Bismuth subnitrate, in doses of 1 V, to 2 drachms, lowers the ratio of sulphuric acid compounds in patients living prin.
1 cipally on albuminoid diet. At the same time indican diminishes or entirely dis appears from the urine. This shows that putrid fermentation going on in the in testine diminishes in spite of the fact that, under the influence of bismuth, in testinal peristalsis has been suppressed. Desoto (Nev. Inter. de Then et Phan, Nov. 15, '95).
The use of the organic in place of the inorganic bismuth should be insisted on The compounds of bismuth with beta naphthol, phenol, tribromphenol, and tetraiodophenolphthalein are remedies which produce practical intestinal anti sepsis. They are indicated in all gastro intestinal fermentations and catarrhs until the symptoms are relieved, the dose to be determined by the severity of the symptoms. They are non-toxic and do not give rise to untoward symptoms. Wilcox (Med. News, July 31, '97).
Bismuth is poisonous when introduced under the skin. It should not, there fore, be employed subcutaneously under any circumstance.
Poisoning. — Poisoning may occur either from local application of bismuth preparations, from internal administra tion, or from subcutaneous injection.
A number of cases of poisoning re corded, produced by the absorption of insoluble preparations of bismuth when used as surgical applications, in which there was acute stomatitis, a blackened, ulcerated mucous membrane, followed by intestinal catarrh with pain and diar rhoea, and in severe cases by a true nephritis. Kocher (Volkmann's Samm. klin. Fort., No. 224, 'S7); Petersen (Deutsche med. Woch., June 30, 'Si).
Case of poisoning by bismuth. A young woman had a large burn on the back, which was powdered with subni trate of bismuth. A dark line appeared on the lips, with headache, nausea, vomiting, fever, and quick pulse, and the urine contained a small quantity of albumin. Neither lead nor arsenic was found by analysis in the bismuth em ployed. N. L. Wilson (N. Y. Med. Jour., Jan. 20, '94).
In the early studies of bismuth the effects of acute poisoning by the sub nitrate of bismuth were alone observed. More recently, however, injecting into dogs repeated doses of the compound at intervals of several days or hours has given results closely allied to those ob served in the human being by Kocher and Petersen. save that death followed in the train of these signs, which were, by reason of the large-size dose. very severe. Flccrations replaced the apli thous patches, the liver was found con , gested, and the coats of the large intes tine blackened. These changes come on in strong, healthy dogs weighing from j fourteen and one-half to fifteen kilo grammes (twenty-nine to thirty-five pounds). (Dalche and Villejean.) The distinction which is to be drawn between a stomatitis resulting from the prolonged use of bismuth and that which is commonly seen after continued closes of mercury consists in a lesser de gree of ptyalism. While the color of the
spot usually becomes black if caused by bismuth, it seldom becomes so dark in hue under the influence of mercury. The changes in the vascular system, which are caused by bismuth in chronic poisoning, consist in the dilatation of the blood-vessels, with consequent relaxation and congestion of the part.
Case of a patient who had been at tacked three times by a scarlatiniform erythema, followed by desquamation in patches, in consequence of having taken 30 grains of bismuth subnitratc that had been prescribed after an attack of diar rhoea. Amedee Dubreuilil (Bull. Gen. de Then, p. 229, '97).
Twins, 3 weeks old, given Squibb's subnitrate of bismuth in the dose of grains every two hours, increased to 15 grains each every two hours. Soon the bismuth passed from the bowels uncolored. The breath took a strong, garlicky odor, so much so that the mother remarked about the peculiar odor. The infants then slowly changed to a dark color, as if asphyxiated. In fants sleepy. Drug almost wholly with drawn; the cyanosis disappeared from both children as rapidly as it had come. A. S. Masson (Annals of Gynec. and Ped., July, '97)'.
Two cases in which, as the result of extensive burns upon the arm, bismuth dressings were applied, causing bluish discoloration, swelling. and superficial ulcers of the gums. These were only controlled when the bismuth still ad hering to the granulations was scraped off. Muehlig (Mlinchener med. Woch., Apr. 9, 1901).
Treatment of Poisoning. — The stom ach should be evacuated and the freshly prepared sesquioxide of iron adminis tered as the antidote to arsenic which is commonly combined with the native bis muth. Demulcents should be freely ex hibited, and stimulants as the case may require. Following the administration of the soluble salts of bismuth accumula tion in the liver may occur; but this is not likely to follow the use of the in soluble preparations.
Therapeutics.
LOCALLY.—.11any of the bismuth salts are useful when applied locally. The subnitrate of bismuth is a neglected remedy for external use. It has been found very useful in acute and chronic moist eczemas, as well as in intertrigo and excoriations in the region of the anus and genitalia in children. In fis sured nipples, herpes zoster, ulcers, and in affections of the mucous membranes it has also proved serviceable.
Of the many bismuth preparations, but one may be substituted for iodoform, namely: bismuth salicylate.
In the first period of the chancroid and in tubercular ulcerations of the skin, if the salicylate of bismuth is dusted once a day on the diseased area, after a few applications the granulations become florid and the lesions show a marked tendency toward cicatrization. H. Brin disi (Ther. Gaz., Mar. 15, '95).