POISONING WITH RED PRECIPITATE. 149 in eight ounces of lime-water. In a few days he had fetor of the breath, swelling and tenderness of the gums, with salivation. (Brit. Med. Jour., 1878, i. p. 367.) Analysis. It is known from corrosive sublimate by its insolubility in water, alcohol, and ether. It is known from white precipitate by its insolubility in acids and by its being blackened by alkalies. A mercurial sublimate may be obtained from it by heating it with dry sodium carbonate. Under certain conditions, this compound may be changed into corrosive sublimate in the stomach. (Pharm. Jour., Aug. 31, 1878, p. 164.) WHITE PRECIPITATE. Ammoniated Mercury.-The symptoms which this compound produces are violent vomiting, cramps, great thirst, purging, pain in the stomach and bowels, and convulsions. Tenderness of the gums and salivation have been observed. After death the results of inflammation of the stomach and bowels are seen. Experiments on dogs and rabbits have shown that this is a formidable poison. The greater number of recoveries have been probably owing to the substance being early ejected by vomiting. Rabbits (which do not vomit) were killed by doses of four and five grains in a few hours. After death, mercury was found deposited in various organs, but more in the kidneys than in the other viscera. (For additional facts connected with the action of this poison, see Guy's Hosp. Rep., 1860, p. 483.) A trial for attempting to poison by this substance took place in 1869. (Reg. v. Seaham, Maidstone Sum. Ass., 1869.) The compound is white, but, as the result of boiling, it gave a yellow color to the gruel in which it was administered. In Reg. v. Hargreaves (Manchester Lent Ass., 1866), a girl was convicted of an attempt to poison her father by this substance. The poison was put into milk and medicine. It produced a burning sensation in the throat and stomach, and thus led to suspicion. About ten grains of white precipitate were detected in some buttermilk. In February, 1873, a boy, æt. 12, was convicted, at the Central Criminal Court, of administering this poison feloniously in medicine. The prosecutor experienced a hot sensation, unlike the bitter taste he had before perceived. A white powder was found in the medicine, which proved to be white precipitate. Analysis. White precipitate is a chalky-looking compound containing about eighty per cent. of mercury. It is insoluble in water and alcohol. As sold, it frequently contains, as an impurity, corrosive sublimate to the amount of one or two per cent., separable by ether or alcohol. It is soluble in acids, not blackened by alkalies, and yields a mercurial sublimate when heated with carbonate of sodium. Stannous chloride produces with it a black deposit of mercury. If boiled in a solution of potash, it evolves ammonia and yellow oxide of mercury is formed. It may be detected in organic liquids and solids by boiling them in one part of hydrochloric acid and four parts of water. The mercury may then be separated by means of copper (see p. 148). It is not used internally, but it is much employed by the poorer classes in the treatment of ringworm. One RED PRECIPITATE. Mercuric Oxide. Red Oxide of Mercury.-This substance is poisonous, but instances of poisoning by it are rare. case occurred at Guy's Hospital in 1833. The patient recovered in four days. In another case a woman, æt. 20, swallowed a quantity of beer containing red precipitate. Four hours after she was in a state of stupor, with a weak, irregular, scarcely perceptible pulse, dilated pupils, cold and clammy skin, and copious discharge from the mouth. She had vomited once shortly before, and red particles were seen in the ejected fluid. There was pain in the abdomen. Under treatment the symptoms abated, but there was pain in the region of the stomach, a desire to vomit, much sali 150 SUGAR OF LEAD-SYMPTOMS. vation, and slight diarrhoea. She gradually recovered. (Brit. Med. Jour., 1878, ii. p. 101.) A case of recovery after the administration of 120 grains has been recorded. (Brit. Med. Jour., 1884, i. p. 56.) Analysis. By its great density and insolubility in water it may be separated from all liquids. Its red color is characteristic. When heated in a closed tube, it is resolved into oxygen and mercury, the latter being deposited in globules. Other compounds of mercury, such as the nitrates, the sulphates, the cyanide, and the sulphocyanide, have given rise to accidents, and in a few instances have destroyed life, but they very rarely require the notice of a medical practitioner. In February, 1891, two men died from the external application of nitrate of mercury as a remedy for an eruption of the skin. The sulphide (vermilion), on account of its insolubility, is probably quite inert. When heated in a dry state with anhydrous carbonate of sodium, all the compounds of mercury yield sublimates of the metal in globules. All the liquid and solid compounds give a dark precipitate of mercury when boiled with stannous chloride. CHAPTER XIII. DEATH. POISONING WITH LEAD.