CORROSIVE SUBLIMATE-SYMPTOMS.

139

pale and anxious. The pulse is small, frequent, and irregular, and is scarcely perceptible when the symptoms become aggravated. The tongue is white and shrivelled, the skin cold and clammy, the breathing difficult; and death is commonly preceded by fainting, convulsions, or general insensibility. The internal parts of the mouth, when examined, are swollen, and sometimes present a white appearance, as if the cavity had been recently washed with a solution of nitrate of silver; the lips are often swollen. Suppression of urine has been frequently noticed among the symptoms: it existed in a well-marked case of poisoning by this substance where the patient lived four days, but did not pass any urine during the whole of this time. (Guy's Hosp. Rep., 1844, p. 24.) This symptom was observed in a case reported by Wegeler (Casper's Wochenschrift, 1846, p. 30), in which a youth, æt. 17, swallowed three drachms of the poison, and died on the sixth day. During the last three days no urine was secreted. The case was otherwise remarkable from the fact that no pain was experienced on pressure of the abdomen, and that the pulse Gaderwent no change until shortly before death. In another case, in which twenty grains of corrosive sublimate in solution were swallowed, suppression of urine and salivation came on the third, and the patient died on the ninth day. (Lancet, 1845, ii. pp. 650, 698.)

The external application of corrosive sublimate to tumors or ulcers may destroy life with all the usual symptoms of acute mercurial poisoning. A quack was convicted of manslaughter (Winchester Lent Ass., 1859, Reg. v. Crook) by applying corrosive sublimate in powder to a cancerous tumor on the face of the deceased. The man died under the usual symptoms. After death the bowels were found extensively inflamed and ulcerated. Corrosive sublimate was detected in the diseased part. At the Exeter Lent Assizes, 1878, a quack-doctor was indicted for the manslaughter of a woman under similar circumstances. The deceased had ulers on her legs, and a solution of corrosive sublimate, largely diluted, was applied by the prisoner in order to cure them. The death of the Woman was assigned to the absorption of the poison; but the judge held that gross and culpable ignorance had not been proved, and under his direction the prisoner was acquitted. A girl, æt. 9, died from the effects of this poison locally applied to the scalp for the treatment of ringworm. The liquid applied was alcohol containing eighty grains of corrosive subhimate to the ounce. She suffered from mercurial poisoning in a severe form, and died on the fifth day after the application. (Pharm. Jour., Sept. 9, 1871, p. 216; Lancet, 1871, ii. p. 413; and Med. Times and Gaz., 171, p. 353.) No theory of idiosyncrasy is required to account for death under such circumstances. In the first edition of the author's work ON Potsons (1848), p. 394, fatal cases are related of poisoning by corrosive Sablimate through the unbroken skin. Two brothers thus lost their Ives, the one dying on the fifth and the other on the eleventh day. Those who deny the power of the unbroken skin to absorb corrosive subLinate and cause all the usual effects of acute mercurial poisoning, should take themselves and not their patients the subjects of experiment. Severe salivation sometimes follows the external application of a mercurial compound. In 1884 a man was tried at the Surry Sessions for putting corrosive sublimate into a kettle of water. He was acquitted. Several persons suffered from partaking of the poisoned liquid.

Corrosive sublimate differs from arsenic: 1, in having a well-marked taste; 2, in producing violent symptoms in a few minutes; and 3, in the fart that the evacuations are more frequently mixed with blood. The symptoms produced by corrosive sublimate, in the first instance, resemble

140

APPEARANCES AFTER DEATH.

those of cholera; but if the person should survive several days more like those of dysentery-violent straining and shreddy mu charges mixed with blood being frequently observed.

Slow or Chronic Poisoning.-The symptoms are much modifi the poison is taken in small doses at intervals for some days o There are colicky pains with nausea, vomiting, general uneasin depression. The salivary glands become inflamed and painful; the and gums are red and swollen, sometimes ulcerated, and there is the breath. A deep blue line, like that observed in poisoning by sometimes found around the edges of the gums. The patient exp difficulty of swallowing and breathing. The constitutional ef indicated by irritability or looseness of the bowels, difficulty of br spitting of blood, cough, general trembling or convulsive mover the limbs, and palsy, with fever and emaciation, under which the sinks. One of the most marked effects of slow or chronic poiso mercurial preparations is salivation, or ptyalism, indicated by an in flow of saliva. This is by no means a necessary symptom in acute poisoning by corrosive sublimate, but it not unfrequentl itself about the second or third day. In many instances the dies too rapidly for this effect to follow; but even when he surviv days, salivation is not always observed. In placing reliance up symptom, it must be remembered that salivation may arise from a of causes irrespective of the use of mercury. (See ON POISONS, p. 366.) Substances sold under the name of Worm Lozenges ha known to cause death by producing fatal salivation. In the sa caused by mercurial compounds the saliva always contains mercury may be detected by Reinsch's process. The elimination of this takes place by all the fluid secretions, but chiefly by the urine and tinal liquids. (Lancet, 1873, i. p. 476.) Workmen exposed to the of metallic mercury exhibit a peculiar form of paralysis, known a curial tremors or "trembles."

