A case of cirrhosis and primary carcinoma of the liver in chronic industrial arsenical intoxication.

Arsenical poisoning may occur in industry, in three forms: (I) From inhalation of or contact with dust of inorganic compounds, (2) from inhalation of arseniuretted hydrogen, (3) from contact with organic arsenic compounds. The inorganic compounds act as local irritants to the skin and mucosa and may have a carcinogenic effect. Arseniuretted hydrogen acts as a haemolytic agent and organic arsenic compounds as vesicants. The hepatotoxic action of inorganic arsenic compounds such as potassium arsenite, which is contained in Fowler's solution, has long been recognized by those using this solution as a therapeutic agent but has been scarcely mentioned as an industrial hazard. Skin cancer constitutes a well recognized occupational hazard. The occurrence of hydrops and ascites following the ingestion of arsenic was first recorded by Bang in 1774. Hutchinson (1895) was apparently the first to report that cirrhosis and ascites can be due to prolonged administration of arsenic and to draw attention to its carcinogenic properties. Since then, many cases suggesting arsenic as an aetiological agent in cirrhosis of the liver have been published. It is almost disregarded today when considering the aetiology of portal cirrhosis.