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Title: Memoranda on Poisons
Author: Tanner, Thomas Hawkes
Language: English
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MEMORANDA ON POISONS.
WORKS BY THE SAME AUTHOR.
_Tanner’s Practice of Medicine._
Fifth American from the Sixth London Edition. Greatly Enlarged and
Improved.
Price, bound in cloth, $6 00; in leather, $7 00.
_Tanner’s Practical Treatise on The Diseases of Infancy and Childhood._
Third American Edition, Revised and Enlarged, by Alfred Meadow, M.
D.
Octavo. Cloth, $3 50.
_Tanner’s Index of Diseases and their Treatment._
With upwards of 500 Formulæ for Medicines, Baths, Mineral Waters,
Climates for Invalids, etc., etc.
Octavo. Price, $3 00.
MEMORANDA
ON
POISONS.
BY THE LATE
THOMAS HAWKES TANNER, M.D., F.L.S.
_THIRD AND COMPLETELY REVISED EDITION._
PHILADELPHIA:
LINDSAY & BLAKISTON.
1872.
HENRY B. ASHMEAD, PRINTER.
EDITOR’S PREFACE.
The present edition of Dr. Tanner’s “Memoranda on Poisons” is in some
respects almost a new book. It was, as will be seen by the Author’s
Preface to the last Edition, Dr. Tanner’s object to furnish the
practitioner with a useful guide to his duties in cases of poisoning.
Experience has, however, shown that the book is more useful to the
student than to the practitioner; and, with a view to render it still
more valuable to the former, it has in great measure been remodelled.
Whilst, therefore, due attention has been paid to what might be called
the clinical aspects of poisoning, its chemical bearings have been more
closely attended to; and the more important and reliable tests have in
each instance been given, as have also the more important processes for
separating poisons from organic admixture. Sick of the old and
clumsy classification of poisons into Irritants, Narcotics, and
Narcotico-Irritants, the editor has endeavored to form some more
rational groups of toxic agents. These groups are, it is true, quite
provisional; and they are somewhat similar to those adopted by Dr. Guy
in his admirable textbook on Forensic Medicine. They have, however, been
worked out independently, whether they be worth anything or no. Briefly
they are these:—
Corrosives.—Simple Irritants, Mineral, Vegetable, and Animal.—Irritant
Gases.—Specific Irritants, Mineral, Vegetable, and Animal.—Neurotics:
subdivided into Narcotics, Anæsthetics, Inebriants, Delirants,
Convulsives, Hyposthenisants, Depressants, Asphyxiants,—and Abortives.
Such a grouping is far from perfect; but it would be impossible to have
anything worse than that still in general use. It is with the hope of
rendering this little volume more generally useful these changes have
been made: a reason at all times all-powerful with its lamented Author.
A. S.
AUTHOR’S PREFACE
TO THE SECOND EDITION.
These Memoranda are intended to refresh the memory of the practitioner
on a subject which is not brought under his notice so frequently as many
other departments of medicine. They are especially adapted to show at a
glance the treatment to be adopted in each particular instance of
poisoning to which a medical man is liable to be summoned.
There seems reason to fear that the crime of slow poisoning is more
extensively practised in the present day than is generally believed. The
study of the following pages will, it is hoped, put the physician on his
guard; and prevent his attributing to natural disease symptoms due to
the villainous administration of deadly drugs.
HENRIETTA STREET, CAVENDISH SQUARE.
CONTENTS.
CHAPTER I.
PAGE
Definition and Mode of Action of Poisons 13
CHAPTER II.
Diagnosis of Poisoning—Duties of the Practitioner 19
CHAPTER III.
Duties of the Practitioner—Treatment of Poisoning 24
CHAPTER IV.
Detection of Poisons 28
CHAPTER V.
Classification of Poisons 32
CHAPTER VI.
The Concentrated Mineral Acids 36
CHAPTER VII.
The Corrosive Vegetable Acids 43
CHAPTER VIII.
The Caustic Alkalies and their Carbonates: Potash, Soda,
Ammonia 48
CHAPTER IX.
Salts of the Alkalies and Alkaline Earths 52
CHAPTER X.
Salts of the Metals: Zinc—Silver—Tin—Bismuth—Chrome—Iron 54
CHAPTER XI.
Simple Vegetable and Animal Irritants 57
CHAPTER XII.
Irritant Gases 59
CHAPTER XIII.
Iodine and Iodide of Potassium 61
CHAPTER XIV.
Phosphorus 63
CHAPTER XV.
Arsenic and its Compounds 66
CHAPTER XVI.
Antimonial Compounds 78
CHAPTER XVII.
Mercury and its Compounds 81
CHAPTER XVIII.
Preparations of Lead 85
CHAPTER XIX.
Salts of Copper 89
CHAPTER XX.
Specific Vegetable Irritants 92
CHAPTER XXI.
Specific Animal Irritants.—Cantharides 92
CHAPTER XXII.
Narcotics.—Neurotics, acting on the Brain and producing
Sleep: Opium 95
CHAPTER XXIII.
Anæsthetics.—Neurotics acting on the Brain and producing
Insensibility: Chloroform—Chloral—Bichloride of
Methylene—Ether—Amylene—Nitrous Oxide 102
CHAPTER XXIV.
Inebriants.—Neurotics acting on the Brain and producing
Intoxication: Alcohol—Nitro-Benzole—Cocculus
Indicus—Fungi, &c. 108
CHAPTER XXV.
Delirants.—Neurotics acting on the Brain and producing
Delirium: Hyoscyamus—Belladonna—Stramonium—Datura
alba—Nightshade 112
CHAPTER XXVI.
Convulsives.—Neurotics producing Convulsions: Nux
Vomica—Brucia—Strychnia 116
CHAPTER XXVII.
Hyposthenisants.—Neurotics producing Death by Syncope:
Aconite—Prussic Acid 122
CHAPTER XXVIII.
Depressants.—Neurotics producing marked depression of the
Heart’s Action: Digitalis—Calabar Beans—Tobacco—Hemlock 129
CHAPTER XXIX.
Asphyxiants.—Noxious Gases, producing Neurotic Symptoms 134
CHAPTER XXX.
Abortives.—Substances producing Abortion 137
APPENDIX 139
INDEX 151
TOXICOLOGICAL MEMORANDA.
INTRODUCTION.
CHAPTER I.
DEFINITION AND MODE OF ACTION OF POISONS.
Toxicology (τοξικὸν poison, and λόγος discourse,) is that branch of
medical science which treats of the nature, properties, and effects of
poisons.
It appears scarcely possible to give any definition of a poison which
will bear a critical examination; insomuch that some have preferred to
deal with the evil effects of any substance, that is _poisoning_, rather
than with the substance itself, the so-called _poison_. Most medicines
are poisonous in improper doses; and even common salt (chloride of
sodium) has caused death.[A] Dr. Guy defines a poison to be any
substance which, when applied to the body externally, or in any way
introduced into the system, without acting mechanically, but by its own
inherent qualities, is capable of destroying life. A cherrystone may
cause death by becoming arrested in the vermiform appendix, and thus
producing peritonitis; boiling water may cause death also; but neither
are poisons: the one acting mechanically, the other by its heat merely.
