ZROISOINTITTG 
BY 
BIN-lODIDE OF MERCURY. 
REPORT OF A CASK OH1 POISON 12s'Gr 
BV BIN-lODIDE OF MERCURY, 
OCCURRING AT FORT GRATIOT, MICHIGAN, 
JTJNIfI S7, 18Q^§ 
BY 
M. K. TAYLOR, CAPT. AND ASS T SURD. U. S. A. 
TO THE 
ST. CLAIR AND SANILAC COUNTY MEDICAL SOCIETY. 
Published by the Port Huron Times Company. 
PORT HURON, MICH. 
iBjO. BEPOBT. 
Private (reo. E. Lee, Co. “ H.v Ist U. S. Infantry, aged about 25 
years, of small stature, and rather spare habit, presented himself at 
the post hospital on the morning of June 20th, 1869, suffering from 
Syphilitic Ozena of the left nares. He stated that it had been troub- 
ling him for some time, but not until quite recently had the discharge 
become offensive. The nose was considerably swollen on that side, 
the discharge quite profuse, and occasionally a little bloody. He 
contracted Syphilis two years since. The following prescriptions 
were made : 
IJ Potassa lodidi 3 ij. 
Hydrarg. Bin-lodidi gr. jv. 
Spr. Lavendulae Comp. fl. 3 ij- 
Syr. Simplex qs. ft. § jv> M. 
Sig., a teaspoonful after eacli meal. 
IJ Hjdrarg. Bi-Chloridi gr. ij. 
Aqua Pur. 3 ij. M. ft. sol. 
Sig., a half ounce to be injected into the nasal cavity three 
times a day. 
A rapid improvement followed the course of treatment, but on the 
24th he re-appeared suffering from Intermittent Neuralgia of the head, 
face and chest of the right side. Twenty-five grains of Quinine were 
prescribed, in doses of five grains each, which arrested the disease by 
the next morning, when bitter tonics were directed to be taken after 
meals for a few days. On the 27th, he appeared at the sick call 
again, and seemed about able to return to his usual duties. The 
nasal discharge had entirely ceased, the offensive odor was pH gone, and 
the swelling of that side of the nose was reduced to nearly its normal 
condition. I directed the continuance of the remedies. He was 
allowed to take these to his quarters from the beginning, being 
instructed, however, as to their nature, and admonished to take proper 
care in their use. It would seem from my subsequent investigations that the teaspoon he used was rather small, so that he was not taking 
the eighth of an ounce at a dose as I had directed He showed the 
bottle to one of the corporals of his room, just as he took the poison, and 
the quantity remaining, as described by him, must have equaled at least 
two ounces. After exhibiting it be remarked 11 he wouldfinish that medicine 
anyhow'' He imd, also, during the day, expressed a wish that he were 
dead to several persons in the garrison, but in such a jocular way that 
no one paid any attention to it. Having swallowed the medicine he pro- 
ceeded to the hospital and asked the steward to refill the prescription, 
then leaving the bottle he returned to bis quarters and lay down 
on a low bench near his bunk. In about twenty minutes his 
comrades noticed that there was something peculiar about him, and 
tried to get him up, but he was insensible, breathing heavily, and 
frothing some at the mouth. Becoming alarmed the non-com- 
missioned officer in charge notified me that lie was very ill, and said that 
he thought Lee had, intentionally, taken poison. I saw him immediately. 
He was wholly insensible, bad stertorous respiration with a little 
frothing at the mouth, respiratory action nearly normal, except slightly 
jerking with the inspiratory movement, pulse SO, moderately full and 
soft, general tnrgesccnce of the face and extremities, the lips partly 
closed, flabby and of a bright crimson, eyelids closed, hut on opening 
them the eyes were fixed, looking directly forward, pupils quite large, 
insensible to light, and the lids, unsupported, slowly returned to the 
former condition. The head was thrown moderately back, fixed, and 
there was a slight tonic spasm of most of the. posterior muscles of the 
trunk. On attempting to raise the head, the whole trunk was raised 
at the same time, flexion taking place at the hips only. Extremities 
flexible and warm, which, together with the face, presented a decided 
venous turgescence, and accompanied by a flush, in places amounting 
almost to a rose color; upon the anterior aspect of the chest this was 
also very marked. While making preliminary arrangements to remove 
him to the hospital he bad spasms of the lower extremities, involving the 
bclowjcnees, the knees being flexed on the thighs, the muscles 
of the plantar surface of the foot and flexors of the toes being very tense, 
hands affected but little, amounting only to a slight rigidity: this extended 
to the whole body, accompanied by moderate opisthotonos. The spasm 
lasted scarcely a half minute, and was then followed by very decided 
short, quick, spasmodic action of the transverse muscles of the abdomen, 
occurring at irregular intervals of a few seconds, this was so much so as 
to produce an exceedingly flattened condition of this region. There was no effort at vomiting. The functions of deglutition were entirely 
paralysed so that on introducing fluids into the mouth they passed direct- 
ly into the trachea producing strangulation, and threatening suffocation, 
I had him removed immediately to the hospital. When laying him on 
his cot a much more severe spasm occurred amounting to a moderately 
•severe epileptic convulsion, and difficult So be distinguished from the 
ordinary exhibition of that malady, except in the subsequent recurring 
.-spasmodic actions of the abdominal muscles. Immediately after this 
the venoms distention and general capillary congestion were consider- 
ably increased, the pulse smaller and more feeble, insensibility, 
flabby lips and louder stertor, with depressed temperature of the 
■extremities continued, the rhythm of the pulse and respiration remain- 
ing unchanged, as well as the rigidity, and be bad all the appearances of. 
