introduction of corrosive sublimate into the stomach. The poison then

kills by corroding or inflaming the alimentary canal, or by causing salivation and its concomitants. When applied to a wound or ulcer corrosive sublimate does not often occasion dangerous symptoms. Yet it is sometimes a hazardous remedy. It is not a convenient escharotic even in a concentrated state; for its escharotic action is not incompatible with its absorption; at all events it certainly sometimes acts constitutionally through the surface of wounds and ulcers, and the symptoms brought on in this way are generally violent. They are the symptoms of mercurial salivation, accompanied at times with well-marked inflammation of the alimentary canal. When applied to sores in a diluted state it has also been known to cause dangerous effects if too long persevered in. A case of the kind has been related by Mr. Robertson, an army-surgeon. After anointing an itchy eruption of the arms for seven days with a solution of corrosive sublimate containing five grains to the ounce, his patient was attacked with fever, inflammation of the stomach and bowels, and in two days more with violent salivation.[962] A case of the same nature has been related by Mr. Sutleffe.[963] His patient, a child, in consequence of having an eruption of the head washed with a solution of corrosive sublimate, was attacked with violent salivation, which proved fatal in a few days. Pibrac has recorded three fatal cases from the free application of corrosive sublimate to ulcerated surfaces. One of these proved fatal in five days, another in twenty-four hours, and a third during the night after the poison was applied. The symptoms generally indicated violent action on the alimentary canal.[964] In an instance mentioned by Degner, fatal in twenty-five days, there was also violent irritation of the stomach; but the chief affection was excessive swelling of the face and throat, together with profuse ptyalism.[965] One of the readiest modes of bringing the system under the poisonous action of mercury is by introducing its preparations into the lungs. It appears from some experiments by Schlöpfer that the fluid preparations act rapidly through the lining membrane of the air-passages. Six grains of corrosive sublimate in solution will thus kill a rabbit in five minutes.[966] But the effects of mercury through this channel are much better exemplified when its preparations are inhaled in the form of vapour. Corrosive sublimate when incautiously sublimed in chemical experiments has been known to cause serious effects. Dr. Coldstream of Leith informs me, that while subliming about twenty-four grains of it with the blowpipe when a student, he and several of his fellow-apprentices were seized with painful constriction of the throat, several had headache, and one had sickness and vomiting. The phenomena produced by the various preparations of mercury in more violent cases, are sometimes protracted tremors,[967] sometimes severe ptyalism and tedious dysentery,[968] sometimes salivation and gangrene of the mouth ending fatally.[969] This last form was produced remarkably in a chimney-sweeper, after cleaning a gilder’s chimney, during which operation he felt a disagreeable sense of tightness in the throat. Several extraordinary instances have happened of poisoning from long-continued inhalation of the vapours which arise from metallic mercury. That vapours do arise from metallic mercury of the ordinary temperature of the atmosphere has been fully proved by Mr. Faraday; who found, that when a bit of gold was suspended from the top of a phial, the bottom being covered with a little mercury, the gold soon became amalgamated.[970] The vapours thus discharged may produce the worst species of mercurialism, if they are diffused through an apartment insufficiently ventilated. One of the most striking examples known of the baneful effects of mercury thus gradually insinuated into the system, occurred in a well-known accident which befel the ships Triumph and Phipps. These vessels were carrying home in 1810 a large quantity of quicksilver saved from the wreck of a ship near Cadiz, when by some accident several of the bags were burst and the mercury spilled. On the voyage home the whole crews of both vessels were more or less severely salivated, two died, many were dangerously ill, all the copper articles on board became amalgamated, all the rats, mice, cockroaches, and other insects, as well as a canary-bird and several fowls, and all larger animals, such as cats, dogs, goats, and sheep were destroyed.[971] The action of mercury is often violently excited when it is applied to the skin even not deprived of the cuticle. The effects of mercurial inunction form a well-known and satisfactory proof of this. Even without the aid of infriction, the soluble preparations of mercury will excite mercurial action by being put simply in contact with the skin. Thus it has been shown by a German physician, Dr. Guérard, that ptyalism may be induced by a warm bath of corrosive sublimate in the proportion of an ounce to 48 quarts of water, and that the effect commonly begins after the third bath with an interval of three days between them.[972] It is not so generally known that the more active preparations, such as corrosive sublimate or nitrate of mercury, may, like arsenic, cause through the sound skin effects almost as violent as through the alimentary canal. The following pointed illustration is related by Dr. Anderson. A gentleman affected with rheumatism, was persuaded by a friend to use a nostrum, which was nothing else than a solution of half a drachm of corrosive sublimate in an ounce of rum. This was rubbed on the affected part for several minutes before going to bed. Ere the friction was ended, he felt a sensation of heat in the part, to which, however, he paid little attention. But during the night he was attacked with pain in the stomach, sickness, and vomiting, and soon after with purging and tenesmus. In the morning Dr. Anderson found him very weak and vomiting incessantly. The arm up to the shoulder was prodigiously swelled, red, and blistered. Next day he complained of brassy taste and tenderness of the gums, and regular salivation soon succeeded.[973] Another case of much interest has been described by my colleague, Professor Syme, where a solution of the nitrate was rubbed by mistake upon the hip and thigh instead of camphorated oil. Intense pain immediately followed, and afterwards shivering; the urine was suppressed for five days, without any insensibility, and during its suppression urea was detected in the blood; ptyalism appeared on the third day, became very profuse, and was followed by exfoliation of the alveolar portion of the lower jaw, but recovery nevertheless slowly took place.