Any substance which can injure the health or destroy life is regarded as
a poison, if given with the _intent_ to do mischief. The words of the
statute (1 Vict. c. 85, sec. 2) are—“Whoever shall administer, or cause
to be taken by any person, any poison, or other destructive thing, with
intent to commit murder, shall be guilty of felony, and being convicted
thereof shall suffer death.” Sometimes poisons are administered, not for
the purpose of destroying life, but of causing some slight injury or
annoyance. An Act passed in March, 1860 (23 Vict. c. 8), provides for
the punishment of a guilty person under these circumstances. If life be
endangered, or “grievous bodily harm” result, the administrator may be
found guilty of felony, and sentenced to penal servitude for a term not
exceeding ten years. If the intent be only to “injure, aggrieve, or
annoy,” the crime is reduced to a misdemeanor, punishable with an
imprisonment for not more than three years.
In accordance with the Pharmacy Act certain substances have been defined
as poisons within the meaning of the Act, so as to put some restriction
on their sale to the public.
Poisons may be introduced into the body in various ways and in various
forms. Thus they may be administered by the mouth or by the rectum, and
they may be given in the form of solids, liquids, or gases, uncombined,
or mixed with various matters. Some agents are more readily absorbed
than others; whilst some textures permit of absorption taking place more
quickly through them than other tissues. Thus, the most diffusible
poisons prove most rapidly fatal, especially when introduced directly
into the circulation by a wound in a vein, or when they are injected
into the subcutaneous connective tissue. Their action is also speedy
when applied either in a gaseous state to the pulmonary air-cells, or as
a fluid to that of the stomach or intestines. The serous membranes, too,
possess an activity of absorption almost superior to that of the mucous
membranes; while absorption through the skin is slow, on account of the
cuticle. Poisons taken into the stomach when that viscus is empty,
necessarily act much more speedily than when it is full. It is
remarkable that the agents which most affect the nervous system do not
appear to act at all when applied directly to the brain or trunks of
nerves. There are also some poisons, as that of the viper, which,
although most deadly when introduced into the blood through a wound, are
harmless when swallowed.
The effects of poisons may be considered as _local_ and _remote_.
The _local_ effects are mainly of three kinds, viz., _corrosion_, or
chemical decomposition, as is seen in the effects of the strong mineral
acids and alkalies; _irritation_ or _inflammation_, varying from simple
redness, in its mildest, to ulceration and gangrene, in its most severe
degree, such as may result from the use of corrosive sublimate; and _a
local specific effect_, produced on the sentient extremities of the
nerves, as is felt on the local application of prussic acid, aconite,
&c.
The _remote_ effects are those influencing organs remote from the part
to which the poison has been applied. These may be either common
or specific; _common_, such as the constitutional indications
of inflammatory fever, however produced; _specific_, like the
constitutional effects of opium over and above its local influences in
relieving pain, &c. Various narcotic poisons produce but little local
change, though their remote effects are very remarkable. For example,
belladonna, in whatever way it may be introduced into the system,
paralyzes the ciliary nerves and so causes dilatation of the pupil. Many
substances have both a local and remote action, as is well seen in the
influence of cantharides upon the part to which they are applied, and
their remote effects upon the urinary organs.
These remote effects must be induced by one of two modes, or, as some
contend, by both: by _absorption_, that is, by the passage of the
poisonous particles into the blood; or by _sympathy_, that is, by an
impression transmitted through the nerves.
In the present day every one allows that poisons may become absorbed,
and that, provided they produce poisonous effects at all, they are
absorbed, in whatever way they may have been applied to the body. But it
is sometimes asked, Is this absorption necessary for their action? The
following evidence may be briefly noticed as in some degree affording an
affirmative answer to this question. Magendie divided all the parts of
one of the posterior extremities of a dog, the artery and vein being
reconnected by quills, so as to preclude the possibility of the effects
being conveyed by the nervous filaments supplying the coats of the
vessels; on applying a portion of upas tieuté to a wound in the foot,
the symptoms of poisoning occurred, and death took place in ten minutes.
If the veins leading from a poisoned part be tied, the arterial and
nervous communication being complete, the symptoms of poisoning do not
occur. Mr. Blake introduced some prussic acid into the stomach of a dog,
through an opening in its parietes, after he had ligatured the vessel
entering the liver (the vena portæ, which, directly or indirectly,
receives the gastric veins); no effect ensued until the removal of the
ligature, within one minute of which proceeding the poison began to act.
And lastly, not only has prussic acid been discovered in the blood of an
animal which perished in thirty-five seconds, but in some experiments
made by Mr. Erichsen, in a case of extroversion of the bladder,
prussiate of potass was found in the urine within one minute of its
being swallowed on an empty stomach.
The chief argument in favor of a _sympathetic_ or direct nerve action,
is the almost instantaneous manner in which some poisons act; fatal
effects occurring, it is said, before sufficient time has elapsed to
allow of absorption. It has, however, been proved that the round of the
circulation may be accomplished much more speedily than has been
imagined. Thus, the ferrocyanide of potassium injected into the jugular
vein of a horse was discovered throughout the entire venous system in
twenty-seconds; and Mr. Blake has inferred from his experiments that a
poison may be diffused through the body in nine seconds. It may
therefore be concluded that in most instances poisons act by being
absorbed and conveyed with the blood to the different organs which they
impair, or the nerve centres which rule the functions of these; some
paralyzing the heart when they reach it, some affecting the brain or the
spinal cord, some stopping the play of the lungs and others acting upon
the different glands. Nevertheless, in view of the extreme rapidity with
which death is brought about in a few instances, the possibility of a
direct shock to the nervous system causing death must not be overlooked.
The action of a poison may be variously modified, and the modifying
circumstances must be carefully taken into consideration in the
formation of a prognosis and in suggesting a line of treatment.
The _quantity_ or _dose_ is the most important of these; many substances
which are deadly in large doses being exceedingly useful as remedies in
small quantities; such are prussic acid, opium, digitalis, arsenic, &c.
