Chapter LVIII: Section IV: Of the Treatment of Poisoning with Mercury

The treatment of poisoning by the compounds of mercury may be referred to two heads,—that which is required when irritation of the alimentary canal is the prominent disorder, and that which is designed to remove mercurial salivation.

Irritation and inflammation of the alimentary canal are to be treated nearly in the same way as when arsenic has been the poison swallowed. In the instance of corrosive sublimate we also possess a convenient and effectual antidote.

Several substances may be used as antidotes; but those which have hitherto been most employed are albumen and gluten.

It has been already hinted that albumen, in the form of white of eggs beat up with water, impairs or destroys the corrosive properties of bichloride of mercury, by decomposing it and producing an insoluble mercurial compound. For this discovery and the establishment of albumen as an antidote, medicine is indebted to Professor Orfila. He has related many satisfactory experiments in proof of its virtues. The following will serve as an example of the whole. Twelve grains of corrosive sublimate were given to a little dog, and allowed to act for eight minutes, so that its usual effects might fairly begin before the antidote was administered. White of eight eggs was then given; after several fits of vomiting the animal became apparently free from pain; and in five days it was quite well.[1030] According to Peschier the white of one egg is required to render four grains of the poison innocuous.[1031] The experiments of the Parisian toxicologist have been repeated and confirmed by others and particularly by Schloepfer; who found that when a dose was given to a rabbit sufficient to kill it in seven minutes if allowed to act uncontrolled, the administration of albumen, just as the signs of uneasiness appeared, prevented every serious symptom.[1032] Dr. Samuel Wright has found that if the administration of albumen is followed up by giving some astringent decoction or infusion, the beneficial effects are more complete, because the compound formed is less soluble in an excess of albumen.[1033]

The virtues of albumen have also been tried in the human subject with equally favourable results. The recovery of the patient, whose case was quoted formerly (p. 312), from Orfila’s Toxicology, seems to have been owing in great measure to this remedy. In the Medical Repository another case is related, in which it Was also very serviceable.[1034] A third very apposite example of its good effects is related by Dr. Lendrick. His patient had taken about half a drachm of corrosive sublimate, and was attacked with most of the usual symptoms, except vomiting. White of eggs was administered a considerable time afterwards, the beneficial effects of which were instantaneous and well-marked; and the patient recovered.[1035] A few years ago Orfila’s discovery was the means of saving the life of M. Thenard the chemist. While at lecture, this gentleman inadvertently swallowed, instead of water, a mouthful of a concentrated solution of corrosive sublimate; but having immediately perceived the fatal error, he sent for white of eggs, which he was fortunate enough to procure in five minutes. Although at this time he had not vomited, he suffered no material harm. Without the prompt use of the albumen, he would almost infallibly have perished.[1036]

Albumen is chiefly useful in the early stage of poisoning with corrosive sublimate, and is particularly called for when vomiting does not take place. But it farther appears to be an excellent demulcent in the advanced stages.

On a previous occasion, mention was made of a few of the facts brought forward by Professor Taddei to prove the virtues of the gluten of wheat as an antidote for poisoning with corrosive sublimate [297, 336], so that nothing more need be said on the subject in the present place. As it is difficult to bring the whole of a fluid containing corrosive sublimate into speedy contact with pulverized gluten, which when put into water becomes agglutinated into a mass, the discoverer of this antidote proposes to give it in the form of emulsion with soft soap. This is made by mixing, partly in a mortar and partly with the hand, five or six parts of fresh gluten with fifty parts of a solution of soft soap. And in order to have a store always at hand, this emulsion, after standing and being frequently stirred for twenty-four hours, is to be evaporated to dryness in shallow vessels, and reduced to powder. The powder may be converted into a frothy emulsion in a few minutes.[1037] Taddei made use of this powder with complete success in the case of a man who had swallowed seven grains of corrosive sublimate by mistake for calomel. Violent symptoms followed the taking of the poison; but they were immediately assuaged by the administration of the antidote; and the person soon got quite well.[1038] It is probable that wheat flour will prove an effectual antidote by reason of the gluten it contains. On agitating for a few seconds a solution of twelve grains of corrosive sublimate along with three ounces of a strong emulsion of flour, and immediately filtering,—I find that ammonia and carbonate of potass have little or no effect, that hydriodate of potass occasions a yellow precipitate, and that the acrid, astringent taste of the solution is removed; whence it may be inferred, that the corrosive sublimate is all decomposed, that little mercury remains in solution, and that what does remain is in the form of a chloride of mercury and gluten.