[974] The mere carrying of mercurial preparations for a length of time near the skin, though not in direct contact with it, may be sufficient to induce the peculiar effects of the poison, as the following example will show. A man applied to a German physician, Dr. Scheel, affected with violent salivation evidently mercurial which proved fatal, but which it was impossible to trace to its real cause till after death, when a little leathern bag containing a few drachms of mercury was found hanging at his breast; and it was then discovered that he had been in the practice of carrying this bag for six years as a protection against itch and vermin, and during that period had frequent occasion to renew the mercury.[975] The effects of mercury as a poison differ with the chemical form in which it is introduced into the system. In its metallic state it is probably inactive. This fact is a material one for the medical jurist to determine precisely; for running quicksilver has been given with a criminal intent. A case of the kind forms the subject of a medico-legal report in Pyl’s Repertory;[976] and another is mentioned in Klein’s Annals.[977] It is well ascertained that large quantities of fluid mercury have been repeatedly swallowed, without any injury or peculiar effect having followed. In neither of the German cases now referred to was any bad effect produced; and it has proved equally harmless when given medicinally to remove obstruction in the intestines. Farther, M. Gaspard mentions in his paper quoted in a former page, that he has left large quantities shut up for many hours in the various cavities of the body in animals, without observing any other result than at times inflammation, which was evidently owing to the mere presence of a foreign body, and not to the action of an irritant poison.[978] It has been already stated, however, that the vapours of metallic mercury, even at the temperature of the air, produce mercurialism when inhaled. But then, in all likelihood, some of the metal is oxidated before being inhaled. At least the chemist knows that the surface of a mercurial trough soon tarnishes, especially when the mercury is not pure. But it may be said that the blue ointment, which is made with running quicksilver, will not act as a mercurial when rubbed upon the skin. Here too, however, some oxidation takes place in the making of the ointment. Mr. Donovan endeavoured to prove that some of the mercury is always oxidated;[979] and I have generally found a sufficient quantity of oxide to account for the effects.[980] It has been farther said, in proof of the poisonous action of quicksilver in its metallic state,—that patients, who have taken it for obstructed bowels, have sometimes been salivated. This accident has, I believe, happened in a few instances where the mercury was retained long in the body. But such cases are undoubtedly very rare. Zwinger mentions the case of a man, who took four ounces for colic, and was seized in seven days with salivation.[981] Laborde relates the particulars of another instance where seven ounces taken in fourteen days excited ptyalism, ulceration of the mouth, and great feebleness of the limbs.[982] In the days of Dr. Dover, when the administration of large doses of fluid mercury was a fashionable practice for a variety of purposes, it was alleged to have even sometimes proved fatal; and the case of an actor is specially mentioned, to whom, when convalescent from ague, Dover gave mercury to the amount of two pounds in five days, and who at the close of that period was seized with headache, colic, restlessness, and costiveness, proving fatal in two days; and the whole lower intestines were found black and lined with minute metallic globules.[983] Perhaps then it must be admitted that fluid mercury is not altogether inactive, speaking medicolegally. But this admission is no argument in favour of the metal being physiologically a poison; because in the course of the cases referred to, a part is in all likelihood oxidated by the oxygen in the intestinal gases. It is said to have been taken in the dose of an ounce daily for nine months, without either good or harm resulting.[984] The question regarding the poisonous qualities of running quicksilver was carefully investigated some years ago by the Berlin College of Physicians in a report on the case in Pyl’s Repertory.[985] They observe that the opinion of Pliny, Galen, Hippocrates, Dioscorides, and many of the earlier moderns, including even Zacchias, had led to the popular belief in the deadly properties of fluid mercury; but that this belief is erroneous; for many surgeons, and among the rest Ambrose Paré, had given without injury to their patients several pounds of it to cure obstructed bowels; and in 1515 the Margrave of Brandenburg, over-heated on his marriage night with love and wine, and rising to quench his thirst, drank by mistake a large draught of quicksilver without suffering any harm. Fallopius mentions that he had known instances of women swallowing pounds of mercury, for the purpose of procuring miscarriage, and who did not suffer any injury.[986] The sulphurets of mercury, like the metal, are not possessed of any deleterious action on the animal body. Orfila found that half an ounce of the sulphuret, formed in a solution of corrosive sublimate by sulphuretted-hydrogen, and half an ounce or six drachms of cinnabar, had no effect whatever on dogs.[987] The sulphurets which have appeared injurious in the hands of Smith[988] and other previous experimentalists must therefore have been impure. Of the compounds of mercury, the red-precipitate and Turbith-mineral act as irritants, besides possessing the property common to all mercurial compounds, of causing mercurial erethysm. But they are not escharotics, though generally termed such. That is, they do not chemically corrode the animal textures. The effects of red-precipitate have been variable. Mr. Allison relates the case of a girl who in a fit of jealousy swallowed thirty grains of it. Being immediately detected, an emetic was given, which operated freely, and subsequently the stomach-pump was used; but on neither occasion was any red powder brought away. She was attacked with burning pain in the stomach, which was removed by opium, and for a week she had a distaste for food, but no other symptom of consequence.