-SUGAR OF LEAD.-SYMPTOMS.-APPEARANCES AFTER SUGAR OF LEAD. Acetate of Lead.-Symptoms.-Acetate or sugar of lead is by no means an active poison. In medical practice it has often been given in considerable doses without any serious effects resulting. When from one to two ounces have been taken, the following symptoms have been observed: a burning, pricking sensation in the throat, with dryness and thirst, vomiting, and uneasiness at the pit of the stomach, followed by severe colic. The abdomen is tense, and the skin covering it is sometimes drawn in. The pain is intermittent and relieved by pressure. There is generally constipation of the bowels. If any feces are passed, they are commonly of a dark color, indicative of the conversion of a portion of the lead into sulphide. The skin is cold, and there is great prostration of strength. The pulse is slow. When the case is protracted, the patient has been observed to suffer from cramp in the calves of the legs, pain in the inside of the thighs, numbness, and sometimes paralysis of the limbs. The affection of the nervous system is otherwise indicated by giddiness, torpor, and even coma. A well-marked blue line has been noticed round the margin of the gums, where they join the teeth. (For a remarkable series of cases of poisoning by acetate of lead, see Lancet, 1849, i. p. 478.) In 1882 a woman was convicted (Reg. v. Louisa Jane Taylor, C. C. c., Dec. 1882) of the murder of Mrs. Tregelles, an aged female, by the repeated administration of acetate of lead. The administration extended over several weeks; and the editor found the body largely impregnated with SUGAR OF LEAD-CHEMICAL ANALYSIS. 151 lead--more especially the stomach. The symptoms were colic, vomiting, blackening of the teeth, paralysis, and at the last epileptiform convulsions. Appearances. In one fatal case of acute poisoning the mucous membrane of the stomach was destroyed in several places, especially near the intestinal opening, and the greater part of the intestines were in a state of acute inflammation. In animals, according to Mitscherlich, when the dose is large the mucous coat of the stomach is attacked and corroded; this change appears to be purely chemical, and takes place in those parts of the body with which the salt of lead comes in contact. If given in a small dose, it is decomposed by the gastric secretions and exerts no corrosive action on the mucous membrane. When acetate of lead was given in a state of albuminate dissolved in acetic acid, death took place with great rapidity; but on inspection, the stomach was not found corroded. This corrosive action belongs to the neutral salt, and is not manifested when the dose is small or when the poison is combined with an acid. Nothing is actually known concerning the fatal dose of this substance; but it may be taken in comparatively large quantity without producing serious effects. Thirty or forty grains have been given daily in divided doses without injury. Chemical Analysis. Acetate of Lead as a solid.-1. If a portion of the powder is heated in a small reduction-tube, it melts, then becomes solid; again melts, acquiring a dark color, and gives off vapors of acetone and acetic acid, easily recognized by their odor and reaction on litmus-paper. A black mass is left in the tube, consisting of carbon and reduced metallic lead. No sublimate is formed. If heated on mica, yellow oxide of lead with reduced metal remains. 2. It is very soluble even in cold water; spring water containing carbonic acid and sulphates is turned milky by it. 3. A small portion of the powder dropped into a solution of iodide of potassium acquires a bright yellow color. 4. When dropped into solution of potash it remains white. 5. In sulphuretted hydrogen water or sulphide of ammonium it is turned black, in which respect it resembles the white salts of some other metals. 