Chapter LVII: Section III: Of the Morbid Appearances caused by Mercury

The morbid appearances observed in the bodies of persons killed by corrosive sublimate will not require many details; since most of the remarks formerly made under the head of the pathology of the irritants generally, and of arsenic in particular, apply with equal force to the present species of poisoning. Still there are some peculiarities deserving of notice, which arise from the greater solubility or stronger irritant action of corrosive sublimate.

The mouth and throat are more frequently affected than by arsenic; and a remarkable appearance sometimes observed, and not excited, so far as I know, by arsenic, is shrivelling of the tongue, with great enlargement of the papillæ at its root.[1013]

The disorder of the alimentary canal is also usually more general, and reaches a greater height before death takes place. Sometimes the irritation and organic injury are confined to the stomach;[1014] but more commonly the throat, stomach, gullet, rectum, nay, even also the colon, are affected. The black or melanotic extravasation into the mucous membrane of the stomach, which has been already several times described as a common effect of the more violent irritants, is also produced by corrosive sublimate. In Devergie’s case and in that of Dr. Venables it was present in a very great degree.[1015]

The coats of the stomach, and also those of the intestines, more particularly the colon and rectum, have frequently been found destroyed. So far as I have been able to ascertain, two kinds of destruction of the coats may be met with,—corrosion and ulceration.

The first is the result of chemical decomposition of the tissues. This kind is evidently to be looked for only when the quantity has been considerable and the dose concentrated. Nay even then it is rare. For on account of the solubility of corrosive sublimate, the facility with which it is decomposed by the secretions or accidental contents of the stomach, and the violence and frequency of the vomiting, this poison is peculiarly liable to be prevented from exerting its corrosive action on the membranes. Hence it is that proper chemical corrosion of the coats of the stomach is seldom witnessed in man.

The appearance of this corrosion differs according to the rapidity of the poisoning. In very rapid cases, for example in animals which have survived only twenty-five minutes, the villous coat has a dark gray appearance, without any sign of vital reaction.[1016] But this variety has never been witnessed in man, in whom the action has been hitherto much less rapid. In the most rapid cases, such as that of Dr. Bigsby, which terminated in two hours and a half (314), or those related by Mr. Valentine, of which one ended fatally in eleven and another in twenty-four hours, the corrosion was black, like the charring of “leather with a red-hot coal, and the rest of the stomach scarlet-red or deep rose-red;—showing that inflammation had set in.” In the former of these two cases the corrosion was as big as a half-crown, in the latter three inches in diameter. In a third case, where the patient lived thirty-one hours, the stomach was perforated.[1017] In the case described by Dr. Venables, and formerly alluded to, where life was prolonged for eight days, there was a patch on the under surface of the stomach as large as two crown-pieces, hard, elevated, and of a very dark olive or almost black colour, besides very general erosion of the villous coat.[1018] In all these cases the disintegrated spot was probably situated where the poison first chiefly lodged.

The corrosion caused by mercury, if examined before the slough is thrown off, will be found to possess an important peculiarity: the disorganized tissue yields mercury by chemical analysis. Professor Taddei repeatedly obtained the metal from the membranes of animals which he had poisoned with corrosive sublimate.[1019] It is probable that mercury may be thus detected although death may not have taken place for some time after the poison was swallowed. For the slough was found adhering in one of Mr. Valentine’s cases, where life was prolonged for seventy hours; and it was not entirely removed even in eight days in one of the cases described by Dr. Venables.

Although, however, it is sometimes possible to find the poison in the stomach, the medical jurist must not perhaps expect to find it so often in the present instance as in that of poisoning with arsenic. For on account of its greater solubility corrosive sublimate cannot adhere with such obstinacy to the villous coat, and is therefore more subject to be discharged by vomiting. Nevertheless, the insoluble compound formed by antidotes may adhere to the coats like arsenic, and so resist the tendency of vomiting to displace them. In Devergie’s case, notwithstanding twenty-three hours of incessant vomiting, although no poison could be detected in the fluid contents of the stomach, it was distinctly found in small whitish masses that lay between the folds of the rugæ.[1020]

It may be here farther observed that corrosive sublimate, as well as other salts of mercury, may undergo in the alimentary canal after death the same change which is produced in arsenic from the gradual action of hydrosulphuric acid gas. It may be converted into the sulphuret. I am not acquainted indeed with any actual instance of such conversion; but that it may occur we can scarcely doubt, not merely from theoretical considerations, but likewise because Orfila met with an instance where calomel taken daily in a case of gastro-cephalitis was discharged by stool in the form of a black sulphuret.[1021]

Another important consideration is, that corrosive sublimate may be decomposed and reduced to the metallic state by the admixture of various substances either given at the same time or subsequently, and the longer the inspection is delayed, the more complete will be the decomposition which is accomplished. Iron, zinc, and other metals are the most active of these substances.[1022]

The other forms of destruction of the coats of the alimentary canal is common ulceration, either such from the beginning, or what was originally corrosion converted into an ulcer in consequence of the disorganized spot being thrown off by sloughing.