[989] Mr. Brett has described a case, in which the symptoms were occasional vomiting, stupor, languid pulse, cold clamminess of the skin, afterwards severe cramps of the legs, tenderness of the abdomen, dysuria, and some purging, and on the third day ptyalism; but the patient recovered.[990] M. Devergie has given a case somewhat similar, but without any ptyalism having followed the irritant effects of the poison.[991] In 1840 I was consulted on the part of the Crown in the case of a girl, who, there was every reason to suppose, had been killed in twelve hours by red-precipitate. The symptoms towards the close were pain in the throat, inability to swallow, vomiting, and excessive prostration; extensive red patches were found on the villous coat of the stomach after death; and I detected mercury in the solid contents and likewise in the inner coat of the stomach. The case did not go to trial, because, although a man by whom she was pregnant came under some suspicion, it rather appeared that the deceased had herself swallowed the poison with the view of inducing miscarriage. Dr. Sobernheim has given the particulars of the case of a young man who died from swallowing an ounce of red-precipitate. He suffered for some hours from vomiting, diarrhœa, pain in the stomach, tenderness of the belly, and colic; next day he had no pain, but coldness, lividity, stiffness, and an imperceptible pulse; and he expired in thirty-three hours. The poison was found abundantly in the stomach and duodenum after death, and some grains of it rested upon little ulcers.[992] As to Turbith-mineral, two scruples will kill a cat in four hours and a half; and several instances of violent and even fatal poisoning with it are mentioned by the older modern authors.[993] The white precipitate or chloride of mercury and ammonia is probably also irritant, though inferior in power to the preparations just mentioned. Two scruples given to a dog occasion vomiting, pain, and some diarrhœa; and cases are recorded of death in the human subject from less doses.[994] But there are no recent facts as to the activity of this compound, and the older cases, which would assign to it very great energy, are open to the objection that this preparation was in former times often impure. The bichloride or corrosive sublimate is a powerful corrosive or irritant, according to the dose and state of concentration; and it also excites mercurial erethysm in a violent degree. The nitrates too are corrosive, and not inferior in activity to the bichloride, as may be inferred from Dr. Bigsby’s case, noticed at page 314. The bicyanide or prussiate of mercury, from the researches of Ollivier, and an interesting case he has published of poisoning with it in the human subject, appears to resemble corrosive sublimate closely in all its effects, except that it does not corrode chemically. Twenty-three grains and a half proved fatal in nine days.[995] M. Thibert has described a case in which ten grains caused death in the same period of time.[996] The symptoms in both instances were those of severe irritation of the stomach, extensive inflammation of the organs in the mouth, and suppression of urine; and in Thibert’s case a small quantity of albuminous fluid was discharged from the bladder instead of urine. The protochloride or calomel, and probably also the protoxide, are the most manageable of the preparations of mercury for inducing ptyalism. Calomel is also an irritant; that is, it causes irritation and inflammation in the alimentary canal when swallowed. This part of its properties as a poison will require a word or two of explanation. Calomel is universally employed as a laxative, but to secure this effect being produced it is commonly combined with other purgatives. When given alone a few grains will in some constitutions induce a violent hypercatharsis; and larger, but still moderate, doses have with most people such a tendency to cause severe griping and diarrhœa as to have led to the practice of combining it with opium when the object is to salivate. These considerations clearly establish that calomel, in a moderate dose of five or ten grains, is an irritant. It farther appears that in larger doses it is said to have occasionally produced very violent effects, nay, even death itself, by its irritant operation. Hoffmann has mentioned two instances where fifteen grains of calomel proved fatal to boys between the ages of twelve and fifteen. One of them had vomiting, tremors of the hands and feet, restlessness and anxiety, and died on the sixth day. The other, he merely mentions, died after suffering from extreme anxiety and black vomiting.[997] Another fatal case has been related by Ledelius in the German Ephemerides, which was caused by a dose of half an ounce taken accidentally. Vomiting soon ensued, and a sense of acridity in the throat; then profuse diarrhœa to the extent of twenty evacuations in the day; next excessive prostration of strength and torpor of the external senses; and death followed in little more than twenty-four hours.[998] Wibmer quotes Vigetius, an author of the beginning of last century, for a similar case, likewise fatal, which was occasioned by half an ounce,—also Hellweg, a writer of the previous century, for the case of a physician, who took an ordinary medicinal dose by way of experiment, and died in five hours under all the symptoms of violent irritant poisoning.[999] These observations being kept in view, what explanation will the toxicologist give of the effects which in modern times have been ascribed to large doses of calomel? It was stated not many years ago by several East India surgeons, apparently with the universal assent of their brethren in later times, that this drug in the dose of a scruple administered even several times a day, is not only not an irritant, but even on the contrary a sedative;[1000] and that in some diseases, for example yellow fever, it has been given in the dose of five, ten, or twenty grains, four or six times a day, till several hundred grains were accumulated in the body, yet without causing hypercatharsis, nay, with the effect of checking the irritation which gives rise to black vomit in yellow fever, and to the vomiting and diarrhœa observed in the cholera of the East. It is quite impossible for a European physician to doubt these statements; for all practitioners in hot climates concur in them, and now that analogous practices have been transferred to Britain, repeated opportunities have occurred for establishing the fidelity of the original reporters. Some American physicians, advancing beyond the Hindostan treatment, have since given calomel in bilious fever in the dose of forty grains, one drachm, two drachms, and even three drachms, repeatedly in the course of twenty-four hours for several days together,—and with similar phenomena. In one instance 840 grains were given in the course of eight days in these enormous doses. The largest dose was three drachms; and it was followed by only one copious evacuation, and that not till after the use of an injection.