Am.  Jour.  Pharm.  V 
September,  1920.) 
Current  Literature. 
toms  of  arsphenamin  poisoning  of  the  liver  were,  bile  in  the  urine, 
albuminuria,  loss  of  appetite  and  jaundice.  Dermatitis  with  atrophy 
of  the  liver  occurred  in  one  patient  who  received  arsenic  in  the  foim 
of  Fowler's  solution,  5  minims,  three  times  daily,  for  five  months. 
{Canadian  Medical  Assoc.  Jour.,  Toronto,  April,  1920,  10,  No.  4; 
through  Jour.  Amer.  Med.  Assoc.,  May  15,  1920.) 
Delayed  Arsenical  Poisoning  Following  Use  oE  Arsphen- 
amin.— Fifty-eight  cases  of  delayed  arsenical  poisoning  following  the 
use  of  arsphenamin  preparations  are  reported  by  Strathy  and  his 
associates.  Eight  of  these  were  fatal,  being  the  first  of  the  series  to 
come  under  observation.  The  remaining  fifty  patients  made  a  slow 
but  otherwise  satisfactory  convalescence.  The  greatest  number  of 
doses  of  arsphenamin  given  in  the  fatal  cases  was  eleven,  the  least 
four.  The  greatest  amount  administered,  where  it  was  possible  to 
obtain  records,  was  6.95  Gm.,  the  least  amount  2.2  Gm.  The  aver- 
age time  of  onset  of  symptoms  after  the  last  dose  was  forty-one  days, 
the  longest  interval  forty-eight  days,  the  shortest  eighteen  days. 
The  symptoms  in  every  case  were  similar.  The  jaundice  on  onset 
was  rapidly  followed  by  nausea,  epigastric  pain,  stupor,  hematemesis, 
delirium  and  death.  Four  of  the  patients  were  wildly  delirious. 
In  all  cases  tested  the  urine  contained  bile,  and  in  nearly  all  cases 
albumin  as  well.  The  blood  picture  was  not  characteristic.  The 
hemoglobin  and  red  cells  were  not  much  reduced.  The  leukocytes 
varied  in  number  from  14,000  to  34,000  per  cubic  millimeter,  and 
the  polymorphonuclear  leukocytes  from  50  to  80  per  cent.  The 
greatest  number  of  doses  of  arsphenamin  given  in  the  non-fatal 
cases  was  fourteen,  the  least  two.  The  average  time  of  onset  of 
symptoms  was  forty-five  days,  the  longest  interval  180  days,  the 
shortest  three  days.  Thirty-nine  of  the  patients  were  admitted  for 
jaundice,  eight  for  dermatitis,  two  for  nephritis,  and  one  for  general 
debility.  Jaundice  followed  dermatitis  in  one  patient,  and  two 
other  cases  of  dermatitis  were  followed  by  peripheral  neuritis.  Coated 
tongue,  poor  appetite,  epigastric  distress,  abdominal  distension, 
headache,  general  malaise,  and  loss  of  weight  were  noted  throughout 
the  group.  Albuminuria  was  present  in  twenty-eight  cases,  bile 
salts  in  thirty-five  cases,  increased  urobilin  and  urobilinogen  in  six- 
teen cases,  leucin  and  tyrosin  were  never  found.  Jaundice  was 
present  in  all  of  the  fatal  group  and  thirty-nine  of  the  non-fatal 
group.  (From  Lancet,  London;  through  Jour.  Amer.  Med.  Assoc., 
May  22,  1920.) 
