METALLIC SALTS 589 



chronic poisoning by mercury has been enormously increased, although re- 

 cently, siace the recognition of the danger in this antisepsis, the number has 

 been lessened by a more judicious use of mercury. 



All salts of MEECUEY are poisonous ! It is true the number of poisonings 

 which have been observed, for example, with mercuric sulphate, with mer- 

 curic iodid, etc., are exceedingly small in comparison with the number of 

 poisonings with corrosive sublimate, the hydrargyrum bichloratum corrosivum 

 (mercuric chlorid). These should not be confounded with mercurous chlorid, 

 calomel, which, in much smaller doses, also has a toxic -effect. I saw a case in 

 which six grams had been taken with suicidal intent, yet it was followed by 

 recovery in a few days. The lethal dose of chlorid of mercury in our popula- 

 tion is about 0.8 gram; I say in our population, because the opium smokers 

 in China can bear enormous doses of corrosive sublimate. 



In acute toxicosis with mercury, therefore, we shall discuss only the clin- 

 ical symptoms produced by corrosive sublimate. In the chronic form we shall 

 concern ourselves more or less with all of the salts, and metallic mercury, 

 even the fumes of mercury, will be taken into consideration. 



What are the symptoms of poisoning iy corrosive sublimated 



If the poison — as in the majority of cases — is introduced through the 

 mouth, widely distributed eschars at once appear upon those areas of the 

 mucous membrane which have come in contact with the poison. Violent vom- 

 iting appears; the vomitus is admixed with blood, and later with shreds of 

 mucous membrane. Colicky pains and profuse diarrhea follow, there is sup- 

 pression of urine or else but a small amount of hemorrhagic urine is voided. 

 Even at this stage a fatal termination may ensue; the subnormal temperature 

 and the small pulse with low tension indicate the approaching end. Usually, 

 however, the sufferings of the patient are decidedly prolonged. The deeply 

 penetrating eschars cause agonizing pain. Ulcerative stomatitis, parotitis, 

 annoying salivation increase the distress. Gastritis and ulcerative enteritis 

 with all of their consequences supervene. The symptoms on the part of the 

 kidney become more intense. The scanty urine shows the characteristics of 

 acute nephritis. After days of misery the patient succumbs to uremic 

 toxicosis. 



In all cases of poisoning with corrosive sublimate the prognosis is serious. 

 Even apparently mild cases may develop acute nephritis and terminate fatally. 



For certainty in diagnosis the presence of mercury must be proven in the 

 vomited material, in the urine, and perhaps in the feces. In a number of 

 cases the history and the typical symptoms will at once indicate the correct 

 diagnosis. 



The therapy consists in immediate and thorough lavage of the stomach 

 with milk and solutions of albumin. Table salt increases the solubility of 

 corrosive sublimate and therefore cannot be employed. Stomatitis is to be 

 treated with solutions of potassium chlorate, the anuria with lukewarm baths 

 and by venesection. The severe pain necessitates the use of opiates. 



We now turn to chronic mercurial poisoning. This occurs most commonly 

 among workers in certain industries. 



I should like here to emphasize the fact that mercurial treatment care- 