[1001] This practice appears not to have been altogether unknown in former times. Ledelius, the author formerly quoted, states, that he had been accustomed to give doses of a scruple, and that Zwölffer even gave a drachm in one dose.[1002] It must be also added, that while the facts quoted above from Hoffmann, Ledelius, and others assign to single large doses a powerful and dangerous irritant action, very different results have been occasionally observed in recent times where even so large a quantity as one or two ounces had been taken. Thus, in the case of a lady mentioned by Wibmer, who took by mistake the enormous quantity of fourteen drachms, although acute pain in the belly ensued, together with vomiting and purging, these symptoms were speedily subdued by oleaginous demulcents; and after a smart salivation, she recovered entirely in six weeks.[1003] Another case has been related by Mr. H. P. Robarts, where an ounce was swallowed by a young lady by mistake for magnesia, with no other effect than nausea at first, rather severe griping and slight tenderness of the belly afterwards, and subsequently languor, headache and indigestion; yet the powder was retained two hours.[1004] It is impossible in the present place to enter into the physiological action of calomel as a remedy; but every one must be satisfied that, with all which has been already written, much still remains to be done before the facts now mentioned can be explained satisfactorily. Can the violent effects described by Hoffmann, Ledelius and Hellweg have arisen from the calomel having been imperfectly prepared and adulterated with a little corrosive sublimate? Or may they be explained by reference to the fact, that the presence of hydrochlorates in solution, particularly hydrochlorate of ammonia, tends to convert calomel into corrosive sublimate.[1005] Mr. Alfred Taylor has made some experiments, to show that the latter explanation will not suffice.[1006] Meanwhile, taking the facts as they stand, it is plain that great caution must be used in ascribing violent irritant properties generally, or even symptoms of irritant poisoning in a particular case, to large doses of calomel. With the view of illustrating the importance of the preceding observations, it may be useful to mention here the heads of a case already briefly alluded to for another purpose, the trial of William Paterson for murder (319).[1007] His wife during the month previous to her death had two attacks of diarrhœa, with an interval of a fortnight between them. On the second occasion it became profuse and exhausting, but without any material pain or considerable vomiting; looseness of the teeth and salivation ensued, and she died in nine days. On examination of the body, the anus was found excoriated, the whole intestines checkered with dark patches, and the stomach red, ulcerated, and spotted with black, warty excrescences; but the late Dr. Cleghorn of Glasgow could not detect any poison by chemical analysis. It was proved that the prisoner, besides procuring, a few months before his wife’s death, a variety of poisons, such as hydrochloric acid, cantharides, and arsenic, had also on different occasions during her last illness purchased in a suspicious manner four doses of calomel varying from 30 to 60 grains each. Among the various ways in which he was charged with having poisoned the deceased, that which was best borne out by the general as well as medical facts consisted in his taking advantage of an existing inflammation of the mucous membrane of the bowels,—whether arising from a natural cause or from poison it was in this view of the case immaterial to inquire,—and keeping up and aggravating the inflammation by purposely administering at intervals large doses of calomel. On the trial Dr. Cleghorn and other witnesses gave their opinion that the doses purchased by the prisoner, if administered, would cause the symptoms and morbid appearances observed in the case. On the other hand, the late Dr. Gordon deposed to the effect, that all the symptoms of the case might arise under the operation of natural disease, and that such doses of calomel were by no means necessarily injurious; the late Mr. John Bell deposed, that it had even been given in much larger doses without injury; and the profession are now well aware, though not at the time of this trial, that in the very malady alleged by the prisoner to have carried off the deceased, namely dysentery, the administration of calomel in repeated large doses is accounted by many a proper method of cure. The doses purchased by the prisoner were considerably larger, it is true. But there was not any evidence of his having administered his purchases in single doses as he got them; and even though there had been evidence to that effect, it would not remove altogether the difficulty of deciding the question, as to the irritating action of calomel, on which the issue of the trial in one view of the case chiefly depended. It is probable that all the compounds formed by corrosive sublimate with animal and vegetable substances are feebly poisonous, or at least very much inferior in activity to corrosive sublimate itself. This has been shown by Orfila to be the case with the compound formed by albumen. Sixty grains of this compound, being equivalent to nearly five grains of corrosive sublimate, produced no bad effect whatever on a dog or a rabbit.[1008] The same has been satisfactorily proved by Taddei as to the compound formed by gluten. Twelve grains of corrosive sublimate decomposed by his emulsion of gluten had no effect whatever on a dog.[1009] It is important to remark, however, that if there be an excess of the decomposing principle, so that the precipitate is party redissolved, the irritant action of the corrosive sublimate is not so much reduced, though it is still certainly diminished. Orfila has settled this point in regard to albumen.[1010] The power of producing mercurial erethysm is possessed by all mercurial compounds whatever, and among the rest by the compounds now under consideration.