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MERCURY                                                             527

membrane. This is followed by diarrhoea with bloody stools and accom-
panied by tenesmus. The urine is suppressed or scanty, containing blood
and albumin. The pulse becomes quick, small and irregular, and collapse
soon supervenes. In some cases spasms, tremors, convulsions and uncon-
sciousness are observed before death occurs. Gangrenous colitis 55 may be
observed, if the patient has survived six or more days.

It should be noted that the symptoms are liable to great variation in
different cases although the doses have been the same.

Salivation, gingivitis and loosening of the teeth with foetid breath are
usually common when mercurial vapours are inhaled.

Intravenous injections of novasurol and mersalyl as diuretics are some-
times followed by dyspnoea, cyanosis, convulsions and death. They may
produce death almost suddenly from anaphylactic shock.

j         Diagnosis.—This has to be  diagnosed from arsenical poisoning.    The

' symptoms of mercurial poisoning commence sooner, and the acridity and the

constriction of the throat are more marked.    The Vomited matters and stools

more   often  contain  blood.   The   irritation   of  the   kidneys  is   also  more


Fatal Dose.—An intravenous injection of 0.06 gramme of metallic mer-
cury as a 40 per cent oil emulsion has proved fatal. On the contrary,
recovery has followed 27.2 grammes (2 cc.) of metallic mercury injected
intravenously with a view to committing suicide.56 Thirty grains of red
oxide of mercury taken with an ounce of acetic acid proved fatal to a girl of
17 years within 30 hours.57 The average fatal dose of mercuric chloride for
an adult is three to five grains. Its smallest recorded dose is two grains
which killed a child.58 Recovery has resulted after the administration of
ninety or one hundred grains, or even much larger doses under" prompt
treatment by milk, eggs, and emetics. The average fatal dose of mercuric
cyanide is ten to twenty grains. That of mercuric nitrate is one drachm, and
of turpeth mineral is forty to sixty grains. Six grains is the smallest
quantity of calomel which has caused the death of a boy, aged fourteen years,
in three weeks from ulceration and gangrene of the face.

Fatal Period.—The usual fatal period is 3 to 5 days, but death may take
place much sooner or later than this.

Treatment—-If vomiting has not already commenced, give emetics or
pass the stomach tube cautiously and wash out the stomach with warm water
to which carbonate ofj&agnegium has been, added. Albumen in the form of
raw white of egg, or vegetable gluten, mixed with a large quantity of skim
milk should then be administered; the albuminate of mercury thus formed,
although insoluble in water, is soluble in excess of albumen, and is liable to
be digested and absorbed if left in the stomach. It must, therefore, be
removed by the administration of emetics or lavage of the stomach. Demul-
cent drinks may be ad-ministered to protect the stomach wall.

Three to four tablespoonfuls of animal_charcoal suspended in about a
pint of water should be administered as soon as possible, as it has the great
power of absorbing mercury salts. The addition of about five drachms of
magnesium sulphate increases the absorptive power of the charcoal and
hastens the removal of the ingested poison.59

The stomach may be washed out with 500 cc. of water containing 30
grammes of sodium thiosulphate. Intravenous injection of sodium thiosul-

55.    Berger, Applebaum and Young, Jour. Amer. Med. Assoc,, Feb. 27, 1932, p. 700.

56.   Leschke, Clin. Toxic., Eng. Transl. by Stewart and Dorrer, 1934, p. 33.

57.    Brit. Med. Jour., Vol. I, 1896, p. 19.

58.    Taylor, Prme. and Pract. of Med. Juris., Ed. X, Vol. n, p. 360.

59.   Leschke, Clin. Toxic., Eng. Transl. by Stewart and Dorrer, 1934, p. 43.