590 IMPORTANT POISONS AND THEIR TREATMENT 



fully conducted and based upon a correct diagnosis has never produced in any 

 patient the symptoms of chronic mercury toxicosis ! 



The symptoms in the beginning resemble those of lead poisoning: pallor, 

 dyspepsia, the appearance of a black line upon the gums (see p. 588), but the 

 typical colic of lead poisoning is absent. The patient emaciates. Diarrhea, 

 stomatitis and salivation, and various dermatoses, such as erythema, eczema, 

 furunculosis, and ulcers of the skin, appear. Nervous symptoms, such as 

 tremor and polyneuritis, follow. These are the signs of increased psychical 

 irritability (erethismus mercurialis), and finally, severe psychical depression 

 (coma). All this makes the life of the patient miserable, and may shorten 

 it. But a greater danger consists in the fact that the kidney may be attacked, 

 and after years of invalidism the patients often succumb to the symptoms of 

 contracted kidney or of chronic nephritis, and even without nephritic symp- 

 toms some patients may succumb to marasmus prgecox relatively early in life. 



The prognosis in the first stages, in case no nephritic symptoms are pres- 

 ent, is not unfavorable ; in the later stages, particularly if psychical disturb- 

 ances have appeared, it is always serious. In treatment, preparations of 

 iodin and bromin (sodium iodid, iodipin, etc.) are most efficacious. Sulphur 

 baths are also used. With intact kidneys, pilocarpin, in the form of subcu- 

 taneous injections, may render good service. 



We now turn to another chapter : Poisoning with gases. 



For the physician only carbonic oxid poisoning has acquired great im- 

 portance. This toxicosis offers a fruitful field, and it is necessary for him 

 to be acquainted with its pathology and therapy. 



Illuminating gas, which contains from 7 per cent, to 10 per cent, of car- 

 bonic oxid gas, and the fumes of charcoal, which contain about 0.3 per cent, 

 to 0.4 per cent., are the sources of this poisoning, the former by the presence 

 of the gas in rooms where it is in use, the latter by the escape of charcoal fumes. 

 Danger may therefore arise from defective or misused gas fixtures and from 

 badly constructed stoves, and in case of fire. 



Of the initial symptoms of the poisoning little is known. Vomiting occurs 

 frequently in this stage, and often, if the patient be unconscious, the entrance 

 of food or vomitus into the trachea may cause death by suffocation. In the 

 stage at which the physician usually arrives, the patient is unconscious, pro- 

 foundly asphyxiated. The temperature is low, cardiac action weak and irregu- 

 lar, the pulse quickening, and in a few hours death occurs. Elevations of 

 temperature up to 102.3° F., and nervous irritative symptoms, such as trismus, 

 tonic and clonic spasms, are not rare. Because of the anesthesia coincident with 

 coma, patients may be severely burned during treatment. The sequels which 

 may follow this toxicosis are particularly serious. These are chorea, polio- 

 myelitis, trophic disturbances of all kinds, gangrene, etc. Metabolism is also 

 seriously deranged; alimentary glycosuria is an invariable symptom and spon- 

 taneous glycosuria frequently occurs. 



The diagnosis is easy on account of the characteristic symptoms. For the 

 detection of carbonic oxid in the blood I advise the examination of blood 

 obtained by venesection. A portion should be diluted with about 30 times 

 as much water, and then boiled with caustic potash. If carbonic oxid be pres- 



