Volume III — Main text

MercTiriiu oorrosiviiSy mercuric diloridei HgC^

sublimate.

I. Prmmgs.^i, a. Dr. J. BncHMBR^sst. 34,topk»Scpt. 7th, 1847, 8 a.m., 10 dr. Merc. cor. 2. 10 a.nL, feeling of uning to urinme in urethra, with scanty discharge-*later no odl uiouch ola-ddcr was full — after micturition persistent sense of iiilness in bladder. Noon^du]) pain in r. frontal emtnenceytendemcMtotouchofhang^ of inferior maxilla. N. very restless, frequent waking, slept only a or 3 m., then woke, changed position^ tossed about. AL,jgreat prastiBtioo and miilatse^ so that after shaving had to lie down a(^ and slept 1 h. i cold hands and feet, increased pain in inferior maxilla, dysphagia, so that he could cat no bread at breakout, flow of viscid saliva which be could scarcely spit out. He went about his usual business, but on account of incre2scd coldness, flow of saliva, dysphagia, &c., he had to go to bed at 10 a.m.. and apply warm wraps to his net. He got warm very slowly and then had confusion of head, except in temples, the salivation continued and the inflamed state of lower jaw. After i h. head heavy and confused ; he could not speak connectedly, and could not express his sensations distinctly. He noticed his unconnected speech and was vexed at it, so that he remained silent some time. At same time great restlessness, he could not lie long in one position, and had to get up. In afternoon digging and shooting in 1. ear so severe that ior 3 m, he wept and cried aloud. Later the same symptoms in a slighter degree. N., slept only for minutes at a time. Urine scanty, red, with brickdust-coloured sediment j ill-smelling sweat towards n. At same lime pricking rheumatic pains in lower extremities. The symptoms lasted 4 d., the sweat 6 d.

h. After 3 months took 20 dr. 2nd dil. Soon, burning and heat in stomach with contractive pains involving bowels, at same time tongcs* tion of heart and anxiety until he had a loose stooL The symptoms lasted 16 h.

c, Dec. 1 2th, 1846. Rubbed into 1. forearm i &t, Merr. mr dissolved in alcohol. Woke about midnight, tossed about fi Confusion of sinciput with undulating pain in both cerebnl bemi Interrupted sleep in m.

</. Rubbed i gr. into gums. M., slight bleeding of gjH drawing pains in teeth.

i. The same dose in clyster caused long-condnued ft (Aiig. Ztg.f. Hm.^ i, Suppl. 78.)

tion 10 a.m

of A^h

Dr. FoRSTNER took. 25th Nov,, 1847, 10 a.m., 2 dr. of a solugr. Merc. cor. in no dr. alcohol. No effect. — 26th, 4 dr. No effect. — 27th, 10 a.m., 7 dr. On waking, m., peculiar pressive pain in r. inguinal glands, as though they would swell ; this lasted i h., and went off on getting up. — 28th, 10 a.m., 10 dr. During d. frequent urging to stool, increased discharge of flatus. — 29th, 8 a.m., 15 dr. After dinner faint feeling and great exhaustion. — 30th, ID a.m. and 10 p.m., 20 dr. No effect. — Dec. ist. No medicine. 5 a.m., tensive pressive pain in 1. inguinal region, with sense of swelling of glands. N, restless, sleep frequently broken, vivid dreams, pulse febrile, skin dry. After rising, transient stitches through both sides of chest, bruised feeling in abdomen, particularly in ciecal region and in course of transverse colon ; on pressure these parts feel as if bruised. This pain lasted all forenoon, got better towards e., but did not go quite off. — 2nd, 10 a.m., 20 dr. i p.m., after dinner febrile pulse, drawing pain in pericranium. Frequent darting stitches through chest, bruised feeling in C£cum and transverse colon increased by pressure. £., irritation in larynx causing dry cough, throat dry. — 3rd. No medicine. Irritating cough as yesterday, abdominal pain less. Great irritability of larynx, — 4th, 9 a.m., 5 dr. Afternoon, feeling as if 1. axillary glands would swell, with frequent transient stitches in them. Cough gone.

{^ibid., 79.)

a. Dr. Gerster, set. 34, took, Aug. ist, 1847, "^o 5 t^^ops of Merc. cor. 2, without knowing what it was. — 2nd, m,, 10 dr. Experienced a styptic metallic taste for I h. — 3rd, m., 20 dr. Same symptoms. — 4th, 30 dr. After 3 h, slight vertigo, confusion in upper part of forehead, yawning, objects appear smaller and farther from eye than usual, for several h. All afternoon drowsy, heavy and confused head, desire to lie down. N., dreamt of incendiarism and murder. Stool smaller and firmer than usual. — 5th, 7 a.m., 40 dr. Soon, slight burning and pressure in stomach, followed by frequent eructations of air. After I h., confusion of head, frequent yawning and desire to stretch himself, slight burning and dryness of eyes, conjunctivae of both eyes red and much injected. Same delusions of vision as yesterday. Humming in r. ear, to which he was accustomed, became much louder. Symptoms relieved by eating. No stool. — 6th, 40 dr. No symptom except slight burning {in stomach ?) for ^ h. The next 3 d. the stools were harder, drier, and smaller than usual, and the 3 following d. softer and moister than usual.

b. October i6th, m., took 10 dr. of a solution of i gr. Merc. cor. in 5J alcohol. Immediately an astringent metallic taste, followed by slight burning in stomach, then slight congestion of head and face with burning of cheeks and uncommonly great discharge of flatus. After 2 h. all objects, especially letters, appeared smaller for several h. After 4 h. burning at edges of eyelids like commencing catarrhal ophthalmia ; photophobia in sunshine. — 1 8th, m., 1 5 dr. Nothing but the metallic taste and burning in stomach. — 19th. 20 dr., astringent taste, flow of saliva and several attacks of rigor, then burning in stomach for i h. During d. frequent attacks of spasmodic cough. — 20th. About the same as yesterday. — 21st. Same, and also two clayey, light yellow

stools. — 22nd, 7 a.m., 14 dr. Metallic taste and rigor whilst and after swallowing the dose; slight burning in stomach for 4 h. II a.m., burning in eyes. Objects all appear smaller and more distinct. This occurred several times during d., especially after yawning, which he required to do all d., though he was not sleepy, and had slept well the previous n. No stool. — 23rd. Quite well. {Ibid,^ 80.)

Katherine H — , art. 21, took, October i6th, i h. before breakfast, 10 dr. of a solution of i gr. Merc. cor. in 3J alcohol. Astringent taste. — i8th. 15 dr., astringent taste and rough feeling in throat. — i9th. 20 dr., astringent taste, flow of saliva, burning in stomach till dinner, shooting headache in frontal region for i h., nausea and inclination to vomit all d. — 21st. 25 dr., astringent taste and flow of saliva for several h., then a transient rigor, several fits of spasmodic cough during d. (Ibid.y 82.)
Dr. Held, set. 27, July 26th, 7 a.m, 2 dr. 2nd dil. Merc, cor., not knowing what it was. Towards e. slight chilliness with short hot iit. Slept badly. — 27th. 2 dr., very exhausted. Afternoon, cutting in bowels and slight drawing in ossa femoris j legs felt gone asleep. Frequent starting up in sleep at n. — 28th. 2 dr., after some h. toothache, which gradually increased and tore from supra-orbital region to superior maxilla. This lasted all d., and was accompanied by chilliness of head and shooting pains in adductor and extensor pollicis of hand and extensor muscles of foot. Afternoon, several watery stools with cutting in bowels. All d. very depressed in spirits. Could scarcely slcep at n. for the toothache, which increased, and if he did sleep he had a feeling of anxiety. — 29th. The pains increased from 7 a.m. so that he took no more of the med. Forenoon, several bilious stools, with violent pains in bowels and troublesome tenesmus. — 31st. 2 dr., the same kind of toothache for several h., confusion of head. N., could not find a comfortable position to lie in, so was rather sleepless. — Aug. 1st. I dr., the toothache increased ; headache involving temples ; in 1. ear, which was painful, full pulsation of arteries i throat rough ; gums of last incisors began to swell with burning pain. £., drawing in limbs deeply seated as if in bones. N., sleepless till m.— 2nd. — Left oft" med. on account of toothache, prostration, and painful swelling of gums. Next d., the head was confused, the toothache continued in lessened intensity, as also the drawing pains in cranial bones. — 4th. 2 dr. ; 4 p.m., with borborygmus 3 pappy brown stools. When at rest shooting in hip-joint relieved by movement. E., chilliness, especially in head, anorexia, thirst. N., sleeplessness and frequent starting on going to sleep. — 5th. 2 dr., same symptoms in increased intensity, chilliness in head, pains in temples, shooting in muscles of lower limbs; great pulsation in cars, especially 1. ; eyes painful ; tearing burning pain from teeth of upper jaw to eye ; roughness in throat| tiresome pressure in stomach. Afternoon, several bilious stools with tenesmus. N., could not sleep on account of anxiety \ burning in orifice of urethra. — 6th. 2 dr., pressive burning pains in eyes, vessels of conjunctiva slightly injected, pain in temples, pressure above 1. eye. Tearing pains from 1. eye to incisors, burning pain in mouth, throat rou^h, difficulty of swallowing. In lower parts of r. side of thorax

shooting pain -, painful pressure in stomach ; cutting in bowels followed by thin bilious stools with straining. Violent itching in orifice of urethra, changing to smarting during micturition, sore stitches through urethra. Pressive shooting pain in hip-joint. Skin equally sore when moving and at rest. Slighter pains in other limbs. No appetite, thirst great, stomach tender. E., intellect so dull could not understand what was said. Before going to sleep, chilliness of head. On falling asleep, which he did later, a shock through whole body ; could not sleep again on account of heat and pressure in chest with anxious feeling. N., the gums round r. incisors swelled. — 7th. No more mcd. Felt rather unwell, no appetite, great thirst, burning pain from mouth to stomach, relieved by drinking cold water. Roughness of throat increased ; coryza. Afternoon, bad-tempered, toothache and swelling of gums continued. — 8th. VVoke pretty well, the only symptoms being burning in throat, toothache, and coryza. Afternoon, darting stitches in hip-joint. The swelling of gums lasted 2 d. longer, as also the roughness in throat. [Ibid.^ 82.)

