe flatulence is
invariably present combined with co1,icky
pain and it assumes sometimes such propor-
tions as to suggest the possibility of an
"acute abdomen." Constipation makes the
patient a victim to ever-increasi~g doses of
an aperient. All these symptoms persist in
spite of a most carefully composed diet.
A most illustrative Case of this kind is
the following: A middle-aged woman
complained of the typical symptom complex
in a rather serious degree. The condition
of the patient became steadily worse in
spite of treatment directed against different
symptoms dominating the picture in a man-
 42 JANUARY, 1929 ORIGINAL "oA.RTICLES
ner varying in intensity at different times
and she was recommended to have a few
teeth extracted with a view to checking the
absorption of toxins ascribed to the severe
pyorrhea and general stomatitis. Her face
assumed a distinctly mask-like expression
and she complained of" having lost all sensa-
tion in the nose and mouth. The orbicu-
laris oris muscle was paralyzed and the lips
could hardly be separated voluntarily. In
spite of extraction of some teeth the gen-
eral condition of the patient, as well as that
'Of the mouth, got worse and energetic treat-
ment on the lines indicated against the sys-
temic poisoning, i. e.) charcoal, aperient and
cutting off the source of poison was com-
menced. This resulted in the most striking
disappearance of all the symptoms includ-
ing the pyorrhea and muscular paralysis
within a fortnight.
Pyorrhea then appears to be, quite in ac-
cordance with the theory of many writers,
only one of the manifestations of a systemic
poisoning originating in the gastrointestinal
tract and the infection caused by spirochete
and other organisms found sometimes in
the pus under the gums is of a secondary
nature. Only in this way can the fact be
explained that the appearance of this affec-
tion among patients on the Continent within
relatively recent times seems to coincide
with the introduction of cheap aluminum
utensils into the households, whereas the
poison contained in these and in tap water
causes the teeth of the English population
t'O be proverbially bad. A patient with
previous perfect health while living on the
Continent, suffered from gastrointestinal
symptoms, rashes and pyorrhea within a
stay of only six months in London. Cases
are known in which death was attributed to
t'Oxic absorption from decayed teeth and
pyorrhea.
AMERICAN MEDICINE
Generalized pruritus, often more serious
locally in many cases in such parts of the
body as the perianal region, scrotum, VUlva
and under the breasts, bouts of urticaria
and herpetiform eruptions appear after
meals and are obviously of gastrointestinal
origin.
The condition is frequently accompanied
by raised temperature quite in accordance
with the well-known fact that poisoning by
a metal of the arsenic group produces a
febrile gastroenteritis.
Further investigations might show
whether some of the organic lesions of the
alimentary tract can be produced by the
irritant in question. It is a well-established
fact that in the etiology of diver.ticulitis for
example, to which much attention has been
drawn of late, apart from mechanical and
bacterial causes, a chronic poisoning by a
chemical substance (e.g., merc1:1ry) appears
to be an important factor. It is certainly a
striking feature that diverticultis seems to
be 011 the increase.
There is clinical evidence to show that
the poison contained in cheap cooking uten~
sils and tap water is readily absorbed from
the gastrointestinal tract into the .general
circulation. Pruritus and the various
dermatoses caused in this way were de~
scribed fully in the previous article. The
absorption of the irritant also gives rise to
catarrh of mucous membranes producing
conjunctivitis, frequent attacks of "C0l111n'On
cold" with pharyngitis, bouts of frequent
vehement sneezing and intense itching in
the nose. It was observed in many cases
that administration of charcoal for relief
of the gastrointestinal symptoms improved
at the same time th'Ose of the "C0l1ll110n
cold."
Apart from the cutaneous lesions de-
scribed in the previous article keratosis of
the.palmsand soles and so-called "chil-
 AMERICAN MEDICINE ORIGINAL ARTICLES
blains" on the fingers and "soft corns" be-
tween the toes are met. with quite frequently.
From the fact that in several cases death
was attributed to a chronic disease of the
skin, e.g., baker's itch, it must be con-
cluded that such dermatoses are only the
external manifestation of a systemic dis-
ease of a most serious nature. The finger
nails become brittle, lose their luster and
appear opaque while longitudinal striation
in various degrees is usually present. The
brittleness and striation of the finger nails
disappear during the period in which the
patients adhere strictly to the prescribed
regime but recur when this is omitted. The
hair frequently falls out in these cases.