6. When the powder is boiled in a tube with diluted sulphuric acid, acetic acid, known by its odor and volatility, escapes. All these properties taken together, prove that the salt is acetate of lead. Fig. 15. Acetate of Lead in solution.—1. A small quantity, slowly evaporated on a glass slide, will give slender white prismatic crystals (see Fig. 15), which are turned yellow by iodide of potassium and black by sulphide of ammonium. 2. Diluted sulphuric acid produces an abundant white precipitate, insoluble in nitric acid, but soluble in hydrochloric acid and in a large excess of potash. 3. It is precipitated of a yellow color by iodide of potassium. The yellow iodide of lead is soluble in potash, forming a colorless solution. It is also dissolved by concentrated hydrochloric acid and by hot water. Sulphide of ammonium, or sulphuretted hydrogen gas, produces a black precipitate, even when less than a 100,000th part of the 4. fied 80 diameters. salt is dissolved. 5. Place a few drops of Crystals of Acetate of Lead, magnithe solution on clean platinum-foil, acidulate with acetic acid, then apply, through the solution, to the surface of the platinum a thin slip of polished zinc-dark-bluish crystals of metallic 152 DETECTION OF LEAD IN THE TISSUES. lead are instantly deposited on the zinc; by this method a small quantity of the metal may be detected and separated. Lead in organic liquids.-Acetate of lead is precipitated by many Thus we may organic substances, especially by albumen and tannin. have to analyze either an organic liquid containing lead, or a solid precipitate consisting of mucus or mucous membrane, or albumen combined with lead. The liquid should be filtered and examined by a trial test, i. e. either by adding to a portion sulphuric acid, when sulphate of lead is precipitated, or by exposing filter paper, dipped into the suspected liquid, to a current of sulphuretted hydrogen gas. If the paper is not stained brown, there is not much lead dissolved; if it is stained brown, we dilute the liquid to destroy its viscidity, should this be necessary, and pass into it a current of washed sulphuretted hydrogen gas until a precipitate ceases to form. The black sulphide of lead should be collected on a filter, washed, and dried; then boiled for a quarter of an hour in a mixture of one part of nitric acid diluted with four parts of water. This has the effect of transforming it, at least in part, into soluble nitrate of lead. This liquid, when filtered, may be evaporated to dryness, the crystalline residue dissolved in water, and the tests for lead then applied to the solution. If the quantity is too small for the application of all the tests, we may first add sulphuric acid; should a white precipitate be formed, soluble in potash (free from lead), and this alkaline solution be again turned black by sulphide of ammonium, this is sufficient evidence of the presence of lead. Should there be no lead dissolved, we must decompose the solid and insoluble matters by boiling them with dilute nitric acid, filter, and test the filtered liquid, previously neutralized; or we may evaporate at once to dryness, destroy the organic matter by heat, and redissolve the residue in nitric acid for testing. In the tissues.-The organic matter, such as a part of the liver or any other organ, should be dried, and afterwards incinerated in a porcelain vessel. The ash should be heated with a small quantity of dilute nitric acid and evaporated to dryness. The dry residue should be digested in a small quantity of distilled water (free from lead), filtered, and, after it has been slightly acidulated with nitric acid, a current of washed sulphuretted hydrogen gas should be passed into it. The production of a brown color or a brown precipitate in a slightly acid liquid indicates the presence of lead. The precipitate may be dissolved in nitric acid and further examined. Lead may thus be detected in the dry residue of urine. All liquid and solid organic substances containing lead yield the metal or its oxide by incineration in a porcelain capsule. Goulard's Extract is a solution of subacetate of lead, containing thirty-five per cent. of the salt; and Goulard Water is a mixture of two drachms of this solution in a pint of water. The effects of these compounds, when swallowed or applied locally, are similar to those produced by the acetate, but are more severe. RED LEAD. This is a mixture or compound of the protoxide and peroxide of lead, much used in the arts. It has occasionally acted as a fatal poison. Dey relates the case of a woman who died from its effects in four or five hours, after convulsions. (Lond. Med. Rec., 1882, p. 117.) WHITE LEAD. Subcarbonate of Lead.