I have seen this appearance to an enormous extent in the great intestines of a man who survived nine days. Numerous large, black, gangrenous ulcers, just like those observed in bad cases of dysentery, were scattered over the whole colon and rectum. In this instance, which occurred to the late Dr. Shortt, the stomach was also ulcerated, but the small intestines were not.

Sometimes the ulceration seems to be a variety of softening of the mucous tissue, as in a case described by Dr. Alexander Wood of this city, which proved fatal in fourteen days, and in which the stomach, cæcum, and ascending colon presented round, softened, greenish spots about the size of a sixpence, and accompanied in the stomach with a tendency to detaching of the membrane in the form of a slough.[1023]

The destruction of the villous coat of the stomach occasioned by corrosive sublimate and other soluble salts of mercury may be distinguished from spontaneous gelatinization by one of two characters. If the slough remains attached, mercury will be detected in it: if separation has taken place, the ulcer exposed presents surrounding redness and other signs of reaction.[1024]

All the other effects of inflammation may be produced by corrosive sublimate, as by arsenic and other irritants. More frequently here than in the case of arsenic peritonæal inflammation is met with. In Devergie’s case the external surface of the stomach along both its curvatures presented the appearance of red points on a violet ground. In Mr. Valentine’s cases there was much minute vascularity, not only of the outside of the stomach but also of the whole peritonæum lining the viscera and inside of the abdomen; and there was even some serous effusion into the cavity. In Dr. Venables’s case the peritonæal coat of the stomach was highly vascular and inflamed, and the omentum also injected.

The urinary organs, and particularly the kidneys, are often much inflamed by poisoning with corrosive sublimate. Dr. Henry has related a case in which this poison proved fatal on the ninth day, and where the left kidney was found to contain an abscess.[1025] In all of Mr. Valentine’s cases the kidneys were inflamed, and the bladder excessively contracted, so as not to exceed the size of a walnut. In Ollivier’s case, caused by the cyanide of mercury, the scrotum was gorged and black, the penis erected, and the kidneys a third larger than natural. In the case described by Dr. Venables both kidneys, but especially the left, were large, flaccid, and vascular, the ureters turgid and purple, and the bladder contracted, empty, and red internally.

Orfila has observed that the internal membrane of the heart is sometimes inflamed and checkered with brownish-black spots. Some remarks have been already made on the light in which this appearance ought to be viewed by the pathologist (p. 271).

Whatever may be the real state of the fact as to the alleged power of arsenic to preserve from decay the bodies of those poisoned with it, all authors agree that corrosive sublimate possesses no such property. Yet it is well known to be a good antiseptic, when applied topically. The experiments of Klanck, noticed under the head of Arsenic, prove that corrosive sublimate at all events does not retard putrefaction in the bodies of those poisoned with it; and Augustin in his analysis of Klanck’s researches infers that it even promotes decay.[1026] I have met with one example in the human subject which seems to confirm Augustin’s opinion. In the case formerly quoted from the Medical and Physical Journal, which was fatal in four days, the relater found the body forty-two hours after death so putrid, though in the month of January, that the examination of it was very unpleasant, the belly being black, and a very offensive odour being exhaled.[1027] Little importance, however, can be attached to a solitary case; for on the contrary Sallin relates a case where the body of a man supposed to have been poisoned with corrosive sublimate was found not decayed, but imperfectly mummified, after sixty-seven days.[1028]

It is unnecessary to detail the proofs to be found in the dead body of mercurial salivation having existed during life. They are of course to be looked for in the mouth, and in the adjoining organs. We must not, however, expect to see much appearance of disease in the salivary glands; for according to Cruveilhier, in persons who die of mercurial salivation these glands do not present any trace of inflammation themselves, but merely serous effusion into the cellular tissue around them.[1029]

Professor Orfila has made some useful experiments as to the effects of corrosive sublimate on dead intestine, which it may be proper to notice in a few words. When applied in the form of powder to the rectum of an animal newly killed, the part with which it is in contact becomes wrinkled, and as it were granulated, harder than natural, and of alabaster whiteness, intermingled with rose-red streaks, apparently the ramifications of vessels. When the membrane is stretched upon the finger, the wrinkling disappears. The muscular coat is of a snow-white colour, and even the serous coat is white, opaque, and thickened. The parts not in contact with the powder retain their natural appearance, and the line of demarcation between the affected and unaffected portions is abrupt. If the powder is not applied till twenty-four hours after death, the parts it touches become thick, white, and hard; but no red lines are visible. It is easy to draw the distinction between these appearances and the effects of corrosive sublimate during life.

Little need be said of the force of the evidence of poisoning with corrosive sublimate, derived from the morbid appearances. If the gullet, stomach, and colon be all inflamed and ulcerated, and these injuries have taken place during a short illness, the presumption in favour of some form of irritant poisoning will be strong. And the presumption of poisoning with corrosive sublimate will be strong, if the usual marks of salivation are also found in the mouth and throat. But such evidence can never amount to more than a strong presumption or probability.