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tion of the mercurial is chiefly on the upper part of the intestine,
it is greatly assisted by giving a saline purge a few hours after it,
for this will act more on the lower part of the bowel. The con-
tents are passed along so quickly, that it is doubtful whether
there is time for much mercury to be absorbed if a purgative
dose of it has been given. Calomel and the metallic prepara-
tions are the two forms most used as purgatives. The former is
the more powerful.

Whatever compound of mercury is taken by the mouth, it, in
the stomach, becomes a complex albuminate containing mercury,
sodium, chlorine, and albumin. This compound, in the presence
of the sodium chloride in the stomach, can exist in solution
there. Precisely what happens to it in the duodenum is doubt-
ful ; but it is quite certain that if the dose is insufficient to cause
purgation some mercury is absorbed, the rest passing out of the
bowel as a sulphide.

Liver. It was formerly taught that calomel increased the
amount of bile formed by the liver. This is now known to be
an error, but [corrosive mercuric chloride] increases it, and pos-
sibly, occasionally when calomel is administered, some of it is
converted into the [corrosive] chloride. Large doses of calomel
are said to slightly diminish the secretion of bile. Calomel and,
to a less extent, preparations of metallic mercury are, however,
called indirect cholagogues, because they, in the manner
already explained, aid the excretion of bile. The stools are
[spinach-] green and contain calomel, mercuric sulphide, and
unaltered bile.

Blood. After absorption the mercurial compound formed in
the stomach and intestines probably becomes oxidized, and cir-
culates as an oxyalbuminate. Minute, long-continued doses of
mercury slightly increase the richness of the blood in red cor-
puscles, and in animals may add a little to the weight of the
body. Large doses produce anaemia. Mercury checks the
emigration of white corpuscles, and this perhaps explains its
antiphlogistic action.



THE SALTS OF MERCURY.

Remote effects. Mercury is excreted by the saliva, bile, urine,
sweat, [faeces,] and milk. In small doses no effects can be at-
tributed to this, but in large doses mercury irritates the salivary
glands and is a powerful sialogogue. By itself it is a feeble
diuretic, but it sometimes powerfully, aids other diuretics. It is
eliminated very slowly, and hence accumulates in the body.

THERAPEUTICS OF MERCURY AND ITS SALTS.

External. Antiseptic action. Solutions of the [corrosive]
chloride are very largely employed. A strength of i in 1000 is
used for washing the hands, for washing the parts to be operated
upon, for soaking towels, lint, sponges, etc., used in operations,
for washing infected articles, infected rooms, furniture, linen,
etc. For wounds and cavities (as the uterus), the strength for a
single washing should not exceed i in 2000, [and weaker solu-
tions are preferable] ; for continual irrigation i in 10,000. Corro-
sive sublimate [tablets], tinted blue, made so that one dissolved in
a pint of water makes a solution of i to 500, are a convenient form
in which to carry the antiseptic. Corrosive sublimate solutions
should always be tinted blue to render them easy to recognize.
[The mixed mercury and zinc cyanide as suggested by Lister is
unirritating. It is said to have but slight germicidal value, but
its inhibitory power is so great that a solution of i to 1200 will
permanently prevent putrefaction in animal fluids. Cyanide
gauze may be made actively germicidal by impregnation with a
solution of i to 4000 of corrosive mercuric chloride.]

Antiparasitic action. White precipitate ointment, diluted
[mercuric] nitrate ointment, and a wash of [corrosive] chloride
are very useful for destroying lice on the head ; and these three,
especially the last, are excellent for destroying the fungus in
ringworm and favus. The oleate of mercury is useful for destroy-
ing that in pityriasis versicolor ; if the skin is easily irritated the
ointment of it should be used. Mercurials should not be applied
over so large an area that there is a risk of poisoning from ab-
sorption.

