584 IMPORTANT POISONS AND THEIR TREATMENT 



to psychical depression, and according to all appearances, to progressive paral- 

 ysis ; and, moreover, in persons affected with disease of the heart, even in rela- 

 tively small doses (2 to 3 grams) it may cause death. We should, therefore, 

 be most cautious in the use of this remedy, sometimes so necessary, for exam- 

 ple, in the treatment of certain forms of delirium tremens ! In cardiac dis- 

 eases, particularly, the use of chloral hydrate is contraindicated ! 



The second remedy to be discussed is chloroform. Every one knows the 

 blessing of its effect, and it is to be hoped that the physician may be spared 

 any exhibition of its deleterious action during his professional career! 

 Chloroform is a potent cardiac poison, and the sudden deaths in narcosis which 

 occur from time to time may be referred to this circumstance. There can be 

 no doubt that chloroform narcosis may produce permanent damage to the 

 organism, such as fatty degeneration of the heart and of the liver, and for 

 this reason our motto must be : Be cautious in the use of chloroform, whether 

 employed as an anesthetic or internally! I shall not detail the symptoms. 

 These are generally known. Fatalities can never be entirely prevented in 

 chloroform anesthesia, but careful, minute investigation of the heart of the 

 patient who is to be anesthetized with chloroform will certainly limit them to a 

 great extent. We must hope that the time is not far distant when less dan- 

 gerous anesthetics will be substituted for chloroform narcosis. A beginning 

 has already been made in this direction by Schleich's infiltration anesthesia. 



In the second halogen, the BKOMi]sr salts shall be briefly mentioned ; these 

 are extensively used in medicine, and thus cause the development of that 

 pathologic picture which we appropriately designate as hromism. Although 

 we cannot avoid using the salts of bromin in the treatment of epilepsy, and 

 although recent observations have shown that the administration of the salts 

 of bromin in food free from chlorin or, at least, almost free from it, is rela- 

 tively well borne, on the other hand we cannot deny that, particularly in pre- 

 disposed individuals, even the therapeutic use of bromin may cause serious 

 symptoms of bromism. It is possible that the administration of bromin in 

 sesame oil may mitigate these symptoms, but it cannot be expected to prevent 

 their appearance entirely. The symptoms are anorexia, metallic taste, dys- 

 pepsia, decided emaciation, dermatoses of many varieties; also a series of 

 psychical and nervous disturbances, particularly loss of memory, and these 

 may lead to_the development of the severest psychical symptoms. The salts 

 OF lODiN act in a similar manner, except that here, as a rule, emaciation, 

 I might say all the somatic symptoms, take precedence of the psychical 

 element. 



We now turn to another of this group of poisons, to phosphoeus, which, 

 at least in Austria, assumes uncommonly great importance, for, in certain 

 cities— especially in Prague, next in Vienna, less frequently in the country— 

 the number of poisonings by this agent, which, in the course of the year, come 

 under the observation of the physician, is an unusually large one. Almost 

 exclusively the cases are suicidal, although the poison is often taken to bring 

 about abortion. But the clinical picture of poisoning by phosphorus has 

 additional interest from the fact that a number of other toxicoses, even a num- 

 ber of diseases for the most part infectious, present or may present a picture 