[1011] The present section may now be concluded with a few remarks on the strength of the evidence derived from the symptoms which are produced by the compounds of mercury. If the medical jurist should meet with a case of sudden death like that of the animals experimented on by Sir B. Brodie, the symptoms alone could not constitute any evidence of poisoning with corrosive sublimate. All he could say would be that this variety of poisoning was possible, but that various natural diseases might have the same effect. This feebleness in the evidence from symptoms, however, is of little moment; because the dose must be great to cause such symptoms, and little can be vomited before death; so that the poison will be certainly found in the stomach. Should the patient die under symptoms of general irritation in the alimentary canal, poisoning may be suspected. But it would be impossible to derive from them more than presumptive evidence. The suspicion must become strong, however, if the ordinary signs of irritation in the alimentary canal are attended with the discharge of blood upwards and downwards. And the presumption will, I apprehend, approach very near to certainty,—at least of the administration of some active irritant poison,—if, at the moment of swallowing a suspected article, and but a short time before the symptoms of irritation began in the stomach and bowels, the patient should have remarked a strong, acrid, metallic taste, and constriction or burning in the throat. When upon all these symptoms salivation is superinduced, the evidence of poisoning with corrosive sublimate or some other soluble salt of mercury is almost unequivocal. That is, if, after something has been taken which tasted acrid, and caused an immediate sense of heat, pricking, or tightness in the throat, the characteristic signs of poisoning with the irritants make their appearance in the usual time, and are soon after accompanied or followed by true mercurial salivation,—it may be safely inferred that some soluble compound of mercury has been taken. Before drawing this inference, however, it will be necessary to determine with precision all the classes of symptoms, more particularly the nature of the salivation. It should also be remembered that salivation may accompany or follow the symptoms of inflammation in the stomach, in consequence of calomel having been used as a remedy. But if proper attention be paid to the fallacies in the way of judgment, I conceive that an opinion on the question of poisoning with corrosive sublimate may be sometimes rested on the symptoms alone. This is another exception to the rule laid down by most modern toxicologists and medical jurists respecting the validity of the evidence of poisoning from symptoms. For a good example of the practical application of these precepts, the reader may consult the trial of Mr. Hodgson, for attempting to poison his wife. In the instance which gave rise to the trial in question, a violent burning sensation in the throat was felt during the act of swallowing some pills; in the course of ten minutes violent vomiting ensued, afterwards severe burning pain along the whole course of the gullet down to the stomach, next morning diarrhœa, and on the third day ptyalism. There were many other points of medical evidence which left no doubt that corrosive sublimate was swallowed in the pills. But even the history of the symptoms alone would have led to that inference.[1012] SECTION III.—_Of the Morbid Appearances caused by Mercury._ The morbid appearances observed in the bodies of persons killed by corrosive sublimate will not require many details; since most of the remarks formerly made under the head of the pathology of the irritants generally, and of arsenic in particular, apply with equal force to the present species of poisoning. Still there are some peculiarities deserving of notice, which arise from the greater solubility or stronger irritant action of corrosive sublimate. The mouth and throat are more frequently affected than by arsenic; and a remarkable appearance sometimes observed, and not excited, so far as I know, by arsenic, is shrivelling of the tongue, with great enlargement of the papillæ at its root.[1013] The disorder of the alimentary canal is also usually more general, and reaches a greater height before death takes place. Sometimes the irritation and organic injury are confined to the stomach;[1014] but more commonly the throat, stomach, gullet, rectum, nay, even also the colon, are affected. The black or melanotic extravasation into the mucous membrane of the stomach, which has been already several times described as a common effect of the more violent irritants, is also produced by corrosive sublimate. In Devergie’s case and in that of Dr. Venables it was present in a very great degree.[1015] The coats of the stomach, and also those of the intestines, more particularly the colon and rectum, have frequently been found destroyed. So far as I have been able to ascertain, two kinds of destruction of the coats may be met with,—corrosion and ulceration. The first is the result of chemical decomposition of the tissues. This kind is evidently to be looked for only when the quantity has been considerable and the dose concentrated. Nay even then it is rare. For on account of the solubility of corrosive sublimate, the facility with which it is decomposed by the secretions or accidental contents of the stomach, and the violence and frequency of the vomiting, this poison is peculiarly liable to be prevented from exerting its corrosive action on the membranes. Hence it is that proper chemical corrosion of the coats of the stomach is seldom witnessed in man. The appearance of this corrosion differs according to the rapidity of the poisoning. In very rapid cases, for example in animals which have survived only twenty-five minutes, the villous coat has a dark gray appearance, without any sign of vital reaction.[1016] But this variety has never been witnessed in man, in whom the action has been hitherto much less rapid. In the most rapid cases, such as that of Dr. Bigsby, which terminated in two hours and a half (314), or those related by Mr. Valentine, of which one ended fatally in eleven and another in twenty-four hours, the corrosion was black, like the charring of “leather with a red-hot coal, and the rest of the stomach scarlet-red or deep rose-red;—showing that inflammation had set in.” In the former of these two cases the corrosion was as big as a half-crown, in the latter three inches in diameter. In a third case, where the patient lived thirty-one hours, the stomach was perforated.[1017] In the case described by Dr. Venables, and formerly alluded to, where life was prolonged for eight days, there was a patch on the under surface of the stomach as large as two crown-pieces, hard, elevated, and of a very dark olive or almost black colour, besides very general erosion of the villous coat.