Appearances after Death.-These, as in the case of arsenic, are confined to the stomach and bowels. Corrosive sublimate, however, the mouth, throat, and gullet; the mucous membrane is softene white or bluish-gray color, and inflamed; that lining the gullet i larly affected, and partly corroded and softened. The mucous mer of the stomach is more or less inflamed, sometimes in patches; and are masses of black extravasated blood found beneath it. Occas this has a slate-color, and the mucous coat beneath may be found red A case occurred in Guy's Hospital in which the mucous membra simply inflamed, much resembling the condition presented in ca arsenical poisoning. The coats of the stomach are sometimes con and so much softened that they cannot be removed from the body w laceration. Similar appearances have been met with in the sma large intestines, especially in the cæcum. In a case reported by Her in which twenty grains were taken and death occurred on the ninth the mucous membrane of the stomach was softened, but there we well-marked appearances of the irritant action of the poison on this The cæcum had been the seat of the most violent inflammation, the surface being of a deep black-red color and there were patches of s ing in the coats. (Lancet, 1845, ii. p. 700; Edin. Month. Jour., 1851, p. 532.) Perforation of the stomach is rare as an effect o poison: there is one case on record. Appearances like those just des have been seen in the intestines, not only where the case has termi

CORROSIVE SUBLIMATE-ANALYSIS.

141

fatally in a few hours, but where it has been protracted for six, eight, and even eleven days.

The smallest dose that is reported to have destroyed life is three grains. This was in the case of a child, and the quantity was accurately determined from the fact of its having been made up by mistake for three grains of calomel, which a physician had intended to order. It is probable that, under favorable circumstances, from three to five grains, or even less, would destroy an adult.

In an acute case a person commonly dies in from one to five days, but death may take place much sooner or later than this. In the shortest fatal case on record the man died in less than half an hour: but the quantity of poison taken was not ascertained. (ON POISONS; CORROSIVE. SUBLIMATE.)

Chemical Analysis.-Corrosive sublimate is usually seen in heavy crystalline masses, or in the form of a white powder. In the solid state1 When the powder is heated on platinum-foil, it melts and is volatilized as a white vapor without leaving any residue. 2. When heated in a closed tube, unlike arsenic, it melts before subliming, and forms a sublimate consisting of stellate prismatic crystals (see Fig. 12). 3. The powder is changed in color by the following reagents: iodide of potassium produces a bright scarlet, potash a yellow, and sulphide of ammonium a black compound; ammonia does not alter its color." 4. The mercury and chlorine may be discovered by one process. Mix the powder with four parts of dried carbonate of sodium free from chlorides (obtained by incinerating the bicarbonate), until the residue in the reduction-tube fuses and becomes white. A sublimate of metallic mercury in distinct and wellFig. 12.

Fig. 13.

defined globules will be obtained (see Fig 14). Detach by a file the end of the tube containing the fused residue, which is chloride of sodium with some undecomposed carbonate. Digest it in water with nitric acid and apply heat until it is entirely dissolved; then add to the solution nitrate of silver. A white precipitate of chloride of silver insoluble in boiling nitric acid will be at once produced The solid is thus proved to contain both mercury and chlorine, and the only compound of these elements. which is soluble in water is corrosive sublimate.

In solution of water. A few drops of the solution of corrosive sublimate evaporated on a glass slide yield slender, opaque, silky prisms (see Fig. 13). When a weak solution of iodide of potassium is dropped on them they acquire a bright scarlet color. This scarlet coloration,

142

DETECTION IN ORGANIC LIQUIDS.

which may be obtained from the minutest crystal and only on solution, proves that the body dissolved in water is corrosive s it is thus distinguished from every other mineral poison and substances whatever. 1. Stannous chloride added to a SO corrosive sublimate produces a gray precipitate, which, after it boiled, is resolved into globules of metallic mercury. 2. Sulf

Fig. 14.