6, Dr. J. NussER, set. 36, took, September 27th5 1847, *° a.m.j 10 dr. 2nd dil. During d. the following symptoms were observed in the order here given : Itching in ). eye, tension about!, scapula^ itching between r. big toe and next one, burning-shooting in middle of r. side of chest as if in muscles, slight shooting in middle of liver, pinchingshooting in upper part of abdomen as if in muscles, shooting in 1, parietal bone, slight shooting-drawing in 1. inguinal region, scraping roughness in pharynx, making him hawk frequently, tearing in 1. zygoma, shooting in head of 1. hip-joint towards outside, shooting pain in gastric region after food, painful griping in middle of I. testicle (continuing next d.), painful tearing in bone of proximal joint of index and ring fingers and thumb (continuing next d.), itching in several parts of skin (scalp, thighs, &c.), often changing to pricking and burning, itching, burning, and pricking under skin in various parts, on breathing deeply shooting in upper part of 1. side of chest internally, itching in anus > when walking, itching, changing to pricking, in skin of middle of back, tearing in upper part of inner side of 1. scapula as if in bone, tearing-shouting in a back tooth, extending thence ii|to «ar, tearing as if in bone about I. eye near root of nose, and in other bony parts, cutting in abdomen and above navel after food, simple pain in hypogasirium, tearing inwards in 1. calf, burning-tearing in 1. upper eyelid, then tearing in 1. arm while standing, trembling of this arm and of the whole 1. half of body ^ all d. frequent obtuse shooting in upper part of 1. side of chest internally, worst when breathing deeply, frequent tearing pain in lowest r. costaJ cartilage. E., weariness of feet and drowsiness. — 28th. Slept well till 3 a.m.^ but with dreams of ridiculous situations, of travelling, &c. M., after breakfast a liquid, yellow, painless stool, with frequent tenesmus, followed by inclination to go to stool, shooting in hepatic region. Noon, pinching on r. side of navel, tearing in r. hip-joint. — 29th. Slept well till 3 a.m. Voluptuous dreams, violent -erections in sleep and after waking, during coitus tardy emission of semen. After midnight tearing in middle of sternum. M., pricking in scrob. cordis, normal stool. Afternoon, cutting in abdomen with

slight call to stool. The 2 last d. constant dryness at back of nose as if in upper surface of velum palati, chiefly in open air, and tearing frequently in 1. shoulder. Many of the symptoms aggravated by walking in open air. £., shooting in interior of I. ear, shooting in upper part of r. side of chest, cutting below navel after eating sour apples, when walking in open air, with slight call to stool. From commencement of proving till now occasional soreness of uvula. — jotfa. Sleep with many disagreeable dreams. Though for 3 d. he had only slept till 3 a.m.,yet he did not feel tired or sleepy. M., violent erections and sexual desire, after coitus burning in fore part of urethra and feeling of strength and lightness. 9 a.m., after micturition slight shooting in fore part of urethra and in sphincter ani. From 8 to lO a.m. shooting in fore put of urethra when walking in open air, then itching in anus. Noon, when eating beef and vegetables, shooting deep in chest, as if in lower part of arsophagus, as though something stuck there that distended the oesophagus and could not go down, he could swallow food and drink, but the pain was increased by swallowing, as also by eructation of air, this was followed by cutting in r. side of upper pare of abdomen. £., when walking return of shooting in fore part of urethra and pricking in 1. testicle, also sharp shooting in tip of 1. thumb. — Oct. 1st. Sleep restless and only till 3 a.m. M., normal stool, tearing in 1. metacarpal bones, itching in skin, changing to pricking and burning, tearing in bones (finger-joints, hip-joint, &c.), shooting in lungs,liver, and testicles. — 2nd. Slept till 3 a.m. During d. unusual shooting in r. testicle.-^ 3rd. Slept all n. After smelling Merc. c. 3 shooting in hepatic region. The symptoms lasted till Oct. 9th. He only slept till 3 a,m., but did not feel fatigued in consequence. He always had cutting in bowels after eating fruit or potatoes. The sexual desire diminished, he had often cutting in urethra. His disposition was cheerful, and he felt increased facility in mental work. (/^iV., 84.}

Dr. Pemerl's proving lasted from 15th to 35th Aug. He took the medicine, Merc. cor. 2, daily, i h. before break^t. — 15th. 5 dr., no symptoms. — 16th. 12 dr., greasy, scrapy taste. After 2 h., when walking, anxiety, discomfort in vesical region as before stool. After 3 h. a peculiar contractive, twitching pain in some muscular fibres of the r. rectus abdominis near navel, lasting 3 m., and frequently returning. After 5 h. dryness of mouth, greasy and nauseous feeling in mouth, but without loss of appetite. Discomfort in umbilical region, no stool. — 17th. 18 dr., felt sick on taking the dose. After i h. some nausea, inclination to vomit, confusion of head, especially over eyebrows. Soft stool at noon. 5 p.m., the discomfort in lower part of abdomen recurred in increased degree. — i8th. 25 dr., same discomfort and pain in hypogastrium and rectus muscle. Normal stool. — X9th. 30 dr., after 1 h. peculiar lax feeling in deltoid muscles. He had felt the same sensation on the i6th and 17th in calves and muscles of thigh*. IVitching of some muscles in calves (inner side of gastrocnemius) • Twitching contractive pains in muscles of r. metacarpus. — aoth and 2 1 St. No symptoms except twitching in rectus abdominis. — aand. 36 dr., no symptoms. — 24th. 30 dr., rheumatic pains in r. deltoid muscle when walking. M., 2 soft stools. Urine scalding. — a5th.

Itching-priclcing pain in muscles in r. hypochondrium and in muscles of r. eyeball, also in umbilical region. For some d. afterwards felt the twitching contractive pains in some fibres of the r. rectus abdominis muscle. (Ibid,^ 91.)

Soon after the second dose of 12^ milligrammes, sensation of obstruction and anxiety in the precordial and epigastric regions, then several palpitations. After the third dose, general sick feeling ; some pains in the stomach ; transitory colic ; sensation of weakness and shuddering in the limbs ; palpitations. After the fourth dose, painful twitchings in the stomach ; weariness of the limbs and trembling when he rises and stands still ; great anxiety ; frequent palpitations ; vague chilliness i sensation of coldness ; paleness of face ; some nausea ; distension of abdomen ; borborygmi ; colic with tenesmus and 6 stools during the n. On the next d. there remained only some sick feeling and less appetite than usual. Three d. later the experiment was again made in the same way ; the same effects were again manifested, only more intense, especially the anxiety, paleness, inclination to chilliness, weariness of the limbs, and the tenesmus. In addition to this, he had several attacks of vertigo, and twice spasmodic vomiting of serous-like fluid, not preceded by nausea. It required 2 d. before he was again in statu integroy and he had no desire to make a third experiment. These doses were given fasting, or at least 4 h. after a meal. (Massblot, in Arch. Gen. de Med.^ ser. iv, xi, 58.)

g. To ascertain effects of M. on nutrition in healthy subjects, Liegois injected 4 ctgrms. daily of M. corr., subcutaneously, on four subjects of soft chancre. They gained considerably in weight. (Gaz. des Hop,y 1869, p. 350.)

II. Poisonings. — i. May 22nd, 1815, about 5 p.m., I dipped my hands repeatedly into a very concentrated solution of corrosive sublimate to take out some anatomical preparations. I forgot to wash my hands, and went about my other occupations. About 11 p.m. I went to bed perfectly well, and was wakened about 1 a.m. by violent pains in the epigastrium, which rapidly increased to a frightful intensity, somewhat ameliorated by bending the body. They were especially severe in the region of the stomach, and seemed to spread thence over the whole diaphragm. The abdomen was rather sunken and painful to pressure ; constricted feeling in the entire thorax ; respiration costal, obstructed and irregular j mouth dry, thirst considerable, forehead, temples, chest, and hands covered with sweat, and having an unpleasant feeling of coldness in them. I was in this condition about i J h., when repeated eructations and nausea ensued. I made an unsuccessful attempt to vomit, and then for the first time remembered the sublimate. Putting my fingers to my tongue, I perceived by the sharp taste that I had forgotten to wash them, which I did now as quickly as possible and drank a quantity of sugar-water. About 2 I finally vomited repeatedly, and at first very profusely. The vomit was slimy, thick, and had a metallic taste, very acrid, causing a painful constriction of the fauces. Epigastrium very sensitive to touch, and the slightest pressure caused most violent pains. The vomiting ceased towards 4 o'clock. The umbilical region became somewhat painfulj and I had

VOL. III. lb

three very liquid stools, with tenesmus. Towards 5 I slept, and wakened about 8, with a dry mouth and skin covered with sweat, but I no longer had the feeling of coldness on the forehead, in the umbilical region, and in the hands. The disposition to vomit was gone, but the epigastrium was still very painful. I took that d. only six cups of bouillon and three dishes of rice-water. The next day I was able to return to my duties, but an unpleasant feeling remained in the epigastrium for 8 d. (Cloquet, in Huber, op. at,)