[1018] In all these cases the disintegrated spot was probably situated where the poison first chiefly lodged. The corrosion caused by mercury, if examined before the slough is thrown off, will be found to possess an important peculiarity: the disorganized tissue yields mercury by chemical analysis. Professor Taddei repeatedly obtained the metal from the membranes of animals which he had poisoned with corrosive sublimate.[1019] It is probable that mercury may be thus detected although death may not have taken place for some time after the poison was swallowed. For the slough was found adhering in one of Mr. Valentine’s cases, where life was prolonged for seventy hours; and it was not entirely removed even in eight days in one of the cases described by Dr. Venables. Although, however, it is sometimes possible to find the poison in the stomach, the medical jurist must not perhaps expect to find it so often in the present instance as in that of poisoning with arsenic. For on account of its greater solubility corrosive sublimate cannot adhere with such obstinacy to the villous coat, and is therefore more subject to be discharged by vomiting. Nevertheless, the insoluble compound formed by antidotes may adhere to the coats like arsenic, and so resist the tendency of vomiting to displace them. In Devergie’s case, notwithstanding twenty-three hours of incessant vomiting, although no poison could be detected in the fluid contents of the stomach, it was distinctly found in small whitish masses that lay between the folds of the rugæ.[1020] It may be here farther observed that corrosive sublimate, as well as other salts of mercury, may undergo in the alimentary canal after death the same change which is produced in arsenic from the gradual action of hydrosulphuric acid gas. It may be converted into the sulphuret. I am not acquainted indeed with any actual instance of such conversion; but that it may occur we can scarcely doubt, not merely from theoretical considerations, but likewise because Orfila met with an instance where calomel taken daily in a case of gastro-cephalitis was discharged by stool in the form of a black sulphuret.[1021] Another important consideration is, that corrosive sublimate may be decomposed and reduced to the metallic state by the admixture of various substances either given at the same time or subsequently, and the longer the inspection is delayed, the more complete will be the decomposition which is accomplished. Iron, zinc, and other metals are the most active of these substances.[1022] The other forms of destruction of the coats of the alimentary canal is common ulceration, either such from the beginning, or what was originally corrosion converted into an ulcer in consequence of the disorganized spot being thrown off by sloughing. I have seen this appearance to an enormous extent in the great intestines of a man who survived nine days. Numerous large, black, gangrenous ulcers, just like those observed in bad cases of dysentery, were scattered over the whole colon and rectum. In this instance, which occurred to the late Dr. Shortt, the stomach was also ulcerated, but the small intestines were not. Sometimes the ulceration seems to be a variety of softening of the mucous tissue, as in a case described by Dr. Alexander Wood of this city, which proved fatal in fourteen days, and in which the stomach, cæcum, and ascending colon presented round, softened, greenish spots about the size of a sixpence, and accompanied in the stomach with a tendency to detaching of the membrane in the form of a slough.[1023] The destruction of the villous coat of the stomach occasioned by corrosive sublimate and other soluble salts of mercury may be distinguished from spontaneous gelatinization by one of two characters. If the slough remains attached, mercury will be detected in it: if separation has taken place, the ulcer exposed presents surrounding redness and other signs of reaction.[1024] All the other effects of inflammation may be produced by corrosive sublimate, as by arsenic and other irritants. More frequently here than in the case of arsenic peritonæal inflammation is met with. In Devergie’s case the external surface of the stomach along both its curvatures presented the appearance of red points on a violet ground. In Mr. Valentine’s cases there was much minute vascularity, not only of the outside of the stomach but also of the whole peritonæum lining the viscera and inside of the abdomen; and there was even some serous effusion into the cavity. In Dr. Venables’s case the peritonæal coat of the stomach was highly vascular and inflamed, and the omentum also injected. The urinary organs, and particularly the kidneys, are often much inflamed by poisoning with corrosive sublimate. Dr. Henry has related a case in which this poison proved fatal on the ninth day, and where the left kidney was found to contain an abscess.[1025] In all of Mr. Valentine’s cases the kidneys were inflamed, and the bladder excessively contracted, so as not to exceed the size of a walnut. In Ollivier’s case, caused by the cyanide of mercury, the scrotum was gorged and black, the penis erected, and the kidneys a third larger than natural. In the case described by Dr. Venables both kidneys, but especially the left, were large, flaccid, and vascular, the ureters turgid and purple, and the bladder contracted, empty, and red internally. Orfila has observed that the internal membrane of the heart is sometimes inflamed and checkered with brownish-black spots. Some remarks have been already made on the light in which this appearance ought to be viewed by the pathologist (p. 271). Whatever may be the real state of the fact as to the alleged power of arsenic to preserve from decay the bodies of those poisoned with it, all authors agree that corrosive sublimate possesses no such property. Yet it is well known to be a good antiseptic, when applied topically. The experiments of Klanck, noticed under the head of Arsenic, prove that corrosive sublimate at all events does not retard putrefaction in the bodies of those poisoned with it; and Augustin in his analysis of Klanck’s researches infers that it even promotes decay.[1026] I have met with one example in the human subject which seems to confirm Augustin’s opinion. In the case formerly quoted from the Medical and Physical Journal, which was fatal in four days, the relater found the body forty-two hours after death so putrid, though in the month of January, that the examination of it was very unpleasant, the belly being black, and a very offensive odour being exhaled.