Paraffinum

Volume IV — Appendix

PARAFFINUM.

A tasteless, inodorous, fatty matter, resisting action of acids and alkalti by dry distillation of wood, peat, petroleum, &c. (It is probable that pa medicinal purposes, identical with petroleum, and that its effects may indications for that drug. We have thought it better, however, to pi9 separately. — Eos.)

I. I. In the Horn. Recorder of Sept,, 1890, there is " pathogenesis " of P. from the pen of the late Dr. Wahle. dubious features of all documents of the kind from this soi can only be indicated here. — Eds.

II. I. a. Mrs. A. M — , act, 36, came to the Royal In 9.55 a.m. on March 15th, 1890. She stated that she hi drinking for a fortnight, and that that m., while still not the sober, she had intentionally drunk a good half-cupful of pa The time could not be accurately ascertained, as her clock h but it seems to have been before 6 a.m. After about \ h. h she began to suffer pain and to vomit ; she vomited twice a mouthful or two at a time, and on the first occasion 8 there was more than a tablespoonful of blood in the vomited (During the previous week she had had several attacks of « due to drinking, but no hxmatemesis and no pain.) The pain { rapidly, and became so bad that she thought she was going 01 mind. On admission her hands and tongue were very trcmul tongue was distinctly red and glazed-looking at the tip and e« the dorsum covered with a thick white fur. The r. pupil w what dilated, the 1. normal ; both reacted rather sluggishly She complained of pain in the pit of her stomach. Temp. ( pulse 120. One tenth of a grain of apomorphine was given n mically, and 6 ni. later she vomited about 6 oz. of matter which a strong odour of paraffin. It consisted almost entirely of yell floating in a golden-yellow fluid. She then drank a large water, and thereafter the dose of apomorphine was repeated ; she vomited material similar to the last, but diluted with t just swallowed. There was no blood on either occasion. Abo

inc ad]

"i

(laK.y she passed a scanty stool, consisting almost entirely of red blood.

H[er menstrual period had ceased normally almost a week before, but

there occurred a slight return of the flow that d. At i she was

ordered a simple warm water enema (a pint and a half), to be repeated

^ftcr an houi^s time. On each occasion the enema brought away a

*Kool having an intense odour of paraffin, but containing no blood. She

Passed 12 oz. of urine, which also had a very marked odour of paraffin ;

^y sftliowtng the urine to stand. the paraffin was rendered visible, floating

** _9, thick scum on the surface. At 7 she complained of abdominal

P^>n. Another warm-water enema was given, and brought away a

**^oo] without any blood ; the odour of paraffin was present to a less

"^^•-ee than before. Shortly after this she passed 40 oz. of turbid

*"~irm«, lighter in colour, but with a marked odour of paraffin. The

^**»p. at 4 p.m. had been 1002'*, but at 8 p.m. it was a degree lower.

^^*~^ Charles Arthur, the dispenser to the Royal Infirmary, kindly

"f^^i^rtook to distil 10 oz. of the first sample of the urine, and 10 oz.

^* It: lie second. As the result of distillation and redistillation about

^ <^..«. of pure paraffin were collected ; and Mr. Arthur estimated that

^^ l-^sast an equal quantity was lost in the process, owing to the want of

L*^^i.ciently delicate apparatus. The two samples were kept separate

|;**~ing the first distillation, and it was found that the first contained

^^*^^«jt twice as much paraffin as the second } thus a total of at least

-S ^.c. of paraffin must have been excreted by the kidneys.

^^ S. At 9 the patient was found lying with her knees drawn up,

z'^"**\plaining of severe burning pain, chiefly at epigastrium. There was

^^^rked tenderness on pressure over that region, and over the 1. lumbar

_^^^on ; she said her abdomen was swollen, but it was not at all

^^^tioeably so. She was still vomiting occasionally, but no odour of

v^Taffin could be detected in the small amount of mucus which was

•^ ^^ought up. She could extend her legs, but said that she had less pain

*< ^"^hen they were drawn up. The exacerbations of pain produced a

\ ^^rked increase in the tremors of her hands. On taking the bedclothes

^ffher abdomen to examine it, there was a distinct though not strong

^our of paraffin from the skin. Her breath emitted a strong odour of

|>araffin. At 10.15 t^^ abdominal tenderness was more general and

more marked, so fomentations were ordered every two hours, and she

was fed with warm milk given frequently in quantities of an ounce at

a time. She had just been vomiting. At 3 a.m. on the i6th the

abdominal tenderness was less, though she was still lying with her

knees drawn up to diminish the pain. The odour of paraffin from the

breath was not so strong. She had not slept at all, and occasionally

imagined she saw cats in the room. She said, however, that she had

not slept the previous n. either. She was still vomiting now and then,

so 15 gr. of subnitrate of bismuth were given, which checked the.'vomiting

for a time. At 5 a.m. she passed 8 oz. of urine with a trace of paraffin

• odour, and a slight ** greasiness " on the surface after standing. When

she was seen at 11 the pain and tenderness in her abdomen were much

less in degree, and had changed in character. The pain had become

griping, and was situated near the umbilicus. The tenderness was in

the r. iliac fossa and lumbar region. She had not vomited since 8 a.m..