Then again, the _mechanical_ and _chemical_ state of aggregation are
all-important; a solid being usually much less active than a fluid or a
gas, and a pure substance much more active than one mixed with insoluble
materials. Even more important is the chemical constitution of the
poisonous agent; as already pointed out, poisonous effects result from
absorption of the poisoning body and absorption implies solution; the
more soluble, therefore, the compound is, the more speedy are its
effects, whilst compounds insoluble in water or any of the juices of the
body are inert. It is not, however, enough that the substance be
insoluble in water; it must be so also in the gastric juice, or it may
give rise to characteristic symptoms. Thus, calomel is insoluble in
water, yet it is a powerful medicine; orpiment is insoluble in water,
yet when swallowed, it may give rise to symptoms of arsenical poisoning,
and so on. As already pointed out, the mode in which the poison is
introduced into the body is of great consequence in estimating its
effects. Then again the _mental_ and _bodily condition_ of the recipient
must be taken into account. Thus, in excited maniacs doses of medicines
may be given without producing any effect which in ordinary individuals
might give rise to serious consequences. The bodily condition,
especially as influenced by habit, is still more important. It may be
broadly stated, that by gradually increasing the dose of a substance
ordinarily poisonous, in course of time enormous quantities may be borne
without producing immediate ill effects. This is especially seen in the
practice of opium eating and smoking, and in a less degree in arsenic
eating, as practised in Styria. The latter instance is, however,
contrary to the usual rule; for whereas with vegetable substances, such
as opium the dose requires to be constantly increased to keep up the
effects, with minerals, the contrary seems to be the case, especially
with antimony and mercury, which cannot be long given without danger to
the recipient.
CHAPTER II.
DIAGNOSIS OF POISONING—DUTIES OF THE PRACTITIONER.
The chief characteristics of poisoning mentioned by authors of repute
are, that the symptoms commence suddenly after taking any substance or
fluid into the stomach, the individual being in a state of health; that
they increase steadily, and are uniform in their nature throughout their
course; and that they prove rapidly fatal. There are many exceptions to
these rules. Thus if the stomach be loaded the appearance of the
symptoms will often be delayed some few hours. Sleep, according to Dr.
Christison, may retard the action of some agents; so that if a person
fall asleep soon after swallowing arsenic or strychnia, for example, no
effect may ensue for four or five hours. Intoxication will mask the
effect of narcotics. Again, the individual poisoned may possibly be
suffering from disease, and an agent may be given which will only
aggravate existing symptoms. The fact must not be forgotten that
sometimes a poisonous draught is substituted for a harmless medicine.
And lastly, after a poison has manifested its effects the symptoms often
remit for a time.
When poison is administered with a criminal intent it is generally in
such a dose as to take immediate effect, although this is by no means
necessary, as there are numerous substances which accumulate in the
system, and when given in small and repeated quantities, ultimately
prove fatal. It must also be remembered that there are many diseases, as
malignant cholera, internal hemorrhage, &c., which commence suddenly,
and rapidly run to a fatal termination. In inflammation of the stomach
or intestines the symptoms often set in suddenly, and might be mistaken
for poisoning; such is also the case in intestinal obstruction, and
especially in ulceration and perforation of the bowels. So also in
organic diseases of the heart, where the symptoms may have remained
latent for some time, death often occurs suddenly from syncope. The
diagnosis of the effects of irritant poisons is not so difficult as it
is in the case of narcotics or other neurotics, where the symptoms are
very similar to those produced by apoplexy, epilepsy, tetanus,
convulsions, or disease of the brain.
Generally speaking, a person may be supposed to be suffering under the
effects of a poison, if soon after taking food or drink, he be seized
with violent pain, vomiting, disorder of the alimentary canal, and
convulsive movements: or if he be attacked under the same circumstances
with vertigo, delirium, or great drowsiness. It must not be forgotten,
however, that poisons may be introduced into the body, not only by the
mouth, but also by means of suppositories and enemata, or in females by
vaginal injections, or by inhalation, or by subcutaneous injection, or
through the true skin after the removal of the cuticle. Should death
ensue, the presumption of unfair play will of course be strengthened by
the discovery of post-mortem appearances similar to those known to be
produced by the poison from which the person apparently suffered.
The post-mortem appearances, however, except in a few instances, are not
very characteristic; nevertheless they may be of great _negative_ value
in proving that a certain poison has not been administered, or that the
patient died from the effects of disease. Two symptoms, excessive
lividity of the body and early putrefaction, formerly supposed to
indicate death by poison, are now known to frequently follow other modes
of death. It may nevertheless be remarked, that the appearances after
death which may be produced by poisons are, in one great class, the
signs of inflammation of the alimentary canal; in another, the signs of
congestion of the nervous system; and in a third, a combination of the
two.
The detection of poison in some of the food which has been left untaken
or in the matters vomited would seem to be conclusive evidence of the
administration of poison; but it is to be recollected that designing
persons have mixed noxious materials with food or rejected matters, in
order to feign poisoning, or to cast unjust imputations upon others.
When called to a case of supposed poisoning during life the
practitioner’s duty is two-fold. His first aim must of course be to
preserve life (see next chapter); his second, to forward the interests
of justice. But if he reaches the spot too late to save life his duties
are undivided, for he has but to see that justice is done, and in order
that there be no failure it is important that all his observations be
committed as speedily as possible to writing. He should inquire the time
at which any substance was last taken, the nature of the symptoms, the
hour at which they commenced, and the precise time at which death
occurred. He must take possession of any food, medicine, vomited
matters, urine, or fæces which may be in the room; and if possible he is
to seal them up, in new and clean vessels, duly labelled, for
examination. Then the position and temperature of the body are to be
observed, the appearance of the countenance, the presence or absence of
rigor mortis, with the nature and warmth of the apartment, the situation
of any marks of violence, and the condition of the inside of the mouth
and gullet. In addition to the ordinary rules to be observed in
conducting post-mortem examinations in cases of suspected poisoning,
something more must be done with a view to preserving portions of the
body for subsequent examination. The alimentary canal is the most
important organ to be thus secured, and it should be removed in separate
portions. A double ligature should be passed round the œsophagus in
the chest, and the duodenum a few inches below the pylorus should be
secured in like manner; by cutting across the gullet and gut between
these ligatures, the stomach may be removed without any danger of
spilling its contents. It is best to open the stomach after it has been
introduced into the receptacle prepared for it, so that its pathological
condition may be noted as early as possible. Another ligature should be
tied low down in the rectum, and the intestines removed and introduced
into a separate vessel prepared for them and then examined like the
stomach. Sometimes it may be necessary to remove the gullet in like
fashion. As much blood as possible should be saved for the chemist, and
a portion of the liver, if not the whole organ, should also be secured.
When everything has been tied up, the jars should be sealed, numbered,
labelled, and initialled, to prevent subsequent confusion and to
facilitate identification. In women the vagina, uterus and ovaries must
be inspected, the brain, spinal cord and thoracic viscera ought likewise
to be examined, and portions of the spleen, kidneys, and muscles should
be reserved for analysis. No antiseptic or preservative fluid is to be
used. When possible it will be best to make the autopsy within
twenty-four hours after death; taking care to make the examination
patiently, thoroughly, and with a mind free from any bias. Poison may be
found in a body, and yet a question may arise as to its having been the
cause of death. Hence in these investigations every organ of the body is
to be examined, in order to learn whether any disease has existed
sufficient to account for the fatal result.