-This is an insoluble, chalkylooking compound, which, like other salts of lead, may give rise to the usual symptoms of lead-poisoning. In one instance it appears to have proved fatal. White lead has been used as a cosmetic to give a fair complexion. It is liable to absorption, and to cause the usual symptoms of poisoning. The cosmetic liquid of Madame Rachel consisted of a lead CHRONIC LEAD-POISONING. 153 compound with fuller's-earth, starch, and hydrochloric acid. Such a compound applied to the skin clearly would set up irritation in the skin and be most injurious to health. Most of the cases of poisoning by this substance have been of a chronic character, carbonate of lead being one of the products of the action of water upon lead. Buchner has also reported the history of a family poisoned by lead accidentally introduced as white lead into flour in a mill. (Freidreich's Blätt. f. Gerichtl. Med., 1884, p. 161.) Chronic Poisoning.-Colica Pictonum, or Painter's Colic, may be considered as the usual chronic form of poisoning by carbonate of lead. The disease is not, however, confined to an affection of the intestinal canal (colic), though this is the most common symptom. There is a peculiar form of paralysis-lead paralysis, or "wrist-drop;" pains in the joints, often termed "rheumatic;" and a peculiar form of cerebral affection, of a fatal character, the prominent symptoms of which are epileptoid convulsions simulating ordinary epilepsy and ending in coma. The symptoms of lead-colic are usually well marked. There is at first pain, with a sense of sinking commonly in or about the region of the navel (the seat of the colon). Next to pain there is obstinate constipation, retraction of the skin of the abdomen, loss of appetite, thirst, a fetid odor of the breath, and general emaciation; with paralysis of a peculiar kind affecting the extensor muscles, and causing a dropping of the wrist, or showing itself in a general paralysis of the limbs. The skin acquires a sallow color, generally well marked in the face; and the patient experiences a sweetish, styptic, or astringent taste in the mouth. A symptom of a peculiar nature was first pointed out by Burton (Med. Gaz., vol. 25, p. 687), namely, a blue line on the edge of the gums where these join the bodies of the teeth; the teeth are of a brownish color. The blue line on the gums may be regarded as a distinguishing sign of lead-poisoning. It is owing to the deposition of lead in these structures a fact proved by the action of chromic acid on the excised gums. When touched with it they acquire a yellow color (chromate of lead), and when afterwards treated with an alkaline sulphide they become black from the formation of sulphide of lead. (Lancet, 1878, i. p. 913.) Lead-palsy usually comes on after several attacks of colic. It shows itself first, and most prominently, in the extensor muscles of the forearm -the muscles supplied by the musculo-spiral nerve; hence the supinator longus muscle escapes. The disease, however, is not always confined to the forearm. The dropped hand, and the inability to raise it, give rise to the term "dropped wrist." Epileptiform convulsions ending in coma are a late affection, in severe cases, as e. g. among workers in whitelead factories, and are commonly a fatal affection. The editor has met with several such cases. Hair-washes generally contain a salt of lead in solution. The use of them may lead to all the symptoms of chronic lead-poisoning. Chronic poisoning with lead often kills the patient, since a great amount of mischief is usually done before the cause is discovered. The appearances found after death have been a contraction of the cavity of the large and small intestines, a considerable thickening of their coats, and degeneration of the kidneys. The contractions have been especially noticed in the colon -the seat of colic. The various circumstances under which this form of poisoning is liable to occur are elsewhere fully described. (See ON POISONS, p. 409.) One of the most frequent causes of chronic lead-poisoning is the use of water kept in leaden cisterns or pipes; or the careless employment of |