Mercurius cyanatus

Volume III — Main text

Mercurius OyanatUB, mercuric cyanide, Hg (CN),.

I. Provings. — 1. A partial proving of the cyanide gave great pros* tration and weakness, a low febrile condition, a whitish-grey deposit upon the tonsils and mouth, extending along the r. side of the tongue, with slightly swollen tonsils and difficult deglutition. These symptoms are given as communicated to me by the prover. The prostration and other symptoms were so severe that he ceased taking the drug,— the second potency had been used^ — and rapidly recovered by the use of baptisia. (W. A. Allen, Horn. Times^ Oct., 1877,)

II. Poisonings. — J. a, A strong healthy man, in April, 1823, after futile attempts to take a preparation of prussic acid, swallowed about 23 J gr. of cyanide of mercury. Immcdiatclv, repeated vomiting mixed with blood ensued, frequent and copious stools, and terrible pains in the whole abdomen. The patient drank mucilaginous drinks. After 4 d. Dr. fCapeler was called. The patient's face was grave, the eyes fixed, and the conjunctiva injected. He confessed, at last, to having poisoned himself in the above-mentioned way. The exterior of the body showed nothing remarkable, except a dark blue discoloration of the scrotum and of the semi-erected penis. Terrible headache \ strong heart-beat ; rather slow, but full, hard and even pulse i free respiration ; slight cough -J normal resonance of the chest. Lips, tongue, and inner surface of cheeks studded with numerous ulcers covered with a greyish pulp; salivary glands swollen; ptyalism ; swallowing difficult, continued nausea, and frequent vomiting after drinking ; great thirst. Abdomen soft, not sensitive to pressure ; frequent urging to stool, with tenesmus; stools infrequent and mixed with blood; suppressed urination. (Twenty leeches to the anus; veal-broth as a drink; injection of bran-water ; boiled barley and honey for gargling.) On the following d. the condition was the same. (Thirty leeches and poultices to the abdomen.) On the 6th d. none of the symptoms had abated ; the condition of the mouth was the same; vomiting, tenesmus, and suppression of urine continued; the abdomen soft, not painful on pressure; the heart-beats violent and strong ; the pulse unchanged. (Venesection.)

Restless^ sleepless n. ; when in a warm bath the anxiety ceases. On the 7th d. the heart-beat not so strong ; pulse a little weaker ; salivation less profuse ; the condition of mouth and other symptoms unchanged. (Thirty leeches.) During d. the patient is quiet^ and only complains of pain in the mouth ; slight convulsions in the extremities. On the 8th d. general weakness, frequent fainting, somnolency, vomiting less frequent, suppression of urine j the semi-erected state of the penis also continues, and the purplish hue. In the e. slow contracted pulse, cold extremities, hiccough. On the 9th d. condition the same. Extreme weakness, and fainting attacks. Continued hiccough. At 2.30 died in a fainting attack.

b. Post-mortem examination 20 h. after death. External condition : Well developed body, dull pallor of the skin, upper and lower extremities rigid and contracted so that the body only rests upon the back ; the muscles red, very large, and covered with a thick layer of fat. Larynx, trachea and bronchix contain much whitish phlegm, a part of which flowed from the nose ; the pleural cavities contain several grammes of pinkish serum ; the lungs somewhat pink, healthy, and crepitating \ wherever a cut is made, much serum flows out. Circulatory system : On making a cut into the skin, muscles, or blood-vessels, pale and very fluid blood flows out. The inferior vena cava is filled with a very large, elastic, and tough coagulum ; the heart, embedded in ^t, appears a little larger than normal, without having hypertrophied walls i but little blood in either ventricle ; fibrous coagula in the r, auricle. Digestive organs : Peculiar stinking odour from the mouth. Inner surface of cheeks and the gums are covered with ulcers, having a greyish coating ; the tongue thicker than normal, ulcerated on its edges, and covered with a very thick dry coating, hard to remove. The pharynx is normal ; in the middle of the oesophagus an ecchymosed pink spot the size of a thaler. The peritoneal cavity contains some yellowish serum. The stomach is of moderate size, and externally normal ; the intestines distended by gas. The mucous membrane is bluish red in the small curvature \ in the cardiac portion and large curvature dark red, exceedingly tumefied, and covered with ramifications of blood*vessels. In the duodenum and jejunum it is very much tumefied, dark red, in some spots quite black, and in others gangrenous. The redness the same in the coecum j pale in the ascending colon, more red in the transverse colon, less in the descending colon, and again darker in the rectum. The mucous membrane throughout the intestines is swollen, and in some portions, particularly in the small intestines, granulated. In all places where the membrane is raised in this manner, there is marked infiltration of serum into the submucous connective tissue. The pancreas is very large, hard, dry, easily torn, and creaks under the scalpel. The liver is enlarged, out the substance shows very little change. The gall-bladder contains a blackish-green, stringy, pitchy fluid. The spleen is small, otherwise normal. Uropoietic organs : The r. kidney is a third larger than normal, its substance u pale ; the 1. is a little smaller and less pale than the r. The bladder is small, contracted, containing a very small quantity of milky urine. The penis semi-erected, and, like the scrotum, of a purplish hue. The

