Mercurius cyanatus

Volume I — Special Symptomatology

{Hydrargyri Cyanuretum.)

Pharmacology. — This salt is prepared by dissolving in sixteen parts of •water, in a glass flask, two parts of crystallized Ferro-cyanuret of Potassium, and then adding three parts of dry per-sulphate of mercury. Boil for half an hour in a sand bath, filter, and evaporate to dryness, stirring constantly. Powder the dried mass, digest it with eight times its weight of 80° alcohol, for some hours, filter while hot, wash the residue on the filter, with hot alcohol, and set aside to crystallize. Collect the crystals, evaporate the molten liquor to dryness, and preserve the whole in a well closed bottle, excluded from the light.

It is formed in white, more or less transparent, four-sided prisms and pyramids, which are odorless, but have a pungent, nauseous, metallic taste. Heated in a close glass tube the crystals fly in pieces, and decompose. Water at 60° F. dissolves 1-11 part of its weight of the salt; at 212° F. 2-5 its weight; 80° alcohol dissolves 1-22 its weight, and when boiling 1-5 its weight.

Officinal Preparations. — (1) Mother tincture — with 80# alcohol, 1 part to 20, by weight ; dilutions. (2) Triturations.

Analogues: — Arum triphyllum, Causticum, Hepar sulph., Kali bichromi cum, Kali causticum, Mercurius iodat., Phytolacca, Muriatic acid, Lach esis, etc.

[In the treatment of malignant diphtheria the 6th dilution has been used. Owing to the intensely poisonous nature of the drug, this is as low as 6hould be used, especially for children. (Hale.)]

Mental Sphere.

Cerebral excitation, with sleeplessness at night. Loss of consciousness; syncope and general debility.

Head.

Headache, with vertigo, and burning in the ears.

Face.

Face pale and wan; bluish cast. Copious epistaxis. Blue face and lips.

Eyes.

Eyes are sunken. Pupils contracted.

Mouth and Throat.

Tongue pale with yellowish streak on the base; swollen, red on its borders.

• Throat looks rough; pharynx red and injected.

Gums swollen and covered with a white adherent layer, under which was found a violet border.

• A white opaline layer formed on the columns of the velum

palati and the tonsils ; on the inside of the right cheek was a round ulcer with a grayish base, the borders as if cut out and surrounded by great redness.

• Pseudo-membranous inflammation of the throat.

• Lips, tongue and inside of the cheeks dotted by ulceration,

covered by a grayish- white coating. Mucous membrane of the throat was very red. Inflammation over the whole buccal cavity. Salivation, a thin, foetid, excoriating discharge. Great difficulty of swallowing.

° Pseudo-membranous croup; (considered a specific in the most

malignant cases by many physicians). 0 Diphtheria maligna, with phagadenic ulceration.

Stomach.

Nausea, vomiting, and frequent diarrhoeic stools, with icy

coldness of the body. Drinks are immediately returned. Burning sensation in the stomach. Increased thirst, with violent irritation of the throat. Vomiting of green mucus. Violent retchings.

Hiccough constant for twenty -four hours.

Abdomen. Abdomen slightly painful.

Violent abdominal pains, increasing with every stool. Colic, followed by hard stool, then a soft one.

Stool and Anus. Fluid stools, tinged with blood. Diarrhoeic stools, smelling badly; green and glairy. Very copious diarrhoea, which is persistent, with moist and icy-cold skin.

Frequent inclination to stool, preceded and accompanied by tenesmus; stools scanty and mixed with blood.

Great inclination to go to stool (with incessant vomiting), followed by liquid stool.

Dark-colored stool.

On making the effort at stool passes pure black blood.

A foetid liquid oozes from the rectum, having the characteristic smell of gangrene, and forming on the linen large black spots.

Pains in the rectum when sitting down, also around the anus,

which is swollen. Hemorrhoidal tumors around the anus, and knobby swelling

of the mucous membrane. Diphtheritic, grayish layer around the anus, similar to that

on the cheeks. ° Malignant or putrid dysentery.