Any suspicious conduct on the part of those surrounding the poisoned
individual should be carefully noted. Acts of this kind arrange
themselves in three heads, as occurring before, or during the fatal
illness, or after death. With the first category the practitioner has
ordinarily nothing to do, but his attention to those coming under the
second and third is often of essential service to the ends of justice.
The kind of acts will suggest themselves to every one, and need not be
further referred to here.
CHAPTER III.
DUTIES OF THE PRACTITIONER—TREATMENT OF POISONING.
When the practitioner is called in to a case of poisoning while yet
there is life, he must set himself to preserve it in whatever way he
best can; in this of course he must be guided by circumstances, but
several broad rules may be laid down. All have one end, but the order
may be varied. That is best which is readiest, the grand rule being to
lose no time. Most of the modes of treatment come under one or other of
the three following heads:—1. GET RID OF THE POISON. 2. STOP ITS
ACTION. 3. REMEDY THE MISCHIEF IT HAS DONE.
1. _To get rid of the poison_ is ordinarily the first thing to be done,
but not always. To do so when the poison has been swallowed two means
may be employed: _vomiting_ or the _stomach-pump_.
The latter is one of the most certain means we possess of emptying the
stomach; and by means of it this viscus may be washed out, and the
antidote, if any be known, administered. In speaking hereafter, however,
of the treatment to be adopted in each particular instance it will be
seen that there are some cases, as poisoning by corrosives, in which
this instrument cannot be used; as it might not only cause laceration of
the tissues, but even perforation of the œsophagus or stomach. It is
hardly necessary to mention that in all cases a certain tact is required
in its employment; the tube having, on more than one occasion, been
introduced into the trachea, and the lungs injected with water, &c. It
is a good rule also to withdraw less fluid than is pumped into the
stomach.
Supposing, however, that this instrument is not at hand, or that it is
an improper occasion for its employment, recourse must be had to
vomiting, natural or artificial. Vomiting is, in many instances, one of
the first and most important signs of poisoning, especially by irritant
substances. When such is the case, it is only necessary to foster the
tendency by copious draughts of lukewarm water; but if there be no
vomiting and the stomach pump be not at hand an emetic must be given. Of
these remedies perhaps there is not one which can be generally used with
so much advantage as the sulphate of zinc in scruple doses; for not only
is it more rapid in its action, but its effects are less depressing than
those of any others. This last recommendation will appear the more
desirable when we remember that the absorption of poisons is promoted by
all lowering measures; and consequently, bleeding, the exhibition of
tartarised antimony, and the administration of drastic purgatives, ought
to be avoided. In poisoning by opium and other narcotics, the sulphate
of copper in eight or ten grain doses will often excite the stomach to
act when other emetics have failed. Ipecacuan wine (six or eight
drachms) is a useful agent in many cases; or if a warm stimulating
draught be needed a scruple of powdered ipecacuanha, with the same
quantity of the sesquicarbonate of ammonia, may be administered in a
wineglassful of water. In the absence of these, mustard proves an
excellent substitute; a teaspoonful or two being given in warm water,
and frequently repeated. Even common salt may be used with good effect.
Vomiting may also be excited by tickling the fauces, as well as by the
free administration of warm water or of hot greasy water.
_When the poison has been applied locally_, to prevent its absorption, a
ligature must be applied between the trunk and the wounded part, as near
the latter as possible; while the deleterious substance is to be removed
by free incisions and plentiful washings. Sucking by the mouth or by
cupping-glasses may also be employed.
2. _To stop the action of the poison if it cannot be readily and
immediately removed._—The means whereby this is effected is ordinarily
the administration of an antidote. As no universal antidote is known,
the treatment will of course vary with the substance taken. This will be
fully explained when speaking of each particular poison.
An antidote, according to Orfila, should possess the following
properties:—It should be capable of being taken in a large dose without
danger; it should act upon the poison, whether liquid or solid, at a
temperature equal to or below that of the body; its action should be
quick; it should be capable of combining with the poison, though
shielded by the gastric juice, mucus, bile, or other substances
contained in the stomach; and lastly, it should deprive the poison of
its deleterious properties.
Antidotes mostly operate by forming harmless chemical combinations, or
by producing insoluble compounds, and thus preventing or delaying
absorption. In most cases they have no effect upon the constitution; but
some may be looked upon as a kind of counter-poison. Thus, the
antagonistic action of opium and belladonna seems fairly made out, and
we might perhaps include under this head chloroform, as in some degree,
an antidote to strychnia.
Dr. Garrod has described a series of experiments in which he employed
purified animal charcoal as an antidote. Dogs, rabbits, and guinea-pigs
were the animals experimented on; while the poisons consisted of large
doses of opium, belladonna, aconite, nux vomica, arsenic, and other
drugs. They were given without mischief when sufficient animal charcoal
was administered simultaneously, or, in some instances, before the
peculiar effects of the destructive drug were developed. This substance
seems to act in a great measure mechanically, but it has also a power of
absorbing alkaloids which may render it useful. Such substances as
magnesia and gruel are sometimes given with the view of protecting the
walls of the stomach, with doubtful benefit.
3. _To remedy the mischief done, and obviate the tendency to
death._—Unfortunately, in a great number of instances, too long an
interval has elapsed between the exhibition of the poison and the time
when the first-mentioned indications can be fully carried into effect;
for, as before implied, if absorption has taken place, direct antidotes
will be of little avail.
Our object must then be to palliate the symptoms as they arise, as well
as to neutralize the _effects_ of the poison on the constitution, by
remedies of an opposite character. Thus in poisoning by depressing
agents and narcotics, or such as destroy the nervous force, all lowering
measures must be avoided, and agents used which will exert a contrary
effect, as stimulants, cold effusion, galvanism &c. The shock to the
nervous system must also be taken account, and appropriate remedies
employed to aid it in rallying.
Thus direct injection of liquid ammonia into the veins has been found
successful in the treatment of snake bite in Australia, by Professor
Halford and others.
Claude Bernard has shown the importance of particularly attending to the
way in which the poison destroys life. For example, curare paralyzes the
motor nerves, puts a stop to all motion, suspends respiration, and so
brings on suffocation; yet by keeping up artificial respiration for a
sufficient length of time, life may be preserved till the poison is
eliminated and the danger over. Strychnia attacks the sensitive portion
of the nervous system; but if the external excitement, which perpetually
provokes reflex action and thereby brings on fatal convulsions, be
guarded against, recovery may ensue. A frog, poisoned by strychnia,
rapidly dies if frequently excited; whereas left perfectly quiet under a
bell-glass, it will, cæteris paribus, recover.
Lastly, we must endeavor to promote the elimination of the poison from
the body, by exciting the excreting functions; for which purpose, in
poisoning by arsenic, after the stomach has been well emptied, Orfila
has proposed the employment of diuretics, because it has been found that
this poison, like most others, is carried off in large quantities by the
urine.
CHAPTER IV.
DETECTION OF POISONS.
