Kalium chloricum

Volume III — Main text

KALI CHLORICUM,

Potassic chlorate, KCIO^

1. Proving!. — i. C. W. A. Blaufuss, set, %%, robust, choleric temperament. — Nov. 6th, 8 am., took i gr. After i h. pulse quickened.— 7th, 8 a.m., 1 gr. No symptoms.— 9th, 8 a.m., 3 gr. Oppression of chest with strong heart s beats. — 13th, 9 a.m., lO gr. Immediately taste like vitriol. After 6 h. pressure on epigastrium, pain in abdomen, cold shudder over back and neck with warm feet. After 2 d. dazed head. — Timt not indicated: Frequently recurring twitching on lower and upper part of forehead going off after 8 h. Great rush of blood toeyes, Nostool at 10 p.m., when he usually had one. Strong, almost audible, heart's beat with oppression of chest and cold feet. Pulse 80. Cold feet and palpitation of heart. Itching all over body, e. in bed, next morning numerous small red papules. Chilliness in open air for 2 d. Persistent chilliness. Intolerable heat in bed, e., febrile state with violently throbbing pulse and heart. Restless sleep often disturbed by disagreeable dreams. (Martin, Archiv^ xvi, i, 182.)

2. G. Grafe, act. 22, sanguine temperament, took Nov. 6th, m., I gr. After 12 h. violent diarrhcea, always watery, at last after 6 d. nothing but mucus evacuated, went ofF on 9th d. Along with the diarrha:a, furred tongue and transient weakness. (/W., 183.)

3. G. F. HiLFERT,ct. 22, choleric temperament. — Nov. 6th, 1835, 6 a.m., I gr. Headache in afternoon. — 7th, i gr., and after ) h. i gr. No symptoms. — 8th, i gr. 3 times at 4 h. interval. After 8 h., irritation in nose causing frequent sneezing with increased discharge, alio next d. with jerking in masseter (the nasal symptoms occurred after 5 g^-)* — Time not indicated: Pretty severe headache; tension in sinciput \ papules on forehead, very hard dry stool ; drawing in thigh and forearms \ great weariness and drowsiness.— 15th, m., 5 gr. Soon, pulse 70 (is usually 64). After 24 h. feeling of strength in eves. After 36 h. pain in upper eyelids, papules between lips and rain. After 48 h. humming in ears, with painful stool, of dry fteces, latterly mucus and blood, and persistent pain in rectum ; another such stool 4 h. later. After 60 h. eyes red and painful, very much out of humour after cheerfulness. After 72 h. irritation in eyes with rush of blood into them, violent epistaxis. After 76 h. fseces soft^ passed without pain. — lime not indicated: Increased sensitiveness of whole £ace, tearing in root of nose, tickling in canthi of eye ; jerking in nerve of lower jaw at foramen maxillare posticum, transient bitter-sour taste. — May 9th, 1836, took i gr. No symptoms. — xoch, 1 gr. No svmptoms. — 12th, 1 gr. Frequent sneezing. — 2i$t, 4 gr. After 6 h. dryness in throat, hoarseness. After 8 h. persistent headache, pressure in r. and 1. hypochondrium to navel. After 12 h. violent erections with emissions, chilliness e. through whole body. After ao h. voluptuous dreams with emission. Afier 24 h. itching in urethra, continued erections with itching on scrotum. — Time not imdicattd: Restless sleep, flushes of beat in face. — 24th, 4 gr. Pains in head.^ 26th, 4 gr. After 20 h. violent coryza. (Ihid.)

4. H. Horn, act. 21, nervous irritable temperament. Nov. 6th, 1835, I gr. After 2 h. pain in temporal region. After 4 h. cutting in stomach. Chilliness for several d. — 7th. 2 gr., chilliness. — 8th. 3 gr., miliary rash with single painful papules on 1. shoulder for 10 d. — 13^1^- 5 gr-) after \ h. cutting headache down to malar bones. After 2 h. tension over forehead, then sneezing and coryza ; pain from temples into carious teeth, violent pressure in eyes, sneezing, then coryau eructation. After 7 h. toothache in upper jaw. After 24 h. hard stool. After 70 h. epistaxis at n. After 72 h. urine veiy turbid. — Time not indicated: Warmth in stomach. Pulse 78 (usually 70), Chilliness for several d. — May 23rd, 1836, 4 gr. Headache on 1. side of head. Attack of ravenous hunger, later anorexia. — 24th. Chilliness, ill humour, anxiety, hypochondriacal tension of ganglionic nerves lasts until relieved by epistaxis. — 26th. 4 gr., after 24 h. nose bled twice ; great hunger at unusual time. (Ibid,^ 184.)

5. H. KuNZMANN, act. 26, phlegmatic, in good health, took Nov. 6th, m., I gr. Immediately nausea with slight shivering. After ^ h. eructation. After 8 h. tensive pain in r. hypochondrium relieved by discharging flatus. — Time not indicated: Turbid urine; shivering all over. — 7th. I gr., after 3 h. flashes of light in both eyes when coughing and sneezing. Easily intoxicated by beer ; urine turbidw-^ 9th. 2 gr., after i h. confusion of head, weariness. After 2 h. vertigo after strong exercise with congestion of blood to head. After 2^ h.

congestion of blood in chest, oppression of chest, violent heart's beats, pulse at r. wrist full, soft, lazy, 68, intermitting every 25 or 30 beats, not synchronous with hearths beats, which arc 80, strong and regular, at 1, wrist small, soft, compressible. — iith. i gr., urine turbid. — 15th. 5 gr., the urine, previously turbid, became clear. Itching of sicin, n., next m. small red papules on thighs and shoulder, not in the joints j they dry up after 40 h., and there then appear some small papules on face. (Ibid.)