skull and spinal column were not opened. Neither in the blood nor in the excrements could M. be found chemically. (Orfila, 7#jr/ccUgii.)

1. A student took at 10 p.m. on Dec. 3rd, after drinking 3 glasses of beer, 2 gr. of cyanide of mercury in a fourth of another glass. He had not taken solid food for 7 or 8 h. Immediately, nausea followed by vomiting. In about 10 m. continuous vomiting was added, violent urging to stool, soon followed by evacuations. Vomiting and diarrhoea now alternated until lO a.m. During this time he may have had 30 to 40 attacks of vomiting and diarrhoea. To these symptoms were added bitter taste, violent colic increased with every evacuation, vertigo, headache, and great chilliness. 4th, 1 1 a.m. — The patient's face cyanotic; pupils widely dilated ; extremities cold ; pulse weak, 130 ; tongue clean ; abdomen not distended, and not painful to the touch. Lungs and heart unaffected, only the heart's impulse and sounds very weak. Urine not passed with the stools. Prescription : milk, mucilaginous drinks, cold applications to head. In e. vomiting had completely stopped. There were two thin evacuations tinged with blood ; these were without urination. Pulse 132, small; cyanosis somewhat less. 5th. — Patient slept all n. On waking violent headache; increased nausea and thirst; difficulty in swallow mg ; entire lining of the fauces highly inflamed; evacuations had ceased; bladder empty. Pulse 102, irregular ; pupils somewhat more contracted. Same prescription. Patient slept much dunng c. ; had no evacuation. Pulse 92. 6th. — Had a good sleep ; pulse 90 ; tongue thickly coated, but no vomiting and evacuations ; otherwise the same. 7th, — In n. vomited 20 or 30 limes, with increased bitter taste. The matter vomited consisted of a whitish, turbid, slimy mass, of alkaline reaction, without any marked odour. Tongue moist and coated ; no evacuation ; bladder empty. Pulse 88 i profuse nose-bleed. Headache and vertigo continued. Ice pill and an injection. After first spoonful of med. vomiting again ; the injection was followed by two dark fa?cal evacuations slightly tinged with blood ; no urine. Pulse 90. Slight nose-bleed, otherwise the same. 8th. — In n. violent vomiting twice of much dark blood, a dark fxcal stool y slight thirst, no appetite ; tongue thickly coated ; formation of vesicles on 1. border of tongue, also on J. side of soft palate -, svirallowing remains difficult ; pulse 90, and regular; but little nose-bleed ; no urine, no sweats. There was no urination up to the loth, when, during an attack of nose-bleed, there was urging to micturate, and the urine passed in bed. The urine, which was collected on the nth, had an acid reaction ; the quantity was too small to take the specific gravity. Microscopical examination showed numerous straight and twisted tubuli covered with finely grained detritus ; no blood-corpuscles. A chemical analysis disclosed much albumen. Once or twice a day, attacks of nose-bleed, alternating with vomiting, up to the i/Ch; also a daily increase of urine. On the i8th no nose-bleed, and no more albumen or tubuli in urine, which was now copious. Pulse 54; tongue still thickly coated. On 20th and 21st no nose-bleed ; the tongue, for the first time, moist and clean ; taste and appetite improved ; pulse 88^ intermitting. On a2nd, no more vomiting, but also no evacuation in

