a comparison of the irritating properties of some mercurial combinations used as antiseptics

257

trismus which was becoming severe. This condition per-sisted until 5 A.M. when the respirations began to increaseand by 6.30 A.M. they were practically normal. At 9 A.M.fuids could be freely taken, though facial spasm and trismuswere produced. 3000 more units of antitoxin were adminis-tered. At 5 P.M. there was no opisthotonos but it appeared12 times within the next 16 hours. On the 19th the effects

of the second injection had been so alarming that hesitation.was felt in proceeding. The boy had been comatose for 12hours. The result of the hesitancy was that from midnightuntil 9.30 A.M. there was continuous opisthotonos and con-vulsions occurred every two or three minutes. Two cubic

centimetres of a 16 per cent. solution of magnesium sulphatewere then injected and the head was elevated to prevent thefluid reaching the respiratory centres. Improvement againfollowed but injection again became necessary. In all, 11 in-jections were given and were followed several times by respira-tory collapse lasting from 11 to 14 hours. The last injection.was given on August 29th. Recovery ensued. Of the valueof the magnesium sulphate in relieving the spasms therecould be no doubt. In THE LANCET of August 15th, 1908,p. 504, our Paris correspondent has also reported a successfulcase of this treatment.

____

MUSSELS AND ENTERIC FEVER.

WITH regard to recent remarks on the polluted conditionof the shores of Lancashire and North Wales, the report ofDr. J. Marsh, medical officer of health of Atherton, nearManchester, is timely. He states that in a somewhat seriousoutbreak of enteric fever that recently occurred there it wasfound in 13 cases " that the sufferer had partaken ofmussels." Dr. Marsh thinks that "greater powers shouldbe given to the county and local authorities to deal with

any such food that is found to carry any disease or is likelyto cause disease." He very justly thinks it hard that personsshould contract enteric fever from eating shell-fish whichcome from a river contaminated with sewage, ’’ and yet eventhe county authorities have not control over that river shouldit happen to be tidal." The patients who had eaten musselshad the disease very severely and there were four deaths, orrather more than 25 per cent. of the cases attacked.

A COMPARISON OF THE IRRITATING PROPERTIESOF SOME MERCURIAL COMBINATIONS

USED AS ANTISEPTICS.

IN S1lrgery, Gynecology, and Obstetr’ics for December Dr.’George B. Lawson records the results of a series of testswhich he has carried out with the object of ascertaining inwhat form combinations of mercury should be used inorder to produce the least possible amount of irritation.

Very little work has been done to ascertain the toleranceof the surface of the body for the various preparationsof mercury of different strengths. Dr. Lawson investi-

.gated the subject by dressing similar parts of the body,in most cases the ankles, with various combinationsof the salts of mercury after having prepared the

surfaces as for a surgical operation. In each experi-ment one ankle was dressed with a cotton-wool com-

press of a certain size soaked with a known quantityof a definite solution of mercuric chloride in distilledwater. The other ankle was dressed in the same way-except that the solution of mercuric chloride was re-

placed by an equal quantity of a solution of variousmercurial combinations the action of which it was desiredto study. Over the compresses were put rubber protective,- cotton-wool and bandages, and the dressings were replaced atintervals so as to keep the skin moist. The condition of theskin was observed at intervals and the time taken to produce

a noticeable inflammation was recorded. From observationsmade on 18 subjects of both sexes and various ages Dr.Lawson concludes that combinations of mercuric chloridewith citric or tartaric acid are more irritant to the skin thanis the case with mercuric chloride alone ; that mercuricbromide and mercuric iodide are also more irritant thanmercuric chloride ; and that the least amount of irritation isproduced by a 1 in 1000 solution of mercuric chloride in normalsalt solution. In carrying out these experiments the followingstrengths were employed :-mercuric chloride, 1 in 500 and 1in 1000 ; tartaric acid, 1 in 500 and 1 in 1000; citric acid,1 in 1000 ; mercuric iodide, 1 in 1000, with potassium iodide1 in 1000 ; mercuric bromide, 1 in 1000 and 1 in 2000, withpotassium bromide 1 in 1000 and 1 in 2000 respectively.Dr. Lawson draws attention to the fact that in applyingantiseptic dressings the water tends to evaporate at theedges, with the result that the solution at these points ismore concentrated and tends to produce a local innamma-tion. A similar result follows when a dressing is repeatedlymoistened with an antiseptic solution.

BISMUTH SUBNITRATE POISONING.

UNTIL recently bismuth has been regarded as non-toxicand the few recorded cases of poisoning after its use havebeen ascribed to the presence of arsenic or other impurity.But it has now been shown that pure bismuth has toxic

properties and its recent administration for purposes of

radiography has brought this fact more into evidence. Inthe .2V<MP York }JIIedical Journal of Jan. 2nd Dr. Emil G. Beckhas published an exhaustive paper on the subject. As

long ago as 1793 cases of poisoning by bismuth subnitratewere recorded but were thought to be due to impurities.The first authentic report of bismuth poisoning was pub-lished by Theodor Kocher in 1882. He observed thatinsoluble preparations of bismuth when applied to

large wound surfaces may be absorbed to such an

extent as to produce characteristic symptoms-acutestomatitis and black discolouration usually beginning on

the gums at the border of the teeth and spreading overthe whole mouth, which are followed by intestinal catarrh,pain, and diarrhoea, and in severe cases by desquamativenephritis. Similar cases were reported by Professor Petersen.Then literature was silent on the subject until 1901, whenProfessor Muhlig reported two cases of poisoning after thedressing of burns with bismuth subnitrate. Later two cases

of poisoning were reported in America after administrationof 60 and 120 grammes respectively of the subnitrate in onedose. The first fatal case was reported by Bennecke andHoffman. 3 An emaciated child, aged three weeks, sufferedfrom enteritis. A mixture of three grammes of bismuth

subnitrate in 100 cubic centimetres of buttermilkwas given in order to diagnose pyloric stenosis byradiography. Twelve hours later cyanosis developedand was followed by collapse and death. After death

methsemoglobinsemia and small quantities of bismuthwere found in the liver and blood. In the same clinicanother fatal case with similar symptoms occurred in a child.Professor Hefter suggested that the symptoms might be dueto nitrite poisoning. The blood and pericardial fluid weretested for nitrites which were detected in both. Then

Bohme proved by experiments that the fseces of children incontact with bismuth subnitrate liberate nitrites. He

injected this mixture into a ligated loop of a rabbit’sintestine and found nitrates and nitrites in the urine but notin the blood. Routenberg has reported a case in which

methasmoglobinaemia and the other symptoms of nitrite

1 Volkmann’s Klinische Vortr&auml;ge, 1882, p. 224.2 Deutsche Medizinische Wochenschrift, June 20th, 1883.3 Munchener Medizinische Wochenschrift, 1906, No. 19.