upon intramuscular injections of an aseptic ergot, 1 mil (15 minims) and repeated in half an hour, if needed. Also reliance should be placed on coffee, especially if this can be retained in the stomach; or coffee may be administered by rectum. Camphor hypodermatically can be several times repeated. It is a mistake to give too much strychnine, pituitary extract, or epinephrine. In poisoning by some nervous depressants, especially morphine, it may be necessary for artificial respiration to be done for many hours.

5. The treatment of the convalescence, which may be protracted, naturally depends upon the character of the poison, the amount of damage that it has done, the length of time it takes that particular poison to be eliminated, and the seriousness of the pathology which the poison may have caused. The poisons that cause cerebral irritation, those that cause stupor, and those that cause severe cardiac depression (if the patient is to recover) are soon eliminated, and the patient is practically well. The poisons that corrode may have caused such ulceration as to produce, later, large cicatrices or perforation, therefore the future is sometimes long in doubt. Those drugs that may produce serious lesions, especially of the liver and kidneys, and those that destroy blood-corpuscles, as potassium chlorate, cause a long, tedious and anxious convalescence. The prevention and treatment of nephritis in corrosive sublimate poisoning will be found outlined under that special heading. A single poisonous dose of lead acetate or of arsenic would rarely cause chronic poisoning as occurs when these drugs are taken in small amounts for a long time.

The convalescent patient generally needs tonics, and especially iron, for some time. He may have circulatory weakness, and more or less severe gastrointestinal disturbances for many weeks. The treatment of these conditions need not be here outlined.

CORROSIVE SUBLIMATE (MERCURIC CHLORIDE) POISONING Owing to accident and to suicidal intent, and to the availability of corrosive sublimate tablets for antiseptic purposes, mercuric chloride poisoning has become very frequent.

The immediate symptoms of poisoning from corrosive sublimate are those of burning and irritation in the throat and esophagus, nausea, vomiting, and epigastric pain. The rapidity with which these symptoms develop depends upon whether or not the stomach is full. If the stomach is empty and the vomiting is more or less immediate, symptoms of intestinal irritation, as diarrhea, do not soon develop, but, if the poison remains longer in the stomach and with the food passes into the intestines, intestinal colic and diarrhea, with later symptoms of duodenal inflammation, occur. Blood is often vomited, and blood may later appear in the stools, and, if considerable amounts of the poison have been absorbed, nose-bleed may occur, and there may be hemorrhages from other parts of the body, especially from the uterus.

There may be cerebral symptoms, as convulsions and coma, or the patient may die in collapse. Later symptoms are referable largely to the kidneys; first an albuminuria, later suppression, general nephritis, and uremic death. Other, later symptoms are those of ulcer of the stomach and intestines, duodenitis, and sometimes jaundice. The patient may linger with these serious symptoms for several weeks before death occurs.

Treatment. If the patient has not already freely vomited, an emetic should be immediately given while other treatments are being prepared. It is well to have the vomitus examined for mercuric chloride, as sometimes the patient makes a mistake in what he has taken and is subjected to a long period of unnecessary treatment.

The researches of Lambert and Patterson1 and later modifications suggested by Fantus2 has developed the following suggestions for treatment:

On first seeing the patient he should be given the whites of three eggs, and then the stomach should be washed out. Later he is given a pint of egg albumin water and the stomach again washed out. After this a tablet suggested by Fantus, composed of sodium phosphite 0.36 Gm. and sodium acetate 0.24 Gm. should be dissolved and administered at once. If sodium

1 Archiv. Int. Med., Nov., 1915.

Journ. of Lab. and Clin. Med., 1916 and 1917.

phosphite cannot be obtained, a solution of sodium hypophosphite 1 Gm., hydrogen peroxide 5 mils and water 10 mils should be administered with water. Theoretically it has been estimated that if the amount of poison taken is known, ten times that amount of hypophosphite should be given, but if such an amount of hypophosphite is given, it should be immediately washed out with warm water by siphonage and then a smaller dose of the hypophosphite antidote given.

As subsequent treatment it seems best to give a glass of albumin water every second hour for some little time, and if much irritation of the stomach has been caused by the poison (which can be estimated by the amount of vomiting and pain, and whether or not the stomach was empty when the poison was taken) demulcents should be given, perhaps best starch water. I Gm. of sodium acetate dissolved in water may be given every three hours for a day or two after the phosphite or hypophosphite mixture has been stopped.