spite of three injections. Same condition on 33rd. Another injection on 24th brought a copious normaJ evacuation. Soup and gruel were well received. On 25th decidedly convalescent, with a remaining tendency to constipation for several d. (Moose, f^irchow*s Archiv^ 1864.)

1. Mr. H — , act. 19, architect, weakly, nervous constitution, several h. after eating a hearty dinner, took a glass of eau sucree in which was put by mistake a teaspoonful of a saturated solution of cyanide of mercury. A short time after taking the poison, the patient experienced a general feeling of coldness, soon followed by nausea, vomitings and diarrhceic evacuations with violent colic. During the evacuations feeling of general prostration, soon amounting to a fainting fit, in which he fell to the floor, where he lay for an indefinite length of time in an unconscious state ; he was alone in his room and received no aid. After consciousness had returned he crawled into bed, where he was found next m., 7 h. after taking the poison. Dr. Leon Simon saw him about 10 a.m. Not knowing the cause of the attack, he received an infusion of tea, which was soon after vomited up. At first sight the young man seemed to be su^ering from an attack of cholerine ; his face was pale, somewhat bluish, and distorted, the eyes sunken, skin icy cold, pulse small, 70 to 76. Tongue pale; violent thirst, but what he drank was immediately vomited \ a disagreeable astringent taste in mouth. He had had no evacuation and had not urinated for 2 h. The abdomen was not tympanitic, or particularly sensitive to pressure. Simon thought that the repeated evacuations had carried the poison from the intestinal canal, and prescribed neither emetics nor chemical antidotes, but gave the patient hepar sulph., 3rd dil., with alternate drinks of milk and albuminated water. 6 p.m., patient had vomited twice, not very copiously, but had had much retching ; 6 fluid oflensivc passages. The skin had become warm again ; the pulse was quicker and stronger — go beats. The tongue continued pale, with a yellowish coating on back part. Scraping in cesophagus i diflicult swallowing; pharynx looked red and arborescent. Violent thirst, burning in stomach ; epigastrium and (slightly) abdomen painful to pressure. No urine apart from stools. N. was spent sleeplessly. Patient was much excited and talked without cessation. He got angry with his watchers, and talked at random in his rage. He drank much, vomited 6 times, and had 8 stinking green slimy stools -, no urine passed. Next m. condition was same as e. before. Skin hot, somewhat moist ; headache ; vertigo when sitting up j ringing in ears; tongue redder at edges, coated grey at back. Hepar sulph. continued. Next d. condition was improved \ he had vomited but once, and had 3 fluid passages much less painful ; passed urine once; sleeplessness and excitability same ; extremely violent headache. Vertigo and ringing in cars on sitting up. Great weakness. Belladonna^^. 1 5th. — Sleeplessness and headache same in n., but not so furibund; less thirst ; no more vomiting; 6 slimy diarrhoeic stools, with some tenesmus. Pulse increased ; skm moderately warm ; less vertigo ; mucous membrane of mouth affected, gums swollen, covered with a white layer, with a violetcoloured margin ; tongue swollen, and covered with tenacious grey