[1027] Little importance, however, can be attached to a solitary case; for on the contrary Sallin relates a case where the body of a man supposed to have been poisoned with corrosive sublimate was found not decayed, but imperfectly mummified, after sixty-seven days.[1028] It is unnecessary to detail the proofs to be found in the dead body of mercurial salivation having existed during life. They are of course to be looked for in the mouth, and in the adjoining organs. We must not, however, expect to see much appearance of disease in the salivary glands; for according to Cruveilhier, in persons who die of mercurial salivation these glands do not present any trace of inflammation themselves, but merely serous effusion into the cellular tissue around them.[1029] Professor Orfila has made some useful experiments as to the effects of corrosive sublimate on dead intestine, which it may be proper to notice in a few words. When applied in the form of powder to the rectum of an animal newly killed, the part with which it is in contact becomes wrinkled, and as it were granulated, harder than natural, and of alabaster whiteness, intermingled with rose-red streaks, apparently the ramifications of vessels. When the membrane is stretched upon the finger, the wrinkling disappears. The muscular coat is of a snow-white colour, and even the serous coat is white, opaque, and thickened. The parts not in contact with the powder retain their natural appearance, and the line of demarcation between the affected and unaffected portions is abrupt. If the powder is not applied till twenty-four hours after death, the parts it touches become thick, white, and hard; but no red lines are visible. It is easy to draw the distinction between these appearances and the effects of corrosive sublimate during life. Little need be said of the force of the evidence of poisoning with corrosive sublimate, derived from the morbid appearances. If the gullet, stomach, and colon be all inflamed and ulcerated, and these injuries have taken place during a short illness, the presumption in favour of some form of irritant poisoning will be strong. And the presumption of poisoning with corrosive sublimate will be strong, if the usual marks of salivation are also found in the mouth and throat. But such evidence can never amount to more than a strong presumption or probability. SECTION IV.—_Of the Treatment of Poisoning with Mercury._ The treatment of poisoning by the compounds of mercury may be referred to two heads,—that which is required when irritation of the alimentary canal is the prominent disorder, and that which is designed to remove mercurial salivation. Irritation and inflammation of the alimentary canal are to be treated nearly in the same way as when arsenic has been the poison swallowed. In the instance of corrosive sublimate we also possess a convenient and effectual antidote. Several substances may be used as antidotes; but those which have hitherto been most employed are albumen and gluten. It has been already hinted that albumen, in the form of white of eggs beat up with water, impairs or destroys the corrosive properties of bichloride of mercury, by decomposing it and producing an insoluble mercurial compound. For this discovery and the establishment of albumen as an antidote, medicine is indebted to Professor Orfila. He has related many satisfactory experiments in proof of its virtues. The following will serve as an example of the whole. Twelve grains of corrosive sublimate were given to a little dog, and allowed to act for eight minutes, so that its usual effects might fairly begin before the antidote was administered. White of eight eggs was then given; after several fits of vomiting the animal became apparently free from pain; and in five days it was quite well.[1030] According to Peschier the white of one egg is required to render four grains of the poison innocuous.[1031] The experiments of the Parisian toxicologist have been repeated and confirmed by others and particularly by Schloepfer; who found that when a dose was given to a rabbit sufficient to kill it in seven minutes if allowed to act uncontrolled, the administration of albumen, just as the signs of uneasiness appeared, prevented every serious symptom.[1032] Dr. Samuel Wright has found that if the administration of albumen is followed up by giving some astringent decoction or infusion, the beneficial effects are more complete, because the compound formed is less soluble in an excess of albumen.[1033] The virtues of albumen have also been tried in the human subject with equally favourable results. The recovery of the patient, whose case was quoted formerly (p. 312), from Orfila’s Toxicology, seems to have been owing in great measure to this remedy. In the Medical Repository another case is related, in which it Was also very serviceable.[1034] A third very apposite example of its good effects is related by Dr. Lendrick. His patient had taken about half a drachm of corrosive sublimate, and was attacked with most of the usual symptoms, except vomiting. White of eggs was administered a considerable time afterwards, the beneficial effects of which were instantaneous and well-marked; and the patient recovered.[1035] A few years ago Orfila’s discovery was the means of saving the life of M. Thenard the chemist. While at lecture, this gentleman inadvertently swallowed, instead of water, a mouthful of a concentrated solution of corrosive sublimate; but having immediately perceived the fatal error, he sent for white of eggs, which he was fortunate enough to procure in five minutes. Although at this time he had not vomited, he suffered no material harm. Without the prompt use of the albumen, he would almost infallibly have perished.[1036] Albumen is chiefly useful in the early stage of poisoning with corrosive sublimate, and is particularly called for when vomiting does not take place. But it farther appears to be an excellent demulcent in the advanced stages. On a previous occasion, mention was made of a few of the facts brought forward by Professor Taddei to prove the virtues of the gluten of wheat as an antidote for poisoning with corrosive sublimate [297, 336], so that nothing more need be said on the subject in the present place. As it is difficult to bring the whole of a fluid containing corrosive sublimate into speedy contact with pulverized gluten, which when put into water becomes agglutinated into a mass, the discoverer of this antidote proposes to give it in the form of emulsion with soft soap. This is made by mixing, partly in a mortar and partly with the hand, five or six parts of fresh gluten with fifty parts of a solution of soft soap. And in order to have a store always at hand, this emulsion, after standing and being frequently stirred for twenty-four hours, is to be evaporated to dryness in shallow vessels, and reduced to powder. The powder may be converted into a frothy emulsion in a few minutes.