« السابقةمتابعة »
The following letter gives the history of the case :
GREENFIELD, N. H., Feb. 11, 1889. DEAR SIR, – The case of George Burnham is as follows: In the summer of 84 he came to me with partial paralysis of one arm, complaining of numbness and loss of power in it. I treated him several weeks, and then he recovered. The next time I knew of him he had an attack in the summer of '85 much like bilious colic, which lasted a week or more. I had no occasion to treat him again till this winter. He has been poorly ever since fall; loss of appetite and vomiting were the symptoms. I was not called to treat him till the first day of January, when I found these symptoms : Great pain, not confined to any one locality, but centering mostly in the back over kidneys, in right side over liver, and over stomach ; the pain tearing in character, nearly constant, and could only be controlled by hypodermic injections of 4 to 36 grain morphine three or four times in twenty-four hours; loss of appetite, with spitting up of food; tenderness over liver, elicited by deep pressure over gall bladder; tongue moist and slimy, the teeth making furrows along it when protruded ; temperature normal; pulse 70, full and strong ; face, haggard and anxious. These symptoms had gradually developed. I suspected the case to be one of lead poisoning. .... Meanwhile the symptoms continued without much change till the 2oth, when the pain subsided and the tongue improved for about a week, when the pain came on again, and the tongue resumed its former appearance. (I forgot to say that the tongue, when he was at the worst, was distinctly black over nearly the entire surface.) The relapse lasted seven or eight days, since which he has been gaining in every particular. The examination of his urine showed it highly acid with sp. gr. 1.026, and so crowded with muriates that it was impossible to make out anything else. A second examination about a week ago gave the same results.
Dr. Prescott, of Nashua, saw the case with me at that time, and our diagnosis was blood poisoning from use of impure water. Anything bearing upon the case you might be able to suggest, would be thankfully received.
Yours very truly,
N. F. CHEEVER, M. D.
SANITARY ANALYSIS OF WATER FOR M. F. SMITH, M. D., HAMP
TON, N. H., JULY 8, 1889. Odor, little ; color, slight yellowish tint; evaporation, quiet ; residue, uniform and nearly white; it blackens some on ignition ; total solids, 6.7; loss on ignition, 1.5; hardness, 3.5 degrees; alkalinity, 1.0; chlorine, .9; free ammonia, .368; albuminoid ammonia, .052; nitric acid, much ; little nitrous acid ; lead, trace, about .o1 grain per gallon; iron, .05; sediment, too much ; infusoria ; bacteria.
Opinion : This water is polluted by vault or drain. Excess of free ammonia indicates urea.
Dr. Smith gave the following information :
The patient drinking the water had symptoms of lead poisoning but not well marked ; and with these, symptoms of some form of rheumatism, which would yield to treatment for a time, and then return again, and so on. The family commenced using this water about four years ago, and for the last three years have had more or less trouble as mentioned above. The horse they had when they moved upon the place seemed to be sound; in about one year it became lame in the fore legs, weak in the knees. They sold him, and in a short time he recovered from the trouble and seemed all right. They now have a young horse that is in just the same condition. The gentleman says : “ The horse seems to appear with his fore legs as my legs feel."
The well is in the cellar, and lead pipe connects it with the house and the stable.
PARTIAL ANALYSIS OF WATER FOR J. 0. DUTRIZAC, M. D., LACO
NIA, AUGUST 19, 1889. Odorless; colorless; evaporation, quiet; residue, uniform and white; residue darkens little on ignition ; chlorine, 3.6; free ammonia, .192; albuminoid ammonia, .078; nitric acid, 7.28; nitrous acid, trace; sediment, some; no lead; infusoria and disintegrated matter. Opinion : This is polluted water. Dr. Dutrizac furnished this information :
The family using this water live on high land. The houses in the neighborhood are not very close together, perhaps 150 feet apart. The well is on a level with the house, about 70 feet from the privy and 50 feet from sink drain Every member of the family has been feeling unwell for a year or two. Two years ago they were very sick, and attributed their sickness to lead poisoning from lead pipe in the water; but to-day there is no lead pipe in the water. I think their sickness was caused by the water alone. Their symptoms are frequent headache, chills, pain in all their limbs, no appetite, no energy, and general weakness.
PARTIAL ANALYSIS OF WATER FOR F. W. JONES, M. D., NEW IPS
WICH, N. H., MARCH 7, 1887. Odor, slightly foul; color, milky and turbid; residue on ignition emits an
minoid ammonia, -31 ; nitric acid, in excess; no nitrous acid ; iron, .1; sedi. ment, too much ; water swarms with bacteria ; infusoria ; scolecida ; cyclops quadricor nis; no lead. Opinion : This water is horribly polluted.
The location and history are as follows:
The well is situated on the side of a hill. The nearest privy is 15 feet distant; another is 100 feet distant. The vaults are not cemented. Sink drain
discharges upon the ground 100 feet away. Water is conveyed in lead pipe about 200 feet long. The family consists of four persons; they are more or less ill all the time; they suffer with headache and sore throat, diphtheria in one case, rheumatism, skin diseases, irregularity of bowels in every case ; 'more or less general debility in all the cases. The kidneys and bladder have been more or less affected in every member of the family, which was first noticed about two years ago in the oldest member. The children and mother were away from home several weeks during the past summer, and the health of all improved ; but the former symptoms returned after they had been at home a short time.
