ALKALIES, SALTS OF ALKALINE METALS, AND METALLOIDS 583 



Of special importance in this gronp of poisons is potassium chlorate- 

 hence we shall briefly consider it. The drug is of special significance for the 

 physician as poisoning by its medicinal use has been frequently observed in 

 the last few years. The quantity of the salt necessary to bring about this 

 condition varies very widely in different individuals. The lethal dose in chil- 

 dren is from 5 to 6 grams and in adults 15 grams or more. 



This toxicosis differs particularly from poisoning by alkalies in that there 

 are no local corrosive effects. 



Such patients, however, show extreme cyanosis, they complain of a sense 

 of burning and oppression in the chest, the skin assumes a yellowish hue 

 hemoglobin (hematin) appears in the urine without any other sign of nephritis! 

 In the further course of the affection there are severe nervous symptoms, such 

 as clonic and tonic spasms followed by delirium and then by deep coma; in 

 this condition the patient succumbs. Moreover, there are undoubted cases of 

 poisoning in which the typical symptoms of acute nephritis appear, and the 

 patient dies of uremia. 



The prognosis is always dubious; but recovery may occur even in the 

 severest cases. 



The diagnosis is made more certain by the demonstration of methemoglobin 

 in the blood, and proof positive is the presence of the salt in the fluid obtained 

 by gastric lavage. If the amounts introduced were very large, the character- 

 istic vapors of chlorin gas are at once given off upon the addition of hydro- 

 chloric acid. The treatment requires immediate and thorough washing of the 

 stomach, and the avoidance of the introduction of acids, for the latter generate 

 in the stomach a very dangerous chlorin gas. The use of enemata is also indi- 

 cated to eliminate the poison which perhaps may already be present in the 

 lower portions of the intestine. 



A few words in regard to the combinations of barium. 

 All of the soluble salts of barium are very poisonous ! Even the insoluble 

 barium carbonate may be changed in the stomach into the soluble barium 

 chlorid, and then have a toxic effect. 



The principal symptoms are : Severe pain in the abdomen, profuse diar- 

 rhea, signs of acute nephritis and an entire host of nervous phenomena. 



The therapy consists in immediate gastric lavage and in the administration 

 of magnesium sulphate and sodium sulphate. 

 The prognosis is very grave ! 



I have included this form of poisoning because the barium salts are reme- 

 dies which enormously increase blood pressure, and therefore barium chlorid 

 has been employed in place of calomel in disturbances of cardiac compensation. 

 The severe symptoms of this poisoning, I might say the absolute impossi- 

 bility of relying upon the action of these salts, forces me to advise against 

 their use, even should these salts, as heart tonics, find eulogists in the future. 



We now proceed to another group of poisonous agents, the metalloids. 

 The first to be considered are chlorin, bromin and iodin, with their combina- 

 tions. Only two of the chlorin combinations are of practical importance, 

 namely, chloral hydrate and chloroform. The first is used as a hypnotic; 

 but it is not a harmless remedy, since upon long-continued use it may give rise 



