1909 The Lancet  
SOME TOXIC EFFECTS OF THE COMMON ANTISEPTICS. IN a recent number of the Archives Générales de Médecine M. Mercade contributes a useful paper on the toxic effects that may follow the excessive use of some of the common antiseptic agents in surgical practice. Mercuric chloride rarely produces more than a local irritation, but occasionally its use is followed by signs that it has been absorbed. An immersion of the hands for five minutes in a solution of the salt has produced a metallic taste in
more » ... etallic taste in the mouth, and salivation, ulceration of the gums, and other symptoms of mercurial poisoning have been observed. The danger of such unpleasant symptoms is greatest when the antiseptic solution is retained in natural cavities or in the recesses of lacerated wounds. In such cases diuretics should be given to eliminate the poison, stimulants should be given for collapse, and stomatitis may be treated with potassium chlorate. Carbolic acid may produce local symptoms of a more or less severe character, including pain, erythema, an eruption of small vesicles, and gangrene. It is interesting to note that while strong solutions of carbolic acid are to be avoided, weak solutions may prove still more dangerous owing to the greater penetration of solutions containing less than 5 per cent. of carbolic acid. The danger of producing gangrene is increased by compression and by continuing the use of the dressings over a long period. In the early stages of gangrene the use of alkaline lotions is recommended, but in advanced cases surgical intervention may be necessary. In some cases the use of carbolised dressings is followed by general symptoms of carbolic acid poisoning, which are said to be relieved by the administration of a 5 per cent. solution of sodium or magnesium sulphate in order to convert the carbolic acid into an inert sulphocarbolate. It is well known that iodoform may produce an erythematous rash, but sometimes its use is followed by general toxic symptoms. In mild cases the symptoms noticed are distaste for food, nausea, agitation, insomnia, and occasionally delirium, iodides being found in the urine. In severe cases the onset is more sudden, gastric and mental disturbances being accompanied by a very rapid pulse. This condition may last for several days and may be followed by death from collapse if further absorption takes place. In such cases the use of iodoform should be stopped and medicinal treatment with opiates, bromides, and diuretics, with a 5 or 10 per cent. solution of sodium bicarbonate, is recommended. Boric acid, though usually considered harmless, has been known to produce severe and even fatal toxic symptoms. In one case death resulted from washing out the pleura with a 5 per cent. solution of this antiseptic. In another case, after the removal of inguinal glands, the wound was filled with powdered boric acid, with the result that after three days a local erythema was observed, accompanied by cyanosis, cold sweats, vomiting, and cold extremities. The temperature rose and the patient died in delirium. Hydrogen peroxide may cause pain when injected into the bladder and other cavities, and in the case of lacerated wounds it may open up fresh routes for infection owing to the rapid disengagement of relatively large volumes of oxygen from the liquid. In some cases the oxygen liberated has been known to enter the vessels and cause embolism. Bismuth subnitrate occasionally produces toxic symptoms when used as a dressing. It has recently become popular in the form of an injection, but several cases of poisoning have been reo corded. The symptoms include vomiting, diarrhoea, fever, and obstinate hiccough, the urine assumes a blackish tint, and a black line may appear on the gums which become painful. In such cases it is necessary to relinquish the use of bismuth in the form of the subnitrate.1 I Zinc chloride in strong solutions, or when allowed to remain in prolonged contact with the tissues, may produce sloughing. THE SICULO-CALABRIAN CATACLYSM. AMONG the victims of the recent earthquake which devastated portions of Calabria and Sicily were a number of medical men, many of whom have left widows and orphans. The Belgian Proyres Medical is anxious to get up an international subscription among the medical profession for aiding the widows and orphans of those medical men who have been killed or have disappeared owing to the results of the earthquake. A number of international committees have been formed in France, Germany, Russia, and other countries, and we bring the subject before our readers both as an appeal for their professional brothers who have suffered and as an instance of the solidarity of the medical profession. Members of the medical profession as a rule are by no means blessed with an overplus of this world's goods, but even a small subscription would be an earnest of goodwill, and be it remembered that a number of small subscriptions very soon mount up into a large one. Professor Jacobs of Brussels has kindly offered to receive any subscriptions for the fund which may be sent to him at Boulevard de Waterloo, 53, Brussels. -POISONING BY MUSCARINE. AN unusual cause of death is reported in the Phairromceutical Journal of Jan. 2nd. In September last a man, aged 33 years, applied a liniment for gnat bites. On returning home he became ill and died on Dec. 10th. The attendant physicians at first thought that he was suffering from multiple neuritis, but they subsequently came to the conclusion that the acute inflammation of the peripheral nerves was caused by muscarine poisoning. It was ascertained that after applying the liniment at night the patient was in the habit of rubbing off the scabs in the morning and then applying the liniment again. Sir James Barr and Dr Nathan Raw had not known a previous case like it and the former came to the conclusion that the cause of death was muscarine poisoning. The contents of two bottles of the liniment were examined by Dr. Benjamin Moore, who found that the chief constituents were soap and alcohol with a small amount of muscarine, a potent poison found in certain fungi. He said that it has the property of stopping the heart in a relaxed condition and causes paralysis of the nervous system. It could not be determined whether the poison had been taken or used by the deceased in sufficient quantity to cause death. On account of the idiosyncrasy of individuals to this poison the minimum quantity required to produce a fatal result is not known. The chief symptoms observable before death are paralysis of the limbs, followed by that of the muscles of respiration, death occurring from respiratory failure. Among other symptoms mentioned were great pallor of the skin, perspiration, and salivation. Dr. Moore, replying to the coroner, said that the usual cause of death from this poison was by eating fungi containing muscarine, and that in the opinion of experts it acted more potently through the 1 See the letter from our Paris correspondent on p. 582 of this issue.
doi:10.1016/s0140-6736(00)50238-4 fatcat:7a76z7xmrvc67mc6sdqkd6sbqq