Irritant action. The acid solution of the nitrate is used to
destroy warts, condylomata, etc. ; no doubt much of its caustic



21 8 INORGANIC MATERIA MEDICA.

action is due to the free nitric acid it contains. Milder prepara
tions, such as the ointment of [mercuric] nitrate, or of red
[mercuric] oxide, if diluted, may be used for tinea tarsi ; and
the same ointments are very beneficial to any ulcer or sore that
requires a stimulant, whether or not it be syphilitic. [In
ophthalmic practice the ointment of yellow mercuric oxide,
known as Pagenstecher's ointment or ophthalmic salve, is largely
employed.] When a milder preparation is required, calomel is
often dusted on the part; and black wash [Lotio Hydrargyri
Nigra, B. P. Calomel, i ; glycerin, 8 ; mucilage of tragacanth,
20 ; lime water, to 160 ;] is very commonly used, especially for
syphilitic sores and condylomata. [This reaction may be used
to determine whether the corrosive mercuric chloride with which
gauze has been impregnated has partially changed into the mild
chloride. If a black color appears upon application of lime
water, calomel is present.]

Itching. Black wash, yellow wash [Lotio Hydrargyri Flava]
(see p. 211), or Unguentum Hydrargyri may be employed to
relieve the itching of skin diseases, such as [pruritus] senilis and
urticaria, if they are not too extensive. A very favorite oint-
ment for many skin diseases is composed of equal parts of diluted
mercuric nitrate, zinc oxide and lead acetate ointments (see p.
178).

Absorbent action. All mercurial ointments and the oleate,
when applied to or gently rubbed into any part which is chroni-
cally inflamed, often aid the absorption of the products of inflam-
mation, if they are not too deep-seated. For this purpose blue
ointment, or Scott's ointment [Unguentum Hydrargyri Compos-
itum, B. P., which consists of mercurial ointment, 10; yellow
wax, 6 ; olive oil, 6 ; and camphor 3,] or the oleate [in an] oint-
ment are very commonly used for chronic inflammation of joints,
chronically enlarged glands, and chronic peritonitis, which cer-
tainly sometimes appears to be cured by the application of a
binder spread with one of these preparations or the Linimentum
Hydrargyri [B. P., which consists of equal parts of mercurial
ointment, solution of ammonia and camphor liniment] even
when the disease is tuberculous. The ointment of the red [mer-



THE SALTS OF MERCURY. 2 19

curie] iodide is, in India, applied to the thyroid gland in
goitre.

Internal. Alimentary canal. Very dilute solutions of
the [corrosive] chloride (4 gr. [.24 gm.] to 10 fl. oz. [300.
c.c.] water with i fl. dr. [4. c.c.] of ^diluted hydrochloric acid
and a little glycerin may be used as a mouth wash for syphilitic
ulceration. Ringer advises gray powder [Hydrargyrum cum
Greta] in minute doses for the sudden vomiting immediately
after food sometimes met with in children. By far the most
important intestinal action of mercury is its purgative effect.
Calomel and blue pill are pre-eminently the purgatives to employ
when there is, from the headache, constipation, furred tongue,
feeling of weight over the liver, and general lassitude, reason to
suspect that the dyspepsia is hepatic. Either of these drugs at
night, followed by a watery purge, in the morning, will often
completely relieve the symptoms. The blue pill at night, and
black draught (Infusum Sennse Compositum) in the morning
have long been a favorite combination. [Acid solutions, as
lemonade, should not be taken until the purgative effects of cal-
omel have passed.] Mercury or calomel is also one of the best
purgatives for cases of cirrhosis, and for cardiac cases in which
there is considerable hepatic congestion. Gray powder mixed
with a little sugar is an excellent purgative for children, or even
for adults, when a very mild purge is required as, for example,
after severe enteritis or peritonitis. [Calomel in small doses
(TS g r - ') -o6 gm.), triturated thoroughly with sugar of milk
and repeated every hour until a movement is secured, is a favor-
ite gentle purgative] or if it is desirable to open the bowels dur
ing typhoid fever. Children take mercury very well. Infants
can easily bear grain [.06 gm.] doses of the gray powder. As
diarrhoea, especially in children, is so often due to the presence
of some irritant, a simple purgative, as gray powder, will, by re-
moving it, often cure the diarrhoea. This preparation hardly
ever causes griping, but calomel is liable to do so. Mercury
compounds are, on account of their intestinal antiseptic action,
much given in Germany for typhoid fever.