It is, certainly, impossible to tell how small a quantity of lead might affect some constitutions, especially under certain conditions of vitality. Without doubt, a person weakened by drinking organically impure water is more readily affected by a small quantity of lead. But it seems from the cases described that there may be great liability to confusion between the effects of water polluted with organic matter and lead poisoning. It may be that in some instances where but a trace of lead, or none, was found on analysis, that the patients were, nevertheless, lead poisoned. They may have drunk water which had remained for some time in the pipe. Frequently such water contains much lead, when water taken directly from the well contains none.
A very singular and interesting case of blood poisoning from use of polluted water occurred recently in the practice of Dr. M. T. Stone, Troy, N. H. The results of the analysis of the water are as follows:
Odor, not marked; color, little yellowish and turbid; evaporation, little foamy; residue, little yellowish and few circles, it blackens on ignition ; chlorine, .4; free ammonia, .005; albuminoid ammonia, .242; nitric acid, .208; no nitrous acid ; no lead; little sediment; bacteria ; infusoria; tissue ; cells ; suspicious looking matter.
Opinion : This water is badly polluted and wholly unfit for drinking purposes.
Dr. Stone gave the following history of the case : Elrose B., aged five years, had been in good health until I was called to see him, when I found him slightly indisposed from what I thought to be indigestion and I prescribed accordingly, expecting he would be all right in a few days, but instead he seemed to be getting worse, with the following symptoms : loss of appetite, complaint of bad feeling in the head or headache all the time, nausea but no vomiting, constipation with clay-colored stools and very irritable, no elevation of temperature, and pulse about 100. These symptoms continued for some time, when he began to have profuse perspiration, with the hands, arms,
feet, and legs cold and clammy, with the irritability increased, and loss of sleep and restlessness.
At this time there appeared an eruption around the finger-nails, less around the toe-nails, of watery blisters, and soon upon the body, mostly upon the back, a vesicular or papular eruption, quite profuse, which soon spread to the legs and feet, and which added to the irritability on account of the itching which accompanied it. This eruption I decided must be a form of erythema multiforme. Soon there appeared upon the ends of the fingers and toes and palms of the hands white patches the size of a split pea and larger, which looked to be filled with matter, but on opening none would be found; they were dead skin, which gradually peeled off. During this time, the bowels remained constipated and there was no elevation of temperature, or but slight, and not continuous, neither was it below normal; still complained of nausea, but had no vomiting, the great cause of discomfort being the itching. The pulse had gradually increased in frequency until it was 160 per minute. The patient was still dressed and was about the house, being up and down.
Counsel was called, and it was the opinion that the patient was suffering from intestinal indigestion, and he was put upon a liberal course of easily assimilated nourishment. He had a slight fever at this time which lasted about a week, the temperature rising only a degree or a degree and a half, during which time the eruption disappeared, the pulse went down to 135, bowels moved freely but no diarrhea, the hands and feet regained their natural warmth, and there was a desire for food. There was a gradual improvement in all the symptoms but the irritability and restlessness. The symptoms indicated that something was causing a debilitated condition of the blood, or blood-poisoning, but the water supply as its source had not been given thought enough to cause particular inquiry, because we expected to find some form of fever or diarrheal disorder as a manifestation, but here we had no diarrhea, but constipation; no fever, neither did the temperature go below normal; no vomiting, but great irritability, and an erythematous eruption.
The improvement continued for a week, when the old symptoms returned, greatly aggravated. The hands and feet again became cold and clammy, and the body covered with a profuse perspiration ; the eruption appeared more profuse than before and this time upon the neck and face, and the pulse 160 to 170 per minute.
No cause having been found, I thought it must be the water, and on inquiry learned that the well was in the cellar, and that the privy was formerly less than twenty feet distant, that it was moved last spring, and that the sink-drain emptied on to the ground some eight or ten feet from the house, and gave orders to have the water from the well excluded from everything given the patient, and sent a sample for analysis, which showed the water to be polluted and unfit for use. Then the cause for the relapse became evident. While he was taking the large quantities of liquid nourishment, he received the water but little and that diluted, and the poison had been somewhat eliminated, and hence the improvement; during the week of improvement, he drank more water and therefore
received a new dose of poison. At the present time the symptoms are abating and he bids fair to recover. The illness at the present time has extended over a period of nearly three months. A sister of the patient next younger had whooping-cough quite severely in the winter, and during the spring and summer has had a cough, and persistent and frequent attacks of vomiting, which were supposed to be after effects of the whooping-cough, but I now believe them to have been caused by the polluted water, for within a few days she has commenced to have an eruption on the hands, arms, and body. One or two other members of the family have had slight diarrhea during the summer.
I have been in practice here ten years, and this house has been occupied by different families all the time, and I don't recall ever having any case of serious illness there before. This family, consisting of father, mother, and five children, have lived there three years and have had more or less slight ailments. The family remarked that never before had they known the water to be in the cellar as much as this year, as the well had overflowed and covered the cellar bottom several times. No doubt the large amount of rainfall during the season had caused a larger amount of the decaying matter from the surface to be carried into the cellar, besides leaching the ground more thoroughly.
The following diagram will illustrate the situation :
The slope of the ground was from the privy towards the house.