AN OUTBLEAK OF ACUTE ARSENIC POISONING CAUSED BY ARSENIC CONTAMINATED SOY-SAUCE (SH?YU) : A CLINICAL REPORT OF 220 CACES

In The preceding pages we have tried to drow a chinical picture of acute arsenic posioning fromsoy-sauce accidentally contaminated which occurred in the City of Ube, Yamaguchi Prefecture, in January 1956. The main symtoms observed in 220 cases out of the total 417 patients were edema of the face, gastrointestinal and upper resoiratory symptoms followed by skin lesion and neuriritic signs which occurred in a limited unmber of patienta in the late atage. In the majority of patients, the symptoms appeared 2 days after the intake of arsenic ond subsided gradually after the 5 th or 6 th day of illness, despite contibuous intake of the poison. These symtoms disappeared rapidly tow weeks after eliminating the arsenic contaminated sauce from the diet. Neuritic symptoms, on the other hand, began to get aggravated later in the second week after suspension of arsenic intake. The liver was palpable as enlarged for one or tow finger breadtha in mosa of the cases, andreturnd to the nomal size in convalescence. Electrocadiogram revealed abnormalities in Q-T interval and P-and T-waves. Ophthalmokogically conjunctivitis, central scotoma and neuro-retinitis were derected. Laboratory data indicated slight anemia, leukopenia, relative lymphocytosis, positive urinary urobilibogen in 60 to 80 % of the cases, normal electrolytes and urea clearance. Fecal occult blood was positive in may of the patients, and in some, occlt blood was demonstrable in gastric and duodenal juice. Chemical analysis of serum was suggestive of slight but definite degenerative changes such as decrease of nucleic acid in liver cells. Hepatic detoxicating function was impaired in about half of the case, but BSP test remained normal. Arsenic was demonstrated in urine in an appreciable concentration even tow weeks after the suspention of arsenic ingestion. A low arsenic concentration was also detected in both gastric and duodenal juice. The root portion of the hair sontained more arsenic than The rest of the hair. The duration of arsenic inogetion was tow oe three weeks in most of the cases, and aresenic content of the soy- sauce whichcaused this accident was estimated to be about 0.1mg per milliliter.