Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

Corrosive Sublimate

This is the most important of the preparations of mercury. It occurs either in crystalline masses of prismatic crystals or as a white powder. It is now known among chemists as the perchloride, though it is frequently spoken of as the bichloride, chloride, and oxymuriate of mercury. It has a powerful metallic and styptic taste, and is soluble in about sixteen parts of cold water and three of boiling water. Alcohol and ether readily dissolve it, the latter having the power of abstracting it from its solution in water. This property of ether is of importance as a means of separating corrosive sublimate from its solution in other liquids. It is important to remember that corrosive sublimate is soluble in alcohol (R. v. Walsh). The liquor hydrargyri perchloridi of the Pharmacopœia contains half a grain of the salt to a fluid ounce of water. Half a grain of the muriate of ammonia is added to increase the solubility of the mercurial salt. Applied externally to the unbroken skin, corrosive sublimate has caused death in several cases, the symptoms being almost identical with those which follow the entrance of the poison into the stomach. Toxic symptoms have followed intra-uterine or vaginal injections of solution of perchloride of mercury, also when it has been used to wash out abscess cavities. Acute poisoning, in some cases fatal, has resulted from the external application of corrosive sublimate to ulcers and tumours.

Symptoms of Poisoning by
Corrosive Sublimate

Acute.—The symptoms come on almost immediately the poison is swallowed. A strong metallic coppery taste in the mouth is experienced, and a choking sensation in the throat. Pain of a burning character is felt, extending from the mouth to the stomach, followed by nausea and vomiting of stringent mucus, more or less tinged with blood, and violent purging, the evacuations being also mixed with blood and mucus. The pulse is feeble, quick, and irregular; the countenance flushed or pale, and the tongue white and shrivelled. This appearance of the tongue is not present in all cases. Broncho pneumonia may occur. The skin is cold and clammy, and the functions of the kidneys are altered and albuminuria present, there being in many cases complete suppression of urine. As is the case with other irritant poisons, the symptoms and effects produced admit of considerable variation. Thus, there may be no pain in the stomach, and no purging. Salivation is present in some cases, but chiefly in those in whom the fatal termination is somewhat prolonged. This sign is not infrequently absent. Poisoning with corrosive sublimate differs from arsenical poisoning in the following particulars:—Corrosive sublimate has a distinct metallic taste, arsenic is almost tasteless; the symptoms in the former supervene immediately the poison is swallowed, in the latter there is a short delay. The discharges in corrosive sublimate are more frequently bloody than in arsenic poisoning.

Chronic.—The symptoms present in this form of poisoning are modified by the size of the dose, and the interval allowed to elapse between each dose. Nausea, followed by occasional vomiting, and pains in the stomach, are complained of by the patient. There is general constitutional disturbance, with anæmia and cachexia, and consequent mental depression. Salivation, as might be expected, is a more prominent symptom than in acute poisoning; but the salivation may be intermittent—that is, it may cease and then reappear, even after the lapse of months, without an additional dose of mercury having been given in the interval. Salivation may also come on in the course of certain diseases, attacking the salivary glands, and it may also be produced by other causes—pregnancy, etc. The glands of the mouth become swollen and painful, the gums tender, and the teeth loosened fall out of the mouth. Periostitis of the jaw may occur. The breath has a peculiar, offensive smell, the bowels are irritable, and diarrhœa is not infrequently present. It must be borne in mind that in certain diseases—granular disease of the kidney—the smallest dose of any mercurial preparation may produce profuse ptyalism. And the toxicologist must be careful not to mistake the affection known as cancrum oris, or “the canker,” most common in delicate, ill-fed children and adults, for the effects of mercury. The nervous system is more or less affected, neuralgic pains and mercurial tremors being present in many cases. The tremors commence in the tongue and face and spread to the arms and legs—they are similar to those of paralysis agitans; at first they are invoked by exertion, finally they become continuous; they cease during sleep. Paralysis may also occur, especially in those exposed to the vapour of mercury. Habit appears to exert some influence on the action of corrosive sublimate, if we may accept the story of the old man of Constantinople, who for thirty years took large doses till his daily allowance was a drachm, and then died at the respectable age of one hundred years.

Post-mortem Appearances.—The morbid appearances are chiefly confined, as is the case with arsenic, to the stomach and bowels; but the corrosive action of the mercurial sublimate is more marked. Inflammation more or less intense is always present in the stomach, the mucous membrane of which may be found of a slate-grey colour, corroded, and so soft as to scarcely admit of the removal of the organ without tearing it. The cæcum and rectum are also sometimes found inflamed, and the mucous membrane softened. Perforation of the stomach is very rare, only one case having been recorded in which this was present. The mouth, throat, and gullet may also present signs of the action of the poison similar to those just described as seen in the stomach. Patches of pneumonia are present in the lungs of some cases, and the kidneys show coagulative and desquamative nephritis.

Fatal Dose.—The smallest dose was two grains in the case of a child, but the exact amount to cause death in an adult has not been accurately determined. Recovery has taken place after one hundred grains has been taken.

Fatal Period.—From half an hour to five days. No exact time can be stated. In one case death took place on the twelfth day after swallowing seventy grains of the perchloride.

Treatment.—Vomiting, if present, must be encouraged; if absent, it must be produced by emetics—zinc sulphate or cupric sulphate, followed by copious draughts of warm water. The hypodermic injection of ¹/₂₀ to ⅒ grain of apomorphine may also be used to produce vomiting. Albumen, the white of egg, or vegetable gluten produced from flour by washing it in a muslin bag, should be given. The albuminate of mercury so formed should be quickly removed by an emetic or lavage by means of a soft tube and funnel in mild cases, as it is soluble in excess of albumen, and may be digested or absorbed. The rapid removal of the poison from the stomach, however, is the end to which all our exertions must tend. The forcible use of the stomach pump should not be employed if it can possibly be avoided, as it may greatly injure the softened mucous membrane of the gullet and stomach. Opium may be given to relieve pain, and opium enemata to relieve purging and tenesmus.

Calomel