and did not vomit again. Her breath, but not her skin, still odour of paraffin. Temp. 99'^°, pulse i lo. About ^ h, later $ passed 3 oz. of dark red urine, containing both blood and albun copiously. In the afternoon the pain was much easier. She paa ^ oz. of dark crimson urine, which gave a marked reaction with tincC of guaiacumjand contained ^ gr. of albumen and 12J gr, of urea pen At 1 1 that n. she was sleeping quietly ; her breath still emitted odour of paraffin. By midnight her temperature was normal, an( did nut rise much above normal again. Half an h. after midni (March tyth) she passed 6 oz. of ruddy, amber-coloured urine, wh gave a slight reaction with guaiacum, and contained a trace of albua and 17 gr. of urea per oz. Shortly after midday she passed 10 oz.. urine similar in colour to the last. Guaiacum showed a trace of bloc but there was no albumen ; the urea was 18 gr. per ounce. L4 samples showed neither blood nor albumen. The total urine pas) on the 1 7th was 28 oz. In the afternoon the paraffin odour had gc from the breath, and there was only very slight tenderness in t abdomen, hypogastric in position. The tremors in the hands h) almost gone. On March i8th her bowels were moved, but there w, no blood in the stool. That evening she needed a drachm of bromii to procure sleep. During the d. she passed only 13 oz. of urine, col taining almost iz gr. of urea per ounce. The next d. the urine wj practically normal again, both in quantity and quality. She was dfl charged on March 22nd. She had no feeling of illness, and waseatiQ and sleeping well, her only remaining symptom being slight treniof (S. W. Carruthers, Lancety 1890, ii, 442.)

1. a. A gentleman began using paraffin as a hair restorer abd Feb. 1st, a little being rubbed on the scalp every n. The following his report :

Feb. 1st — 28th. — No result apparent; indeed, hair seemed to t

getting much thinner. March isc — 31st, — Had a hard dry cough

worse on lying down after applying the P. Often coughed for \ h.

a time. No pain of any sort, but was frequently kept awake for in

or two in the n. with the cough, I did not seem to have a cold 1

this time, and the cough went away during very cold weather wil

the wind in the east. April ist — 30th. — Began to have bad headacli

in back part of head^ from crown down to nape of neck ; these alwx

came on during any mental exertion, such as casting a few columns

figures. I woke every m. regularly at 4 with a headache of this sol

and feeling more tired than when I went to bed ; also frequently h

a crick in the neck, and a feeling of pain and stiffness in the r. h(

when getting up and starting to walk. About same time bccal

extremely constipated, with considerable bleeding from every motion

and veins on nose got much more marked than ever they had b«

before. Complexion was dirty yellowish ; no appetite ; loss of flei

much perspiration on least exertion. About May 7th I left off usj

the P., and in a few d, bleeding stopped, and constipation got mt

better ; headaches also gradually got better ; in about a fortnight tl

were entirely gone. (My hair is not very different from what it \

when J started.)

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h. My wife used P. for six mos. in the same way^ beginning 3 »os. before me. Her hair is now very much thicker. For last 2 mos. 5"C had constant headaches down back of neck and head : it was this which enabled me to find out the cause of mine. She also suffered "try much from constipation, and complained of great weakness, slwiys feeling tired. Suffered much from corns ; also got a wart on "Wd and pimples amidst hair and on neck ; great itching of skin, specially on head j scabby eruption behind ear. These symptoms giaduaity disappeared on discontinuing the use of P., but a month after 'he had a very severe earache ending in suppuration, which has lasted a fortnight.

f. The people next door, who were also restoring their hair, complained of the most frightful headaches, which they were told were "eurajgic. (Burnett, Horn. IVorld^ Aug., 1891.)

1. Dr. Dyce Duckworth observed case of a workman in a paraffin

manufactory. He often spilt some on his trousers, and generally satu-

'•"ted the parts over his thighs ; his hands and forearms were often

£;^vered with the oil. After working for a week an eruption appeared.

"ere is now (after 3 weeks), on front of thighs and legs, and on back "v forearm, a vesicular rash ; it is everywhere similar in character ; on '"'thighs there are some thickened patches of cuticle and sordes covering ?^ft of the eruption ; the vesicles are aggregated in places and isolated ^■5 the margins ; there is no itching in the affected part, but some irrita-

'On is complained of. Two d. later : — patient has had two baths ; some ?* the cuticle, &c., is removed from the thigh, and nature of disease is

"^ttcr seen j some vesicles seem inclined to be pustular at their sum-

•^its ; a hair is seen in the centre of each of them. (Med. Times and

Gff*., 1864, 11, 650.)

