On examination after death, the usual marks are discovered of inflammation or corrosion of the mucous membrane of the stomach and bowels. The internal surface is often found of a slate-gray colour, and that of the mouth is white or bluish-gray; effects which are somewhat characteristic of the action of this poison.

The smallest quantity which is known to have caused death is three grains, and that was in the case of a child. {Taylor on Poisons, Lond. 1848, p. 402.)

Several cases are on record of death from the external application of corrosive sublimate, in which its poisonous constitutional effects were experienced, both as exhibited in the alimentary canal and the mouth. in one instance, that of a child, though the poison had produced extensive sloughing in the part to which it had been applied, absorption nevertheless took place, and a most violent effect upon the mouth came on, attended with gangrene. in another instance, occurring in an adult, on examination after death, the alimentary canal was found strongly inflamed, and the lower part of the colon and rectum were in a state of sphacelus. Other facts in great number might be adduced, to show that the medicine, when absorbed from the surface, exercises on the stomach and bowels an irritant influence similar to that which it evinces when swallowed.

Treatment of Poisoning. The stomach should be well washed out by the free use of demulcent drinks, with which some antidote should be administered. Albumen, in the form of the white of eggs, as the most convenient, should be immediately resorted to, or, in the absence of this, milk or wheat flour; for, though these may not completely neutralize the poison, they certainly tend to lessen its activity; and it is of the utmost importance not to lose time. The most efficient antidote, when it can be obtained, is probably the hydrated protosulphuret of iron. After the stomach has been cleansed, a cathartic should be given with the antidote; and measures afterwards employed to counteract the inflammation and irritation, for which purpose the aid of opium will be highly valuable.

Mode of Operation

Corrosive sublimate is capable of producing its characteristic effects on the system, both through the alimentary canal and the skin. Meeting with albuminous matters in the tissues and liquids with which it is brought into contact, it probably unites with these even when given in small doses, forming an albuminate of the salt, from which it is probably dissolved through the agency of the alkaline chlorides in the blood, and thus enters the circulation not strictly as corrosive sublimate, but as a compound of this and the alkaline chloride.

Therapeutic Application

in reference to the uses of corrosive sublimate as a topical remedy, I shall speak hereafter. For its effects on the system it is much less used than some of the other mercurials, on account of its occasional harshness, and the danger of giving it in such doses as to ensure a decided constitutional impression. its employment is confined mainly to secondary venereal affections, chronic rheumatism of a peculiarly obstinate character, and chronic cutaneous eruptions, whether syphilitic or not. it is usually administered with other alteratives, especially the compound decoction, and compound syrup of sarsaparilla. With the latter, however, unless taken promptly after the mixture, it is liable to undergo decomposition, and to be converted into calomel. An objection has been made to its administration in connection with albuminous or glutinous substances, under the impression that it-might thus be rendered insoluble and inert; but, as suggested by Sou-beiran, this is probably the safest way of administering it; as its corrosive effects are thus obviated, while, being soluble in the blood, it is probably taken into the circulation without difficulty.

Administration

The dose of corrosive sublimate is from one-sixteenth to one-quarter of a grain, three or four times a day. Should it irritate the stomach and bowels, in any dose given, this should be diminished, or a little opium may be administered with it. The most convenient method of exhibition is usually that of pill, which may be made with the crumb of bread; great care being taken to diffuse the medicine equably through the mass.

Corrosive sublimate is frequently used on the Continent of Europe, in the form of a bath, with a view as well to its constitutional impression, as to a local effect on the skin. in this mode it is applied chiefly to obstinate cutaneous affections. in the Hotel Dieu of Paris, a bath is used containing at first half an ounce of the corrosive sublimate, which is sometimes increased to an ounce or even two ounces; only half the quantity being used in the cases of women. in describing the effects of these baths, MM. Trousseau and Pidoux state that they first produce heaviness of the head and drowsiness, with slight pains in the stomach, and sometimes, though rarely, vomiting and diarrhoea. After several repetitions of them, a papulous eruption is apt to appear on the legs, which is occasionally so inconvenient from the itching and pain, that it is necessary to suspend the bathing. The remedy is not pushed to ptyalism unless in syphilitic cases. The baths are given every other day, and on the intervening day the patient is immersed in a bran bath. The effects of the remedy are described as most happy in the cure of obstinate skin diseases. {Trait, de Thérap., 4e ed., i. 201-2.) Sulphuretted baths used conjointly, cause a blackening of the skin, which does not disappear till after desquamation. Pediluvia may be employed also to affect the constitution, having the strength of half a grain of the chloride to a pint of water.

Solutions of corrosive sublimate, containing from one-sixteenth to one-quarter of a grain in a fluidounce of water, may be used for inhalation in the form of spray, by means of the atomizer, in chronic syphilitic affections of the glottis and larynx.

A Solution of Corrosive Sublimate (Liquor Hydrargyri Bichlo-ridi, Lond.) was directed by the London College, consisting of ten grains, each, of the bichloride and of muriate of ammonia, in an imperial pint (f§xx) of distilled water. The dose is from one to four fluidrachms, containing from one-sixteenth to one-fourth of a grain of the corrosive sublimate, to be taken in some mucilaginous liquid.