552 MEDICAL JURISPRUDENCE A sudden outbreak33 of zinc poisoning occurred amongst the inmates of a large institution near London. About 400 persons were served at tea with stewed apples cooked in galvanized iron vessels. Within a few minutes more than 200 oi those who partook of the stew complained of dizziness, colic and tightness m the throat. There was some diarrhoea. Only ten persons were at all seriously ill, and all of them were able to carry out their ordinary work next day so that obviously the effects of the poisoning soon passed off. The chemical examination of some of the stewed apples remaining from j the meal showed that they contained 7 grains of zinc, expressed as zinc oxide, in the pound ; this is equivalent to 25 grains of hydrated zinc sulphate to the pound, Poisoning "by zinc salts is very rare indeed. Accidental poisoning has occurred from zinc sulphate having been taken in mistake for magnesium sul- phate. Cases are recorded in which it was taken with intent to commit suicide or to procure abortion. It has been very rarely administered homicidally. Zinc chloride has been used suicidally, but rarely for homicidal purposes. Poisoning by this salt has occurred from its application to a wound or to a raw cancerous surface, from injection of a 50 per cent solution into the rectum in mistake for glycerol,33 as also from vaginal douching with a solution of 1 drachm to 1 litre of water.34 Burnett's fluid has caused poisonous symptoms through being mistaken for fluid magnesia. Zinc oxide is not, as a rule, poisonous, but its fumes, when inhaled, are highly poisonous. Zinc stearate causes poisonous symptoms in children from, accidental inhalation of the powder, and produces interstitial pneumonia and peribronchial inflammation. Schalepfer85 reports the case of a child, aged 7J months, who died thirty-four hours after inhaling zinc stearate. Cyanosis and dyspnoea were the principal symptoms, and a state of ** acidosis " was noted twelve hours before death. At the necropsy the lungs were found voluminous. The bronchioles contained plugs of zinc stearate and mucus, which appeared as wormlike masses. Extensive areas of emphysema were separated from each other by small scattered, atelectatic zones. Zinc phosphide is used by agriculturists to destroy field-rats ,'but is rarely used as a human poison, although cases of human poisoning have occurred recently. In his annual report for the year 1951, the Chemical Examiner, Madras, mentions that twelve cases of human poisoning occurred during the year under report, and describes the details of two fatal cases of poisoning by zinc phosphide of which one was accidental and the other was suicidal. He also mentions three fatal cases of cattle poisoning by zinc phosphide. The salts of zinc are eliminated from the system chiefly by the bowels and to a slight extent by the kidneys. Zinc may be found in a small amount in the body after death o^ing to its absorption by food kept in zinc or galva- nized iron vessels. BISMUTH The salts of bismuth which are commonly used in medicine are— ,«. 1- Bismuth Carbonate (Bismuth Oxycarbonate or Bismuth Subcarbonatc), 2(Bi2O£CO8), H2O.—It is a heavy, white, odourless, tasteless powder, insoluble in water, but soluble with effervescence in nitric acid and in hydrochloric acid, It is a pharma- copceial preparation, the dose being 10 to 30 grains. It occurs in the composition of Trochiscus bismuthi compositus, 1\ grains being contained in each. 2. Bismuth Subnitrate (Bismuth Oxynitrate), BiONOa, HO.—It is a heavy, white powder in minute crystalline scale. It is insoluble in water and alcohol, but soluble in dilute nitric acid. It is known as magistery of bismuth, and is sometimes used as a cosmetic under the name of pearl white. It is a non-official preparation, the dose being 5 to 20 grains. r ' 3. Bismuth Salicylate (Bismuth Oxysalicylate or Subsalicylate), BiOCrl&Oa,—It is a heavy, white, amorphous powder, having neither taste nor odour. It is insoluble in water, alcohol and glycerin. It is an official preparation, the dose being 10 to 30 grains 32. Brit. Med. Jour., Feb. 3a 1923, p. 201. 33. Witthaus, Med. Juris, and Toxic., Vol. IV, p 713 34 Brit. Med. Jour., Dec. 2, 1922, Ep., p. 79. 35. Amer. Jour, of Diseases of Children, Chicago, April 1926, p. 474.