1. Dr. Ogston communicates effects on workmen similarly brought •nto contact with P. in a manufactory at Aberdeen. Eruption of nodules and pimples speedily appears on exposed skin of those who are for the first time engaged in the manufacture, lasting for a few weeks or months, and then generally diminishing and disappearing. In a few exceptional individuals it does not disappear, but, assuming a chronic character, produces so marked and prolonged an affection of the skin that the general health becomes impaired, and the cessation of the employment becomes a necessity.

a. In the acute and recent form, the skin of hands, wrists, arms, feet, and legs becomes covered with a rash of bright red nodules, closely approximating to each other, and usually largest and most numerous on wrists, or wherever dress tightly embraces skin, — dorsal aspect of parts being most severely affected, palms and soles enjoying complete immunity. Similar nodules arise, though to a less extent, on face, neck, and other parts of body to which the oily matters find access. On examining minutely the skin of those so affected, the following are the leading peculiarities of the eruption : — The bright red nodules, hard to touch, tender on pressure, varying little in size (= about a grain of barley), are of a rounded form, and consist each of a single hair-follicle with the parts immediately around it, which are inflamed, indurated, and reddened ] the hair emerges from the very summit of the nodule,

and the orifice of the follicle is much enlarged and easily visible to the naked eye as a "pin-hole" aperture; the dilatation extends to the deeper part of the follicle, which forms the kernel of the inflamed icDot-> the retention of its contents evidently contributing ro the inflammMory induration around ; the gaping mouth of the follicle exhibits masses<=>' cast-off epithelial scales, dry and friable instead of greasy and tcnaciou ^ The nodule has little of the tendency to run on into suppuration observable in an ordinary comedone, and its contents cannot t^* squeezed out ; on the contrary, the redness and induration, ift^= remaining for some little time, gradually diminish and Anally disappea ^ leaving the hair-follicle enlarged, and its mouth gaping so as c^ exhibit the retained epithelial masses, mixed with dirt. In faa, tl^ acute form consists of successive crops of these nodules, the ski between them retaining its natural pliancy and elasticity. Men wit — dark complexions and strong hair are especially liable to this persisterrrr= patency of the hair-follicles, those of fair complexions and hght c= reddish hair escaping comparatively unaffected.

h. When the disease assumes a chronic form it exhibits the foUo*-— « ing characteristics :— The backs of feet and toes, the dorsum of th hands and fingers (between, not over, the Joints), exhibit a peculii honeycombed appearance of the skin, which is elevated, thickened, lo inelastic, so as to hinder flexion. These patches are of natural colou< and not inflamed (except where an isolated papule exhibits the appeal ance described under the acute form) ; they consist of densely groupc^^ arrays of hair-follicles, with indurated cutis between and around their the follicles packed with dry, brittle accumulations of epithelial scales so extensive as to be easily visible through the dilated mouths of th follicles — these being large enough to admit the extremity of ti ordinary probe. 7 he hairs themselves have disappeared from tbes patches, having probably become atrophic from the pressure of ih epidermic masses, while cracks and bleeding fissures travcnc th indurated parts, and in rare instances a follicular abscess gives varict; to the picture. Knuckles, palms and soles remain unaffected. In th< subjects of the chronic malady the complexion is pale and the tongm foul, while the loss of flesh betrays the effect of the sleepless night caused by the constant irritation and pain of the skin of the affectec extremities. [Edinb. Mtd, Jaurn,^ xvii, 554.)

1. In 1886 I was consulted by a man who had formerly been employed in a factory where much paraffin was used. (He sutftreci from an inveterate eczema, and found that this was greatly improve) whilst working with P.). He told me that the vapour had a singula effect, making some of the workmen insane. They can see thing^ that are actually not visible ; for instance, they will see the rails in i station whilst a train is on them. They desire to kill people. Boy (who are much affected), will jump at a straight wall and try t< scramble up it. (Clarke, Horn. Worlds July, 1891.)

2. G. M — , a?t. 2^, suffering from rickets, and having a /^wA*' for drinking everything that came in his way, had imbibed som^ paraffin. An emetic and a purge had got rid of a good deal of it, but when he was brought to mc a month afterwards he had, in additi<*»

to his rickets and a cough, bad appetite ; pallor, with dark rin^ eyes ; every now and then seems to collapse, goes into a cornc keeps quiet, will not play. He was quite bright in e. ; had cold) in bed, complaining of burning fever, and then going cold and ell I gave him phosph. 2, and in three weeks he had lost pallor an rings, and had ceased to mope, but had come out all over smalt vhtch discharge, the matter having the odour of parafHn. {f^k

1. In America, " paraffin oil " is used by women in washing a tablespoonful being put into a bucketful of water, as it ma linen of a better colour. Dr. Bliem has seen cases in whic practice has been attended with unpleasant consequences to the dresses. One of them experienced the following symptoms :— ^ occipital headache, loss of strength, emaciation, diarrhcea, dyi characterised by fulness on slight eating, accumulation of gas, an severe attacks of suffocation, finally relieved by eructations (Sonthtrn Journ. of Htm., July, 1 890.)