On Arsenical Paelysis. 19 



The circumstances point to the conclusion that the hemorrhage 

 in the cord in this case was similar in nature to those found in experi- 

 ments on animals where the changes in the spinal cord take place a 

 few heures after intoxication. Thus we see that arsenic affects the cord 

 and probably simultaneously with it the peripheral nerves ^). Popow's 

 case of arsenic intoxication where extravasation of blood as well as a 

 few changes in the ganglion cells were found also confirms this view. 



My case then presents the following instructive facts: 



1) It is a case of paralysis from arsenic where the symptoms 

 have developed themselves in an exceptionally typical and sudden manner. 



2) Contrary to the rule this case has caused death. 



3) On post mortem examination a little column of extravasated 

 blood was found in the left half of the grey substance at the level of 

 the 2°'^ lumbar nerve. 



4) This hemorrhage ought not to have produced the paralysis. 

 6) It has not caused disorders either of the bladder or rectum. 



6) Nor been followed by other distinct symptoms. 



7) Nor caused any distinct change in the conveyance of pain. 



8) On the other hand the paralysis could satisfactorily be explained 

 by the widely spread polyneuritis. 



9) Paralysis was incomplete and almost transitory in the arms 

 but permanent in the legs. 



. 10) Also the large spinal gagliou cells were ^distinctly degenerated 

 and many in high degree atrophic. 



11) Arsenic thus produces in man changes both in the inedulla and 

 peripheral nerves and apparently simultaneously because 



12) the rapid appearance of the sensory symptoms speaks against 

 the possibility that the neuritis is secondary; and the hemorrhage in 

 the medulla shows that this is primarily affected by arsenic. 



As regards literature of arsenical paralysis see Dana, »Brain» 1887 

 and Alexander's Inaugural Dissertation Breslau 1889. 



1) Virchow's Arch. Bd. 112. 