1. £. Maktin, set, 26, irritable nervous constitution, subject to rheumatic affections, at present healthy. — Nov. 6th, 1835, took at 6 and 10 a.m. i gr. Immediately persistent bitter taste, cold feeling of tongue. Soon, slight tearing in r. wrist and along ulna. After } h. pressive pain in r. malar bone under border of orbit, then tension in neck, check, and temple ; this recurs after 8 h. After i h. violent sneezing, pricking burning in tongue ; expectoration of mucus removes the bad taste. After ij h. drawing in root of nose. After 3 h. tongue furred at back, anorexia, tightness of chest, confusion of head. After 6 h. repeated. After 12 h, very burning papule on 1. cheek, — Tirru not indicated : Painful pressure in 1. upper costal region j stool very sluggish, occurs at 11.30 p.m., liquid stool next m., urine very turbid, great chilliness, shivering all over body. — 7th, at 6 and 10 a.m., i gr. After \t h. drawing and tension in r. side of face. After i h. violent sneezing. After 3 h. liquid stool. After 48 h. a very much inflamed hang-nail ; urine turbid. — Time not indicated: Tension in r. cheek under eye, extending to ears, afterwards on 1. side \ gums bleed readily when brushing teeth. — loth, 6 and 10 a.m., i gr. After \ h. drawing pain in r. cheek, making him sneeze. After 1 h. violent sneezing. — Time not indicated : Tongue furred at back. Pressure in scrob. cordis with apathetic disposition and chilliness. Transient internal coldness in r. forearm. Itching vesicle on back of r. hand. Great chilliness. Tranquil dreams of prophecies of death on several n. Sadj desponding, apathetic disposition with chilliness in e. Sexual desire very much diminished. — nth, 6 and 10 a.m., i gr. Immediately bitter taste as usual. Chilliness with stiffness of hands ; restless sleep, full of vexatious dreams. Quiet dreams of death from typhus fever. — I2th. 5 gr. Soon coldness in precordial region. After 10 m. pressure and empty feeling in stomach. After \ h. eructation with nausea. After \ h. roughness in oesophagus. After i h. distinctly perceptible but not quick heart's beats with coldness in precordial region. After 20 h. much twitching in head and body. After 24 h. very itching papules with small vesicles on back of I. hand ; disappeared during d. but recurred next m. After 72 h. rheumatic pains in several parts. — Time not indicated: Constant urging to stool, which is normal in character. Great chilliness with shivering. — 17th. 5 gr., similar symptoms. — May 12th, 1H36, m., i gr. K. chl. mixed with I gi^- 3fd trit. Immediately coldness of tongue and oesophagus for 5 m. After 20 m. drawing in r. check and gums with a kind of cramp of muscles of r. check. After i h. slight irritation to cough in larynx. After 2 h. increase of saliva. After 3 h. drawing and tearing in both wrists. Taste of cherry-laurel water with salt. — 16th. Same dose.

Drawing tension in r. cheek followed by desire to sneeze. Violent coryza with much sneezing and great flow of natal mucus.-^i 7th. Same dose. No new symptoms. — 26th, 6 a.m.j 4 gr. Immediatelj feeling of shivering. After 3 h. headache in 1. temple ; feeJing ot warmth in stomach ; frequent rumbling in belly with tendency 10 diarrhcea. After 6 h. much flatus during d. After 12 h. Irequenc urging to urinate. — Time not indicated: Confusion of head when walking in open air. Drawing in r. cheek with pain in lobe of cv, worse sometimes in masseter muscle, sometimes under orbit, Soundh after-taste. Very itching papules and small vesicles on back of L hand, going off during d. but returning next m. — 27th, m., 4 gr. After 12 h. itching vesicles on back of r. hand, lasting several d. After 24 h. restless sleep, wakes towards m. from anxious dreamt, lying on back, loudly snoring and breathing with difficulty. — Tinir ff#r fadrcated : Tensive drawing in 1. cheek under orbital border* Scraping in throat. Many not very itching vesicles filled with pus and with xA areola on limbs. {Ibid.)

1. W. Oehler, zt. 22, of sanguine irritable disposition, took Nov. 7th, 1835, m., I gr. Much eructation, with pains alternately in cheit and belly. — 8th, 9th, loth, m., 2 gr. No symptoms.— I tth, nu, 5 gr. Violent cough and coryza. Constant chilliness. After 7 d. urging to urinate. — May 21st, 1836, 4 gr. After 8 h. flow of mucin and saliva, sharp, burning, sour taste, pain in pelvic region, itching aD over body. — 23rd. 4 gr., the pain in pelvic region increases, and is accompanied by diarrhoea, which lasts 10 d., gradually going oflF. — a4tfay 4 V""* ^c*^dache with vertigo. Papular eruption on thigh and r

of mouth. Many dreams of events that occurred during d. (Md,)

1. Fr. Reichmann, set. 20, sanguine temperament, took hfoveoibcr 6th, I gr. Disagreeable salt sour taste. Soon, sneezing. Swelling of upper lip. Some eructations, griping in belly. Pulse 74, generally 70, Coldness of r. arm. — 7th. I gr. Soon sneezing ; increase of swelluc of upper lip — 15th. 5 gr., tension in face with forcing towards eycS| especially r. side. Urging to stool. On 5th n., epistaxis firom r. nostril. After 6 d. spasm in 1. eye, swelling of lower lip, cramp in r. index and leg. {Ibid.)