impending dissolution. 
The treatment consisted first in administering about 3 jv, aqua 
ealcis diluted with an equal quantity of water. Failing to got 
him to swallow the fluid in the ordinary way, and while the stomach 
pump was being arranged, I placed him in a recumbent position and 
putting a small quantity of fluid in the mouth, then closing the nostrils, 
an effort at deglutition was induced so that by repeating the process I 
succeeded in getting the whole amount down, This I followed by a 
solution of Bi. Garb. Potassa, when regurgitation of the contents of 
the stomach in small quantities occurred, corresponding occasionally 
with the abdominal muscular contractions, at other times not. It 
was not vomiting as generally observed, but a (prick regurgitation such 
as one often feels after a hearty meal, when the contents of the 
stomach are somewhat acrid, and are thrown up accompanied with some 
gas. In the course of fifteen minutes about a pint had been dis- 
charged by tins process with manifest relief, as he began to be more 
conscious of what was required of him, though deglutition was still 
difficult. This was followed as fast as practicable with two drachms 
of Fluid Ext. Ipecac, given in a glass of warm water. But a singular 
phenomenon was now manifested, consisting chiefly in this, that so often 
as he attempted to swallow, the fluid would pass seemingly down the 
(Esophagus nearly to the stomach and then, instantly, he rejected by 
regurgitation with a small portion of the contents of the stomach ; 
this peculiarity was manifested only at such times as he attempted to 
swallow. Before I gave the Ipecac another slight convulsion 
occurred, followed by a diminution of the spasmodic action of the 
muscles of the abdomen, if he was allowed to remain undisturbed. By closing the nasal orifices I succeeded in getting down most of the 
Ipecac, when I permitted him to lie quietly for a few moments. He 
soon relapsed into a state of stupor, with his eyes partially closed and 
fixed as at first, but with less muscular rigidity of the posterior muscles 
of the trunk. At the expiration of about ten minutes I had him 
aroused, when on repeating a full dose of the Ipecac he vomited 
freely, became conscious of his condition and complained of intense 
pain in the region of the umbilicus and below, but said nothing of 
any distress in the stomach. In the evening all the distress in the 
abdomen had in a measure ceased, and he then complained of his 
throat. Since his recovery he says this distress of the throat was a 
sense of constriction, and by his own sensation located it in the larynx, 
though he says it hurt him when attempting to swallow. After the 
free vomiting he was allowed to rest for a half hour, when Sulphate of 
Morph., in doses of 1-6 of a grain with 1-4 of a grain of Ipecac, was 
given every fourth hour for the next 12 hours and after that a free saline 
to open the bowels. Ptyalism appeared in about 80 hours but not very 
severe and the tongue was reddened along the middle, fissured and dry. 
There was no disposition to diarrhoea. The second day he began to 
ask for food, when milk and lime-water were allowed, and he convalesced 
rapidly. I may remark that the nasal syphilitic ulcerations improved 
equally fast. 
This case of poisoning presented the aspects of profound sedation. 
The muscular spasms of the abdomen may be regarded as efforts in 
part to produce emesis, but the sedative action of the agent was so 
powerful on the stomach as to arrest the usual muscular contractions 
of that organ, and prevent the discharge of its contents until the 
poison was rendered less active by its partial chemical decomposition, 
and conversion into a Prot. lodide. When he became rational lie 
stated that the first sensation in the stomach was a slight nausea soon 
followed by some pain though not very severe, and this by a very 
severe pain in the back part of the neck with excessive secretion 
of salivia, after which he remembers nothing until the operation of 
the emetic. It was only a few moments after this frothing 
at the mouth had commenced, from the account given by his room-mates 
as well as from his non-recollections of events that he became insensible, 
and remained so until relieved The full poisonous effects were 
exhibited in about fifteen minutes after he took the medicine; 
and from that time until he regained his consciousness was over three 
quarters of an hour. The quantity of the poison taken must have been unite two grains of the B'miodide of Mercury and one drachm 
of lodide of Potassa. 
