Poisoning by Sir William Burnett’s Disinfecting Fluid. By Richard
Hassall, M. D.—The first case I have to relate is one of unusual in-
terest. In the first place, the instances of poisoning by chloride of zinc
which have been placed on record are very few; in the second place,
the train of nervous symptoms observed was of a most remarkable char-
acter ; in the third, the efficacy of prompt treatment is illustrated in a
very striking manner.
In the systematic writing of our leading toxicologists no mention is
made of chloride of zinc as a poisonous substance ; the only salt of zinc
referred to as possessing any interest in this respect is the sulphate.
Even Dr. Taylor, in his elaborate work on “ Poisons,” bestows upon the
chloride but the most cursory notice, and the subject is evidently sug-
gested to him rather by the methodical arrangement of his matter than
from any precise information as to its toxicological properties.
Dr. Stretton has recorded two cases of poisoning by chloride of zinc.
In one, twelve grains of the salt were taken; in the other, two hundred
grains dissolved in a wineglass full of water. Both the patients recov-
ered. In the Medico-Chirurgical Transactions for 1850, a most inter-
esting case, which terminated fatally, is detailed by Dr. Letheby; and
it is to the same paper that we must look for whatever accurate know-
ledge we possess of the poisonous properties of this substance.
In May, 1851, a man who a week previously had taken some of Bur-
nett’s fluid by mistake for gin became a patient at the Metropolitan Free
Hospital. His first symptoms were described to have been severe pains
in the stomach, distressing vomiting, frothing at the mouth, and a livid
countenance. He appears to have got over the immediate effects of the
poison, without any treatment whatever. After a week there was great
emaciation, weakness, pain in the stomach, and constant sickness. Under
treatment, which does not seem to have been guided by any precise in-
dications, he gradually recovered. A few other cases are casually
reported, but too concisely to permit of any definite conclusions.
That instances of poisoning by chloride of zinc should be rare is a
matter of surprise, when we consider how common is the use of Sir
William Burnett’s fluid; and when attention is called to the circum-
stance which led to the accident I am about to relate, this surprise will
be very much increased. A gentleman was very much in the habit of
having recourse to a draught of Murray’s fluid magnesia for the relief
of occasional sickness. One day, being about to sit down to dinner,
sickness supervening, he called for his usual draught. About three
ounces by measure of a liquid was brought to him, and rapidly swallowed.
It turned out that a bottle of Sir William Burnett’s fluid was in the
house for disinfecting purposes; out of this bottle my patient had been
supplied. On comparing the two bottles, it was observed that their size
and shape were closely similar-—the resemblance even extended to the
labels; and in short the general aspect of the two was so nearly iden-
tical as readily to favor a mistake. Sir James Murray’s fluid magnesia
has been in general repute for many years; and it is very much to be
regretted that in introducing Sir W. Burnett’s fluid care was not taken
to adopt some distinctive character for the bottles. The risk of mis-
taking a dangerous poison for a harmless medicament ought surely to be
avoided.
On the 6th of November, 1852, at about six p. M., three ounces by
measure—probably four ounces three drachms, troy, by weight—of Sir
Wm. Burnett’s disinfecting fluid were hastily swallowed, as I have al-
ready mentioned. As this took place just before dinner, it may be in-
ferred that the stomach was empty. This circumstance it is important
not to pass over, since it must have operated in a two-fold manner to
augment the danger of the case. The irritant and even corrosive fluid
was brought into immediate contact with the coats of the stomach, and
the system would be in the most favorable condition for absorption.
The first symptom experienced was a sense of constriction in the
fauces, and then a hot, burning sensation in the stomach marked the
arrival of the fluid in that organ. There was no pain in the mouth, or
even in the (Esophagus, nor was there any appearance of corrosion about
the lips or mouth. This I account for by the suddenness with which
the draught was gulphed down, leaving no time for any local effect.
Almost immediately after the accident, the case was also seen by Mr.
Hancock, Dr. Seaton, and my brother, Dr. Arthur Hassall. Within
two minutes a quantity of water was swallowed, and vomiting was excited
by thrusting the finger down the fauces. Ten minutes were consumed
in getting ready a quantity of eggs and milk; when these were procured
they were liberally administered. Vomiting was renewed by irritating
the fauces, but it is remarkable that it did not set in spontaneously for
nearly an hour. After this time the mixture was thrown off instantly
after being taken, by the most violent action; it returned as a solid,
coagulated mass ; one portion of which was so large and so firm as
almost to cause suffocation. This treatment was kept up throughout the
night, and until two P. M. of the following day, the patient vomiting
continuously, and rejecting the milk and eggs in the same curdled state.