A lady had struck the left leg against a door, some ten years before, so that she could not lie upon it. Subsequently a hardness appeared on the place, which a quack treated with two caustic plasters. On the e. of May 7th he sprinkled upon the place 5SS of sublimate, with the direction not to remove the plaster before 4 a.m. Meanwhile the lady was attacked with such an intolerable pain that she walked the room as if crazy, and uttering loud screams. Up to the next e. there were added general cramps and convulsions of the hands and feet. 9th. — Retching and actual vomiting. 10 and nth. — Swelling of the throat, which increased in the n., so as to threaten suffocation. On the 1 2th Degner was called, and found her head and neck very much swollen j the tongue rigid and swollen \ the throat so inflamed that it was only with difficulty she could speak or swallow ; the teeth loose ; the breath mercurial ; on the leg a crust a handbreadth wide and twice as long \ below the scab an open sore the same size ; and about the affected locality a great inflammatory swelling. 13th. — With the rest, the throat continued so swollen that she could not swallow any fluid -y besides heat in mouth and throat as from red-hot coals. 14th. — Having expectorated clots of blood, the patient pulled the membranes from the roof of the mouth with her fingers, causing so great a hemorrhage that Degner feared she might die, in consequence, that very d. The apothecary, on calling that e., found roof of mouth, throat, and tongue so swollen that she could scarcely speak ; in the fauces an ulcer the size of a pea, and on 1. side of soft palate a fissure ; loose teeth and profuse salivation. 15th. — Condition the same; salivation profuse } diarrhoea, the excrement having the same odour as the mouth. Next d. throat seemed less swollen externally, but 6ice and cheeks were swollen as much, and hard. i7th and i8th. — ^The same pitiable condition. Pain in stomach ; inclination to vomit \ sleeplessness; bloody salivation j headachcj especially about temples. The next d. the patient complained greatly of slight delirium \ she did not know what she was about. 20th. — Increased delirium ; she could scarcely be moved any longer, and refused both medicine and nourishment on account of the pain in swallowing. The next d. worse. Beside the daily expectoration of clotted blood and membranes from the mouth, weakness, which would not permit her to get up \ constant salivation. 23rd. — No improvement. The next d. swelling in r. cheek was less, but not the hardness. In the n. of 24th to 25th a tooth fell out of itself. 25th. — Salivation less. Weakness and delirium increased. In m. pulse imperceptible ; salivation less j she seemed to sleep a little, which had not been the case previously, wakening in a fright, and no longer complaining of pain. 27th. — No pulse. Great anxiety. At

ti. she wept bitterly, and her cries filled the house. 28th, — She died at 7 a.m., unconscious, with distortion of limbs. During the whole time there was no fever, and the urine was natural, with a white sediment. The surgeon who attended to the dressing of the limb said that not only were the cheeks, gums, palate, and throat ulcerated, but the maxillary bones were exposed also. Autopsy not permitted, {^pp. ad, voi. vi Act. Nat. Curios. j Norimb. 1742 ; p. 22.)

3, Two 8er'ant girls, who had had an inunction over the whole body of sublimate ointment for itch, got a vesicular erysipelatous inflammation of the skin, with vomiting, diarrhoea, and tenesmus ; also ulceration of the buccal mucous membrane, without salivation. Both died in spite of medical treatment; the one after 4^, the other after 6 d., having had formication of the extremities, but no convulsions or sensorial disturbance. In both corpses, the epidermis was found loosened in various places, the corium highly inflamed. Serous and mucous membranes of stomach and small intestine as well as the omentum were inflamed ; the mucous membrane of larynx and trachea cinnabar-red and covered with reddish mucus. In the one who died first was found redness of the mucous coat of the bladder and ureter ; intense hyperemia of the kidneys ; two purulent deposits in the region of the pelvis of the 1. kidney ; congestion of the uterus and tubes, and in the vascular territory of the vense cavz, of the coronary veins and cerebral sinuses. In the other an inflamed place on the serous covering of the liver ^ bloody serous exudation in the pericardium and mediastinum i mflammation of endocardium and of endothelium of large arteries. Only in the kidneys of the first was M. chemically detected. (Canstatt's Jahrtsb.^ 1B64, B. 5, p. 106.)

A merchant from Liege, a:t. 30, of strong constitution, who had never been sick, went to Paris on business. Aug. 6th, 1 813, he got a slight diarrhoea, without known cause, which lasted 3 d. and was cured with ipec. On the 13th, seeming to be fully recovered, he drank, about 3 p.m., from a glass without any mark upon it, containing a solution of sublimate in alcohol. The horrid taste disgusted him so that he broke the glass. An astringent feeling in the throat and frightful pains in the epigastric region were the first symptoms. The physician came at 3.50 p.m., and was told that the man had vomited much green, bitter, not bloody matter, and had had 3 stools. His condition was as follows : — Dorsal decubitus ; red, swollen face \ very restless ; sparkling eyes ; contracted pupils ; reddened conjunctiva ; dry, cracked lips ; rather moist, yellow-coated tongue ; frightful pains in the entire alimentary canal, especially in the pharynx ; abdomen distended, especially painful to pressure. The vomiting had ceased, but the diarrhoea continued. Pulse 112, regular, small, contracted ; burning hot skin, especially on the forehead ; respiration obstructed ; infrequent and difficult micturition, urine red j perfect consciousness ; inclination to sleep i occasional spasmodic movements in muscles of face, arms and legs ; persistent cramps in all extremities. (White of egg water ; 20 leeches to epigastrium ; two cold, laxative clysters). About 5, decided improvement ; he had taken all the drink (6 lbs.), vomiting profusely, and had had tour stools. He got 4 lbs. of a decoction of linseed to

drink. About 6, vomiting, cessation of cramps, pulse lOO. About 9, very imperfect sleep. About midnight, biting in anus, bloody stools, severe pains in sigmoid flexure, pulse 115, small, contracted. (Ten leeches along descending colon ; two clysters with laudanum.) Vomiting ; 4 much less bloody stools ; almost sudden cessation of pain ; inclination to sleep. On 14th, about 8 a.m., less distension and less painfulness of abdomen ; tongue moist ; no inclination to vomiting or diarrho&a ; pulse 96 ; skin less hot ^ cessation of cramps ; consciousness perfect. £., pulse 106 ; extreme heat of skin without increased pains (narcotic clyster). On 15th, he felt much better; had slept part of the n. and wanted to eat. Tongue moist; pulse almost normal ; great weakness ; at e. the same condition. On m. of i6th, having slept wellj he complained only of trifling, not persistent, pains in epigastrium ; appetite good. On 17th and ] 8th, condition the same. On 21st, convalescence set in, and on 31st, he returned home quite cured. (Orfila, 7(?x., sub voce.)

a. May 6th, 1825, about 11 p.m., a woman was found by the physician in the following condition : — She lay in bed with the limbs relaxed ; skin cold and covered with sweat ; ^ce pale; eyes dull and heavy, with dark rings surrounding them ; an expression of pain and horror, as one might feel who lives but to die. Whitish, contracted lips and tongue ; great thirst ; swallowing so difficult and painful that the least liquid caused contractions of oesophagus and stomach followed by vomiting of whitish, slimy, stringy, and subsequently green bilious matter. Pressure on the throat was painful ; burning along whole cesophagus. Skin of abdomen cold ; pain in epigastrium on slightest pressure. Diarrhoea, with intense urging and smarting. She com* plained of great burning and intolerable pains in stomach. Pulse slow, weak, thready, almost imperceptible. Respiration very slow. On the floor, in various places, lay patches of white slimy matter, seemingly vomit. Under a table in a corner there was a wet place strewn with a white powder, having the taste and look of sublimate. (White of egg water, 30 leeches to epigastrium, 20 to neck, and a large poultice to abdomen.) At 8 a.m. she could speak more easily ; pulse fuller and skin warmer. Noon. — Depression greater; sensibility gone in lower half of body. She had had a cold sweat. About 5 p.m. she died, retaining her consciousness to the last. There was no trace of delirium observed at any time,

h. Jutopsy, 17 h. after death. — A very fat, large corpse. Rigor mortis very great ; body cold ; upper extremities semi-flexed, lower ones extended. No trace of ecchymosis in skin, connective tissue or muscles. Vessels of dura mater slightly injected. Arachnoid injected, especially on 1. side ; some bloody serum in cerebral ventricles ; brain substance slightly injected and firmer than natural. Tongue thick, with large papillx and glandulse mucosae, the latter almost as large as a small pea ; inside of larynx violet-coloured and injected ; on lower surface of epiglottis a gangrenous-looking spot. Trachea rose-red ; bronchi and their ramincations still more manifestly inflamed ; lungs crepitant and their substance reddish ; 4 oz. of reddish serum in pleurae. Heart larger than normal ; both sides enlarged; the walls thickened}

the endocardium not reddened. Pharynx red ; velum strongly injected ; an ecchymosis on back of uvula ; oesophagus almost normal, except in its lower third, where congestion begins, increasing toward stomach, which was small and thickened ; its external surface brick-red ; under the serous membrane a number of little ecchymoses, giving it a marbled appearance ; its veins distended with air ; its internal surface throughout blackish-red, especially on the folds formed by its contraction ; its mucous membrane easily torn j contents greenish j between the folds a considerable number of whitish granules resembling sublimate or calomel in appearance. In the duodenum very much fainter traces of inflammation ; it was filled with green bile. In the omentum many ecchymoses along both curvatures of stomach. In the other intestines nothing noteworthy, and only in the rectum some traces of congestion. In the pelvic cavity about 8 oz. of sanguinolent fluid. Liver, spleen and kidneys normal. In the r. ovary an ecchymosis an inch in size. Chemical examination of the powder found in the room discovered sublimate. Neither in the vomit nor in the contents of the stomach was there a trace of sublimate ; but metallic mercury was demonstrated by various methods, a proof that the sublimate had combined with the albumen, milk. Sec. (Devergie, jfrch. GM. de Mcd.^ ix, 463, 1825.)

1. Sarah Wild, set. 49, sanguine-melancholic temperament, took, with her four children, nearly 2 dr. sublimate, about 7 a.m., Dec. 26th, 18 1 6. In her the following symptoms occurred : — Great thirst, violent pain in pr:ccordia, pulse small, tremulous, rapid ; great heat and extreme soreness in pharynx, with dysphagia ; in swallowing a little liquid the raw feeling becomes very severe. Incessant and violent vomiting of blood and matter the colour of coffee-grounds ; repeated and very offensive stools. After 18 h., change of the pain to the umbilical region for 8 h., thence to the lumbar region till death. Entire lack of pulse 12 h. after the poisoning ; even the heart beat in an undulatory, tremulous manner. Brain apparently very much affected. Pupils scarcely sensitive to the strongest light ; tongue clean. No urine. Sensible to the last moment. After great suffering death ensued 31 h. after poisoning.