Remote uses. In cases of heart disease mercury is often com-



22O INORGANIC MATERIA MEDICA.

bined with digitalis and squill as a diuretic (as in the well-known
Guy's diuretic pill : blue pill, powdered squill, powdered digi-
talis, of each i gr. [.06 gm.] ; extract of hyoscyamus, i^ gr.
[.10 gm.] ), and in some cases this combination does great good.
The [corrosive] chloride is most often used for adults, and the
gray powder for children.

Syphilis. Mercury in any form is powerfully antisyphilitic.
This action is so important that it makes mercury one of the most
valuable drugs we have. It has already been mentioned that it
may be applied locally to syphilitic ulcerations, but to be of any
use it is essential that it should also be administered so as to reach
the blood. It is a direct antidote to the syphilitic virus ; it can
completely cure the patient ; its use must be continued over a
long time, but it should never be pushed to salivation. Treat-
ment should be begun at as early a stage as possible, [as soon as
the diagnosis is established.] It is especially valuable in the pri-
mary and secondary stages ; authorities differ as to its value in
tertiary syphilis. It is as efficacious for the congenital as for the
acquired disease. It is also administered for many non-syphilitic
varieties of chronic inflammation, but not so often as formerly.
Patients with disease of the kidneys do not bear it well. The
[yellow] iodide is very commonly prescribed for syphilis, and
often succeeds when other preparations have failed. Its great
disadvantage is in its instability. Mercurous tannate (dose, i
to 2 gr. [.06 to . 12 gm.] in a pill) is strongly recommended by
some authorities.

[Mercurol (not official) is a chemical combination of nucleinic
acid and mercury, the former being obtained from yeast. It is
a brownish-white powder, soluble in water but insoluble in alco-
hol. It is employed in a 2 per cent, solution as an injection in
gonorrhoea. This apparently destroys the gonococci, lessens
the severity of the inflammation, and tends to prevent the de-
velopment of complications. It does not entirely stop the dis-
charge in all cases.]

13. SAL ALEMBROTH. [Not official.] Ammonio-Mercuric Chlor-
ide. A double Mercury and Ammonium Chloride.



THE SALTS OF MERCURY. 221

SOURCE. Mix 271 parts of [Corrosive Mercuric Chloride] with 107 of
Ammonium Chloride, both in solution, and evaporate.

CHARACTERS. Flattened rhombic prisms, freely soluble in water or gly-
cerin. It contains one molecule of [Corrosive Mercuric Chloride] combined
with two of Ammonium Chloride. Three grains [.20 gm.] of Sal Alembroth
contain two grains [.12 gm. of Corrosive Mercuric Chloride]. It is a very
powerful antiseptic, but does not combine with albumin so readily as [Corro-
sive Mercuric Chloride], and is therefore less irritating.

[USES OF SAL ALEMBROTH.]

Sal alembroth gauze (containing i per cent. ) and sal alem-
broth wool (2 per cent.), both tinted with aniline blue, which is
bleached by the discharge, so that it is easy to see if it has soaked
through, are much used to dress wounds antiseptically.

Sal alembroth injections (^ gr. ; [ioa gm.] in 10 minims,
[.60 c.c.] ; of water) are a convenient non -irritating form in which
to use mercury subcutaneously in syphilis. [The precautions
mentioned below should be observed.]

14. MERCURO-ZINC CYANIDE. (Not official.) This consists
of one molecule of Mercuric Cyanide combined with four molecules of Zinc
Cyanide.

CHARACTERS. A white powder.

USES OF MERCURO-ZINC CYANIDE.

Mercuro-zinc cyanide gauze and wool, each containing 3 per
cent, of the salt, and each tinted pink, are much used in anti-
septic surgery, as the salt is unirritating. It is also used as an
ointment.