2. F. VuLPius, set. 21, phlegmatic melancholic temperament^took November 5th, 1835, I gr. Sneezing with violent coryza. Pukep usually 65, rose in 4 h. to 80, then to 90, for several h. — Nov. 6th. 2 gr., sneezing with coryza, pulse 85. — 7th. 3 gr., sneezing witb coryza, sourish taste. — 14th. 5 gr. Soon spasmodic drawing in cheek to maxillary joint, sometimes with tearing in superior maxilla. After 6 h. pulse 85. After 8 h. shooting pain in r. temple, goinK and coming j violent rigor, afternoon. After 12 h., in e., violent headache, goes ofF next d., spasmodic pressure in maxillary joint, with single stitches in both jaws and teeth, especially r. side ; sneezing with coryxa. After 24 h. pain in occiput, sometimes extending to both jaws » e., occasional shooting in various parts of face. After 28 h. vesicles on lower lip. After 72 h. rheumatic pains in various parts. After 6 d. pain in r. temple, urine very turbid. — May i8th, 1H36. 4 gr., burning alkaline taste. After 6 h. violent shooting pain in r. knee-jomt. After

48 h. confusion of head, some cough. - {Ibid.)

1. F. VVerther, act. 23, choleric No symptoms. — 8th.

.30th.

4 gr-

violent

coryza.

temperament, took Nov. 6th, 3 gr., violent itching all over

I gr., 7th, 2 gr. body, (ibid:)

1. P. H. WiLKEN,asc. 22, sanguine temperament, took June 3rd, after breakfast, 4 gr. Immediately increased mucus in mouth. After 8 h. some stitches in eyes ; empty feeling of occiput with peculiar feeling in nape muscles, then pain in occiput ; anorexia. — 4th, after breakfast, 4 gr. After 10 h. stool rather looser than usual. After 12 h., in e. oppression of chest with feeling as If lungs were slightly constricted with a narrow thread. Next m. this was nearly gone. He then took 4 gr. In afternoon the chest pain returned with greater force, and by e. had become very violent. The following 3 d, the chest pains continued, but went off on 4th d., when he took 4 gr., whereupon the chest pains recurred, but again went olf in 2 d. Feeling of uneasiness. [Ibid,)

2. A girl, St. 25, suffering from faceache, took \ gr. This caused dryness in throat and chest with cough and constriction of chest as from sulphur vapour. (Ibid.)

3. I took a single dose of 5 gr. dissolved in water, and found a sense of congestion to the head, accompanied by pain of forehead. A few weeks after, I took a dose of 10 gr., and the same symptoms were produced, continuing about 2d. I then waited for a period of some months, and took a dose of 15 gr. in a glass of water. It first produced slight acceleration of spirits, followed by congestion of brain to such an extent that one half of head, face and nose felt paralysed. The symptoms continued for 2 d., and then gradually subsided. There was also a loss of taste, being scarcely able to distinguish different kinds of meat. The muscles of the palate felt contracted, and the mucous membrane of mouth and throat appeared tanned, as from tannic acid. I have frequently used (while attending scarlatina patients) a solution of K. chl. as a wash for the mouth in the m. j but if continued for 2 or 3 d. in succession, similar symptoms to those I have described, but in less degree, were produced. (Osborn, Lancet^ '859j "7 3^4-)

4. E. T. D — , in perfect health, took Jan. 7th, 1832, 3j, and on ' ^h, 3J, without effect. On 16th took ^ss, which caused considerable diminution of appetite, and some flatulence, for several d. On 2i8t, at 4 p.m., pulse 80, took 3j- ^" 3" ^ pulse was 64 ; in another h. it varied from 56 to 65, a little exertion or movement instantly raising it to latter number; it was also much smaller and weaker. Shortly after dose, weight, fulness and distension began to be felt in epigastric region, gradually increasing, with twisting sensation and flatulence, to 10 p.m., when orandy relieved. N. was quiet, but next d. weight and fulness, with twisting, recurred, amounting to rather severe pain, but subsiding spontaneously towards n. The same thing occurred on two following d., requiring opium for relief, and for some d. yet all food caused uneasiness. For several weeks following prover had ha^morrhoidal protrusion, which he had never experienced before. There

VOL. III. 4

was also diuresis for first i8 h. (TuLLY^ Bost. Mtd, and Sttrg, J%

vi, 327-)

1. W. N. 6 — , in perfect health, likewise took 9j and 3) without effect. Jan. i6th,at 7 p.m., pulse 76, took 3»- In an h. or two pulse was diminished considerably in force, and about 10 beats slower. Some diuresis occurred, but n. was quiet. Next d. strong tense of weight and distension at stomach, with deficient appetite and flatulence. These symptoms continued through iftth and X9th, so that aninaal food could nut well be taken. On 21st, being well again, he took at 4 pjn. 3j, pulse 72. In an h. it had fallen, and was considerably smaller and weaker than usual. It continued at same point to 7 o'clock, rising to 64 on exertion j by 8 it had fallen to 48, and was still smaller and weaker. Between 7 and 8 copious alvine evacuation. Between 8 and 9 walked \ mile, and immediately on returning had some hcaYT oppressive pain and sense of sinking at stomach, so urgent as to require speedy mitigation. Pulse now only 36 ; moderate sweating; 2 oz* of brandy relieved, and n. was quiet. Next m. weight and pain at stomach recurred, relieved by brandy again, but returning after food» and at length became so severe after a short walk as to require full doses of opium (up to 20 gr.}. Pain had now extended to umbilical region, and become lancinating ; there was swelling, hardness and soreness, and intolerance of least pressure, in both epigastric and umbilical regions, with inability to sit erect, and much flatulence and eructation. By e. the opium had relieved, but a paroxysm of vomiting occurred at 9 p.m. N. was good, and next m. he only felt some vertigo, (/fti^.)

