586 IMPORTANT POISONS AND THEIR TREATMENT 



the liver and certain forms of mushroom poisoning, but, imfortunately, these 

 are beyond the limits of this article. 



Some reference must be made to chronic phosphorus poisoning which is 

 the terror of the workman in the manufacture of phosphorus matches; and 

 presents itself in the form of a phosphorus necrosis of the lower jaw. In 

 Austria, on account of the excellent hygienic measures enforced by the super- 

 vision of the Government, this form of the disease has become a rarity. 



We now turn to another agent, sulphur and its combinations, of which 

 poisoning by sulphureted hydrogen and carbon iisulphid are the most im- 

 portant. 



Poisoning with sulphureted hydrogen is rare, but occurs most frequently 

 in chemical laboratories and among workmen in latrines. If the gas is pres- 

 ent in great amounts, and the air is, therefore, relatively deficient in oxygen, 

 the affected individual soon shows the severest symptoms, and rapidly perishes. 

 In less severe cases there is debility, weakness and vomiting occur, followed 

 by fibrillary muscular contractions, etc. Generally this form of poisoning is 

 of slight importance. On the other hand, poisoning by carbon bisulphid 

 occurs more frequently, and leads to very interesting changes in the retina 

 which until recently have been but little studied. 



We now turn to a very important toxicosis, that of aeseistic and its com- 

 hinations. 



All soluble combinations of arsenic are poisonous! The sjrmptoms vary 

 according to the amount of the poison ingested, the ready solubility or insol- 

 ubility of the substance, and the state of the stomach; if taken on a full 

 stomach the phenomena appear less rapidly than on an empty stomach. 



In the severest form, asphyxia arsenicalis, symptoms arise which very 

 closely resemble the clinical picture of cholera Asiatica and in a few hours may 

 cause death. I refer to such symptoms as vomiting, diarrhea, rice-water-like 

 stools, and cramps in the calves of the legs ; in less severe cases the same symp- 

 tom-complex is produced — although less rapidly — and the symptoms of toxic 

 enteritis (purulent stools, tenesmus, etc.) are more prominent. 



A positive diagnosis can only be made when arsenic is found in the vom- 

 ited material and in the excretions, for which purpose it is necessary to de- 

 termine the presence of arsenic by positive methods, and to isolate it: If 

 arsenious acid has been employed, an accurate microscopic investigation will 

 occasionally demonstrate that this substance is present: The white particles 

 are extracted with a forceps from the vomited material, rinsed with water, 

 and dissolved in hot water ; upon cooling, the characteristic small octahedra 

 of arsenious acid are found as crystals. 



_ What must be done in the treatment of this condition ? The answer is 

 this : Immediate and thorough lavage of the stomach, administration of cal- 

 cmed magnesium in water, also washing out the stomach with this preparation 

 and the administration of Bunsen's remedy, namely, hydrated oxid of iron; 

 if at hand, lime water may be employed; by frequent and copious enemata, the 

 mtestme must be emptied, and the poison thus expelled from the bowel. 



Chrome arsenic poisoning is very interesting on account of the extreme 

 cachexia, the severe nervous disturbances such as polyneuritis, etc., and the 