Globules of Mercury.

hydrogen and sulphide of ammoniumi after a time, a black sulphide, not s alkaline or diluted acid. 3 If after has been acidulated with hydrochlo bright copper-foil, wire, or gauze is into it, the copper will acquire a sil deposit, even in the cold, but more ra heat. When the copper with the deposit is dried and heated in a tube, of mercury are sublimed (see Fig. 14) In organic liquids.-The liquids separated by filtration from any insol tions. The latter should be presse and set aside for a separate analys liquid portion should be slightly a with hydrochloric acid, warmed, and copper-foil introduced; if this is not immediately coated with me may be allowed to remain for some hours. When a deposit h place, the copper should be removed, washed in water and aftery ether, and dried. If the quantity of corrosive sublimate dissolv organic liquid is moderately large, it may be removed by means Place the filtered liquid supposed to contain the dissolved pois stoppered tube; add to it twice its volume of ether, and agitate th at intervals for a few minutes. Allow the liquid to subside, pou ether into a large watch-glass, and submit the liquid to spor evaporation. As the ether evaporates, the corrosive sublimate deposited in white, silky-looking prisms. These may be pu necessary, by solution in water or alcohol, and the solution aga tallized. Corrosive sublimate may thus be separated from ars other mineral poisons in solution. If mercury and arsenic are as in a poisonous mixture, or in the tissues, the arsenic may be removed by distillation with hydrochloric acid (p 130). Masses sive sublimate may be sometimes locked-up in thick, viscid mucu in such cases, the coarse powder being heavy, it may be separ simply agitating the viscid liquid in water and then decanting th portion suddenly. This poison is decomposed and precipitated b organic substances, such as albumen, fibrin, mucous membrane; gluten, tannin, and other vegetable substances. Thus, then, we always expect to find it in the stomach in a state of solution. methods of analysis are chiefly directed to the separation of the r only. The suspected liquid is boiled, filtered, and acidulated with chloric acid. 1. To one portion add stannous chloride in excess boil the liquid and filter to separate the mercury, the whole of w precipitated either as a black powder or in gray globules. On boili deposit in strong hydrochloric acid, the small globules coalesce t liquid mercury. 2. Into another portion of the liquid introduce foil and gently warm. The copper becomes covered with a la silvery-white metal, either immediately or in a few hours. A quantity of copper may be thus coated. The coated copper sho

DETECTION OF MERCURY IN THE TISSUES.

143

digested in warm alcohol or ether, dried, and heated in a reduction-tube, when a sublimate of silvery-white globules will be obtained, well marked by their opacity, lustre, and spherical shape when examined with the icroscope (see Fig. 14, p. 142). The sublimate of metallic mercury dfers from that of arsenic in the fact that, when heated, it sublimes Saply as metal without change. It is not oxidized (like metallic arsenic) by heating it in a reduction-tube, but is simply transferred with its tallic lustre and globular form from one part of the tube to another. Is the event of a doubt existing respecting the nature of the sublimate, the following experiment will solve it. Cut off by a file the portion of glass a which the globules are deposited; introduce this into a wide, short tube, with a few drops of nitric acid. Heat the acid liquid and evaporate it dryness on a sand-bath. White crystals will remain if the sublimate was mercury and too great a heat has not been applied. On touching the white residue cautiously with a drop of a weak solution of iodide of potassium the crystals will acquire a scarlet color. In place of copper, a weizhed slip of gold foil may be wound round a rod of zinc and introfaced into the acidulated liquid. The gold is soon covered with a silverywhite layer of mercury. In doubtful cases the deposition may be allowed to go on for twenty-four or even forty-eight hours. The gold-foil must then be detached from the zinc, rinsed successively with water, alcohol, and ether, dried, and introduced into a reduction-tube. On gently heating the portion of the tube containing the gold-foil, a sublimate of metallic globules of mercury is obtained, and the foil resumes its original yellow color and weight. The sublimate must be further examined and tested, as above described.

In the tissues.-Insoluble substances suspected to contain mercury, as well as the soft organs, e.g. liver and kidneys, may be cut up and boiled 'n one part of hydrochloric acid and four parts of water until dissolved. The mercury may then be separated by copper or by gold with zinc. This method will show the presence of mercury, but not of corrosive submite, in the body. Whether the mercurial compound has acted as a pison or not must be determined from symptoms and appearances; whether it has been given or taken as a medicine or not, is a conclusion which must also be determined from other circumstances. The proof that the mercury was really in the form of corrosive sublimate could only be derived from the discovery of some undissolved portions of the solid poison in the stomach or its contents, or from a separation of the poison itself by means of ether. If thus obtained after filtration of an organic quid, it would show its presence in the form of a soluble salt; and it may be remarked that all the soluble salts are poisonous, and are rarely used internally as medicines. If undissolved, the absorbed mercury may have ben derived from some mercurial medicine innocently taken by the deceased. Nothing is more common than to discover traces of mercury in the stomach, bowels, liver, kidneys, or other organs of a dead body. No importance can be attached to this discovery in the absence of evidence that the deceased had actually suffered from symptoms of mercurial poisoning. As to the mercury found in the tissues, it may have been derived from a soluble or insoluble compound, or from exposure to the vapors of the metal or of its salts in various trades.

CALOMEL Mercurous Chloride.-This substance, although commonly regarded as a mild medicine in small doses, may destroy life by causing excessive salivation with ulceration and gangrene; and in large doses it acts as an irritant poison. A man suffering from eczema of the scrotum was directed to employ black wash, consisting of one drachm of calomel