2. Dr. Tully himself took same doses with similar results, including the haemorrhoidal protrusion, and rather more diuresis. {ibid.)

3. IsAMBERT experimented on himself and others with iC. chL He found it eliminated rapidly and unchanged, principally by salivarr glands and kidneys. Doses of I — 6 grm. produced no appreciable results. From 8 or more grm. salivation occurred for 2—3 h. with saline taste, and salivary glands continued ^*- weak " for 5 or 6 d. A slight alteration in voice was noticed. The only constant eflect on the digestive function was increase of appetite. In high doses it showed well-marked diuretic properties. Twenty grm. daily induced frequent micturition, and slight sense of weight and pain in renal region, urine during whole time of elimination was strongly acid, and deposited urates abundantly. (/W., Ixiii, 32.)

II. Poisonings. — i. An inquest held Jan. i6th on the body of Mr. John S.Tuttle, of Bergen, New Jersey, revealed the fact that deceased was suffering from phthisis \ that he applied to a physician, who ordered ^vitj of K. chl. to be put up in twelve packages, one of which was to be taken daily in a pint of water. He took 4 powders on 4 consecutive d., when pains in bowels became very severe, incessant vomiting came on, and Anally death ensued. Drs. Booth and Olcott made a P.M. examination, and found external coat of stomach inflamed ; internal coat was yellow (as was matter he had vomited) it was soft and could be easily separated off with the handle of the scalpel, leaving the muscular coat bare. Both witnesses were of

5'

opinion that the medicine was the immediate cause of death. {Brit, Med, Journ.y l86l,i, 159.)

1. Dr. Fountain took on March 22nd, i86i, at a single dose, t oz. potass, chlor.^ with a view of verifying his belief in its innocuousness in large doses. The most violent results followed, viz. inflammation of the stomach and intestines, and a copious diuresis, lasting several h., followed by complete suppression of urine for 6 d, preceding his death. {Amer. Med. Times April, 1861, p. 245.)

2. A little girl, act, 2^ years, took about h oz. of potass, chlor. ; she had severe vomiting, which lasted for 7 h., when she died of gastritis in spite of all help. Another remarkable symptom of the poisoning was the profound lethargy of the child, which probably prevented its showing symptoms of pain. (Brit. Med, J&um.^ 1878, ii, 966.)

3. The patient was an Irish girl, single, set. 20. She was admitted to N, Y. Hospital April lOth, 1888, at 4 p.m. She had taken on previous e. two tablespoonfuls of K. chl. by mistake for Rochellc salts. On admission she was in a state of profound prostration \ temp. 99°, pulse 136, resp. 32. Surface was very cyanotic; breathing rapid, but not laboured ; pulse very feeble. She vomited freely before and after admission. In spite of whisky, digitalis, and strophanthus, symptoms grew worse. At 6 p.m. temp, had risen to 104"^. During n. bowels acted 3 times^ motions dark brown and semisolid ; dark-coloured urine was passed involuntarily. It was proved to contain many bloodcells, large masses of altered hzmoglobin, and much albumen. Next m. temp, fell, and pulse and resp, improved for a few h. By noon pulse and heart were again profoundly weak, and temp, rose to 101*2^. There was a verv extraordinary colour of skin, conjunctivjc, and lips, an intense anscmia with a cyanotic hue, and a very distinct sepia-brown chocolate tint where epidermis was thtn \ also great restlessness. Inhalation of oxygen produced no improvement. She slept constantly, and died 37 h. after poisonous dose. At necropsy, colour of blood was not materially changed, and a slight hue of jaundice was added to the anxmic and chocolate colouring. Blood in the great vessels was liquid, and of very dark chocolate colour. Heart was soft and flabby \ lungs normal, but cut surfaces very brown. Spleen was large and firm. Kidneys large, capsules non-adherent, surfaces smooth ; bladder contained 3 oz. of urine^ of dark brownish-black colour and not at all translucent. All viscera were coloured like blood. Microscopically, very extensive fatty degeneration of heart was evident, especially in papillary muscles of 1. ventricle. Many straight tubes in pyramids of kidneys were found filled, even to distension, with broken-down bloodcells and metharmoglobin. Spectroscopic examination of blood revealed spectrum of methxmoglobin with much distinctness. Conversion of hemoglobin into metharmoglobin explains dyspncca and altered colour. (Peadody, a. Y, Med. Rec.y July 21st, 1888.)

4. Man, set. 53, had been for two years in the habit of taking K. chl. largely for chronic throat trouble. He looked very pale and waxy. He fell ill with feverish sore-throat, after having taken more of drug than usual ; became very anxmic, passed no urine, vomited, and was

jaundiced. He became steadily weaker, and died comatose. PM, appearances were as in former case, but spleen was six times its normal size. (Ibid.)