A. AutQpiy. — Face frightfully disfigured, skin of back and sides purple. Mesentery and peritoneum highly inflamed, considerable effusion in abdominal cavity. Gall-bladder very full and large. Liver covered with pale livid spots the size of a sixpence. Bladder contracted to size of a walnut ; uterus inflamed, but not larger than in women who have borne several children. Stomach not much distended, but very livid along the greater curvature, with a portion of the omentum adherent, and containing a large mass of dark grumous fluid. At the cardiac portion a circular black place 3 in. in diameter, involving all the tunics and easily penetrated with the finger; internal surface very much inflamed, the rugse a deep carmine, the remainder scarlet. (Valentine, Edinb. Med. and Surg. Joum,^ xiv, 468.)

Sarah, daughter of the preceding, set. 3, began to purge violently 3 h. after the poisoning. Discharge of large masses of bilious matter by vomiting and stool. Pulse small, uncounuble ; extreme thirst, persistent ischuria. Distressing pains till 6 p.m., then sudden quiet and

death I2 h. after the poisonine. Autopsy. — Skin dark crimson colour, nearly purple. Omentum and intestines highly inflamed ; kidnejs not so much so. Mesentery full of red blood. Bladder firmiy contracted. Marked exudation of bile on the concave surface of the liver ; gallbladder nearly full of bile. Stomach deep scarlet within, from cardia to pylorus, with a black circular place in the region of the former, about the size of half a crown, its edges indented and involving nearly the whole thickness of the stomach, which was not very full or a milky fluid. (Ibid,)

William, act. ii, vomited profusely, at times easily and again with pains, especially in the region of the scrobiculus and navel % Qj%phagia. After I2 h., coffee-ground coloured vomit of clotted blood and violent purging of coagulated lymph, clots of blood, and a delicate transparent membrane. Great thirst, deep lethargy, pulse small, trembling, and weak; very scanty urine. To the last moment sensible. No radial pulse 12 h. before death, which occurred 24 h. after the poisoning. Autopsy, — External appearance as in 7. Eyes more sunken, dark colour of the back, peritoneum very much inflamed. Intestines extremely inflamed, partially livid ; one third of the liver almost colourless, gallbladder very much distended ; large serous effusion in the abdominal cavity. Bladder firmly pressed down on the pubic bone, the size of a walnut. Stomach greatly distended and filled with a black grumous mass ; the cardiac portion, ^r more than in the two preceding cases, destroyed \ a black circular spot 3 in. in diameter, whence a general inflammation extended over the whole internal coat. Deep scarlet, almost crimson, redness, especially of the rueas ; the greater curvature yellowish, livid, and very soft externally. (Ibid.)
George, ast. 8, vomited violently and incessantly a sticky frothy mucus ; great pain in pharynx, complete dysphagia, great restlessness, violent pain in scrobiculus, pulse rapid and weak, no unne. Within 6 h. repeated urging to stool, with discharge of great circular pieces of coagulated lymph. 27th. — Very bad n., complained greatly of severe pains about the navel ; vomiting less severe, extremities cold, intense thirst, tongue red and burning, coma, pupils insensible, pulse weak and small. Stool livid, grumous, and offensive, abdomen very painful to the slightest touch. Urine scanty. 28th. — Complete stupor, pulse barely percepdble, frequent vomiting of a blue slime, like dissolved blue pill ; great restlessness, moderate stool, dirty, hard, containing a worm. 29th.—- Death at 5 a.m., about 90 h. after the poisoning. Autopsy, — 7 h. after death. Quiet aspect. Eyes open, no discoloration of front part of body, no special distension of abdomen ; subsequently carmine redness of shoulders, back, and hips. After sawing through the skull the calvarium was raised with difliculty, and only after cutting through the dura mater, on account of its very extensive and strong adhesions. AH the vessels of the dura and pia mater, one sinus lateralis and one sinus posterior, strongly injected with red blood, as also the medullary portion of cerebrum and cerebellum, and most of the choroid plexus. No unusual quantity of fluid or perceptible disorganization in either of the ventricles. Lungs redder than usual at that age. About 2 oz, of watery exudation in the pericardium, and about the same quantity in the

2+7

pleural cavity ; heart Arm and of natural appearance. Peritoneum extremely vascular. Omentum almost gone; its remainder, along with the intestines, injected with bright red blood. Gall-bladder nearly full of bile. Liver natural in its appearance, but its peritoneal covering, like that of the mesentery, strongly injected. Bladder shrivelled, very small and empty j kidneys inHamed. In the stomach a pint of bluish material, and the following lesions: — In the cardiac portion, a black circular place, about } in. in diameter, whence, as from a central point, a uniform bright redness spread over the whole inner coat. The very large and numerous ruga: more inflamed than the other parts -, the texture of all the coats completely destroyed, only the peritoneal coat remaining upon washing away the disorganised parts i the whole larger curvature had externally the same appearance. {Ibid.)

Martha, xt. 14, swallowed only a little of the poison, spitting the greater part out. Vomiting as with the others, but less. Immediate pain in scrobiculus, no dysphagia, pulse small and irregular. No urine or stool. 27th. — Rcstle?s n., pupils dilated, insensible ; pulse uncountable, toward midnight sopor. 28th. — Sopor till noon. Ischuria, pulse changeable and weak, pupils still insensible, contraction of the corrugator supercilii, with partial squinting ; some appetite. 2Qth. — yuiet n. ; copious discharge of urine, general improvement. Steady improvement and recovery complete Jan. 3rd. (Ih'id.)
Early in the m. of Jan. 15th, 1815, a healthy woman about 30 years old, having recently been delivered of her Hfth child, drank, by mistake of her nurse, a solution containing 30 gr. of sublimate. While drinking, she noticed a very violent burning in the stomach, and inquiry led to a discovery of the mistake ai once. In a few m. the physician arriving found her sitting in bed, her finger in her mouth to excite vomiting, whereby a quantity of fluid was ejected. She complained of intolerable pain in the oesophagus and upper part of stomach, gradually moving downwards. (Emetic of ipec.) In a few m. she became faint. Two large spoonfuls of strong liver of sulphur solution induced violent vomiting. The remedy was repeated in the intervals of vomiting, which was assisted by warm water and chamomile tea, with some sal absinth. 2 or 3 h. after the poisoning cramps set in, at first in the toes and feet, then in the hands and fingers, and subsequently in the arms and legs. Severe cramp in the r. breast drawing toward the back, just below the scapula-, breast greatly contracted, secretion of milk suppressed. She appeared greatly exhausted. A little later serious fainting fits, recurring at short intervals. Repeated complaint of burning, deep in the stomach, the more relieved the more she took liver of sulphur, so that afterward she made no more complaint of burning, i or 2 spoonfuls of mucilage given toward evening were vomited. The first n. passed quietly, yet the woman seemed very much exhausted. i6th. — The entire d. almost like the previous n, ; free from pain, fainting or cramps, and occasional sleep. The stomach refused everything. The second n. disturbed by frightful dreams, distressing thoughts. 17th. — Early in m., formication as if asleep. About 4 or 5 a.m., complaint of pain in the scrobiculus ; borborygmi perceptible to hand upon abdomen. Warm cloths and ether soon removed

the pain. During d. she took frequently some negus, oatmeal gruel, and toast, which were retained. At e. very urgent tenesmus, with discharge of mucus and blood only, relieved by two of the usual clysters. Thenceforth all went better. When she attempted to eat animal food, a week or so later, her teeth seemed loose and dull. About this time pieces of dead epithelium, like boiled potato skins, were discharged from the mouth and throat. A large piece of the gum came away from the socket of a tooth drawn a short time before ; also a piece, the size of a pea, came from the side of the tongue. Tongue, gums, and throat continued tender during this time. No special constitutional change was left. The r. breast remained in the contracted condition mentioned, the milk appearing several d. later in it than in the other when she again became a mother in 1818. {Edinb, AUtd* yourn.y xvi.)

a, March 14th, 1848, at 6 p.m., I was called to a young man xt. 21, who had taken poison at x 0 a.m. When I saw him he was in a condition of extreme exhaustion, and confessed having taken over a drachm of sublimate, which he had obtained ostensibly for use in his business as a jeweller. He had eaten nothing since 6 p.m. the day before. He looked pale and anxious ; sur^ce, especially of the extremities, cold ; pulse almost imperceptible; tongue very dry. No injury to the buccal mucous membrane could be discovered. The vomiting began a few m. after the poison was taken and continued almost incessantly. The vomit was a white froth with considerable blood, covering the floor fur some distance about his bed. He had also had a profuse, firm, natural-looking stool. He complained greatly of pain In the gastric region, not aggravated by pressure however. On account of the incessant vomiting, as well as from fear of greater injury, the stomachpump was not used. He was immediately given the whites of four eggs in water, and ordered the same every h. 15th, 8 a.m. — fi. slee|>less. He complained much of abdominal pain, especially in the gastric region, increased by pressure. He had had three stools, which, contrary to strict orders, the servant had thrown out. She said they were dark fluid. He had vomited three or four times the same bloody froth as before. The pulse had risen to 80, but was still very small and weak, with frequent intermissions. Tongue red and dry, papillae elevated, like a ripe strawberry. (Laudanum with syr. aurant.) About 10 p.m. pulse 100 and stronger, with fewer intermissions j the skin warmer; the pain less ; neither vomiting nor stool the whole d. i6th, 8 a.m.^ No sleep. He complained of considerable pain and tension ; neither vomiting nor stool in the n. ; pulse loo, strong, regular ; tongue ttill unnaturally red, with elevated papilla. (Castor oil.) About 9 p-m. I learned that he had slept 3 h. After the oil he vomited about a quart of very acrid stufF, looking like port wine dregs, with great relief. Pulse 100, regular, strong ; skin generally warm ; he had scarcely any pain $ no vomiting since m. Tongue less red and somewhat moist on the edges. The young man and his friends were very sanguine in their hopes, and in fact all the symptoms were improved. lytn. — N, sleep* less again with very little pain. Two fluid stools with considerable blood ; no vomiting ; pulse quite regular, moderately strong. Tongue

had become pale and moist ; scarcely any pain in abdomen even to hard pressure. His countenance, however, did not correspond with these apparently favourable symptoms. It had an anxious expression and was extraordinarily pale, with blue about the lips and ala: nasi. I now observed for the first time that the breathing was pretty difficult, and immediate auscultation showed the smaller bronchi nlled with mucus. No pain in deep breathing. He had complained of dyspncea 2 h. before my visit. He said he felt a constriction and pressure on the chest. (Blister to the chest.) At my next visit, about i o'clock, I found the breathing loud and rattling. He had no pain, but was evidently in extremis ; as during the whole illness the intelligence was undisturbed. Within 24 h. he had passed no urine. For food during his illness he had received white of egg, oatmeal gruel, arrowroot with broiled meat a.nd water. Death about 2.30 p.m.