It is evident that the irritant being ab-
sorbed into the general circulation must
necessarily do considerable damage to the
kidneys. Albuminuria with the presence of
red blood cells in the urine is quite a com-
mon occmrence in the symptom complex.
It was shown that besides lead present in
several cases the existence of another irri-
tant plays the more important part in pro-
ducing symptoms. It is, therefore, not sur-
prising to find low blood-pressure much
more often than high blood-pressure in
these cases and this is an expression of
myocardial degeneration resulting from
prolonged action of this other irritant. A
systolic blood-pressure of between 80 and
110 m111. Hg. is in my experience a very
common occurrence in this country among
middle-aged and even older patients.
Giddiness and excessive perspiration
were observed in many cases and anemia is
a regular occurrence.
Such is the picture of poisoning after it
has lasted for years. Very frequently the
patients give a history of having suffered
from stomach trouble since childhood,
"cramps" and constipation being the chief
complaint which they can remember.
JANUARY, 1929 43
Since the poison has been found to be
contained in tap water, it would be reason-
ably expected that every person living in
London would be affected and probably
even in the whole country as the water
supply is nearly everywhere uniform and
conveyed by the same means. As a matter
of fact it was sho:wn that a very large pro-
portion of the popUlation in this country is
suffering from gastrointestinal symptoms;
the remainder who apparently do not com-
plain of any obvious disease may be com-
pared to those "arsenic eaters" who having
got used to the poison taken in minute doses
since childhood are not affected e:ven by big
doses accumulated in the body.
One case observed in this country appears
to be of considerable interest. A woman,
aged 26, who had always been in perfect
health while living on the Continent and
for a few years in ~ondon, had two normal
confinements but began to suffer eight days
before termination of her third pregnancy
from a "cold" with sneezing cough and
headache. Later her only complaint was
intense headache with a normal tempera-
ture. By the next day she began to be
comatose with severe acetonnria, a small
amount of albumen in urine, a fair number
of hyaline and granular casts with a few
blood fells and some reducing substance
which was not glucose. Toxemia of preg-
nancy was diagnosed and Cresarean section
performed. The patient died the next day
from paralysis of respiratory center, the
temperature rising to about 105 0 before
death. Subsequent laboratory investiga-
tions of a preserved sample of her urine re-
vealed the presence of lead but 110 arsenic.
The child born by Cresarean section
showed two days after birth twitching of
the right wrist and round the eyes and
mouth. The temperature was 103.6°.
Meconium was hard and urine contained
 44 .T,\NUARY, 1929 ORIGINAL ARTICLES AMERICAN MEDICIl-lll

traces of albumen and minute but definite the irritant contained in water is not of
trace of lead. On the fourth day a rash mineral rather than metallic nature. That
appeared first on the forehead consisting this disease is caused by water becomes evi-
partly of papules but mostly of vesicles dent when the "enema rash" is kept in
which spread not very markedly over trunk mind, an exanthem produced by the appli-
and on to the sides of the fingers. Peeling cation of a simple enema of tap water with-
also commenced. Slight rectal hemorrhage out the addition of any irritating substance.
occurred. Treatment co~sisted of the ad- It appears within 24 hours from the appli-
ministration of Magn. sulph. and the child cation of the enema first on the legs and
recovered after a few weeks sufficiently well arms spreading rapidly all over the body as
to be taken abroad where it has enjoyed a rash which causes severe pruritus and is
perfect health for the last three years. of a pink color not unlike that of measles.
It will be well to examine now the ques- The symptom complex does not result
tion how far animals are affected by the from the taking in of the poison by the
irritant. While thoro investigation must mouth for a 'period extending only over
be left to veterinary surgeons, a disease days or weeks. It runs a chronic course
~ay be mentioned which affects dogs and from the beginning, only minute traces of
roani fests itself in formation of abscesses the poison being taken daily, not sufficient
between the toes. It should also be remem- to' produce an acute intoxication. After a
bered that dogs, including those which are sufficiently long time the cumulative action
kept clean, are frequevtly found to lick of the irritant produces the well-established
their paws and other parts apparently be- chronic condition with acute exacerbations
·cause they itch. This leads one strongly to of the poisoning, the outcome of which de-
"Suppose that dogs too suffer from this
pends on the rapidity and energy applied to
symptom identical with dhobie itch, etc., in the elimination of the poison. The appear-
human beings as one of the several mani- ance of the different symptoms is then
festations of the poisoning. .
merely a question of degree and is regu-
To what degree cattle are afflicted with lated by intake of, and elimination of the
alimentary trouble was revealed by statistics poison from, the body.