coating ; entire mucous membrane of mouth and fauces red and arborescent. Nitric acid^. i6th. — General condition same; fever in n., with sleeplessness and violent headache ; no vomiting ; no evacuation ; condition of mouth somewhat worse. A white transparent layer, resembling mucous syphilitic patches, has formed on palatine arches and tonsils ', further, there was present on inner surface of r. cheek a round ulcer with greyish base and sharply defined ed^, surrounded by a bright red cK>rder. Nitric acid^^ 17th and i8th. — Condition the same, except that the ulcer in the mouth had spread, and was covered with a layer of greyish exudation ; great thirst, cannot take warm drinks or meat broth, the latter seemed to him too salt. Constipation, and some pain in belly ; the latter is not distended, and not very sensitive to pressure ; urine clear but scanty. On 1 7th patient was left without med. On i8th and 19th he received sulphur^. He had continuous hiccough for 24 h. ; this was at last relieved by nux vomica. 20th. — Condition of mouth improved. Ulcerated surface clean, and is beginning to cica^ trise ; gums less swollen, less red, and the white coating has disappeared from these and from throat. Less thirst ; meat-broth and light soups well received. Constipation ; urine more copious ; nights are more quiet ; still patient has not his natural sleep. The neuralgic headache still continues during first part of n. Pulse small and weuc, 70 to 75. Patient could sit up yesterday for an h. without being too much fatigued thereby. On 21st improvement continued, but on 22nd there was a sudden return of watery evacuations, which were preceded by violent colic $ no urination ; tongue is again covered with a grey coating; patient has a very disagreeable metallic taste, a return of the thirst, aversion to food, nausea ; pulse accelerated but weak ; skin moist and cold, and general prostration. Arsenicum^'. 23nl. — Symptoms in mouth better; increased diarrhoea; since yesterday, is blackish, fluid, very foetid stools, and violent colic; urine scanty uid dark. Extreme weakness, pale face, icy-cold skin ; small thread-like pulse, 1 00 ; thirst moderate ; aversion to food. China*. 24th.— Diarrhoea the same ; patient very weak ; pulse small ; skin moist and icy cold. Hippocratic face ; could not sleep at n. on account of frequent evacuations. Carbo veg.^ 25th. — But 8 evacuations during past 24 h. They were more yellow ; one of them contained some blood. Pulse stronger, 100 ; skin not so cold, and countenance more natural; less thirst ; tongue retains its grey coating. Gums less inflamed and swollen, but teeth painful. Mucous membrane of mouth and pharynx quite clean. Carbo veg.'^. 26th and 27th. — Considerable improvement. Diarrhoea checked and strength returning. Patient can remain up almost an h. ; some return of appetite ; patient can take soup ; when sitting he complains of pain in rectum and about anus. 29th. — No more diarrhoea, but pains in rectum are becoming unbearable. The parts about anus are swollen, sensitive, and somewhat red ; no stool, but some black blood is expelled when making the effort. Belladonna**, 30th, — All symptoms worse ; 6 profuse evacuations of blood ; patient is again extremely weak ; pains in anus continue very severe ; around anus small haemorrhoidal tumours, and wart-like eleva> tions on mucous membrane. Rhus tox*^. March 31st, April 1st and

and. — The bloody passages have ceased, but not the pains ; besides the

above-mentioned symptoms, there is found about the

anus

greyish

diphtheritic coating, quire similar to that on the inner cheeks ; also erosions on mucous membrane j in short, condition of anus was similar to the pathological affection styled ulcerating mucous patches. Merc. solub.^**. 3rd. — Aggrav'ation of pain in rectum ; extension of ulcers and of diphtheritic coating ; ichorous discharge from rectum diffusing the characteristic gangrenous smell, and leaving broad blackish stains on sheets. Lachesis'\ 4th. — Rather less pain, and much less gangrenous odour ; discharge from anus still profuse, but more pus-like. Since yesterday m. some pain in calf of 1. leg -, on examination it was found that the veins formed two hard cords, which united a little below the bend of the knee ; the slightest touch is very painful. Lachesis^'. 5th, 6th, and 7th. — Improvement daily; discharge from anus growing less and less -y it is of a serous nature, and has scarcely any odour. Yesterday patient had a painful passage, but sensitiveness has much decreased. He can now sit on an air-cushion. The leg is much in the same condition, and begins to swell as soon as he is on his feet. loth. — Discharge is nearly stopped ; parts around anus are somewhat red, but there is no swelling or any diphtheritic coating ; patient remains up for several h. each d. ; for 2 d. past he has been able to cat and digest meat. Daily, one or two soft stools, but slightly painful. The leg is less painful but continues somewhat swollen. No mcd. 1 2th. — Condition same as 2 d. ago. Lachcsis*^. 14th. — Leg is less painful, venous cords having grown much smaller ; rectum and anus almost well. Lachesis*'. l8th. — Improvement continues. 28th. — Leg continues somewhat painful ; otherwise well. Lachesis^ 8 d. after patient visited Simon. His condition was improved in every way. He could walk more than an h. without fatigue. May 14th. — • Simon saw the patient for the last time ; he had resumed his usual occupations. (Bw//, df la Sec, Med, Horn, cU Franciy iv, 340.)

