Symptoms of Poisoning by Corrosive Sublimate.
The effects, as well as the modus operandi, of this salt, will vary with the quantity swallowed. We shall, therefore, first consider the acute symptoms which supervene a dose sufficiently powerful to destroy life in a few hours; and afterwards those which may arise from its long continued use in small quantities, and at different intervals.
1. Symptoms which follow a large dose. A most painful burning and sense of constriction is experienced in the fauces; dryness of the mouth and lips; excruciating pain in the stomach and bowels, increased by the slightest pressure, and generally attended with considerable distention; excessive vomiting and purging of frothy mucus; the countenance is frequently red and swollen, and the eyes exhibit a sparkling appearance, accompanied by contraction of the pupils. The pulse is in general quick, small, and hard; suppression of urine takes place, and cold sweats; anxiety; universal pains; convulsions, and death. If the patient survives long enough, a violent ptyalism, and sloughing of the mouth and gums may take place.
2. Symptoms which are produced by the repetition of small doses. In this case the mercurial salt acts as an “Accumulative Poison.” (See page [148]). The most striking of the symptoms are those arising from its specific action upon the salivary glands, in consequence of which an increased flow of saliva takes place, the gums become tender and sore, the breath intolerably offensive, and if the use of the salt be not discontinued, the teeth loosen, and even fall out, and their loss is sometimes followed by that of the bones of the palate, or maxillæ; at the same time other evils, although perhaps less apparent, soon arise; the strength and muscular powers of the body begin to fail; emaciation proceeds rapidly; cardialgia, dyspepsia, diarrhæa, and a train of morbid symptoms succeed; violent pains are experienced in the muscles, tendons, or joints; tremors of the limbs, and even paralysis may result; and in some cases, pulmonary consumption terminates the existence of the unhappy sufferer. It has been asserted that Corrosive Sublimate, when taken for a long time in small quantities, will sometimes occasion all the symptoms of debility above enumerated, together with hectic fever, without producing salivation. This is a truth which the author’s personal experience will enable him to confirm. The Countess of Soissons, mother of the celebrated Prince Eugene, was accused, at the latter end of the seventeenth century, of having destroyed her husband by these means. A question of considerable importance has arisen, with regard to the specific effects of mercury, which demands some notice in this place. Whether salivation, after having entirely subsided, can ever return without a fresh exhibition of Mercury? Two instances are related by Dr. Mead of the return of salivation, after an interval of several months, when not a particle of mercury had been administered, in any form, during that period.[[270]] Dr. Male, in his work on Juridical Medicine,[[271]] relates an analogous case which occurred in his own practice: “In March, 1815,” says he, “I gave a small quantity of triturated mercury to a respectable woman in this town, who had been long ill; she became suddenly and unexpectedly salivated. She soon recovered, and enjoyed better health than she had done for a considerable time. In October, without (as she informed me) having taken any medicine whatever, the salivation returned with extreme violence, her mouth sloughed and mortified; and in a few weeks she died.” Dr. Hamilton, the Professor of Midwifery in Edinburgh, relates in his lectures the case of a married lady, who had been under the necessity of going through a course of mercury, under the care of the late Mr. Bennet, who, from motives of delicacy did not enquire very minutely into the particular circumstances; but, according to the rule of the day, gave his patient a sore mouth. Four months afterwards she miscarried, and salivation again came on. It was removed for a week, at the end of which it returned, and harrassed her for about twelve months.[[272]] The author, in his Pharmacologia,[[273]] has cited a case from Hufeland’s Journal, (vol. ix) wherein mercurial influence, after its complete subsidence, had been renewed by doses of opium. In the trial of Miss Butterfield, at the Croydon assizes, for poisoning Mr. Scawen, in the year 1775, the merit of the case entirely hinged upon this question. See vol. 1, p. 303.
Physiological action of Corrosive Sublimate.