When neither albumen nor gluten is at hand, milk is a convenient antidote of the same kind.

Iron filings would appear to be also a good antidote. MM. Milne-Edwards and Dumas have found that when they were administered in the dose of an ounce to animals after twelve or eighteen grains of corrosive sublimate had remained long enough in the stomach for the symptoms to begin, the animals recovered from the effects of the poison, and died only some days afterwards of the effects of tying the gullet, which operation was necessary to prevent them vomiting. The iron obviously acts by reducing the corrosive sublimate to the metallic state.[1039]

Meconic acid, the peculiar acid of opium, which will be described under the head of that poison, is also probably a good antidote. Pettenkoffer correctly remarks that this acid has a great tendency to form very insoluble salts with the metallic oxides, particularly with the deutoxides, and above all when the acid is previously in union with a base which constitutes a soluble salt.[1040] On this account it must be a good antidote. Pettenkoffer adds, that the precipitating action of the meconates is the reason why “the operation of corrosive sublimate on the animal body is almost entirely prevented by opium.” Opium, however, cannot be safely used in such quantity as to decompose all the corrosive sublimate in a case of poisoning; for I find that an infusion of thirty-three grains is required to precipitate all which can be thrown down from a solution of five grains of the mercurial salt. I am not aware of any instances on record where poisoning with corrosive sublimate has been prevented or cured by opium given so as to decompose the salt; but a very remarkable case will be related under the head of Compound Poisoning, where the phenomena of its action were masked and altered in a singular manner. There is little doubt that the alkaline meconates must prove valuable antidotes for corrosive sublimate. At present an effectual barrier to their employment is their rarity; but they might be rendered more accessible, as a great quantity of meconate of lime, which is at present put to no use, is formed in the manufacture of muriate of morphia; and meconate of potass may easily be prepared in sufficient quantity from the meconate of lime.

It has been alleged by Dr. Buckler of Baltimore, that a mixture of gold-dust and iron filings is an effectual antidote; but Orfila denies this statement; and the fact if true would be unimportant, on account of the improbability of the materials being ever at hand in practice.[1041]

M. Mialhe suggested not long ago as an antidote the proto-sulphuret of iron prepared by decomposing sulphate of protoxide of iron by hydrosulphate of ammonia; and Orfila found that it is a perfect chemical antidote, which altogether prevents the poisonous action of corrosive sublimate, if administered to animals either before or immediately after the poison; but he further ascertained that the lapse of ten minutes was sufficient to render it of no use.[1042] It is difficult, however, to perceive why in this respect it should differ from white of egg or any other chemical antidote.

As to the old antidotes for poisoning with corrosive sublimate, such as the alkaline carbonates, the alkaline hydrosulphates, cinchona, mercury, charcoal,—Orfila has given them all a fair trial, and found them all inefficacious. It would appear, however, from a case related in a late American journal, that frequent doses of charcoal powder have much effect in soothing the bowels and allaying the inflammation after the poison is evacuated.[1043]

The treatment of mercurial salivation consists in exposure to a cool pure air, nourishing diet, and purgatives, if the intestinal canal is not already irritated. In some of the inflammatory affections it induces, venesection is required; in others it is hurtful. In some complaints induced by mercury, as in iritis, the poison appears to be its own antidote; for nothing checks the inflammation so soon and so certainly as mercurial salivation.

Dr. Finlay of the United States proposed to check mercurial salivation by small doses of tartar emetic frequently repeated, so as to act on the skin;[1044] and Mr. Daniell has recommended large doses of the acetate of lead as an effectual antidote for the same purpose.[1045] I have tried both of these plans several times with apparent success. In one instance particularly, where a severe salivation was threatened by the administration of six grains of calomel in three doses, and where profuse salivation, ulceration of the tongue and swelling of the face actually did commence with violence, the mercurial affection after a few days rapidly receded under the use of large doses of acetate of lead.—Dr. Klose, a German physician, says he has found iodine to possess the property of arresting the effects of mercury on the mouth.[1046] The iodide of potassium is generally acknowledged to be one of the best remedies for eradicating the constitutional infirmities left in many by severe courses of mercury.

A great deal might be said on the treatment of the secondary effects of poisoning with mercury. But a thorough investigation of the subject would lead to such details as would be inconsistent with the other objects of this work.