The detection of a poison is, in many instances, no easy matter; it
should not therefore be rashly undertaken, except by one well skilled in
the minutiæ of the processes to be adopted; but on the other hand, there
are so many points of practical importance which may be noted by the
practitioner in charge, that his attention should be specially directed
to these. The exact determination of the cause of death will depend
partly on the symptoms noted during life and on the appearances
found after death. These come within the province of the ordinary
practitioner; on the other hand, the special physical, chemical and
physiological portion of the inquiry should be referred to the expert.
In a book of this scope it is impossible to give full details with
regard to these last, but a brief sketch nay be useful.
The physical examination, say of the contents of the stomach and
intestines, should commence with noting the smell, color, and general
appearance of the matters submitted for examination. The odor, for
instance, may be useful in indicating the presence of prussic acid, of
alcohol, of opium, or of phosphorus. The color may indicate the presence
of salts of copper, of fragments of cantharides, &c. The general
appearance may give some clue to the mode of introducing the poison, the
kind of food or drink used to conceal it, &c. Seeds of poisonous plants
may be found: this is especially the case in India, where the seeds of
datura are frequently used for criminal purposes; or the poisonous
substance may have been administered in such quantity that a portion of
it may at once be secured for analysis. This not unfrequently happens in
poisoning by arsenic. It is not enough to employ the naked eye in
examining these suspected matters; a hand lens of some power should be
used; in this way characteristic crystalline forms, botanical
peculiarities, and such like, may be made out.
Still these are merely introductory to the most important part of the
research, which ought to be undertaken systematically, especially if
the quantity of material to be operated on is small. Most frequently the
matters to be examined are mixed, some soluble, some insoluble; but
there may also be submitted for analysis portions of the pure substance.
The object of the analyst is to obtain the substances which he has to
examine chemically in as pure a condition as possible, so that there may
be no doubt about the results of his testing; also, of course, to
separate active substances from those that are inert, all being mixed
together in the stomach and alimentary canal. Again, in dealing with
such fluids as the blood, or the tissues of the body, their natural
constituents must be got rid of before the foreign and poisonous body
can be reached. There is this difficulty further to contend with: that
some of the most poisonous of substances are of unstable composition and
readily altered by chemical reagents; to this group belong many
vegetable and most animal poisons. These, therefore, must be treated
differently from the more stable inorganic compounds. With an inorganic
poison we may destroy all organic materials mixed with it, trusting to
find it still recognizable after the process; not so with an organic
substance: that must be separated by other than destructive means.
When the mixture submitted for examination consists of bodies perfectly
soluble and perfectly insoluble, simple filtration may suffice to secure
their separation; but this is rarely the case, some colloidal material
being ordinarily mixed with the crystalloid, and the plan of separating
them by _dialysis_, as proposed by Graham, not being altogether
successful. When the substances looked for are volatile, distillation
may be employed to secure them in a state of purity; in this way
prussic acid is separated; but in the case of the poisonous alkaloids
other means must be adopted.
I. In the separation of such an alkaloid as strychnia, for example, the
suspected material is first of all acidulated by one of the weaker
mineral or stronger vegetable acids (hydrochloric acid is best), and the
whole carefully heated over a water bath. After a time this mixture is
to be filtered, and the filtrate well washed with boiling distilled
water, and the filtered fluid subjected to evaporation. When dry the
substance is to be rubbed up with distilled water, and again filtered;
this process to be repeated until a tolerably pure product be obtained.
This is next to be neutralized by hydrogen sodium carbonate, or
bicarbonate of soda, and the freed alkaloid taken up by rubbing or
shaking it with chloroform or ether, and the whole set aside in a
well-corked tall test tube. Finally, the ether or chloroform containing
the alkaloid is to be removed by a pipette and allowed to evaporate
spontaneously, when the alkaloid will probably be left behind in a state
fit for testing. This process is a modification of that invented by
Stas, in following out the case of the Count Bocarmé.
II. For the destruction of organic matter in the search for an inorganic
poison, such as arsenic, a process introduced by Fresenius and Von Babo
is commonly employed. Its essentials are as follows: The organic matter
is to be reduced to as fine shreds as possible, and mixed with about
one-eighth of its bulk of pure hydrochloric acid. This is to be heated,
and, as it boils, from time to time crystals of potassic chlorate are
added, until the solids are reduced to a straw-yellow fluid. This is
next treated with hydrogen sodium sulphite, or bisulphate of soda,
until a distinct smell of sulphurous acid is given off, after which
sulphuretted hydrogen is to be passed through the fluid, concentrated if
necessary, for some hours, thus throwing down most metallic poisons in
the form of sulphide. This precipitate is to be collected and further
tested.
When exceedingly small quantities are dealt with the microscope is of
use, and the plan of subliming alkaloids and examining their crystals
under the microscope, introduced by Guy and Helwig, will be found very
useful. The shape of crystalline poisons is a valuable means of
determining their identity; arsenic and antimony may thus be readily
distinguished, as may other well known substances.
The spectrum has not yet been applied to toxicological research,
although it has been employed to determine the existence of a blood
stain.
CHAPTER V.
CLASSIFICATION OF POISONS.
There is nothing more difficult in toxicology than to give a
satisfactory classification of poisons, insomuch that some have fallen
back on the no-classification, or natural history system, and grouped
poisons as mineral, vegetable, and animal, according to their source. In
despair of achieving anything better, a modification of the old and
well-known system is here followed, poisons being classed as Corrosives,
Irritants (Simple and Specific), and Neurotics; the latter group is,
however, further subdivided, something in the same way as that adopted
by Dr. Guy. The group of corrosives should comprehend all which by
contact destroy the bodily textures, and so occasion death. These same
substances, when diluted, may be incapable of destroying the tissues
directly, but may do so by setting up inflammation; these with certain
others having like effects, would form the group of simple irritants.
They kill by virtue of their secondary effects on the constitution. But
some substances, like arsenic, are not only capable of inducing local
inflammations, with their secondary effects, but are also possessed of
certain specific and well marked properties differing in each case.
These are _specific irritants_.
Neurotics comprehend all poisons whose effects are mostly referable to
the nervous system, necessarily a most diverse group, which we are not
yet in a position to minutely analyze. Some, however, act mainly on the
brain, some on the spinal cord, some on certain nerves only, or on the
vasomotor system of nerves; some act it is hardly possible to tell how.
There was an old group of _septic_ poisons; to this might still be
referred certain noxious gases, such as sulphuretted hydrogen; or were
it made to include all poisons acting directly on the blood, it would
include the still more dangerous gas, carbonic oxide.
The following table exhibits these subdivisions, and some of the poisons
contained in each:
{ { Sulphuric.
{ Strong Mineral Acids { Nitric.
{ { Hydrochloric.
{
CORROSIVES. { Vegetable Acid Oxalic.
{
{ Alkalies { Strong Alkalies.
{ { Alkaline Carbonates, &c.
{ The above diluted.
SIMPLE IRRITANTS { Lime.
