Further Notes on Retrobulbar Neuritis Due to Thallium Poisoning *

In a previous communication9 three examples of an unmistakable syndrome due to thallium intoxication were reported, and the damaging effect of thallium upon the optic nerves was stressed. The therapeutic uses as well as distressing toxic sequellae were reviewed, together with the history of the metal. The disorder is characterized by temporary loss of hair, peripheral neuritis, nervousness, and failure of vision after the prolonged use of small amounts of thallium. There are associated evidences of peripheral neuritis, and the optic nerves become dangerously damaged, the visual acuity falling almost to nil, the visual fields stamped with the stigmata of large central scotomata, and the nerve-heads deprived of substance. It is a rare condition. The victims have generally been young women who have been bothered with hypertrichosis for which they have unknowingly used a potent thallium-containing (thallium acetate 7.18 per cent) depilatory, Koremlu Cream.t The manufacture of this preparation was discontinued in the spring of 1932 because of a pleaded bankruptcy, but the same concern has since been manufacturing another depilatory, Croxon,4 the contents of which are as ineffective with regard to their advertised power as they are innocuous. Males have likewise been affected by exposure in the preparation of thallium salts industrially, by accidental ingestion, by malicious poisoning, and after therapeutic administration. Since the publication of the earlier paper9 other cases have come to light and those previously reported have been repeatedly observed, so the opportunity is taken for reviewing the situation and reporting the later observations upon those already studied. Through the kindness of Dr. Lillie and Dr. Stine their reported cases are presented with reproductions of the visual fields. Dr. Haft has generously extended the privilege of reporting his case to which my attention had been called while the original paper was in