Modes of administration of mercurials. ( i) By the mouth. Tha
Liquor Hydrargyri Perchloridi [B. P. which is corrosive mercuric chloride, I ;
ammonium chloride, I ; water, 1000] is often given to adults, usually in
doses of I to 2 fl. dr. [4. to 8. c.c.] For the later symptoms of syphilis, po-
tassium iodide is often combined with it. [Mercuric] iodide is formed and is
kept in solution by the excess of potassium iodide. Mercurous iodide, known
as the [yellow] iodide, is much used by some. It is insoluble in water, and
is incompatible with potassium iodide, red [mercuric] iodide and metallic mer-
cury being formed. The best preparation for children is ^ to I gr. [.03 to
.06 gm.] of gray powder, given just often enough to avoid purgation.

(2) By the rectum. Occasionally mercury is given as a suppository.
[Each may contain 5 gr. ; .30 gm. of mercurial ointment.]



222 INORGANIC MATERIA MEDICA.

(3) Endermically. Mercurials, especially calomel, are often dusted on
sores and ulcers, and lotions are also locally applied. Mercury can be ab-
sorbed in this way.

(4) By inunction. Blue ointment may be rubbed into the skin. The
best position is the inner side of the thigh. Usually a piece the size of the
top of the thumb, rubbed in once a day, is enough. It has been put inside
the sock, for then it is rubbed into the foot during walking. A very efficient
way of applying the ointment in children is to smear it on a flannel binder
which is worn round the abdomen. [The oleate may be employed for inunc-
tion ; this possesses the advantage of not staining the clothing.] Mercury is
rapidly absorbed by these means.

(5) Hypodermatically. One-eighth of a grain [.008 gm.] or less of
the [Corrosive] Chloride dissolved in about 5 to 8 minims [.30 to .50 c.c.] of
distilled water is used for a dose. The needle of a hypodermatic syringe is
plunged deeply into some muscles, preferably those of the gluteal region, and
to the outer side of it, so that the patient does not sit or lie on the spot. If
much pain is caused, a piece of ice may be held over the part before the injec-
tion and after the needle is withdrawn. The injection should be repeated
daily ; before going to bed is a good time. With proper care no abscesses
result. This is a very rapid and thorough way of bringing the patient under
the influence of mercury. Mercuric cyanide is also a good salt for subcu-
taneous injection.

(6) Fumigation. Calomel, [the black oxide, or the red mercuric sul-
phide known as Cinnabar (neither of the last two are official), may be] used.
The patient, who is naked, sits on a cane-bottomed chair ; a blanket, which
reaches to the floor, is fastened lightly round his neck. Twenty grains [1.20
gm. of the salt] are placed in a porcelain dish, over a spirit lamp, under the
chair. [The mercury] volatilizes, and is absorbed by the skin. A bath
should last twenty minutes j with obvious modifications this method may be
applied to patients in bed.

(7) Inhalation. This is rarely or never used.

(8) Baths of three drachms [12. gm.] of [corrosive] chloride to thirty
gallons [114 liters] of water, with one fluid drachm [4. c.c.] of hydrochloric
acid added, have been used, but they are now very rarely employed.

TOXICOLOGY.

Acute poisoning is [not] rare. Salts of mercury, especially the mer-
curic, produce severe gastro-intestinal irritation, causing great pain, vomiting
and diarrhoea. The corrosive [chloride] and white precipitate are the prepa-
rations usually taken. [In case of acute poisoning albumin, the white of an
egg (one being sufficient for 4. gr. ; .24 gm. of the corrosive chloride, the
albuminate re-dissolving in an excess), milk and flour are useful. Vomiting
should be induced by mustard and lukewarm water, apomorphine or by irrita-
tion of the fauces.]