1. A healthy young man, zt. 21, had incautiously gargled with a strong solution of potass, chlor., in course of which he had avirallowcd a considerable quantity. The following d. he complained of sickncn and of pain in the sides and loins. Signs of acute gastritis rapidly followed ; nausea and severe pain in the splenic region were the chiet symptoms. Some enlargement of the spleen detected. Heart and lungs were normal, but distinct cyanosis, especially of lips and extremities, was present. Two days after the poisoning severe vomiting set in and lasted till the end. Icterus followed, but disappeared before death. On 4th d. severe epistaxis ; extreme precordial anxiety followed, but without any notable signs in the heart or lungs s and some rigidity of muscles of extremities was observed. Death took place on 8th d. Throughout the illness hardly any urine viras paticd. Temp, subnormal ; pulse fair. P,M^^ 4 d. after death, revealed brown colour of blood-vessels \ it was normal to spectroscope. Spleen greatlr enlarged, brownish in places, and capsule soft. Kidneys enlarged and cortical portion expanded. Microscopically, the straight and convoluted lobes were found filled with numerous brownish, irregular-shaped masses of hemoglobin. The stomach showed acute and chronic catarrh, with a few ecchymoses. The Urge intestine and rectum contained a large quantity of brownish watery fluid, and the mucous membrane appeared oedematous. Other organs normal. (Ji!r^. 7tme$ and Gax.^ 1883, ii, 526.)

2. a. Von Mering discriminates between acute and subacute poisoning by the chlorate. In acute cases — such, for instance, as result Iron one large dose, death results in a few hours from decomposition of the blood, with symptoms of severe vomiting, profuse diarrhoea, intense dyspnoea, cyanosis, and profound cardiac depression. After death a chocolate- brown colour of the blood is seen, while the tissues generally are relatively very little changed. T'he blood contains methaemoglobinj &c. With less acute forms death results from the accumu* lation of oxidation products in the organs as well as in the blood, especially in the Icidneys.

b. Thefoilowingconditionsareseen: Greyish-violet petechias, icterus, accumulation of haemoglobin in the blood, changes in the red corpuscles, dyspncea, and cardiac depression \ gastro-intestinal disturbances such as profuse diarrhoea and severe vomiting, the vomited matter being generally greenish black j and enlargement of the liver and spleen. Functional alterations in the kidneys, such as anuria, occur % the scanty, turbid urine having a reddish-brown or black colour, and exhibiting spectra of methsemoglobin and haematin, and being niao highly albuminous. It also contains numerous detritus-masses of red blood-corpuscles in the form of brownish cylinders or flakes. Neuroses, urxmic convulsions, delirium, coma and rigidity of the limbs mc observed.

c. The subjective phenomena are : Headache, anorexia, tenderness of the stomach on pressure, pains m the hepatic and lumbar regions.

Rali chloriCum.

intense oppression of the chest, and a feeling of extreme weakness. After death the characteristic chocolate colour of the blood is noticed ; the spleen, liver, and kidneys are considerably enlarged and filled with accumulated products of destruction of red corpuscles. The greatest alteration is seen in the kidneys, in which both the straight and (he convoluted tubes arc filled with cylindrical or irregular brownish masses. The osseous marrow is brown and contains many decomposed bloodcells. The gastric mucous membrane is swollen and ecchymoscd. (Land, Med. Record, 1884, p. 518.)

1. A man, a*t. 49, was ordered pot. chlor. on account of a vesical catarrh following gonorrhoea. He took by mistake 60 grammes (1 oz.) in 36 h. When seen by Or. Bohm he was pale and collapsed, in a condition very suggestive of cholera, suffering greatly from pain over stomach, and with suppression of urine. Soon after a feeling of numbness and formication in the hands and feet came on, causing great distress and restlessness. The urine, blood, and the P.M. appearances were such as have been already described in other cases. {Ibid.y 1883, p. 436.)

2. Dr. F. Marchand has recently published four cases observed by himself (T'lrr/tm/V Archivy Bd. 77, Heft. 3), three of them fatal, and has found that the P.M. appearances and the microscopic alteration of the blood coincided with those observed in animals experimentally poisoned with potass, chlor. The ages of Dr. M.'s patients ranged from 3 to 7 years. The dose varied from I2 giammcs in 36 h. to 25 grammes in 30 h. The symptoms were vomiting, hxmaturia, a more or ]ess icteric tint of skin, rapid wasting of flesh and strength, delirium, and coma. The urine contained quantities of disintegrated bloodcorpuscles. The blood itself was of a remarkable chocolate colour, which did not alter on exposure to air. The same colour can be produced artificially by adding chlorate of potash to blood. If the proportion of the salt be considerable, the blood assumes a syrupy and even gelatinous consistence, and the red corpuscles tend to agglomerate into glutinous masses. The spectroscope shows that the lines characteristic of the hemoglobin have been replaced by a distinct absorption band in the red part of (he spectrum, due to the conversion of the hajmoglobin into mciha;moglobin, an oxidation product of the former. The poisonous eft^ects of the drug are therefore probably the result of its oxidising action on the red corpuscles. The debris thereof are either excreted by the kidneys, colouring the urine brown, or they accumulate in the renal cortex and cause death by suppression of urine and "urarmia." The kidneys themselves are enlarged, and their surface is brown, but they exhibit no inflammatory appearances, the main alteration being the infarction of their tubules with corpuscular detritus. [Aied. Times and Gaz.^ '879, ii, 64O.)