Urinary Organs. Retention of urine during five days. Suppression of urine. Urine yellow, amber-colored; painful.

Urine clear, but scanty. Urine scanty and dark.

Numerous whole cylinders, or broken down, with fine detritus;

no blood globules; a quantity of albumen. Urine contained in the bladder is extremely albuminous. ° Bright's disease.

Generative Organs.

{Male.) Penis is of a dark color, is in a state of semi-erection. Scrotum is of a dark color.

Heart.

Pulse small, depressed, 76.

Pulse stronger and more frequent, 90.

Pulse weak, 130, with cold extremities and cyanosed face.

Pulse 102, irregular in the morning (noticed only at one time).

Beating of the heart is violent and rough.

Severe contractions of the heart, repelling the hand.

Lower Extremities.

Severe pain in the left calf; the veins form two strings which unite in the neighborhood of the ankles; the least touch is extremely painful; leg much swollen (varices). Generalities.

General debility, syncope, icy-coldness of the body. Extreme prostration, frequent vomiting, hiccough. Great sensation of chilliness. Extremities agitated by light convulsive motion.

Volume II — Special Therapeutics

This drug is almost as poisonous as the Cyanide of potassium. It may not kill as suddenly, but the sufferings of the victim are a hundred times more intense.

In cases of poisoning by this agent we have all the symptoms of Hydrocyanic acid, to which are added the terrible effects of Corrosive mercury. Worse than this, even, we have a picture of the most malignant forms of diphtheria . The following are its characteristic symptoms :

“The tongue is pale, with a yellowish streak on the base; swollen, with red edges.

“ The throat looks rough ; pharynx red and injected. •

“ Gums swollen, and covered with a white adherent layer, under which is found a violet border.

“ A white opaline layer forms on the columns of the velum palati and tonsils ; on the inside of the right cheek was a round ulcer with a grayish base, the borders as if cut out and surrounded with great redness.

“ The lips, tongue , and inside of the cheeks dotted by ulcerations, and covered by a grayish-white coating.

“ A pseudo-membranous formation extends all over the fauces and down the throat.

“Inflammation of the whole buccal cavity, with salivation, fetid breath, and great pain on swallowing.”

We have here a picture of malignant diphtheria accompanied by ulceration. This pathological condition, coupled with the suddenness and severity of the attack, fully indicate this drug above all others.

The concomitant symptoms are equally important as an indication, namely : epistaxis, cerebral congestion, pupils contracted, syncope, loss of consciousness, vomiting, diarrhoea, diphtheritic formations on other portions of the mucous membrane, and even the skin.

The diphtheritic process attacks the kidneys, causing one of the worst varieties of Bright's disease, and it may prove to be one of our best remedies in the croupous form of nephritis, and in albuminuria following diphtheria and scarlatina.

I once saw an epidemic of malignant scarlatina, which presented nearly all the symptoms and conditions caused by this drug. It had not been introduced into our Materia Medica at that time, or I might have saved some cases.

Malignant dysentery is closely imitated by the symptoms of the Cyanuret of mercury. It is attended by great prostration, putrid bloody stools, diphtheritic patches at the anus, ulceration, gangrene, and finally collapse and death.

It causes phlebitis and varicosis, and ought to be specific in the worst cases, as well as varicose ulcers.

Physicians have reported cases cured by Mercury cyanide of what they termed malignant membranous croup , but it is evident that the croupous symptoms were due to an extension of the deposit or exudation to the air-passages.

I would suggest its possible usefulness in those cases of sudden paralysis , or sudden heart failure, which occurs after attacks of diphtheria, even when it has been supposed to be non-malignant in its character.

Among other remedies for diphtheria, none resemble it in intensity of action; but those which approach it nearest are Kali caustic, Kali bich., and Lachesis.

The 6th dilution or trituration is as low as it can be safely used for children; the 3d cent, in adults. The use of this medicine alone, or in connection with a gargle or spray of Chloride of lime (Liq. calcis chlor., 5j ; Aqua, §iv), is the best treatment now known for this terrible disease.