{ Zinc.
{ Silver, &c.
{ Arsenic.
{ Mercury.
SPECIFIC IRRITANTS { Antimony.
{ Phosphorous.
{ Iodine, &c.
{ Opium.
{ Prussic Acid.
{ Chloroform.
NEUROTICS { Belladonna.
{ Aconite.
{ Strychina.
{ Conium.
{ Tobacco, &c.
_Irritant_ poisons give rise to pain in the stomach and bowels,
faintness and sickness, and purging with tenesmus. The evacuations are
often tinged with blood, the pulse is feeble and irregular, and the skin
cold. Many of the substances of this class from irritating the tissues
with which they come in contact, produce a severe burning sensation in
the mouth and œsophagus, as well as in the stomach. The degree of
local destructive action produced will of course vary in proportion to
the amount of the vehicle with which the noxious agent may be diluted.
Irritants cause death by inducing collapse or convulsions, or by
exciting severe inflammation; or, after a variable interval, by leading
to stricture of the œsophagus. The diseases which most resemble the
action of irritants are, malignant cholera, severe diarrhœa, colic,
gastritis, enteritis, rupture of the stomach or intestines, and
obstruction of the bowels, mechanical or otherwise.
The symptoms of apoplexy, epilepsy, and uræmia bear a resemblance to
those caused by some of the poisons of the neurotic class. Others give
rise to delirum with spectral illusions or convulsions. Sometimes there
is tetanus, sometimes coma or syncope. Diseases of the brain and spinal
cord, likely to be confounded with these, are often very insidious in
their progress, and hence may suddenly give rise to suspicious symptoms.
The history, mode of attack, &c., will generally negative any suspicion
of poisoning.
I.—CORROSIVES.
CHAPTER VI.
THE CONCENTRATED MINERAL ACIDS.
The first division of the Corrosive consists of the Strong Mineral
Acids. In this chapter we have to review the effects, &c., of the acids
commonly encountered, which are Sulphuric Acid, Nitric Acid,
Hydrochloric Acid, or a mixture of two or more of them.
SULPHURIC ACID (_Oil of Vitriol_).—This heavy, oily looking liquid is
met with in two states, concentrated and diluted; and being extensively
employed in commerce and manufactures is much more frequently used as a
poison than the other mineral acids. Many infants and young children
have been poisoned by it; occasionally also men, under the influence of
drink. The acid is not unfrequently thrown over the person, either to
disfigure the features or to destroy the clothes. The parts of the body
with which it is brought into contact are stained at first of a white,
and afterwards of a dark brown or black color. The smallest fatal dose
of concentrated acid recorded, in the adult, is one drachm; but recovery
has taken place after as much as two ounces. But it must be understood
that the acid proves fatal mainly by its power of corrosion, so that a
small dose of the concentrated acid is more dangerous than is a much
larger dose of it in the dilute form. The average period at which death
occurs is from sixteen to twenty-four hours; but on the other hand,
death may not occur for months, and may only follow the organic changes
induced by cicatrization following the swallowing of the acid, or the
malnutrition following its destructive action on the coats of the
stomach.
_Tests._—It is not within the province of these Memoranda to treat of
the various processes by which poisons are to be detected; for to make a
trustworthy analysis requires the skill of a professed chemist, whose
assistance should be allowed in these medico-legal investigations. Where
the character of a dead man or the life of a supposed criminal is at
stake there must be no chance of error. The ordinary tests will,
however, be briefly described, if only to help the physician to treat
the case more satisfactorily than he could do by merely guessing that an
irritant or narcotic had been employed:
Concentrated sulphuric acid is usually a brownish colored liquid, which
chars or corrodes wood or other organic matter brought into contact with
it, and when mixed with water gives out heat. When diluted, its presence
may be thus detected:
1. The liquid is known to be acid by its action on litmus paper.
2. Add to a portion of the suspected liquid a few drops of nitric acid,
and then a solution of nitrate of barium; a white precipitate (sulphate
of barium) will fall if sulphuric acid be present. This test is
extremely delicate; for although other acids yield a precipitate on the
addition of nitrate of barium, yet as such deposits are all soluble in
nitric acid the previous addition of this acid will prevent their
formation.
3. The precipitate should next be collected, dried, and reduced with
charcoal by the blow-pipe flame to the condition of barium sulphide.
This, when treated with a drop of hydrochloric acid, gives off
sulphuretted hydrogen, known by blackening paper dipped in acetate of
lead solution.
To examine a piece of cloth stained with this poison it is only
necessary to boil it in distilled water and then apply to the liquid the
barium test as before.
NITRIC ACID (_Aqua fortis_, _Red Spirit of Nitre_).—This substance has
been employed as a poison for upwards of four centuries. Like the oil of
vitriol it is found in commerce in a concentrated and in a diluted
state. Cases of poisoning by it are rare. It produces a yellow stain on
the skin. Two drachms is the smallest quantity which has destroyed life;
but less than this would probably prove fatal, if it produced much
corrosion about the wind-pipe. Death has occurred from it, in one hour
and three quarters; the average would be within twenty-four hours.
Several cases ending fatally have followed the inhalation of the fumes
of this acid, probably by inducing very extensive inflammation of the
lung.
_Tests._—The concentrated acid may be known by its orange-colored
irritating fumes, and by its action on copper, tin, or mercury.
1. When poured on copper-filings, effervescence takes place, a red acid
vapor is given off, and a green liquid remains (solution of nitrate of
copper).
2. In a diluted state it is detected by its acid reaction; by no
precipitate being obtained by nitrate of barium or by nitrate of silver,
proving the absence of sulphuric and hydrochloric acids; further, by
neutralizing the liquid with potass, evaporating it, and then procuring
crystals of nitrate of potassium, in the form of lengthened fluted
prisms, which are permanent in the air. These crystals may be powdered
and moistened with strong sulphuric acid, when a colorless acid vapor
(nitric acid) will be evolved. Or the powdered crystals may be mixed
with an equal bulk of fine copper filings, moistened with water, and
treated with a few drops of sulphuric acid; when ruddy acid fumes will
be given off.
3. Other tests for nitric acid are, (_a_,) its action on morphia, which
it turns red: (_b_,) its action on green iron sulphate, which it
blackens; (_c_,) a trace of it along with sulphuric acid gives with
narcotine a blood red color; and finally, (_d_,) along with hydrochloric
acid it dissolves gold.
HYDROCHLORIC ACID (_Muriatic Acid_, _Spirit of Salt_).—Not more than
half a dozen cases of poisoning by this acid have occurred in the last
fifteen or twenty years in this country. In May, 1859, a woman
sixty-three years old was admitted into King’s College Hospital within
three-quarters of an hour of swallowing half an ounce of the strong
acid. She had burning pain in the throat and stomach, vomiting of brown
shreddy matters, and great prostration. Death occurred in eighteen
hours, from the corrosive action of the poison. This is the smallest
dose which has been known to prove fatal.