3. Hacmoglobinuria produced by large doses of potass, chlor. — A woman was suddenly taken ill with cyanosis and dyspnoea, and passed masses of hscmoglobin both ptr rectum and per vaginam ; the urine and the vomited matter also contained masses of haemoglobin. On the 3rd d. of her illness, the patient became slightly jaundiced, while the cyanosis passed of}*; on the 4th d. she died. Beyond an

enlargement of the spleen, which was painful to the touch, no was found during life the seat of disease. The Uood showed of leucocytes, but the red corpuscles showed nothing ver3r abnomul. The P.3I. examination showed all the organs healthjr except the spleen, which was large, soft, and looked like a blood-clot; the blood wis fluid and dark brown ; the kidney showed, in the cortical and medullary parts, chocolate-coloured streaks. The microscopical exjuninadon of the kidneys showed the convoluted tubes and straight tubes to be filled partly with granules and partly with small round discs of the size of blood-corpuscles, in which, however, the colouringmatter was precipitated. The glomeruli were perfectly intact. The hKmoriobin was not found within the glomeruli or in their capsules, but was abundant in the convoluted tubes, whose epithelium in most places was found intact. The patient had taken for a slight sore-throat about x) oz. solid pot. chlor. (Dreschfeld and Stoells, Tram, Imttmmt, Med. Congress^ l88l, vol. i, p. 398.)

1. Amy VV., xt. 3. suffering from purulent ophthalmia, wm ordered, on March 9th, 10 gr. chlorate of potash thrice daily. Alucb improvement resulted both locally and generally, and the medicine was continued until May ixth. The eyes several times seemed nearly well, but she had relapses due to un^vourable weather. Until May i idi the med. had apparently disagreed in no way; on this date the dose was reduced to 5 gr. ^' On May 1 8th she came with a venr soie mouth. The saliva dripped from her lips, there were numerous follicular ulcers on the tongue and inside of lips, and one large one occupied a surface the size of a shilling on the back part of the dorsum of the tongue. The salivary glands were enlarged and tender, and the mouth full of saliva, although the ptyalism was not extreme, nor wc»e the gums sore. In the latter respect, and in the existence of the larger ulcers on the tongue, the stomatitis differed from that caused aw mercury.*' {Med, Times and Gaz,j 1858, vol. i, p. 527.)

2. a. A young man suffering from an acutely inflamed carbuncle on the nape took the chlorate in 15 gr. doses every 4 h. for 2 d., and then had 2 symmetrical ulcers form on the side of the tongue, each being about the size of a fourpenny piece. There was no general stomatitis, and the sores healed slowly when the remedy was suspended,

b. To a boy, xt. 8, 8 gr. of the chlorate were prescribed thrice daily for pustular ophthalmia. After 4 d. the eyes were much better^ but the mouth became affected by most acute ulcerative and follicular stomatitis. The whole mucous surface was red, and on the tongue, lips, and cheeks, &c., were numerous grey-based ulcers. The salt not suspended, and in about a week the mouth was well again.

£. A little girl suffering from pustular ophthalmia. Stomatitis bling that of the previous case, though less severe, was induced by the chlorate. It also disappeared whilst the remedy was continued.

d. A similar case occurred at the Metropolitan Free Hospital, also in a child. (Hutchinson, Lancet^ '858, vol. i, p. 265.)

e. Two years ago I gave the chlorate to a lady pregnant for the fifth time, and whose previous labours have all been premature. After using it for about 10 d. she became affected with spongy swelling oC

le gums, accompanied by small, highly irritable ulcers on the tongue,, checks, and gums, and by considerable sahvation. These symptoms disappeared on giving up the medicine, but their appearance was always attributed by my patient to the use of the chlorate. The lady having again become pregnant I recommended her to resume the chlorate, but she had only used it for 8 d. when the same form of stomatitis recurred in a severe degree, and at once yielded on discontinuing the mixture. She has never at any other time suffered from sore mouth in any form. (Jno. Traill, Lancet^ 1^58, vol i, p. 375.)

Volume IV — Appendix

KALI CHLORICUM. (S4e voi, p48)

P. 5451. 3 from bottom, for ‘e.” read “13.”

II. 14. St1nwAGon records the case of a patient suffering from mucous patches of secondary syphilis for whom tablets of K. chl. of § gr. each were prescribed. Four d, later a fiery erythematous and papular eruption made its appearance over the back and neck. ‘There were no subjective symptoms. ‘The possibility of mercury havin produced this eruption was carefully excluded. The rash disappeare 2d. after discontinuing the drug, but reappeared on 3 other occasions, when K. chl. was administered experimentally. (N.Y, Med. Record, 1883, ii, 65.)

1. A woman of 28, affected with simple amygdalitis, consulted a physician who ordered her K. chl. Desirous of being rapidly cured, she consumed in 1} d. 40 grm. of the medicine, gargling with it and swallowing much of the solution, On e. of and d. she was brought to the hospital, Her condition was serious, pulse 124; temp. 398; resp. 28. Conjunctive had a yellowish tint ; and there was dark blue coloration of cheeks, nose, upper lip, and chin, Patient was agitated, complained of great thirst, and vomited once, Urine was acid, dark brown, contained blood and albumen but no sugar; when kept it became black. Cylinders also were found in it. On 3rd d, jaundice had augmented ; blue patches showed themselves on face, feet, and hands ; ‘tonsils and uvula were bluish, throat dry ; pulse 124, small and soft ; temp. 393 resp. 36. In e., urine was very scanty, still containing blood and casts. ~ Patient was very agitated, but soon fell into coma, and succumbed at midnight. P. M., skin and viscera were found yellow, and kidneys showed signs of acute infammation— brownish colour on section, collection of red globules in cylindrical form in tubes (straight and convoluted), swelling and cloudiness of epithelium, Spleen was increased in volume ; liver soft. No microscopic examination. (Hormerer, Deutsche Med. Wech., 1880, No. 38.)