b. yfutopsy^ same c. about 8. — Mucous membrane of mouth and oesophagus entirely normal, the chief action being visible in the stomach , whose mucous and muscular coats from thecardia out for a distance of 34 in. were changed to a gangrenous mass, having a corroded torn aspect and adarlc brown, almost black colour. The mucous membrane for a considerable distance about this gangrenous portion was brownred, but the pyloric half of the stomach, with the exception of some little red spots, was quite normal. In the duodenum and the rest of the intestinal canal nothing abnormal was perceived, except a slight congestion of some of the valvule conniventes in the jejunum and ileum. The bladder contained about half an ounce of urine. Cavities of heart empty. Blood did not seem to be coagulated. Lungs crepitant throughout. The entire respiratory mucous membrane in larynx, trachea and bronchi as far as could be seen was in a condition of intense congestion and varied from dark red to purple. The smaller bronchia? were filled with a frothy, bloody fluid. As no disturbance of the cerebral functions had occurred the brain was not examined. (WaOE, London Med. Gazette, 1848.)

A man, xu 27, took, with suicidal intent, 60 to 70 gr. of sublimate dissolved in water, and came into hospital May 24th. Soon after taking the poison he observed a strong metallic taste in the mouth, with a peculiar smell, then desire to vomit and soon afterwards vomiting, with a sense of constriction in the throat and trembling of the feet. In stomach and oesophagus he had no severe pains whatever. The vomiting brought up first food, then serum, and ceased some h. later after a physician who was called in had given an emetic. Soon after that he was brought to the hospital, where milk and white of egg in water was prescribed. The next d.the feeling of constriction in the throat changed to a severe pain, with an unpleasant tickling, coming paroxysmally and lasting only a few seconds, during which a convulsive cough with great anxiety appeared. The cough was a throat cough, i. $. like the cough occasioned by putting the finger in the throat. During these paroxysms of coughing, repeated at short intervals, expectoration of a bloody mucus and feeling of suffocation with extreme uixiety. Evidences of enteritis, severe colic, tenesmus and frequent loose stools (at least twenty in 24 h.) of a slimy liquid, with consider-

able biood. Stool very painful, so that he had to cry out, 26th. — Gums swollen, and all the signs of a severe mercurial stomatitis, of which, for the sake of brevity, we mention here only a considerable swelling of tongue, cheeks, velum, uvula and pharynx ; upon the latter, grey soft pseudo-membranous masses are formed. Some stupor and disturbed iatellect. Pulse 86. 30th. — ^Pulse 72. He suffers less, but there is still blood in all the stools, which, however, arc not so frequent. June 2nd. — ^Thc inflammation of mouth diminished and circumscribed ; the grey membranes begin to come oW. Swallowing still painful ; ^ce pale ; only slight traces of blood in stools. 4th. — No more bloody stools. Pulse 84. He is better generally, getting up and walking in the garden. For some d. he has been taking a solution of chlorate of potash. 5th and 6th. — Condition the same, except increasing weakness, yih. — Pulse 88. Extreme weakness and very pale colour. Stools, coming after eating, of yellowish fluid, without blood. P.m., numerous, reddish-grey, round, ecchymotic spots, not disappearing on pressure, made their appearance over body and limbs, especially on the lumbar region. Urine dark brown, albuminous. Surface very pale. Blowing with first sound of heart, heard at base. Hiccough with every movement of the body. 9th. — Death, without convulsions or agony. [Monit. des sciencei m^d., 1859.)

A gentleman, xt. 50, took over a drachm of sublimate in a quantity of water Feb. 27th at 8 a.m., and immediately began to hawk and complain of constriction with burning in the throat and dysphagia* (Oil, and zinci sulph. ^ss.) After 2 h. Blacklock found him hawking, dischar£^ing always a mouthful of mucus and blood, and having just passed a bloody stool, preceded by two natural ones ascribed to aloes taken the previous e. Pulse 120. Tongue white and moist; very disquieting hiccough. Thus the whole d. Toward e. hawking and dysphagia less frequent and severe. Face a little puffed. 28th. — Frequent and copious bilious vomiting and purging ; a regular cholera. Pulse over joo and weak. Face puffed and fuller than usual. Thirst so intense that every 2 or 3 m., in spite of the pain in swallowing, he called for milk. Very disquieting hiccough. Ischuria, even with the stools, since the poisoning, and no desire to urinate. Neither fulness nor pain in the abdomen except in the scrobiculus, where slight pressure causes pain. March ist. — Continued vomiting of bile and occasionally curdled milk. Diarrhoea stopped. Complains of burning in oesophagus and rectum ; numbness and loss of feeling in extremities. Pharynx dark red, painful to external pressure. Pulse 100, soft and weak. Inclination to sleep, which is disturbed by the hiccough ; continued ischuria. Abdomen soft and compressible, and not painful to pressure except in the scrobiculus. 2nd. — As yesterday \ a natural, though scanty stool. 3rd. — Burning in oesophagus and rectum, thirst, dysphagia, and continued suppression of urine. Less frequent hawking. Bilious discharges up and down. Occasional sleep in spite of the hiccough recurring regularly 26 times a m. Face puffed. Pulse 100, soft and weak. Tongue white and moist. 4ih. — Breath offensive, but the mouth not at all painful, and no salivation. Stiffness of the arms added to that of the legs, in lesser degree however. Urine still suppressed.

5th. — Pulse almost imperceptible at wrist. Complains of dyspnoea, and desires to be raised up in the bed ; continued hiccough. Vomits now and then a little bile, cannot swallow. Death about noon. Autopsy not permitted. (Edinb, Med. Journ.^ vol. xxxvi, 1831.)

a, J. W — , a strong man, act, 38, took, Feb. lOth, 1843, at

10 a.m., 2 dr. of sublimate in coarse pieces which he chewed and swallowed, and afterward drank about a pint of water. Soon after that a doctor gave him 4 eggs. He vomited, and a piece of sublimate half as large as a nut was found in the chamber, which, it was supposed, had not been swallowed. Brought into the hospital soon after, he exhibited great prostration, cold extremities, natural respiration, pulse almost imperceptible, tongue and lips swollen. He was sensible, and complained of constriction in oesophagus. He got the whites of 4 eggs. 2 p.m., increased swelling of lips and gums. Beginning salivation ; pain along oesophagus to stomach, causing intense dysphagia. Yellow masses with blood had been expelled by several paroxysms of vomiting. Some pain in abdomen j cramp in lower extremities ; pulse small and weak ; tongue white and almost filling cavity of mouth ; skin somewhat warmer. (About 2 pints of milk and the whites of 24 eggs.)

11 th. — Violent hiccough during n. ; great pain in stomach on pressure ; swallowing more difficult ; headache i several evacuations up and down, the latter of a green colour. Feet very cold ; the entire skin yellow. 12th. — Skin still very yellow j pulse much contracted j swelling of lips diminished. Evacuation, upward greenish, downward dark coloured^ mixed with blood. Stomach region very painful ; swallowing still difficulty extremities warm. 13th. — Swallowing goes better, but there is still a burning in the oesophagus. Pulse like yesterday. Has passed no urine since his admission. Very little sleep lastn. Hiccough continues. Pupils contracted. Extremities cold. Several stools, streaked with blood, one or two consisting entirely of blood and mucus. Tongue cannot be protruded for swelling. 4 p.m., some delirium, increasing up to e. 14th. — 6 a.m., breathing stertorous ; facial muscles paralysed ; toward noon he seemed to have a great constriction of oesophagus. The ability to speak was lost, and gradually consciousness also. Since last evening no stool, and no urine till death at 3 p.m.

h. Autopsy^ 22 h. after death. — Body rigid throughout. No signs of decomposition (atmosphere cold and dry). Peritoneum healthy, containing about an ounce of bright yellow fluid. Inside the stomach, about 4 inches from the pylorus on the greater curvature, an inflamed place the size of the palm of the hand. The mucous membrane was very injected with red blood, and showed throughout signs of inflammation. Of the slate-grey colour sometimes seen after sublimate poisoning, there was nothing, nor any appearance of erosion or ulceration- Duodenum and jejunum healthy. In the lower two thirds of the ileum there was slight inflammation of the mucous membrane, which from the caecum on was more considerable, with at last many small ulcers. Liver large and full of blood ; gall-bladder contracted, almost entirely empty. Spleen normal as to size, full of blood, its peritoneal covering thin and adherent. Pancreas healthy. Kidneys of normal consistence, the cortex showing many little red points, espe-

cially between the infundibula, apparently from incipient inflammation. On the back of the right kidney was a cyst the size of a marble, 611ed with clear fluid. Bladder very much contracted, containing about i oz. of turbid urine. Mucous membrane of oesophagus showed an inflammatory redness, but was otherwise normal. Old pleuritic adhesions in chest ; lung-substance cedematous, rather Arm and doughy ; at base of r. lung inflammatory oedema. Bronchial mucous membrane universally inflamed, and tubes full of frothy mucus. Bronchial glands slightly enlarged. Pericardium contained ^vj of clear yellow fluid. Heart seemed healthy, only somewhat smaller than natural. Cranium not opened. (Taylor, Poisons^ ist ed.)