If the corrosive sublimate has had time to be absorbed in any amount, the next object of treatment is to protect the kidneys, and toward this end alkalies should be given, and plenty of water, and Lambert and Patterson suggest the drop method of rectal irrigation for this purpose, with a liquid carrying a solution of an alkali, about 4 Gm. (1 drachm) to 500 mils (a pint). They suggest potassium acetate, but probably the milder sodium citrate would act as well, and sodium salts are better than potassium salts. Also the colon should be irrigated twice daily to of sure and remove all mercury that may have reached that region, and it is well to wash out the stomach twice daily for the first few days, unless the patient vomits repeatedly, to be sure to remove any mercury that is excreted into the stomach.

As troublesome as the Murphy drip may be, Lambert and Patterson urge that it is necessary to repeat this treatment at short intervals until such time as two examinations of the urine on successive days have shown a negative test for mercury. They also urge that, if a very large amount of mercury was absorbed, or if the kidneys were previously damaged, the above treatment should be used intermittently for three weeks.

If acute nephritis actually develops, the treatment is of that lesion, and although Lambert and Patterson advise sweating and hot packs, this seems inadvisable. If the kidneys cannot act, it seems unwise to concentrate the poison in the blood by profuse sweatings. Also, if there is edema, it seems inadvisable to introduce large amounts of water into the system. Hot applications to the back are beneficial.

As there is a tendency to acidosis in all conditions where there is vomiting and where food cannot be administered, especially carbohydrates, alkalies are advisable, and the "imperial drink" suggested by Weiss' which consists of potassium bitartrate 4 Gm., sodium citrate 2 Gm., sugar 4 Gm., and a little lemon juice, in water up to 250 mils, makes a very pleasant method of administering the alkali. It is well to have the potassium bitartrate and the sodium citrate in powder form to dissolve in the lemonade just before it is to be drunk. This seems good treatment, for it not only offers a pleasant alkali but also sugar, and sugar and starches, as soon as starches can be retained, tend to prevent the acidosis that is likely to develop. Also to protect the kidneys, and especially if acidosis has developed, alkaline solutions may be injected into the colon.

In spite of these strenuous treatments and of the apparent success it is doubtful, if a poisonous dose has actually been absorbed, whether life can be saved; however, whether or not a lethal amount has been absorbed can never be determined at the time of the active treatment. Even excessive doses taken into the stomach may, for some reason, not be absorbed, and may be rapidly eliminated by the emetic measures inaugurated. On the other hand, a small poisonous dose may be largely and rapidly absorbed.

WOOD ALCOHOL (METHYL ALCOHOL) POISONING Methyl alcohol poisoning had occasionally occurred and been described, but lately poisoning from this substance has become very frequent on account of the prohibition laws. This deadly alcohol has been taken by accident; distributed by intent; and 1 Journal A. M. A., June 2, 1917.

1

used to adulterate all kinds of beverages. It has even been shown that producers and distributors have been perfectly cognizant of the fact that it was a deadly poison, and yet they have allowed innocent individuals, to suffer permanent injury or be killed by this alcohol. Hanging is too good for such miscreants.

Methyl alcohol occurs in the distillate of wood, while ethyl alcohol, grain alcohol, is obtained from the fermentation of grains and fruits. Beverages made from methyl alcohol can generally not be distinguished from those made with ethyl alcohol, although large amounts of methyl alcohol will furnish a distinctive odor. Chemically the ingestion of methyl alcohol is shown by a large increase of formic acid in the urine.

The primary symptoms of wood alcohol poisoning are dizziness, perhaps nausea and vomiting, some disturbance of vision, and more or less befogging of the brain. Later in some cases, rapidly in other cases, blindness occurs with the pupils widely dilated. If the poisoning is fatal, the circulation becomes weakened, there may be delirium, then coma and death. Blindness is probably rarely followed by recovery of vision, although the patient may live after blindness has occurred. Whether the blindness and cerebral symptoms are due to the formation of formic acid has not been determined, but there is no known antidote.

The only treatment of such poisoning is the rapid evacuation of the stomach, purging, and the administration of stimulants, as coffee and atropine. Perhaps it would be wise to do venesection and then introduce a physiologic saline solution into the veins.

So many times stupor and coma are due to acidosis, that it would seem wise to treat a case of methyl alcoholic stupor as though acidosis were the cause. Certainly it would do no harm, after the stomach had been emptied and an evacuating enema had been given, to introduce, both into the stomach and into the bowel, sodium bicarbonate and sodium citrate solutions.

The toxic dose of wood alcohol may vary, at least it has not been determined definitely, but repeated small doses apparently will cause cumulative poisonous effects. In animals who have