In the evening blood appeared in the vomited matter, a quantity of
mucus, and a portion of mucous membrane measuring an inch and a
quarter square. Throughout the third day the vomited matter was still
streaked with blood. There was no action of the bowels until the third
day, when they acted spontaneously; the stool was of a black, coffee-
ground appearance, and entirely wanting the odor of feeces. The urine
presented nothing unusual.
From the beginning the patient experienced the most distressing head-
ache, and utter inability to sleep, and violent “ clawing” pain in the
stomach. This “ clawing” in the stomach persisted in great severity
for a long time, and even now (March, 1853) is felt when the stomach
is empty. On this (the third) day, the pain described was felt in-
tensely, but there was no tenderness on pressure; the pulse was 90, and
had no remarkable character. Leeches were applied to the epigastrium,
and followed by poultices. This gave no relief; indeed this was only
obtained by taking bland, warm things, such as gruel, arrow root, and
milk. Opium brought no ease. There was an excessive nervous de-
rangement and prostration, tremor of the limbs, and a great disposition
to pick the bedclothes; a feeling of sinking, and an urgent craving for
food ; the tongue was intensely red.
It was quite a fortnight before anything but black stools appeared;
then they were pale, clayey, dry, and crumbling, showing no evidence
of bile. The bowels being, moreover, sluggish, an occasional pill of
blue-pill and rhubarb, and a draught of senna and tartrate of soda, were
taken. These gave no pain or inconvenience; the stools gradually
improved, but it was six weeks before the proper proportion of bile ap-
peared, and they assumed a natural appearance. Throughout this time
there was no natural appetite, but a morbid craving for something where-
with to allay the irritation of the stomach. From the third day the skin
assumed a ghastly bluish-green tint; this lasted for a long time, and has
not even yet quite disappeared. Great emaciation was observed; the
skin looked as if it was stretched tightly over the bones of the face and
hands.
I have now to detail the curious train of nervous symptoms which at-
tended this case. The prostration, muscular tremors, wakefulness, were
early observed. The sense of smell underwent a singular perversion :
every kind of roast meat, if ever so slightly burnt, roasted coffee, tea,
&c., had to my patient an intolerable putrid odor; roast mutton was
especially offensive. Scents and perfumes prepared with alcohol gave
an odor resembling that of hemlock; on the other hand, putrid and
feecal matter had no apparent odor at all.
The perversion of taste was not less remarkable; and the points of
resemblance between the phenomena of- taste and smell, served to illus-
trate the relation existing between these senses. Roast meats and crusts
of bread were intolerable; and most foods had a burnt taste, especially
raw oysters, which resembled burnt flour, and felt quite dry, clinging to
the mouth. Things naturally insipid, such as the crumb of bread and
potato, gave a more natural flavor and were better relished. Acids did
not taste acid, nor alkalies alkaline, and to him quinine was not bitter.
These peculiarities continued strongly marked for some time, and the
senses of smell and taste are still imperfect.
I have now to return to the history of the case. A gradual improve-
ment was made for the first two months, the urgency of the symptoms
described having subsided. Too early a return to accustomed avocations,
while the strength was still low and the nervous system had not yet re-
covered its equilibrium, brought on an attack of illness of extreme se-
verity. The patient was seized with symptoms resembling the onset of
influenza; there was excessive nervous prostration, hyperaesthesia, and
great irritability, which passed into a condition resembling tetanus ; no
noise could be borne; the slightest shock caused a start; if the bedclothes
touched the toes, tremors approaching convulsions ensued. For five
nights there was no sleep. There was a terrible pain in the right side
of the head, which would last for hours; when'this subsided, nausea and
retching ensued; the pulse rose to 120 or 130. There was some febrile
movement; the skin was alternately very dry and moist. During this
secondary attack the liver again evinced a sluggishness of action, and the
urine, which hitherto had been normal in quantity, became excessive;
on one occasion seven pints were passed in five hours. In the first in-
stance blue-pill and ipecacuanha and salines were ordered. For fourteen
days the patient was confined to his bed, when the intensity of the symp-
toms had subsided, he still complained of the gnawing of the stomach.
Dr. Wilson was consulted, and magnesia, with bismuth and hydrocyanic
acid, were prescribed, and attended with some relief. A gradual im-
provement has again taken place, but the natural hue of the skin has
not quite returned; the taste and smell are still impaired; the pain in
the stomach is occasionally felt, and the general strength is reduced.
I will not lengthen this communication by entering upon a minute
analysis of the symptoms observed, but I must beg to arrest attention to
some points of especial interest. The poisonous action of chloride of
zinc—that is, in that state of concentration in which it is found in Bur-
nett’s fluid—is of a double character: it has a local corrosive action, and
a general toxical effect, the result of absorption.