2. A child of 21 mos. had had scarlatina 8 weeks previously. All at once, it was seized with dyspnoea, and the mother, fearing diphtheria, gave him in course of 14 h, a teaspoonful of K. chl, Next m, he was seized with diarrhoea, cyanosis of face, and collapse ; and death ensued in }h. Autopsy found no diphtheria, but effusion into pleura, pericardium, and peritoneum—the serum’ of which, examined with the spectroscope, gave the line of methemoglobin. Blood was brown ; spleen enlarged, dark brown, filled (as also was medullary cavity of bones, which showed same tint) with globular detritus, The renal

canaliculi were free } stomach and duodenum normal ; intestinal mucous membrane and glands were swelled, (v. Haselberg, Berl. kUn, H^ochtnschr.f 1880, Nos. 49 and 50.)

1. a. A healthy, robust girl, aged i, gained access to a bottle of chlorate of potassium, and ate about three drachms of the crystals. As she had partaken of food a short time previously, and drunk largely of water immediately afterwards, no symptoms of poisoning showed themselves for 2 h., except that she complained of a pain in her stomach about \ h. afterwards, which was supposed to arise from indigestion, and was treated with paregoric. Two h. after she had ingested the drug, she vomited very freely, ejecting from her stomach the food and water that she had t^en. She passed from her bowels at the same time a large quantity of greenish mucus, followed by a clear mucus. After this she became much prostrated, with a feeble pulse and a bluish, ashen hue of countenance. It was not discovered until this occurred that she had taken so much of the drug ; and a physician was then called in. Under the use of alcoholic stimulants the prostration soon passed off, and she commenced playing, and continued to do so for more than 2 h. ; but she seemed to be in a state of excitement, and played boisterously.

b. She then slept for 2 h., and, on waking, asked for water and ate a little. She seemed very restless, and her countenance still had the bluish appearance. At 8 p.m., 8 h. after she had taken the drug, she vomited again, became very much prostrated, and was thought to be dying ; but she again rallied under the use of stimulants. The matter ejected was simply the water and food she had taken. She slept tolerably quietly until midnight, asking for water frequently ; at that hour her bowels moved again, the passage being greenish water and slime, after which her extremities became cold, and the pulse became imperceptible at the wrists. Stimulants were freely administered, but without effect. At 2.30 a.m. she vomited a large quantity of water, after which she sank very rapidly, and died quietly at 2.45, just 15 h. after she had taken the drug, She complained but once of pain in stomach and bowels, although frequently asked. During the first part of the n. her heart beat with great force, so as to jar the hand when placed over the precordial region, and her pulse was full and bounding. The urinary secretion was increased during the afternoon, and seemed irritant to the bladder } and there was no suppression or abnormal appearance of this secretion. (Bokde, N. T. Med. Rev.y Nov. 8th, 1870.)

1. The following are Marchand's cases, summarised in II. 9.

a. A child of 6, treated for a slight pharyngeal diphtheria with K. chl., was, during convalescence, taken suddenly with vomiting and convulsions, which were soon followed by death. At the autopsy, the blood presented a chocolate colour, which it retained for some h. after exposure to the air. Liver, spleen, heart and lungs showed same hue.

i. A child of 4 entered the hospital for a violent ulcero-membranous stomatitis. A solution of 15 grm. of K. chl. was prescribed, of which at least two thirds were taken in a day. Next d. there was torpor, cadaverous paleness, strong beat of heart, pulse 100 and

scarcely perceptible. There was diarrhœa like that of typhoid, »nd vomiting of liquid mucositics. On the following days, there w« delirium, jactitation, hasmaturia, epistaxis. Then, by degreei, the general condition improved ; but the child was ailing for a fortnight. The urine, examined with the microscope, contained a copious twi* ment composed mainly of elongated, brownish, cylindrical masses.

c. A child of 3, under treatment for pukaceous sore throat, took ii grm. of K. chl. in 36 h. The d, after, an emission of dark-brown urine, manifestly sanguinolent, was observed, and thereupon came vomiting and cerebral disorder — phenomena which {persisted for some d. more. Three d. after the commencement. Dr. Marchand si« patient for first time, and found her in a completely stupid state^ without fever or dyspnoea, responding with difficulty to questions; skin was yellowish ; all food was immediately rejected ; a little epi« gastric sensibility. Thanks to tepid effusions, iced drinks, chainpagM| &c., the vomitings at length ceased ; but the child continued rcstlesH ground her teeth, and lost consciousness more and more. Thegcnen state by end of 8ih d. was exactly that of acute hydrocephalus. T« the other symptoms was added convulsions, inequality of pupilii Cheyne-Stokes breathing, and at length stiffness of neck and opistb» tonos. She died on the loth d. The sanguineous urine had conCaioo albumin and a great number of altered blood-corpuscles, arranged il brown cylinders as in previous case. The spectroscope shewed neithe the lines of haemoglobin nor those of hxmatin ; and yet the colour a the urine was that of a solution of hxmatin. At the autopsy, th blood was found liquid, without special coloration. There were Itf appreciable lesions in the brain. The kidneys were profoundly altered at any rate in the medullary portion, which contained a great numix of small miliary agglomerations of lymphoid cells. All the pyriiniiii canals were stuffed with the brown cylinders.

d. A child of 6 — 7 was treated for slight croup with 25 grm. (J K. chl. in 30 h. Vomitings and bloody urine ensued, followed b rapid collapse and death in a few d. There was no autopsy.

