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Bismuth Paste in Acute Suppurations

F. McKelvey Bell
JAMA. 1912;LVIII(24):1873-1874. doi:10.1001/jama.1912.04260060222021.
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ABSTRACT

To the Editor:  —The casual reader of Dr. Emil G. Beck's "Warning Against the Indiscriminate Use of Bismuth Paste in Acute Suppurations" (The Journal, May 25, p. 1622) might infer that I had reported two cases of bismuth poisoning following intra-abdominal drainage by this method. I wish to clear up any ambiguity in this connection and to point out that the only case of serious poisoning was that following curettage of a lumbar sinus of considerable size, in which a large quantity of paste was injected immediately after operation: no provision had been made for drainage and the bloodvessels and lymphatics were still exposed. The case of slight poisoning was a fecal fistula opened retroperitoneally through the lumbar muscles.In the eleven intra-abdominal sinuses there were no symptoms of poisoning or other untoward effects and while I am prepared to admit that there may be an element of danger in

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