1 6. A fifteen-year old student, on May 15th, 1874, took and swallowed a portion of a powder containing 2 scruples of sublimate, which had been prescribed for his father for external use. As he at once felt a severe burning, he threw away the remainder. After 5 m. repeated vomiting set in. He drank much milk afterwards, and again vomited, throwing up food which he had eaten for dinner. The violent pains in throat and stomach and constant retching drove him from the garden, where all this happened, to his room, saying that he was unwell, presumably from his dinner. After 2 h, diarrhoea every h., lasting entire n. and next forenoon. The pains and weakness increased continually, and at noon he confessed to his mother that he had taken some of the powder. Condition after 20 h. : Powerful muscular body. Temp. I00'4°; rcsp. 22. Thoracic-diaphragmatic breathing ; pulse 108. Skin dry; face red ; pupils alike, reacting well. The inner surface of the lower lip, the region of the frenum, base of the tongue, and velum, especially on r. side, covered with a grey-white, firmly adherent crust ; mortified mucous membrane. Organs of respiration and circulation normal, as also liver and spleen. Abdomen not enlarged, but very resistant. He complains of pains in the mouth, throat, and stomach ; the latter sensitive to pressure, as also the region of the sigmoid flexure. The evacuations are painless, consisting of a soft but formed, pulpy mass, light grey, with red streaks in it in considerable quantity, with much liquid. He said he had passed no urine since yesterday evening, that the fluid came exclusively from the rectum. He was perfectly quiet. No appetite; no thirst. (Magn. hyd. in water. Milk, white of 2 eggs.) l6th. — Till midnight he was very uneasy and had frequent stools, afterwards slept well. About 5 a.m., stool of a granular, sulphur-coloured mass. No urine in spite of much straining, the bladder being actually empty. 5 p.m., no evacuation since m. ; urged to attempt to urinate, he passed, after much straining, some thick milky drops. Temp. 99*68^ } resp. 20 ; pulse 76. Pains in stomach have ceased, but it is still sensitive to pressure. Kidney region not sensitive to deepest, hardest pressure. Since m. he has taken emuls. ol. c. tinct. opii. 17th. — He says he feels very well ; has appetite, but swallows with difficulty. Temp. 98-32°; resp. 16 ; pulse 76. No pain at all. For more than 30 h. no evacuation, no vomiting. Not a drop of urine. At n. he had formication all over body. About 4 p.m., copious, normal-looking, pappy evacuation, containing two living lumbrici. Feels well, appetite good^ no thirst, no urine. i8th. — Frequent, black, loose

stools after midnight. Urinary secretion has begun. Feeling of pressure in gastric region. Temp. 9824^ ; resp. 18 ; pulse 76. Abdomen flat. Crusts begin to come off in pieces from mouth and throat. At noon he ate some milk-food with relish. At 5 p.m. a spinach-green evacuation, followed by severe pains in stomach. Cold fomentations to stomach. 19th. — Slept well. In m. two spinach-green evacuations and each time urinated. Itching in whole skin, which is quite dry, Severe pains in stomach region, which is somewhat full ; the percussion tone being very muffled — tympanitic. Apparently there was a haemorrhage into the stomach. Swallowing very difficult. Extreme weakness. Temp. 96-44°; resp. 18; pulse 76. loth. — During n. several dark green, very tenacious stools. Urine steadily increasing in quantity, containing some albumen. Skin dry. Restless. Hiccough now and then. Pains in stomach less. 21st. — N. very restless, no sleep. Hiccough is much more frequent. Burning in chest and abdomen. Crusts have mostly come off from mouth ; places thus denuded of epithelium appear as extensive, rather depressed spots sprinkled with coarse red grains. No srool. Urine normal in quantity, containing some albumen. Pains in mouth, and in swallowing^ some pains in stomach. (Morphine.) 22nd. — Very little sleep. Much plagued by the very frequent hiccough, so that he cannot eat and can hardly speak. Temp. 9392° ; resp. 18 ; pulse 76. Pure blood flows from anus. Very troublesome itching in skin. Burning in intestines ; great depression. E., the great increase of heart's action since m, is very remarkable; there is no enlargement demonstrable. The heart's impulse is very extended, visible at a distance, and so strong that the whole thorax and both hypochondria, especially I., from stomach to navel are vehemently jarred by it. Beats 76 ; tone metallic-sounding, but clear. Singultus ceased at e. Very considerable difficulty in swallowing. Temp, 9212^ ; resp. 18. 23rd. — Considerable sleep during n. Early in m. an evacuation consisting of hard feculent masses in bloody Huid. Urine normal in quantity, containing but a trace of albumen. Hiccough entirely stopped ; restless. Temp. 9824° ; resp. 20 5 pulse 108, small. Heart's action strong as yesterday. E., has taken no food today. Face pale, collapsed. Consciousness no longer quite clear. Abdomen flat. Two coffee-ground evacuations. Cold fomentations to abdomen. 24th. — He has groaned whole n. through. Before midnight a black-green, very copious evacuation, followed by involuntary urination and passage of blood per anum. Below navel to the r, a hard swelling, the size of a lemon, very painful (cxtravasated blood) i percussion tone over it dull. Restless. (Morphine.) Soon afterward he slept. Temp. roo'04° ; resp. 14, very deep with long-drawn inspiration ; puisc 112, small. Toward e. dulness to r. of navel very much increased in extent, apparently also flattened out. Unconscious, very restless, frequent groaning. Skin dry. Thermometer could not be applied, but temperature was seemingly higher than normal. The expired air smells very plainly like spoiled meat. Heart's impulse still very strong and extended, but no more on the whole than yesterday or this m. At same time pulse became steadily more rapid and smaller, and later was imperceptible in the radial, while heart's impulse was still

vigorous. Blood flows from rectum. Jactitations became less frequent and weaker. Death before midnight. Autopsy neither desired nor permitted. (Lowy, Wiener med. Presse^ 1874, No. 34,)

A carpenter, act. 30, received for r. supra-orbital neuralgia pills of sublimate, which he took for 14 d., and then left the hospital. He had trembling of the limbs, especially when they were extended ; heaviness of the extremities ; trembling of the feet in walking. The trembling was worse on the 1. side, especially in the m. on rising, at e. with feverishness. Sense of coldness of the 1. side, worse after midnight, so that he could not get warm ; towards e. icy coldness ; cold chills in the sacral region, as if there were shot in there ; sweat first in 1. axilla, then general, on waking from sleep in the n. (Buchker, A. h, Z., xxviii, 155.)
W — J registrar, received for a slight herpetic trouble sublimate pills, and took altogether 24 gr. The herpetic difficulty was cured, but the effects were frightful. He writes : ** My teeth, previously sound, became loose, and six came out. A nasal discharge ensued, of the character of isinglass, drying to a strong hard mass, especially in the posterior choanx and frontal sinuses. Of this mucus, hard pieces, the size of a bean, frequently bloody, were discharged from the nose, at the same time there were often the most dreadful pains in the head. Respiration through the nose was maintained by snuffing water and tobacco. The cartilage of the nose was perforated, but the nose did not fall in ; the sense of smell was lost entirely. No improvement from the regular use of water. Subsequently the discharge became more consistent and purulent ; the teeth became affected again at the roots, manifested by a prickling pressure, and always ending by prominence in the sockets -, profuse lachrymation in the open air. In the front of the head, especially on the r. side, an unpleasant pressure, changed to a crampy pain by obstruction of the discharge. Sleep frequently only for an h." Cure after discharge of a great portion of the necrosed upper jaw. {Ibid,)
A woman, act. 29, contracted syphilis, for which she was treated by means of corrosive sublimate. Violent ptyalism took place, 4 lbs. of saliva being excreted in the 24 h. As this secretion diminished, diarrhoea appeared and increased. Soon after, the patient complained of anxiety and heat, with a fixed, obtuse, and deep-seated pain at the epigastrium ; loss of appetite, nausea, tension of abdomen ; great thirst and dryness of throat, and rapid pulse. These symptoms were aggravated when the stomach was full. During 5 d. some amelioration was remarked, but bilious vomiting supervened, and the pain and diarrhoea increased. The frequency of the calls to stool became remarkably great ; a watery yellowish fluid, resembling saliva, being voided. The deep-seated pain above the umbilicus prevented the patient from lying on her back and 1. side, and was increased by a full inspiration. Some d. of relief followed, after which a violent increase of fever appeared, with a return of the diarrhoea, an acute pain at the epigastrium, and orthopnoea. Blood-letting was prescribed. The following m. the parotids were hot and painful, the mouth was burning, the pulse small, and the stools were suppressed. 1 owards e. the breathing became

^SS

stertorous, the anxiety extreme, the pulse thready and intermittent, the extremities cold, and the face hippocratic. She expired in the n. The pancreas was found red, swollen, and somewhat more consistent than natural. It weighed 8 oz., and the blood ran freely from it upon dividing it. The duct was dilated. The parotids also were inflamed. (Copland, />iV/., sub voce Pancreas.)