_Tests._—The concentrated hydrochloric acid of commerce is of a
yellowish color, it fumes in the air when strong, and produces dense
white fumes with the vapor of ammonia.
1. It may be identified by boiling with black oxide of manganese;
chlorine being given off, which is known by its odor, color, and
bleaching properties.
2. When diluted, its presence is ascertained by nitrate of silver
causing a dense white precipitate (chloride of silver). The chloride is
distinguished from other salts of silver by (_a_,) its insolubility in
nitric acid, and in caustic potass; (_b_,) by its being soluble in
ammonia; (_c_,) by its melting and forming a horny mass when dried and
heated.
MIXED ACIDS.—These acids being used for commercial purposes when
mixed—_the nitro-muriatic_ (aqua regia) to dissolve gold, and the
_nitro-sulphuric_ (aqua reginæ) to dissolve silver—might occasion their
being employed as poisons. _Sulphate of indigo_, which consists of a
solution of indigo in strong sulphuric acid, has proved fatal in cases
where it has been accidentally taken.
_Symptoms, Treatment, &c._—The _symptoms_ produced by the mineral acids
are much the same in all cases. There is violent, burning pain in the
mouth, œsophagus, and stomach, commencing _immediately_. The burning
is followed by retching and vomiting of a dark colored liquid with
shreds of mucus, and portions of the mucous membrane of the œsophagus
or stomach. The inside of the mouth is shrivelled and more or less
corroded unless the agent has been given in a spoon or otherwise passed
over the tongue to the back of the fauces. The outside of the lips and
mouth will probably present the stains characteristic of the acid used.
There is great thirst, difficulty of swallowing, and impeded
respiration. The bowels are confined; the urine scanty or suppressed.
Next succeeds great exhaustion, the pulse becomes quick and feeble, and
the skin gets cold and clammy. The countenance is anxious and expressive
of great suffering; death speedily occurs, the intellectual faculties
remaining clear to the last.
These acids may prove fatal without entering the stomach by causing
asphyxia, the chink of the glottis becoming closed by swelling of the
fauces, &c. They have sometimes been administered by the vagina, rectum,
&c., and been poured into the ear during sleep.
Where recovery takes place from their immediate effects there is always
fear of death resulting at the end of one or two years from stricture of
the œsophagus, and even at an earlier period, unless proper treatment
is adopted. Occasionally one of the secondary effects of sulphuric acid
has been profuse salivation.
The _post-mortem appearances_ are the following: The body may have a
healthy appearance. Usually there are stains about the mouth, fingers,
and wherever the cuticle has been reached by the acid. The inner surface
of the mouth, fauces, and œsophagus, is usually white and corroded,
or dark brown and shrivelled, the mucous coat being easily detached. The
epiglottis and glottis are usually swollen. The gullet resembles the
mouth in most respects. The outer surface of the stomach and intestines
is very vascular, that of the former being sometimes corroded and
occasionally perforated. The stomach is sometimes contracted, sometimes
distended with gas, and contains a thick, dark brown fluid; its inner
surface has a charred, blackened appearance, the mucous membrane between
the rugæ being of a scarlet hue. The pylorus is mostly contracted; while
the inner coat of the duodenum and small intestines presents a similar
appearance, in a less degree, to that of the stomach. When perforation
occurs it usually takes place posteriorly, and the edges of the rent are
softened. The escaped matters may have acted on the adjacent viscera.
According to Casper, after poisoning by sulphuric acid the bodies resist
putrefaction for some time, owing perhaps to the acid neutralizing the
ammonia of decomposition. It may be the same with the other mineral
acids.
_Treatment._—Bicarbonate of soda, or calcined magnesia, or the
carbonate of magnesia, should be immediately given, mixed in milk or any
mucilaginous fluid; the doses being continued at short intervals, until
it may be inferred that the acid is neutralized. In the absence of these
remedies substitutes may be found in chalk, whiting, soap and water, or
the plaster of the apartment beaten up with water. Oleaginous and
mucilaginous fluids, as olive oil, linseed tea, barley water, milk
gruel, &c., may be freely given, either alone, or as the vehicles of the
antidote. The success of this treatment will depend upon the promptitude
with which it is adopted.
The stomach pump should not be employed; the disorganized and softened
state of the gullet and stomach, rendering them excessively liable to
perforation.
Should the larynx be affected and the breathing impeded, tracheotomy
must be at once had recourse to.
After a sufficiency of the antidote has been given the use of
mucilaginous diluents must be continued for some time, and the
subsequent treatment will be that for gastro-enteritis. Great benefit
will be derived from the use of oily enemata.
The external parts which have been injured by the acid should be well
bathed with soap and water, and treated like burns.
CHAPTER VII.
THE CORROSIVE VEGETABLE ACIDS.
OXALIC ACID (_Acid of Sugar_).—This is one of the most important
poisons with which we have to deal. From its cheapness and well-known
properties it is frequently made use of in cases of suicide, while from
its resemblance to Epsom salts it has on several occasions been taken in
mistake for that medicine. The smallest dose which is known to have
proved fatal is one drachm, which killed a boy æt. sixteen in eight
hours. Taylor relates the case of a woman, aged twenty-eight, who was
found dead one hour after swallowing three drachms of the crystallized
acid. Christison mentions an instance in which one ounce destroyed life
in ten minutes, and another case where the same quantity killed a girl
in thirty minutes. One example has been recorded where a fatal result
ensued probably within three minutes of the acid being swallowed.
The poisonous properties of the _Binoxalate of Potash_ (Salt of Sorrel,
Essential Salt of Lemons) are due to the oxalic acid it contains. This
salt, which exists in the leaves of the wood sorrel (Oxalis acetosella),
is sold to bleach straw, remove ink-stains, &c. It is very cheap; is
almost as powerful as oxalic acid itself, and gives rise to the same
kind of symptoms; it has been taken for the purpose of suicide, as well
as in mistake for the bitartrate of potash, or cream of tartar.
Oxalate of lime exists in considerable quantity in the leaves and stalks
of the common edible rhubarb (Rheum Rhaponticum). It can hardly be
considered poisonous.
_Symptoms._—The effects of poisoning by oxalic acid are peculiar. When
the dose is large (half an ounce or more) and the solution concentrated,
it proves very rapidly fatal. It produces a hot burning sensation in the
fauces and œsophagus in the act of swallowing, severe burning pain in
the stomach, and in most instances immediate vomiting. The vomited
matters are strongly acid, of a dirty green or black color, and consist
of the contents of the stomach with altered mucus and blood. The
remaining symptoms are a sense of constriction or suffocation, lividity
of the countenance, great prostration of strength, feeble pulse, cold
clammy perspirations, and convulsions, which speedily terminate in
death. When a smaller quantity has been taken, much diluted, its
corrosive properties are weakened or destroyed, but the nervous
symptoms, as cramps and numbness, may be well marked.