Nearly all of the works on Toxicology say that the action of Bin- 
iodide of Mercury is analogous to that of Bichloride. It is very 
clear however that in this case such did not obtain. That the agent 
is equally prompt, powerful and dangerous there can be no doubt; 
indeed I am not sure but it is more rapid in its effects from the fact 
that unlike Corrosive Sublimate it forms no precipitate with albumen 
and therefore remains soluble in the stomach in the presence of any 
albuminous matter in its contents. 
The case taking me somewhat by surprise, I had to be governed 
solely by my prepossessions in regard to the chemical relations of tin; 
poison, thinking for the mopient that the Carbonate of Potassa 
obtained by the decomposition of the Bicarbonate with the lime 
water would decompose and reduce it to a still less active agent than 
the Prot. lodide. A very casual examination of the subject, how- 
i j . * ft'a* U'* 1 “ 
ever, led me to correct such impressions. ihe Mercury cannot 
be seperated from its lodine affinities in the presence of the lodide of 
Potassium, so far as I am aware, but by Sulphuretted Hydrogen, ei the 
free or in combination with an Alkaline base as with Potassa or 
Ammonia, when the Sulphide of Mercury is thrown down Strictly 
speaking therefore, the Sulphides of Ammonia or Potassa or agents of 
like character are its only antidotes. The Sulphide of Potassa 
is the most eligible as it Tan be administered in doses of five or six 
grains largely diluted with safety; a quantity which would be quite 
sufficient to neutralize an equal amount of the poison. 
The works on Toxicology direct us to employ albumen freely in 
poisoning by Corrosive Sublimate with the view of forming an 
insoluble precipitate with the agent, and say further that the treatment 
for poison by the the Biniodide should be the same. In this there 
could not be a greater error. The latter forms no precipitate with 
albumen; on the contrary where albumen of the egg has been 
partially coagulated by being kept for some time in connection with 
lime water, or salt, or the usual means of preserving eggs for winter 
use, the Biniodide in its solution with lodide of Potassium renders 
it soluble at once, and the effects are such that the reactions of the 
Sulphide of Potassa are greatly delayed; indeed it requires several 
hours to obtain a precipitate of the Mercury in the presence of 
albumen, and not until a lapse of a whole day is the Biniodide of 
Mercury fully decomposed. It is clear therefore that albumen should' not Be given uh an antidote in this fonu of poisoning; for if 
shields the agent from the action of remedies which under other 
circumstances promptly decompose it and render it comparatively- 
inert. 
As .Bin-iodide of Mercury is becoming' a popular remedy in the 
treatment of diseases of Syphilitic origin,.and mistakes are liable to 
occur, it would scour necessary that our Toxicologists should give this, 
subject a more thorough investigation and indicate to the profession 
some additional means of counteracting its baneful effects. Not 
only this, but I am fully satisfied that if its peculiar and nearly 
painless or stupefying action were mure fully understood by the people 
at large, those seeking the means of self destruction would choose this 
in place of almost any other, save perhaps Chloroform and Opium. 
Its sedative and stupefying action on the nervous system is appalling 
when taken in over-doses, and only the most prompt and efficient 
efforts will avail in saving life. So far as my means of judging 
indicate, the employment of Liquor Potassa, solutions of Carb. 
Potassa, extemporaneously prepared, lime water followed imme- 
diately by Bicarb. Potassa; and the Sulphide of Ammonia or 
Potassa, the latter being the better, followed by emetics or the 
stomach pump, constitute our chief antidotes. 
The extreme rarity of casualties of this kind—no cases being 
reported, according to the leading works on medical jurisprudence— 
lias led to neglect on the part of Toxicologists, and Chemists in 
determining more explicitly, in varying emergencies, the best course 
to pursue in the treatment. My own means at command are far too 
limited to enable me to fix upon anything more definitely as an 
antidote, or to suggest more an efficient treatment when the articles 
above named are not at band. I have little faith in emetics alone 
if the poison has been taken long before the patient is seen by the 
medical attendant. 
I have spoken of the poisonous agent in this case as the Bin- 
iodide of Mercury, though chemically speaking, it is a solution of the 
Hydrargyro-lodide of Potassium. Inasmuch, however, as we pre- 
scribe it as a Biniodide, I prefer so to consider it.