THE SALTS OF ARSENIC. 22J

Chronic Poisoning. Ptyalism by mercury or its salts produces a train of
remarkable symptoms. They were very common when it was the practice to
give larger doses of mercurials than are now employed, and they are occasion-
ally seen in those who work in mercury. In the present day, when the patient
shows any sign of mercurialism, the dose is reduced. The symptoms (which
constitute hydrargyrism or mercurialism) may be brought about however
the mercury is taken. The first indications noticed are slight factor of the
breath and soreness of the gums when the teeth are [brought forcibly together,
by closure of the jaws. ] Then follows a disagreeable metallic taste in the
mouth, the gums become swollen and soft, and they bleed readily. Next
there is a considerable increase in the amount of saliva secreted. All these
symptoms gradually become more marked, and the tongue swells. The teeth
are now -loose, the saliva, which is thick and viscid, pours from the mouth, the
parotid and salivary glands are enlarged and tender, and there is a slight rise
of temperature. In olden days the symptoms occasionally ended in the falling
out of the teeth, extensive ulceration of the mouth and tongue, necrosis of the
jaw, great weakness, emaciation, anaemia, a watery state of the blood, a lia-
bility to haemorrhages, exhaustion and death.

More rarely the symptoms are, for the most part, nervous. These occur,
chiefly, if not entirely, among those who work in the metal and inhale the
vapor. The first to be observed is tremor, beginning in the face, then invading
the arm, and afterwards the legs. Early in the case the trembling is seen only
on movement ; soon it is permanent. It resembles paralysis agitans. Usually
there is considerable weakness of the affected muscles ("mercurial palsy").
There may be pains, and a weak mental condition is common. Nothing has
been found, post-mortem, to account for these symptoms.



GROUP VII.

Arsenic, Antimony, Chromium.

The compounds of these metals have several physiological and some
chemical points in common. The oxide of each is externally a powerful
caustic. Internally Arsenic, Antimony, and (as far as we know) Chromium
compounds are severe gastro-intestinal irritants. Arsenic and Antimony in
large doses both cause general fatty degeneration.

I. ARSENUM.

As=[74-9.]

i. ACIDUM ARSENOSUM. [Arsenous Acid. As. i O 3 =i97.68.
Synonyms. Arsenic Trioxide. White Arsenic.]

SOURCE. Arsenical ores are roasted and purified by sublimation.
CHARACTERS. [A heavy, solid, occurring either as an opaque, white



224 INORGANIC MATERIA MEDIC A.

powder, or in irregular masses of two varieties the one amorphous, trans-
parent and colorless, the other crystalline, opaque or white. Solubility. In
30 to 80 parts of cold, in 1 5 parts of boiling water. ]

INCOMPATIBLE. Lime water, iron salts, and magnesia.

IMPURITIES. Lime salts.

Dose, ^ to dr gr. ; [.ooi to .006 gm.]

Preparations.

1. Liquor [Potassii Arsenitis. Solution of Potassium Arsenite.
Synonym. Fowler's solution. Arsenous Acid, 10 ; Potassium Bicar-
bonate, 20 ; Compound Tincture of Lavender, 30. Boil in sufficient
distilled water to make 1000.] No decomposition occurs, but an alka-
line solution of arsenous acid is formed. Strength. i percent, of
Arsenous Acid.

Dose, 2 to 10 m. ; .12 to .60 c.c. "

2. .Liquor [Acidi Arsenosi. Solution of Arsenous Acid. Arse-
nous Acid, 10 ; is boiled with diluted Hydrochloric Acid, 50 ; and dis-
tilled water to make looo.] No decomposition occurs, but an acid
solution of arsenous acid is formed. Strength. I per cent, of Arse-
nous Acid.

Dose, 5 to 10 m. ; [.30 to .60 c.c.]

a. SODII ARSENAS. Sodium Arsenate. Na,HAsO 4 +7H,O[=
311.46.

SOURCE. Heat to redness Arsenous Acid, Sodium Nitrate, and Sodium
Carbonate ; dissolve the fused mass in water and crystallize. Sodium Pyro-
arsenate is formed. As J O J +2NaNO,+Na s CO 3 =Na 4 As/) 7 4-N 2 O s -f CO,. On
adding water to the Pyroarsenate, a solution of Sodium Arsenate, which crys-
tallizes on standing, is formed. Na 4 As J O 7 -|-HjO=2Na 2 HAsO 4 , which crys-
tallizes with 7H,O.

CHARACTERS. Colorless, transparent, monoclinic prisms, having a mild
alkaline taste. Solubility. In 4 parts of water.]

