[931] Seidel quotes a case from Hasselt, in which a father, for the purpose of obtaining insurance money, killed his child by calomel.
§ 848. Treatment of Acute and Chronic Poisoning.—In acute poisoning, vomiting usually throws off some of the poison, if it has been swallowed; and the best treatment seems to be, to give copious albuminous drinks, such, for example, as the whites of eggs in water, milk, and the like. The vomiting may be encouraged by subcutaneous injections of apomorphine. The after-treatment should be directed to eliminating the poison, which is most safely effected by very copious drinks of distilled water (see “[Appendix]”).
The treatment of slow poisoning is mainly symptomatic; medicinal doses of zinc phosphide seem to have done good in mercurial tremors. Potassic iodide is also supposed to assist the elimination of mercury.
§ 849. Post-mortem Appearances.—The pathological effects seen after chronic poisoning are too various to be distinctive. In the museum of the Royal College of Surgeons there is (No. 2559) the portion of a colon derived from a lady aged 74.[932] This lady had been accustomed for forty-three years to take a grain of calomel every night; for many years she did not suffer in health, but ultimately she became emaciated and cachectic, with anasarca and albuminuria. The kidneys were found to be granular, and the mucous membrane of a great part of the intestine of a remarkable black colour, mottled with patches of a lighter hue, presenting somewhat the appearance of a toad’s back. From the portion of colon preserved mercury was readily obtained by means of Reinsch’s test. The black deposit is in the submucosa, and it is, without doubt, mercurial, and probably mercury sulphide. In acute poisoning (especially by the corrosive salts) the changes are great and striking. After rapid death from corrosive sublimate, the escharotic whitening of the mouth, throat, and gullet, already described, will be seen. The mucous membrane right throughout, from mouth to anus, is more or less affected and destroyed, according to the dose and concentration of the poison. The usual appearances in the stomach are those of intense congestion, with ecchymoses, and portions of it may be destroyed. Sometimes the coats are very much blackened; this is probably due to a coating of sulphide of mercury.
[932] Path. Soc. Trans., xviii. 111.
In St. George’s Hospital Museum (Ser. ix. 43, y. 337) there is a stomach, rather large, with thickened mucous coats, and having on the mucous surface a series of parallel black, or black-brown lines of deposit; it was derived from a patient who died from taking corrosive sublimate. With the severe changes mentioned, perforation is rare.[933] In the intestines there are found hyperæmia, extravasations, loosening of the mucous membrane, and other changes. The action is particularly intense about the cæcum and sigmoid flexure; in one case,[934] indeed, there was little inflammatory redness of the stomach or of the greater portion of the intestine, but the whole surface of the cæcum was of a deep black-red colour, and there were patches of sloughing in the coats. The kidneys are often swollen, congested, or inflamed; changes in the respiratory organs are not constantly seen, but in a majority of the cases there have been redness and swelling of the larynx, trachea, and bronchi, and sometimes hepatisation of smaller or larger portions of the lung.