In a man and woman who had taken sublimate for chancre, but were not salivated, there appeared inflammation of the r. eye, which involved not only the posterior surface of the cornea, but also the serous

■covering of the iris. The pupil was angular ; the eye very painful, as ^if too small ; all the sensations aggravated in bed. (v. Ammok, Zeitsch, f. Ophih.^ i, 121.)

a, LfiwiN treated a large series of cases of syphilis with subcutaneous injection of corrosive sublimate. The smallest dose Injected was -^ gr,, the largest J gr. For experiment J gr. and i gr. were injected. Injection is followed either immediately or soon afterwards by more or less lively reactive redness diffused round injection point, with swelling coming apparently from the depths of subcutaneous tissue, and a more or less firm infiltration focus which remains as a hard swelling after the inflammation is gone. Very seldom an abscess is formed. Pain sometimes occurs after the injection, of a pretty severe character, or the puncture sometimes remains for a considerable time sensitive to pressure,

b. It causes several forms of afl^ection of mouth : i. Slight inflammation (stomatitis), with swelling and tenderness of submaxillary glands. The stomatitis is characterised by hypcraemia of buccal m.m., of gums, and of mucosa of cheeks. Afterwards there is swelling, hyperesthesia, tenderness of organs of mastication, and increased secretion of parotid and submaxillary glands. 2. Stomatitis ulcerosa diphthcrica ; ulceration of buccal m.m. with tendency to gangrene, covered with dirty yellow coating resembling the diphtheric membrane. This is particularly at the last tooth and at the fold at junction of the upper and lower jaw, which is liable to be bruised during mastication \ on the check where it is exposed to pressure of teeth ^ and on the sides of the tongue. 3. Ptyalism without stomatitis. At beginning of treatment patients sometimes complained of falling out of hair. Perspiration, especially at n., was a frequent phenomenon. Some of the patients got a chlorotic colour of skin and m.m., and complained of debility. In some, 6 to 12 h. after injection, there appeared single spots on various parts of body the size of a pin's head, and resembling ecchymosis, surrounded by a pale red areola. They appeared suddenly, and went off gradually with desquamation of epidermis. The lymphatic glands of pharynx and of submaxillary region are apt to become affected in cold weather. The patients complain of sore-throat, particularly when swallowing, the tonsils are swollen and red, and there are sometimes swollen and sensitive glands in the region of the angle of the lower jaw. Very seldom is there mercurial tremor or erethism.

c. If the injection cure is pushed too far it may cause a state resembling malignant gastro-entcritis. This commences with gastric symptoms such as anorexia, loaded tongue, bad taste, which is sometimes descnbed as metallic, rarely nausea or vomiting. After some

time in stomach a burning, increasing to pain and most felt on pressure. Later diarrhoea, sometimes the stools tinged with blood. Sleep at n. disturbed by anxious startings. Face pale, conjunctiva especially pale, eyes dull, countenance looks suffering. Great weakness, must sit down after walking a few steps. Urine often increased, and its sp. gr. diminished, pale yellow colour. Pulse contracted, quick, 90 to 100, and on exertion 1 30. Attacks of sickness and vertigo were common. Vertigo even in bed, faintness and coma. Then the pulse would sink to 68. Skin sometimes covered with sticky sweat. The gastric symptoms sometimes increased^ then there came vomiting and dysenteric bloody stools with tenesmus. (G. Lewin, Die Behandlung der Syphilis mit subcutaner Sublimat Injection^ 1869.)

Dr. MuLLER, of Bern, described a case of hysterectomy for carcinoma uteri, in which a i in 1000 solution of the perchloride had been used for disinfection of operator's hand, a i in 2000 solution for the sponges, and a i in 4000 solution for washing the wound. Two d. after the operation the patient was seized with diarrhoea and albuminuria, the stools were mixed with blood, and the quantity of urine passed was very small. Death ensued on the 3rd d., and the p9st~ mortem revealed the existence of ulceration in the colon. There was no nephritis. (Lond. Med, Record^ p. 118, 1886.)
Dr. Butte summarises as follows the effects of corrosive sublimate solution used as antiseptic injections. Some h. after the injection, sometimes only on the following d., diarrhoea supervenes, with tenesmus, the motions soon becoming slimy, stained with blood, and exceedingly offensive. The rectal pain is marked, and severe colicky pains are complained of in the abdomen. Nausea and vomiting are often present. Salivation is generally absent, at any rate for some d., but stomatitis may occur. There is great dryness of mouth and throat, with intolerable thirst. The quantity of urine excreted is most frequently diminished, sometimes to the extent of anuria, and it contains more or less albumen with epithelial cells and casts. The pulse becomes small and rapid ; the temperature is probably only affected secondarily to the enteritis.'**' The patients generally complain of intense headache, with much prostration, which may amount to collapse. Erythematous eruptions on the skin of vulva^ thighs, face, arms, and trunk are often noticed, or the skin may become dry and irritable. Certain patients appear to be abnormally amenable to the toxic influence of the sublimate, especially cachectic and debilitated subjects. The post-mortem appearances comprise injection of the lower part of the small intestines, while in the large intestines the mucous membrane is extremely hyperxmic, and is necrosed in patches and often covered with a diphtheritic exudation. The kidne3rs are enlarged and pale in colour; examined microscopically the canaliculi are blocked by deposits of oxalate of lime, and there are signs of parenchymatous inflammation. (Ibid,^ p. 266.)

Mr. S. Snell relates (Prtfrf., 1883, i. 180) the case of a woman, act. 4X, in whom a drachm dose of lig. hydrarg. perchlor. immediately caused vomiting and a temperature of 104°. Under % grs. of hyd. c cret. the temperature rose to ioi"8**, panied with vomiting, &c.} as before.

After abortion at the third month, a young woman of 24 was ordered an injection of i in 2000. Instead of calling on the nurse to give the injection, the patient's sister took upon herself to inject into the rectum ^ litre of the solution, containing about 17 centigr. of the sublimate. In the course of a (cw m. patient was seized with intense general tremulousness, more marked in the upper extremities ; her voice became feeble and consciousness dull. On arrival of the doctor ^ h. after injection, patient^s face was pale, the skin cold and clammy. She was unconscious, pulse 130, small and feeble; resp. 56, shallow and irregular. The tremors had disappeared, but the tonus of the muscles had increased to such an extent that the limbs preserved the position in which they were placed for more than a m. Attempts to induce the patient to swallow gave rise to attacks of dyspnoea. In spite of treatment the breathing became more and more embarrassed, and it was necessary to resort to artificial respiration. The pulse became imperceptible, and the face cadaveric. Death appeared imminent, but as the heart still pulsated the treatment was persisted in for 3 h., when patient began to show signs of returning life. She had never shown any symptoms of hysteria, and everything pointed to the sublimate as the direct cause of the attack. [Ibid.j p. 499.)
a, Mrs. — , ast. 28, large and plethoric ; weight 220 pounds ; called at my office at 7.30 p.m., May 27th, 1881, in an excited condition, and said she had taken poison about k h. before. I asked her what kind of poison she had taken. She said bed-bug poison, or corrosive sublimate, and that she had taken half a glassful. I told her that in that case she must die. She was at this time retching violently. •• Can't you do something for me ?" I told her I would do what I could, and as soon as possible. I gave her over a pint of a strong solution of salt in tepid water. With this she vomited copiously. I also gave her the whites of a dozen and a half of eggs, she being able to take only four or five of them before they were ejected. During this time, which occupied i\ h., she purged and vomited blood a great many times ; and at 9 I ordered a carriage and sent her home. 28th. — At 9 a.m. I called, and found her quite comfortable except a burning in the throat, and also in the rectum after a stool. During the n. she had passed stools of blood quite frequently, and had voided a large quantity of urine. The abdomen is quite tender ; the temperature is 99"^, and the pulse 115. I ordered injections of the aqueous fluid extract of hydrastisj^r/* rectum, in the proportion of two teaspoonfuls in half a pint of warm water, to be uken after each stool. In the evening I found the pulse 80, and the temperature 100°. The patient says the injections afforded great relief. The abdomen is not so sore, and the burning in the bowels has entirely ceased. The stools are not bloody. There has been no emission of urine. Continued the same treatment. 29th, a.m.— Pulse 94, temperature 100°. She complains mostly of her throat. The tenderness of the abdomen is almost entirely gone. No passage of urine. I passed the catheter, but obtained none. Gave iod, potass., 10 gr. in solution every h. Also ordered jaborandi injections to be substituted for the hydrastis. £., the pulse is 105 ^ the temperature 100*2'^. The patient only took the iod. potass, a few

VOL. Ul. 17

times, as it nauseated her. She has perspired freely most of the d. Passed the catheter, and there still was no urine. Ordered half of the original dose to be eivcn in two spoonfuls of milk. 30th, a.m. — Pulse 106; temp. ioo'2 , The general condition is the same as last c. She has very smalt stools every h. Continued the same treatment. E., pulse go, temp. 99'9°. The patient is quite drowsy, but drinks a little milk. When getting up to stool, she vomits a little. Administered 10 dr. of apK>cynum cannabinum in the mother tincture hypodermically over the r. kidney. After waiting \ h., the catheter was passed, but there was no urine. 3i5t, a.m. — Pulse 96 ; temp. 999^* The stools are very small, and have a cadaverous smell ; no urine ; complains of no pain ; takes milk and medicine ; vomits a good deal of bile. Gave 10 dr. of apocynum in the arm hypodcrmically. Also, to satisfy the husband that the bladder had the power to eject urine, I injected an ounce or more of warm water into it, which was promptly voided. E., pulse 88, temp. 99°. Gave hypodcrmically over the r. kidney gr. | of pllocarpin. In less than 5 m. a profuse perspiration was produced, a large quantity of bile was thrown from the stomach, and a very large stool passed, but still there was no urine. Ordered apis mel. 2 trit. every \ h. June ist, a.m. — Pulse 90, temp. 996°. She is about the same. Gave gr. i of pilocarpin hypodermically, and she commenced perspiring in I m. by the watch. Passed the catheter, and there was no urine. Gave the apis every h. E., Dr. Burt was present in council. Pulse 80, temp. 99°, The patient is still able to walk. Dr. Burt advised pilocarpin gr. \ to be given hypodcrmically twice a d. Also potass nit. every 2 h. 3rd, a.m. — Pulse 88, temp. 99S^- She is becoming weaker, her speech is more difficult, the face is very much swollen, the tongue thick and deeply marked along the edges by the teeth. The hiccough was subdued by the use of small pieces of ice ; no urine j she is quite drowsy. Elm water was given her to drink ; pilocarpin hypodermically ; alternated nit. potass and nit. ac. every h. E., the patient seems brighter. In the afternoon hiccough set in, which would not yield to ice ; but with ice and hot water in quick succession it yielded completely. The pulse this evening is 85, temp. 99'2°. The face is not so much swollen, and she can talk a little better. Repeated the pilocarpin, and continued same medicine. 4th, a.m. — Pulse 90 ; temp. 999^. She seems quite stupid. The face is very much swollen j we can scarcely understand a word that she says, but she is entirely conscious, and answers yes and no by a nod or a shake of the head. She is very quiet, and says that she has no pain. The catheter fails to find any urine in the bladder. Same remedies. E., pulse 80, temp. loO'S^* She is becoming very weak. The swelling has decreased very much. The pilocarpin docs not produce as profuse perspiration as before. She complains of some pain across the kidneys. Hot fomentations were applied and the same medicine continued. 5thf 4.3O a.m. — Was called in haste to find that my patient had passed quietly away a little before 4, without even a moan, or anything to indicate to the watchers that dissolution had taken place.

h. At 4 p.m. an autopsy was held ; present, Drs. W. H. Burt, Duncan and Snyder. 7'here were two inches of adipose over the

abdomen. The peritoneum was normal. The stomach was very much inflamed, its cardiac portion being almost perforated by ulceration. The kidneys were examined very carefully. They were found to be inflamed, and so hard that to dissect them was like cutting into firm cheese. The ureters were also inflamed. The small intestines were almost normal. The descending colon was slightly inflamed. The inflammation of the liver had been severe, and its texture was solid. The gall-bladder was full of bile, and decidedly inflamed. There was no urine in the bladder, and it was literally lined with fat. The uterus was normal. (I have neglected to state that during her sickness, at the proper time, she menstruated as if she had been in perfect health.) (Skiles, Climqut, Oct., 1881.)