Dose, ^ to T V gr. ; [.002 to .006 gm.]

Preparation.

Liquor Sodii Arsenatis. [Solution of Sodium Arsenate. Syn-
onym. Pearson's solution. (Pearson's solution is really one-fifth as
strong as the official Liquor Sodii Arsenatis. )

SOURCE. Dissolve Sodium Arsenate, I ; deprived of its water of
crystallization by heat, in distilled water, 100.] Strength. I per cent
of Sodium Arsenate.

Dose, i to 10 m. ; [.06 to .60 c.c.]

3. ARSENI IODIDUM. [Arsenic Iodide. Asl,=454.49.]
SOURCE. Made by the direct union of Iodine and Metallic Arsenic [or
by mixing solutions of Arsenous and Hydriodic Acids and evaporating.



THE SALTS OF ARSENIC. 225

CHARACTERS. Glossy orange-red, crystalline masses, or shining orange-
red, crystalline scales, having an Iodine-like odor -or taste. Solubility. In 7
parts of water, and in 30 parts of Alcohol. ]

Dose, ^ to ^ gr. ; [.002 to .006 gm.]

Preparation.^

Liquor Arseni et Hydrargyri lodidi. See Mercury, p. 212.
4. FERRI ARSENAS. See Iron, p. 196.

ACTION OF ARSENICAL COMPOUNDS.

External. Arsenous acid has no action on the skin, but
applied to raw surfaces it is a powerful caustic.

Internal. Alimentary canal. Unless the dose be very small
all preparations containing arsenic are very severe gastro-intes-
tinal irritants (see Toxicology). Part at least of this effect is
due to excretion of the arsenic into the stomach after absorption,
for if given subcutaneously there may be no local effect, although
there is intense gastritis soon after injection. In minute doses
they are gastric stimulants, causing dilatation of the gastric ves-
sels and an increased flow of gastric juice. Small doses also
stimulate the duodenum.

Blood. Arsenic is absorbed into the blood. Nothing is
known of its physiological action there ; but it can, in some forms
of anaemia, increase the haemoglobin and the number of red cor-
puscles. Given to animals it considerably increases the red mar-
row at the expense of the yellow, and slightly stimulates the for-
mation of compact bone.

Circulation. In the frog the rapidity and force of the heart
are lessened till it finally stops. This is a local action, for it
takes place when applied to the excised heart. Large doses
destroy the capillaries and lead to haemorrhage.

Remote effects. In many diseases arsenic evidently profoundly
affects metabolism, for the patient recovers under treatment by
this drug. It is doubtful whether, if given in small doses to
healthy persons, it usually does more than sharpen the appetite.
It has been stated by Dogiel to unite with albumin ; another
view, that of Binz and Schulz, is that arsenous acid becomes
arsenic acid by taking oxygen from the protoplasm, but that the

15



226 INORGANIC MATERIA MEDICA.

arsenic acid subsequently yields up the oxygen again, and that
the activity of arsenic is due to its being a carrier of oxygen.
Some of the people in Styria eat white arsenic in small quanti-
ties, and it increases their strength, weight, and appetite, and
clears their complexion. It is probable that the reason why
these people can take arsenic in such quantities is that an anti-
toxin is developed in them. Wood concludes that small doses
of arsenic check tissue change and decrease nitrogenous elimina-
tion, whilst toxic doses have the opposite effect. But there is
no proof of any of these statements, and we have no certain
knowledge of the influence of arsenic on nutrition, nor do we
know of any action to which its beneficial effects in many dis-
eases can be referred ; but as the drug certainly in some way
alters the condition of the sufferer it is vaguely called an altera-
tive. It is eliminated by the urine, the alimentary canal, the
sweat, the saliva, the milk, and even the tears, but it is also
stored in the body, chiefly in the liver and kidneys. It may be
found many years after death in the bodies of those who have
taken it 'during life. It can pass from the mother to the foetus.

THERAPEUTICS OF ARSENICAL COMPOUNDS.

External. Formerly arsenous acid was used as a caustic to
destroy growths, lupus, warts, etc., either pure or as a paste.



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