540 poisons : their effects and detection. [§ 713. 
and soon afterwards vomiting, and very often diarrhoea. The diarrhoea 
is not severe, never assumes a choleraic form, and is unaccompanied by 
cramps in the muscles. After a considerable interval there is marked 
dryness of the mucous membrane (a symptom which never fails), the 
tongue, pharynx, and the mouth generally seem actually destitute of 
secretion ; there is also an absence of perspiration, the nasal mucous 
membrane participates in this unnatural want of secretion, the very tears 
are dried up. In a case related by Kraatzer, 1 the patient, losing a son, 
was much troubled, but wept no tear. This dryness leads to changes in 
the mucous membrane ; it shrivels, and partly desquamates ; aphthous 
swellings may occur, and a diffuse redness and diphtheritic-like patches 
have been noticed. There is obstinate constipation, probably from a 
dryness of the mucous lining of the intestines. The breath has an 
unpleasant odour, there is often a croupy cough ; the urinary secretion 
alone is not decreased but rather augmented. Swallowing may be so 
difficult as to rise to the grade of aphagia, and the tongue cannot be 
manipulated properly, so that the speech may be almost unintelligible. 
At the same time, the motor nerves of the face are affected, the patient’s 
sight is disturbed, he sees colours or sparks before his eyes ; in a few 
cases there has been transitory blindness, in others diplopia. The pupil 
in nearly all the cases has been dilated, but in exceptional instances 
it has been contracted. The levator palpebrce superioris is paralysed, 
and the resulting ptosis completes the picture. Consciousness remains 
intact almost to death ; there is excessive weakness of the muscles, 
perhaps from a general paresis. If the patient lives long enough, 
he gets wretchedly thin, and dies from marasmus. In more rapidly 
fatal cases, death follows from respiratory paralysis, with or without 
convulsions. 
Van Ermeugem, from a pickled ham which caused severe poisoning 
of thirty-four persons, isolated an anaerobic microbe ( Bacillus botulinus ); 
the toxine produced by this organism appears to produce similar symp¬ 
toms to those detailed, and is believed to be the cause of “ botulism.” 
The post-mortem appearances which have been observed are—the 
mucous membrane of the mouth, gullet, and throat is white, hard, and 
parchment-like ; that of the stomach is more or less injected with 
numerous haemorrhages : the kidneys are somewhat congested, with 
some effusion of blood in the tubuli; the spleen is large and very full of 
blood, and the lungs are often oedematous, pneumonic, or bronchitic. 
1 Quoted by Husemann, “ Vergiftung durch Wurstgift ” (Maschka’s Handbuch ). 