When this salt is introduced into the stomach in a large dose, it immediately exerts a corrosive action on that organ, in consequence of which the heart and brain become sympathetically affected, and death results from the suspension of their functions. For this view of the modus operandi of this mercurial salt we are indebted to Mr. Brodie,[[274]] whence it would appear that its physiological action is very different from that of arsenious acid; the former acting as a simple escharotic, on the coats of the alimentary canal, the latter requiring to be absorbed, before it can display its energies. These observations, however, apply only to those cases in which the quantity of poison has been so considerable as to destroy life in a few hours; where the dose has been small, and the symptoms have arisen from its frequent repetition, the salt produces its effects by a different mode of operation. In this latter case it is absorbed, and carried into the current of the blood, so as to be distributed to every part of the living system; and it has been asserted that, after the long continued and improper use of mercury, it has been discovered in different parts of the body, and even in the brain, in the form of globules. In this way then deleterious effects may arise from the external application of corrosive sublimate, and numerous instances are recorded where such consequences have followed the injudicious use of lotions and plasters, into which it had entered as an ingredient.[[275]] In the Medical Repository, for December, 1821, Mr. Sutleffe has communicated the case of a girl of five years of age, who became salivated, and died, in consequence of an application made to the head for tinea capitis, consisting of pomatum rubbed up with a few grains of corrosive sublimate.
Antidotes to Corrosive Sublimate.
After the view which we have taken of the operation of this salt in large doses, it necessarily follows that copious dilution is the very first object which we have to accomplish, and then the ejection of the fluid by vomiting. Sydenham relates an interesting case of poisoning by this substance, which was successfully treated by copious draughts of water, and repeated vomiting.[[276]] But it becomes a question of great practical importance to enquire, whether there may not exist some counterpoison or antidote which, by decomposing the salt, will at once disarm it of its virulence? This question has been investigated in a very masterly style by Orfila, who has clearly proved by experiment, that neither the alkaline salts and earths, the sulphurets of potass and of lime, nor the martial alkaline tinctures, as proposed by Navier,[[277]] deserve the least confidence; for although the salt may by some of these bodies be decomposed, yet the resulting oxide will prove as virulent as the original compound; equally inefficient are the other substances which have been proposed as counter-poisons, such as sulphuretted hydrogen, solutions of sugar,[[278]] the infusions of Peruvian bark,[[279]] and metallic mercury.[[280]]
M. Orfila having observed the facility with which albumen decomposes corrosive sublimate, and gives rise to a triple compound of albumen, muriatic acid, and protoxide of mercury, induced him to ascertain by experiments whether the white of eggs might not prove an antidote to that poison; the result of his inquiry has shewn that this is the case; and that by mixing such albuminous matter, in large quantities, with the diluents given to provoke vomiting, the happiest effects may be anticipated. Many examples are recorded of the success of this practice. In the Transactions of the King and Queen’s College of Physicians in Ireland, an interesting case of this kind is related by Dr. Lendrick; it is, however, but justice to state, that there are instances also of the failure of this antidote. In the 41st volume of the London Medical and Physical Journal, p. 204, the reader will find the case of a girl who was poisoned by a drachm of sublimate, and who, notwithstanding the copious administration of albumen, died in ninety hours afterwards.
It has lately been discovered that vegetable gluten, as existing in wheat flour, is capable of producing upon corrosive sublimate the same chemical decomposition, as that which we have stated to arise from the action of albumen; whence the administration of wheat flour and water has been suggested as a ready antidote. On the trial of Michael Whiting, for administering poison (corrosive sublimate) to his brothers-in-law, George and Joseph Langman, the housekeeper, Catharine Carter, stated in evidence, that the flour, (which was subsequently proved to contain corrosive sublimate) could scarcely be made into dumplings with milk[[281]]; and another witness, Mrs. Hopkins, a neighbour who took charge of the dumpling that had not been boiled, described it as “a comical sort of paste; like glazier’s putty more than paste, though not greasy.” In order to ascertain the correctness of this statement, we mixed powdered sublimate with wheat flour, and proceeded to make it into dough with milk; when the same difficulty as that stated by the above witnesses, embarrassed the process, and satisfied us of the truth of their testimony. The phenomenon would appear to depend upon the mutual chemical changes which arise in the gluten and mercurial salt.