[933] There is only one case of perforation on record.
[934] Lancet, 1845, p. 700.
In St. George’s Hospital Museum, there are (from a patient dying in the hospital) preparations which well illustrate what pathological changes may be expected in any case surviving for a few days. The patient was Francis L——, aged 45, admitted to the hospital, February 27, 1842. He took a quantity of corrosive sublimate spread on bread and butter, was immediately sick, and was unable to take as much as he had intended. The stomach-pump and other remedies were used. On the following day his mouth was sore, and on March 1st his vision was dim; his mouth was drawn over to the right side, and he lost power over the left eyelid, but he had no pain; he passed some blood from the bowel. On the 2nd he passed much blood, and was salivated; still no pain. On March 4, on the evening of the sixth day, he expired; he was drowsy during the last day, and passed watery evacuations.
Prep. 14a, Ser. ix., shows the pharynx, œsophagus, and tongue; there is ulceration of the tonsils, and fibrinous exudation on the gullet. The stomach (43b, 199) shows a large dark slough, three inches from the cardiac extremity; the margin surrounding the slough is thickened, ulcerated, and irregular in shape, the submucous tissue, to some extent, being also thickened; there is fibrine in the ileum, pharynx, and part of the larynx. The action extended to the whole intestine, the rectum in prep. 145a, 36, is seen to be thickened, and has numerous patches of effused fibrine.
It is a curious fact that the external application of corrosive sublimate causes inflammatory changes in the alimentary canal of nearly the same intensity as if the poison had been swallowed. Thus, in the case of the two girls mentioned ante ([p. 647]), there was found an intense inflammation of the stomach and intestines, the mucous tissues being scarlet-red, swollen, and with numerous extravasations.
§ 850. The effects of the nitrate of mercury are similar to the preceding; in the few cases which have been recorded, there has been intense redness, and inflammation of the stomach and intestines, with patches of ecchymosis. White precipitate, cyanide of mercury, mercuric iodide, and mercurous sulphide (turpeth-mineral) have all caused inflammation, more or less intense, of the intestinal tract.
§ 851. Elimination of Mercury.—The question of the channels by which mercury is eliminated is of the first importance. It would appear certain that it can exist in the body for some time in an inactive state, and then, from some change, be carried into the circulation and show its effects.[935] Voit considers that mercury combines with the albuminous bodies, separating upon their oxidation, and then becoming free and active.[936]
[935] Tuson gave a mare, first, 4 grains, and afterwards 5 grains of corrosive sublimate twice a day; at the end of fourteen days, in a pint of urine no mercury was detected, but at the end of three weeks it was found.