III. Experimtnts on animah. — I. Three gr. of corrosive sublimate in substance were put upon the connective tissue of the thigh of a medium-sized dog about ii a.m. At 6 p.m. he seemed dull. Next m. about 1 i a.m. pulse was very rapid, tongue moist and natural in colour. No sign of paralysis or vertigo. At 5 p.m. dyspnoea, the dog lying upon his side. Next m. he was dead, jiutopsy.^-Tht thigh was infiltrated and considerably inflamed ; the place upon which the sublimate was put was greyish. On the mucous membrane of the stomach (which was natural in colour), close by the pylorus, were found six or seven coal-black spots, caused by extravasated venous blood. The small intestine was normal, the rectum somewhat red. The crepitant lung was brown, containing much blood, and floating on water. Mitral valve cherry-red ; otherwise heart was healthy. (Orfila, Tox.y sub voce.)

About II a.m. 6 gr. of sublimate in substance were applied to the connective tissue of the inner aspect of the thigh of a very large dog. About I p.m. he vomited j next d. burning thirst \ the 3rd a. he would not eat, and endeavoured to guzzle water, which he immediately vomited again. Inconsiderable vertigo without spasm or paralysis. Death about 4 p.m. Jutopsy, — The thigh operated upon was very much infiltrated and excessively inflamed, but not an atom of the sublimate was to be found. The mouth was greyish i the stomach contained much yellowish mucus \ the mucous membrane here and there cherry-red, and, at the pylorus, ulcerated. The small intestine seemed normal, the rectum very much inflamed. The tricuspid valve of the heart was beset with minute black points of extravasated blood, which the slightest friction changed to ulcers ; otherwise the heart was healthy. The lungs were crepitant, somewhat infiltrated, and floated on water. (Ih'tfi.)
Sept. 13th, about 11 a.m., 6 gr. of dry sublimate were introduced into the connective tissue of the back of a small, weak dog. On the 15th, he would not eat and had a burning thirst, but vomited as soon as he drank. On the 16th, 17th and iSth, condition the same, with marked increase in the rapidity of heart's action. Death the n. after the ]8th. jfutopiy. — Intestinal canal appeared unchanged. Endocardium in both chambers of the heart red and inflamed ; numerous red spots on some of the columns carne<c \ lungs engorged and spotted black. (Ibid,)

26o

Injection of one grain sublimate into the jugular vein or a large dog produced salivation, dyspnoea, and symptoms of inflammau'on of the lungs, which increased in the days following, and there were added vomiting, diarrhoea, fever and cramps. On the 4th d. the dog died. The lungs were beset with blackish swellings the size of a pea, of which some were inflamed, others suppurating, and still others gangrenous (bronchial glands?) ; liver was black and softened ; gall-bladder full of thick, black, viscid bile. (Gaspard, yourn, (U Phys., i.)
A gr. of sublimate, dissolved in ^ss of distilled water, was injected into the jugular of a bitch. After 15 m., she was taken with a chill, dulness, diarrhoea, dyspnoea, and salivation. The symptoms of pneumonia and dysentery increased. There was tenesmus, with mucous and bloody stools ; and after si h. she died. The lungs were extensively inflamed and distended with blood, sinking in water. The intestinal mucous membrane was red and inflamed, and covered with a dirty sanguinolent and ichorous mucus. (/W.)

Volume IV — Appendix

MERCURIUS CORROSIVUS.

(See vol. iii, p. S36.)

II. 29. a, A patient who bad been delivered 3 months previousl^i and had been in continual ill health since, came to Dr. H — on I5t_ Jan., complaining of pain in the throat, rhagades at angles of mou specific-loolcing papules on face, breasts, and axillx^ large papules c^ j genitals, and enlarged lymphatics. He prescribed K. iod. internall ;y^ and on 17th, about 3 p.m., applied a sol. of corrosive sublimate (sc:»J Plenckii) to genitals by means of cotton wadding, and painted che--»r and mouth with it. On her return home, she complained of grc^r pain about body, and suddenly fell to ground, unconscious. An h. after she was found in a helpless state by the neighbours, and was conveyed to hospital, where, at 6 p.m., she was registered as sutfering' from peritonitis. On 18th she was ansmic and fainting. There wi» inflammation and vesication wherever the sol. had been applied. On 19th vomiting returned, of greenish character, with threatening collapse. The cauterised parts appeared leathery and dry. In e. she hid several brown-coloured watery stools. 20th. — Collapse increised; large deposit in urine; abdomen painful to pressure. 2ist. — Prol'use diarrhoea mixed with blood and matter, and great pain all over bodv. 22nd. — Collapse imminent ; hyaline casts in urine. 23rd. — Vomiting returned ; hiccup, of which there has been more or less since 19th, it now troublesome; diarrhcea still present; cauterised surfiiccs irt granulating. 25th. — Pulse scarcely perceptible, and at noon the increasing collapse ended in death.

l>. The autopsy showed among other changes the intestines congested throughout ; in ileum and large bowels inner surface was congested and discoloured, with diphtheritic ulcers on upper part; mucous membrane swollen and ecchymosed. Extensive peritonitis, small intestines glued to pelvic organs. Left Fallopian tube was distended, and contained pus. Slight parenchymatous degeneration of kidneys. {Afed. Press and Circular^ June i ith, 1890.)

A young woman, 24 years of age, after a violent emotion^ aborted at the third month of her pregnancy. Two days later she had a rigor, and the lochia (abundant at hrst) became scanty and foetid. She was ordered irrigations containing i^^^ of corrosive subli* mate. Instead of calling in the nurse to give the injection, the patient's sister took upon herself to inject into the rectum ^ of a litre of the solution, containing 17 centigrammes (about 2^ gr.) of the sublimate. In the course of a few m. the patient was seized with an intense general tremulousness, more marked in the upper extremities ; Sex voice became feeble and consciousness dull. On the arrival of the doctor, who was immediately sent for, half an h. had elapsed since the

^anb

jcction had been administered. The patient's face was pale, and her ^n cold and clammy. She was unconscious ; pulse r 30, small and ^blc ; respiration 56, shallow and irregular. The tremors had disspeared, but the tonus of the muscles was increased to such an extent '^t the limbs preserved the position in which they were placed for ^■"e than a minute. Attempts to induce the patient to swallow gave c to attacks of dyspnoea. A solution of albumen was injected into .^ rectum, together with hypodermic injections of tincture of musk. f^^ skin was rubbed with hot cloths and alcohol. Notwithstanding ** treatment, the breathing became more and more embarrassed, and ^'^^^ found necessary to resort to artificial respiration. The pulse '^^ne imperceptible, and the face cadaveric. Death appeared immi- '^t } but, as the heart still pulsated feeblv, the treatment was persisted

^r upwards of 3 h. The patient then began to show signs of ^^irning life, and she recovered consciousness i^ h. later. She was ^^^valescent in about 4 d. The patient had never shown any sym- ^^Qis of hjrsteria, and everything pointed to the sublinute as the direct ^^tte of the attack. {Leiui. Me J. Record, Nov. 15th, 1886.)

^ III. 6. Klemperer experimented on rabbits by subcutaneous .ejection of M. corn, to ascertain condition of kidneys induced by it. '-t) acute cases, where amount of drug was large and death rapid, a considerable amount of renal congestion was found. If life was (Prolonged 5-10 h., haemorrhages were found, chiefly in parenchvma, ^d there was also cloudy swelling of epithelium. If duration of life ^as still longer, parenchyma showed marked signs of inflammation. These were seen to some extent in the tubules of the cortex, but were less obvious there than in the straight tubules ; in the latter inflamnation quickly led to necrosis. In half the cases there was a deposi- ;ion of chalk, together with degenerative parenchymatous inflamnation ; the former appeared 18-25 ^' ^^c*" death, at first in the casts bund in the diseased tubules, and similar deposits occurred later in the traight tubules. Added to the above conditions, was generally a slight .ffiection of the glomeruli. When the poisoning became more chronic, he parenchymatous inflammation was less marked ; the necrosis of ells in the straight tubules occurred only to a slight extent, and calci- [cation was absent \ but in the interstitial tissue the signs of inflamsation were abundant. In the kidneys of dogs there was a parenchylatous nephritis, which terminated, not in necrosis, but by fatty egeneration of the cells ; a deposit of chalk occurred only to a very mited amount. {Lanatj 1890, ii, 409.)

Volume IV — Supplement

MERCURIUS CORROSIVUS.

In the first No. of the Reports of the London Homeopathic Hospital (Oct. 1891), there is a proving of this drug from the pen of Dr. J. H. Clarke. It is a record, cacendng during 142 days, of symptomis commencing after rubbing the 3x dil. on the gums to relieve a gumboil. It is calculated that during the two days’ use of this measure a quantity of tinct. = gr. at, of the salt was employed, The patient, however, had only recently been seriously out of health; and after using the M, corr, it is noted that “all the old symptoms returned, and new ones as well.” Under these circumstances, we hardly see our way to do more than refer to the observation in question,

Mercurius corrosivus

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