'showing that 75 per cent. of the total veteri-
The opinion has been frequently expressed
nary bills of· farmers in Bedfordsh,ire are
that the dertX!atoses and especially the
attributable to indigestion of cows. j t was
pruritis get more pronounced at night be-
oObserved that the condition of patients suf-
cause of the warmth produced by the
fering from the different· dermatoses under
blankets in bed. It certainly has often
·discussion and gastrointestinal symptoms
been observed that besides pruritus several
were aggravated among others by consump-
of the other syinptoms show in a more
tion of meat, especially the fat parts of it.
marked degree at night, e.g.} flatulence,
This is apparently the cause of the derma-
colicky pain, twitching of the legs, etc., and
toses being sometimes attributed to con-
'sumption of bacon. this fact must be rather attributed to the
main meal being taken in .the evening, which
Should further investigations in the
is the direct cause of these symptoms.
direction indicated show that the affections
Whereas dhobie itch is at its height in the
of both human beings and animals a.re iden-
tical then the question will arise whether late night hours the condition of the eczema
on the hands (cheiropompholyx) appears
 AMERICAN MEDICINE ORIGINAL ARTICLES
fully developed early in the morning, being
in direct relation to the main meal taken
the previous evening.
It is a known fact that the urine of pa-
tients suffering from chronic arsenical
. .,
pOlsonlllg may contam. sugar. Tl .
. le lmpor-
tance of the regularity with which a slight
reduction of Fehling's solution occurs in
patients suffering from the symptom com-
plex is obvious. It led in several cases to a
hasty cliagnosis of diabetes with which it
certainly has some common features. The
reduction, however, disappears with treat-
ment directed against the poisoning but is
not influenced by regulating the carbohy-
drate metabolism. In the investigations
Pasteur and His Discoveries
BY
CHARLES O'GRADY, B.Sc., M.D.
Cbarleston, W. Va.
Louis Pasteur was bom at Dole, Decem-
ber 27. 1822. He was the son of Jean
Joseph Pasteur and Jeanne ROCl4i, and was
the third child born to them. Pasteur's
father had been a soldier under the Emperor
Napoleon, and served three years in the
Third Regiment and was finally promoted
to Sergeant Major and made a Knight of
the Legion of Honor,
A fter his discharge from the army came,
on the return of the Royalists to power, he
settled down to follow his former trade,
which was that of tanner. In a short time
he moved his family to the town of Arbois,
In this town was where Louis Pasteur grew
to manhood, and where he received his first
schooling. He was sent to the primary
school attached to Arbois College, and later,
when attending the regular classes in col-
lege, was known as a good, average pupil.
JANUARY, 1929
care was taken to exclude those who were
suffering from true diabetes.
The pathologic condition with the several
symptoms as described in this and the previ-
0us article was observed on patients in daily
practice. Several important examinations,
physiologic and chemical, could obviously
in these circumstances not be performed.
Whereas it is belie:ved that the description
of the symptom complex is complete from a
clinical point of view, it remains to find out
the exact nature of the irritant in question
contained in tap water and cheap aluminulU
utensils. It is evident that this can only be
ascertained by close cooperation of the
clinician and toxicologist.
He was able to take several prizes without
much difficulty.
He had one friend in Arbois College,
Prof. Romanet, who had a decisive influ-
ence on the mind and heart of Pasteur.
Remanet was first to, discover the hidden
spark in his pupil. He saw that he worked
hard and carefully-so carefully that he
was considered slow, and tMt he never
made a statement unless sure of it, altho
he had a vivid imagination.
This care and caution in Pasteur was a
characteristic. of him thrtt liie, and was the
reason of his friend's belief that he would
succeed at anything he tried. Prof. Ronianet
inspired him with the idea of entering the
Ecole Normale in Paris. Pasteur's first
trip to Paris, when he was fifteen, was not
to last long as he had to return home after
two months from homesickness.