€. A syphilitic, with a mania for treating himself, at last tool K. chl., and died suddenly. At the autopsy, there was yellowish hui of skin, petechiEE, and hemorrhagic effusions into the subcuuneoa cellular tissue. Kidneys were hypertrophied ; surface smooth, choco late-brown in colour, studded with numerous points of dark brown cortex very thick, of same colour as surface ; medullary substance oii still darker brown with a manifest brownish striation, directed toward the pyramids. Under the microscope the excretory canals were foufl charged with briJIiant brown cylinders evidently composed of matters derived from the blood.

III. Experiments an anhnais. — i. a. The question, wherein lies tl poisonous action of K. chl., is answered by the results of e^ t|

made by Felix Marchand upon animals, whose attention was to the subject by meeting several cases of poisoning.* If trcsh bi' is mixed with a solution of chlorates of potash and sodium, there after a short time peculiar changes. The well-known bright-red col(

• Sec II, 9, ig.

blood, which it instantly takes when mixed with a salt or kali solution, passes in a few h. into a dark reddish-brown, and this gradually into a clear brown. The time at which the last change takes place depends upon the quantity of the salts which is added. A i per cent.

Klution of the salt gives rise, after 15 to 17 h., to a considerable colour, d a 4 per cent, solution destroys, after 4 h., all traces of the ha:matoglobulin (at 50° R.). Very soon this sample takes a syrupy con- ^tency, which by the addition of a 2*5 per cent, solution of the salt Mises in a short time into an almost solid gelatinous form. This mass %is a remarkable durability and appears unchanged for weeks, especially in relation to putrefaction. In order to determine these conditions upon living animals, Marchand fed daily, for one week, a dog which weighed 17 kilogr. with 5 grm. of sodium chlorate, and when this luced no efFect, he increased it to 10 grm., given in two doses; the dog remained to all appearance in perfect health. He then ire 50 grm. in five doses ; on the following midnight the dog was bad. On examination the entire quantity of the blood was found to be of a watery consistency and of a dark chocolate or sepia-brown colour, which did not change upon exposure to the light. All the organs had a peculiar blackish-brown appearance. The lungs were of a smoky-gray, and the heart-muscle of a dark brown colour j spleen greatly enlarged. The kidneys were enlarged, altered, and the capsules smooth and of a dark chocolate- brown colour ; the body of the kidney was found, on section, to be of the same blackish-brown colour as the surface, and of solid consistency. The bladder was contracted and contained about a teaspoonful of a thick, brownish fluid ; also a crumbling, brownish-red coagulum, about the size of a bean. A microscopic examination of the kidney showed in most of the tubuli uriniferi, especially in the cortical substance, a transparent, homogeneous, brownish cylinder, also numerous cylindrical masses, formed apparently out of aggregated blood corpuscles. The epithelium of these tubes appeared thickened, especially in the cortical substance, and the corpuscles were in tnasses. The brownish fluid in the bladder contained granules in active molecular motion. A spectroscopic examination of the diluted blood showed the haematin line with a clear stripe in the centre, A still weaker solution failed to show the hsematin stripe, but the lighter stripe remained. The diluted blood remained still of tbe coffee-brown colour when held to the light, and did not become red on shaking, but formed a brownish-white foam, like beer.

b. In order to obtain an earlier stage of the kidney affection he took a dog weighing from 7 to 8 kilogrs., and within 16 h. gave 15 grm. of chlorate of potash in three equal doses ; 7 to 8 h. after the last dose the dog was bled to death. The blood from the arter. femoral, was of a markedly dark, brown-red colour, which did not redden in the light and in the spectroscope showed a weak tracing of the capillary haemoglobulin streak. Both kidneys were of a pale brownish colour and showed on section several cuneated but small radiated dark brown spots and stripes, which began under the capsules and gradually disappeared in the cortical substance, The bladder was very much distended with a dark brown (more correctly a greenish-brown), thick

urine, which was mingled with a very abundant slimy white prtcipi tate, which undoubtedly had prevented the emptying of the bladder The spleen was greatly swollen, reaching across to the right side ofthi body ; the capsule was smooth, polished, blackish^brown ; the whole pulp homogeneous, quite solid, and of a very dark, blackish-red colour The other organs had a peculiar dark, brownish-red colour.

c. According to these experiments and from observations upon men, there can be no doubt that chlorate of potash (and suda) in larj doses may produce death, through a peculiar and most remarkable alteration of the blood, especially the blood-corpuscles and the hxmi tin, while the alteration of the spleen, kidneys and urine foilovrsas; secondary result. The blood loses its power to take up oxygen ; th hxmatoglobulin is decomposed and the corpuscles disorganised ; thd are accumulated in different organs, such as the spleen, kidney, am marrow of the bones, to be finally completely destroyed, and pa through the kidney to be excreted, during which the epithelium o the urinary canals is but little or not at all altered; and if the quann't of disorganised blood-corpuscles is great enough, death follows (ViRCHow's ArchiVf Ixxvii, 455.)