BISMUTH. 
§ 853-] 
mouth, and ulceration—also catarrh of the intestines, and the inflamma¬ 
tory condition of the kidneys usual when that organ has to excrete 
metallic substances not natural to the body, the “ metallniere, ,; or metal 
kidney, of the German writers. One case is recorded of death in nine 
days of an adult after taking 7-7 grms. (2 drms.) of bismuth subnitrate. 
The recorded symptoms were a metallic taste in the mouth, pain in the 
throat, vomiting, purging, coldness of the surface, and spasms of the 
arms and legs. A post-mortem examination showed inflammatory 
changes in the gullet, windpipe, and throughout the intestinal canal. 
Recovery has, however, taken place from a single dose three times the 
amount mentioned. It is possible that the fatal case was due to impure 
bismuth. 
Bismuth subnitrafce has produced fatal effects in children, when it 
has been introduced into the alimentary canal for the purposes of radio- 
scopic examination. In the case of two infants reported by Boehme 
{Arch. f. exp. Path., 1907) there were rapid collapse, cyanosis, and 
symptoms of methsemoglobinsemia. These effects have been ascribed 
to the reduction of nitrate to nitrite ; it is said that infant but not 
adult faeces effect this reduction. 
§ 853. Extraction and Detection of Bismuth in Animal Matters. 
-—Bismuth appears to be excreted principally by the bowels as sulphide 
of bismuth ; but it has also been detected in the urine, spleen, and 
liver, and Lubinsky has found it in the saliva and in the epithelium of 
the mouth of persons taking one of its preparations. Without denying 
the possibility of its existing in a soluble state in the saliva, its presence 
in the mouth may, under such circumstances, be ascribed to the 
lodgment of particles of subnitrate or subcarbonate of bismuth in the 
interstices of the teeth, etc. It will then be evident that, if a person is 
supposed to have been poisoned by a large dose of bismuth, and the 
analyst fail to find it in the stomach, the contents of the bowels should 
be next examined. 
The extraction of bismuth must be undertaken by nitric acid, and 
boiling for at least two hours may be necessary to dissolve it out from 
the tissues. Such organs as the liver and spleen are boiled in a finely 
divided state with a litre of dilute nitric acid (strength, 5 per cent.) for 
the time mentioned, filtered, and the filtrate evaporated to dryness ; the 
remainder is then carbonised by strong nitric acid ; and, finally, the 
charcoal is boiled with equal parts of nitric acid and water, and 
the whole evaporated to dryness. By this method every trace of 
bismuth is extracted. The dry residue may now be brought into 
solution and tested for bismuth. The best solvent for the nitrate of 
bismuth is dilute nitric acid 50 per cent. ; the dry residue is therefore 
dissolved in 100 or 200 c.c. of the acid, and fractional parts taken for 
examination :— 