[1037] Taddei made use of this powder with complete success in the case of a man who had swallowed seven grains of corrosive sublimate by mistake for calomel. Violent symptoms followed the taking of the poison; but they were immediately assuaged by the administration of the antidote; and the person soon got quite well.[1038] It is probable that wheat flour will prove an effectual antidote by reason of the gluten it contains. On agitating for a few seconds a solution of twelve grains of corrosive sublimate along with three ounces of a strong emulsion of flour, and immediately filtering,—I find that ammonia and carbonate of potass have little or no effect, that hydriodate of potass occasions a yellow precipitate, and that the acrid, astringent taste of the solution is removed; whence it may be inferred, that the corrosive sublimate is all decomposed, that little mercury remains in solution, and that what does remain is in the form of a chloride of mercury and gluten. When neither albumen nor gluten is at hand, milk is a convenient antidote of the same kind. Iron filings would appear to be also a good antidote. MM. Milne-Edwards and Dumas have found that when they were administered in the dose of an ounce to animals after twelve or eighteen grains of corrosive sublimate had remained long enough in the stomach for the symptoms to begin, the animals recovered from the effects of the poison, and died only some days afterwards of the effects of tying the gullet, which operation was necessary to prevent them vomiting. The iron obviously acts by reducing the corrosive sublimate to the metallic state.[1039] Meconic acid, the peculiar acid of opium, which will be described under the head of that poison, is also probably a good antidote. Pettenkoffer correctly remarks that this acid has a great tendency to form very insoluble salts with the metallic oxides, particularly with the deutoxides, and above all when the acid is previously in union with a base which constitutes a soluble salt.[1040] On this account it must be a good antidote. Pettenkoffer adds, that the precipitating action of the meconates is the reason why “the operation of corrosive sublimate on the animal body is almost entirely prevented by opium.” Opium, however, cannot be safely used in such quantity as to decompose all the corrosive sublimate in a case of poisoning; for I find that an infusion of thirty-three grains is required to precipitate all which can be thrown down from a solution of five grains of the mercurial salt. I am not aware of any instances on record where poisoning with corrosive sublimate has been prevented or cured by opium given so as to decompose the salt; but a very remarkable case will be related under the head of Compound Poisoning, where the phenomena of its action were masked and altered in a singular manner. There is little doubt that the alkaline meconates must prove valuable antidotes for corrosive sublimate. At present an effectual barrier to their employment is their rarity; but they might be rendered more accessible, as a great quantity of meconate of lime, which is at present put to no use, is formed in the manufacture of muriate of morphia; and meconate of potass may easily be prepared in sufficient quantity from the meconate of lime. It has been alleged by Dr. Buckler of Baltimore, that a mixture of gold-dust and iron filings is an effectual antidote; but Orfila denies this statement; and the fact if true would be unimportant, on account of the improbability of the materials being ever at hand in practice.[1041] M. Mialhe suggested not long ago as an antidote the proto-sulphuret of iron prepared by decomposing sulphate of protoxide of iron by hydrosulphate of ammonia; and Orfila found that it is a perfect chemical antidote, which altogether prevents the poisonous action of corrosive sublimate, if administered to animals either before or immediately after the poison; but he further ascertained that the lapse of ten minutes was sufficient to render it of no use.[1042] It is difficult, however, to perceive why in this respect it should differ from white of egg or any other chemical antidote. As to the old antidotes for poisoning with corrosive sublimate, such as the alkaline carbonates, the alkaline hydrosulphates, cinchona, mercury, charcoal,—Orfila has given them all a fair trial, and found them all inefficacious. It would appear, however, from a case related in a late American journal, that frequent doses of charcoal powder have much effect in soothing the bowels and allaying the inflammation after the poison is evacuated.[1043] The treatment of mercurial salivation consists in exposure to a cool pure air, nourishing diet, and purgatives, if the intestinal canal is not already irritated. In some of the inflammatory affections it induces, venesection is required; in others it is hurtful. In some complaints induced by mercury, as in iritis, the poison appears to be its own antidote; for nothing checks the inflammation so soon and so certainly as mercurial salivation. Dr. Finlay of the United States proposed to check mercurial salivation by small doses of tartar emetic frequently repeated, so as to act on the skin;[1044] and Mr. Daniell has recommended large doses of the acetate of lead as an effectual antidote for the same purpose.[1045] I have tried both of these plans several times with apparent success. In one instance particularly, where a severe salivation was threatened by the administration of six grains of calomel in three doses, and where profuse salivation, ulceration of the tongue and swelling of the face actually did commence with violence, the mercurial affection after a few days rapidly receded under the use of large doses of acetate of lead.—Dr. Klose, a German physician, says he has found iodine to possess the property of arresting the effects of mercury on the mouth.[1046] The iodide of potassium is generally acknowledged to be one of the best remedies for eradicating the constitutional infirmities left in many by severe courses of mercury. A great deal might be said on the treatment of the secondary effects of poisoning with mercury. But a thorough investigation of the subject would lead to such details as would be inconsistent with the other objects of this work.