7 gr-

ill. Expgr'tmints on animals, — r, a, A small bitch received dissolved 'n\ distilled water. For 5 m. retching, cramps, alternated with weakness ; respiration and heart's action at Krst accelerated, then abnormally slow. Death in 10 m.

b. About 3 gr. were injected into connective tissue of thigh of a dog. In 3 m. retching and spasms, broken from time to time by fits of weakness lasting } h. The animal then remained weak with tottering gait ; the vomiting stopped. In 4 h. all symptoms disappeared.

r. About I gr. were injected into the jugular vein of a young dog ; he immediately fell on his side \ slight spasms, lasting but some seconds; very slow respiration, heart-beats only 32 per m. Respiration and circulation grew slower and slower, and the animal died without spasms in 5 m.

d. The P.M, changes were of no decided character. Lungs contained little blood, and crepitated ; heart was relaxed, and its chambers contained much blood, which was partly fluid. In the dog killed by injection into the jugular, the blood formed very elastic, firm, fibrous coagula in the vena cava ascendens and the iliac veins. In the other animals the blood in the vessels was mostly fluid. The colour of the

mucous membrane of the stomach was very variable ; in 2 cases there were dark red spots, formed by the union of many small vessels. The same colour, somewhat less marked, was found in a dog which received 12 gr. after fasting 36 h. The same appearance of mucous membrane of stomach and intestines was seen in the dog killed by hypodermic injection. This dog*s stomach was partly filled with food. Another dogf killed in the same way, had eaten nothing for 48 h. j the mucous membrane of stomach and intestines was whitish ; he had vomited several times. In all the stomach was closely contracted, except in the one killed in 10 m. by injection into the jugular vein. In all, without exception, the liver was filled with copious fluid blood. (Orfila, 0^. ff>.) 2. 1 poisoned a large dog with the cyanide^ by injecting some of the crude drug under the skin. The symptoms were — nausea ; vomiting ; excessive thirst ; many stools, of what I took to be blood but proved to be bile and mucus, with much tenesmus ; respiration very slow, the last h. before death about i per m. ; dilatation of pupils -, intermittent pulse, beating twice, then stopping once, then beating 5 times and stopping twice. The dog had no pain, but was in a listless state, with excessive and complete prostration. Post-mortem examination revealed inflammation of the larynx, with its mucous membrane and that of the ^posterior nares loaded with mucus j cardiac portion of stomach highly -inflamed, the viscus containing about a pint of bile and mucus ; whole .intestinal tract filled with bile and rectum congested ; liver highly congested i both ventricles of heart filled with dark bloody in r. a white fibrinous clot. (Burt, y/m/r. Homceopathiity ii, 29.)

Volume IV — Supplement

MERCURIUS CYANATUS. (See voli, p. 260.)

Il, 4, I was called to a young man of 28, and found him with altered countenance, small and frequent pulse, cold sweat: throat, velum palati and base of tongue were covered with greyish false membranes, apparently well-organised. Patient acknowledged that he had endeavoured, on the previous d., to poison himself with cyanide of mercury, but had taken so large a dose as to cause vomiting, This had saved him. I gave the antidotes to mercury, and improvement soon set in. Little by little, the false membranes diminished in thickness, but the tongue changed in appearance, and the buccal mucous membrane showed mucous patches like those of secondary syphilis.* (Lion Simon, Trans, of Paris Hom. Congress of 1889, p. 100.)