I have already endeavored to account for the absence of any appear-
ance of corrosive action in the present case about the lips or mouth by
the rapidity of swallowing. In Dr. Letheby’s case, however, corrosion
was marked; “the lips were swollen; their inner surface and the lining
membrane of the mouth presented an opaque white appearance;” and
“ when the child attempted to swallow water the greater part returned
by the nostrils.” The locaLagtion of the poison was also marked by the
“ hard and leathery” consistence of the stomach after death; but al-
though in the case before us thq^hiouth and oesophagus escaped, I cannot
doubt but the stomach suffeYM^ the vomiting of blood, the shred of mu-
cous membrane rejected, and the passage of blood by stool indicate some
sign of local injury; and this was the more likely to occur from the
stomach being empty. Had food been present the chemical action of
the poison would have been spent upon it, and the coats of the stomach
would have been more or less protected. One circumstance in connexion
with this local action deserves especial notice on account of its bearing
on the treatment of similar cases of poisoning. It might, prima facie,
be concluded, that the salt would speedily be decomposed, and removed
in altered combinations by a moderate supply of albuminous matterand
vomiting; but this does not appear to be the case. An enormous quanti-
ty of eggs and milk was passed through the stomach, and yet for many
hours it was constantly rejected, strongly coagulated from the action of
the poison. Dr. Letheby also detected a considerable quantity of chlo-
ride of zinc in the tissues of the stomach in his case, although vomiting
had taken place. From this consideration, then, fortified by the success-
ful issue of the case, I would strongly urge the necessity not only of a
copious but a long-continued supply of albuminous matters. I think it
the more important to refer to this point, because the treatment of
poisoning by chloride of zinc is still unsettled or misunderstood. In one
of Dr. Stretton’s cases, soap-suds were administered, and in the case re-
ferred to at the Metropolitan Free Hospital. The physician who had
charge of it, in reporting the history, recommended that soap or carbon-
ate of potash or soda should be given in order to throw down carbonate
of zinc. This practice is doubtful. The carbonate of zinc, although in-
soluble, might still be injurious; certainly calomel, carbonate of lead,
sulphate of baryta, and other substances, cannot be said to be inert.
The constitutional effects of the poison in this case are well marked; one
of the earliest manifestations of the absorption of the poison into the
blood is remarkable. The ghastly, bluish-green color of the skin can be
attributed to no other cause than to the action of the poisonous compound
(probably more especially of the chlorine) on the blood. It is unneces-
sary to refer at length to the nervous symptoms already detailed. It
must be difficult to analyze the constitutional symptoms, and to deter-
mine how much is to be attributed to the hydrochloric acid and how
much to the zinc. The experiments, however, of Orfila, Blake and
Letheby, seem to prove that the nervous symptoms are dependent upon
the zinc. Dr. Letheby is of opinion that the poison enacts a distinct and
specific action on the motor and organic system of nerves. The excessive
prostration, the strange perversion of the senses of smell and taste, the
tremors of the limbs, and the tendency to tetanoid convulsions, observed
by myself, would appear to corroborate this opinion.
As the recorded cases of poisoning by chloride of zinc show that
this substance does not generally cause death in consequence of its
primary corrosive action, it is a point of especial interest to consider by
what means the elimination of the salt from the system can be pro-
moted, and its secondary effects obviated or mitigated. The three great
depurating sources are the liver, the kidney, and the skin; but it re-
quires some caution before determining upon stimulating these organs
to action. As in the case of poisoning by arsenic, chloride of zinc
appears strongly to irritate, if not to inflame, the kidneys. In Dr.
Letheby’s case, the kidneys were greatly congested; in my case, the
kidneys did not appear in the first instance to be much affected. The
effect upon the liver was more marked; the arrest of its action was no
doubt one reason why the poison was so long delayed in the system.
Possibly more advantage might have been taken of the favorable con-
dition of the kidneys. Are we to regard the excessive diuresis which
marked the second attack as an effort of Nature to get rid of the poison
remaining in the system ? The peculiar character of the symptoms
attending that attack clearly show that the system was still laboring
under its effects. Before putting an increased strain upon kidneys, how-
ever, we must take care to ascertain that they are free from any conges-
tion or inflammation. If they should be in this condition, then we
must turn to the liver, and especially the intestines. Saline purgatives,
with jalap, might be employed with advantage; and at the same time
every effort should be made to promote the free action of the skin ; warm
baths and friction would be of most material assistance. M. Bonvier,
jn treating cases of zinc-poisoning among workmen engaged in oxide of
zinc manufactories, detected zinc in the washings of the skin. A similar
fact has been long known with reference to lead-poisoning.
I cannot quit this case without once more insisting upon the propriety
of so altering the appearance of the bottles in which Burnett’s Fluid is
sold as to obviate the possibility of its being again taken by mistake for
fluid magnesia.—Lancet.