In cases of recovery the mouth may remain sore for some time, the tongue
swollen, the abdomen tender, the stomach very irritable, and there may
be troublesome diarrhœa. In two instances there has been loss of
voice for several days, owing to the action of the poison on the nervous
system. Twitching of the muscles of the face and extremities has also
been observed.
_Post-mortem Appearances._—The mucous membrane of the fauces,
œsophagus, and stomach is generally white and brittle, but often
colored with the brown mucous matter discharged. The stomach often
contains a black fluid, like coffee-grounds, consisting principally of
altered blood; and its sub-mucous coats are vascular and dark colored.
The stomach though seldom perforated, may yet be so softened as to be
with difficulty removed entire, and sometimes this is not possible. This
softening may be due to the post-mortem action of the poison; but its
effects during life in softening and bleaching the mucous membrane are
sufficiently marked. Occasionally the stomach is black and gangrenous
looking. If death has occurred quickly, the small intestines are seldom
much affected; but where the symptoms have been protracted there are
usually signs of congestion and inflammation.
_Treatment._—Chalk, whiting, or magnesia, suspended in water, or in
some demulcent fluid, must be administered immediately; and if
necessary, vomiting should be excited by tickling the fauces, or
administering emetics of sulphate of zinc and ipecacuan, followed by
large quantities of emollient drinks. The antidote, to be effective,
must be given as soon as possible, the plaster of the apartment, or any
form of mortar being used in the absence of the remedies just mentioned.
Alkalies (soda, potash, or their carbonates) are not only useless, but
they form salts with oxalic acid, which are as injurious as the acid
itself. When there are symptoms of collapse, stimulants are to be freely
employed.
From the tendency to softening, the stomach-pump should not be used.
_Tests._—Crystals of oxalic acid are met with as four-sided prisms,
colorless, without odor permanent in the air, and very acid; this last
character distinguishing them from crystals of sulphate of magnesia and
sulphate of zinc. The crystals, when heated, melt, and are dissipated
without combustion, and leaving no residue. This character is important
as a means of distinguishing oxalic acid from other similar crystals.
They are soluble in from eight to twelve parts of cold water. This acid
may be thus recognised in solution:
1. _Nitrate of silver_ throws down, with oxalic acid, an abundant white
precipitate (oxalate of silver), which is soluble in nitric acid. The
oxalate of silver, when dried and heated on platinum foil, detonates,
and is dissipated in a white vapor.
2. _Sulphate of calcium_ causes a white precipitate with oxalic acid
(oxalate of calcium) which is soluble in nitric or hydrochloric, but not
in any vegetable acid.
The solution containing the acid should be concentrated before testing,
if it be not present in considerable quantity.
Lime water and all soluble lime salts throw down precipitates with
oxalic acid; but as these are liable to be mistaken for a precipitate
with sulphuric acid, it is better to use sulphate of calcium which is
slightly soluble, as the test agent. A good deal of the test solution
must be used, and the precipitate takes time to settle.
3. _Sulphate of copper_ gives a faint bluish precipitate with oxalic
acid (oxalate of copper), which is not redissolved by a few drops of
hydrochloric acid.
These tests will not act if the solution contain nitric acid in excess,
in which case the liquid must be evaporated to crystallization, and the
crystals washed and redissolved in water.
These tests for oxalic acid should never be applied without previously
separating it from all organic matter. This is best done by first of all
acidulating the suspected fluid with acetic acid, and then adding
acetate of lead, which combines with the oxalic acid to form a white
insoluble salt, which may ordinarily be removed by filtration or
subsidence. This filtrate, after being well washed, is to be diffused in
water, and into this a current of sulphuretted hydrogen gas is to be
passed for some considerable time. This will throw down the lead as
sulphide, leaving the oxalic acid in the fluid; any organic matter will
also be carried down. Filtration will separate the solids from the
liquid containing the acid, which may now be evaporated until crystals
are formed, which may be tested in the usual way.
ACETIC ACID.—Although this acid, in its concentrated state, is highly
corrosive, yet it is very seldom brought under the notice of the
toxicologist.
In the case of a young woman reported by Orfila, death quickly occurred
after several attacks of convulsions. At the subsequent post-mortem
examination, the integuments of the dependent parts of the body were
found very livid; the tongue and œsophagus were of a dirty brown
color, the latter being intersected by a fine net-work of capillary
vessels; and the interior of the stomach was interspersed with black
elevations caused by the presence of coagulated blood in the sub-mucous
areolar tissue. The mucous membrane was entire.
As regards the _treatment_, it is only necessary to administer draughts
containing magnesia or its carbonate, followed by mucilaginous or
demulcent drinks.
TARTARIC ACID, though not a corrosive, may be here placed along with the
other vegetable acids. Strange as it may seem, tartaric acid has
destroyed life in at least one instance in this country; an ounce having
been given in mistake for an aperient salt. The deceased swallowed the
whole at once, and immediately called out that he had been poisoned. He
complained of intense pain in the throat and stomach, as if he had
swallowed oil of vitriol, or was on fire. Soda and magnesia were
administered without avail; and after death, at the end of nine days’
suffering, the stomach and intestines were found much inflamed.
CHAPTER VIII.
THE CAUSTIC ALKALIES AND THEIR CARBONATES; POTASH, SODA, AMMONIA.
The second division of the class of Corrosives has now to be considered.
It contains the Caustic Alkalies, and some of their Salts. Poisoning by
any of these agents is rare.
POTASH.—This substance, in its caustic state, as found in commerce, is
in the form of grey-colored cakes. It has an acrid taste, is soapy to
the touch, and very deliquescent. Moulded in cylinders, it is often
employed as a caustic (Potassa fusa). In solution (Liquor potassæ) it is
strongly alkaline, and imparts a brown stain to black cloth.
_Potassium carbonate_ or _Carbonate of Potash_ (Pearlash) is extensively
used by laundresses and in the dressing of woollen cloth. It is
generally sold in a granular condition, white, inodorous, and strongly
alkaline; it is soluble in water, but not in alcohol.
CAUSTIC SODA.—This agent resembles potash in its general properties.
The _Sodium Carbonate_ or _Carbonate of Soda_ (Soap-lees) bears a
similar resemblance to the carbonate of potash, except that it
crystallizes easily, and effloresces on exposure to the air.
AMMONIA.—When pure, ammonia is a colorless, pungent gas; but it is
commonly met with dissolved in water, as the liquor ammoniæ. Its vapor
is poisonous, and may prove fatal by producing inflammation of the
larynx and trachea, and even of the lungs. A case is recorded of a
French boy, æt. six, who killed his younger sister by making her swallow
several teaspoonfuls of a solution of ammonia. Other instances have also
occurred where the liquor ammoniæ has either been taken in mistake for
the aromatic spirit of ammoniæ, or purposely, to destroy life. An
instance is recorded by Dr. Taylor, as occurring in the practice of Mr.
Hilton, where liquor ammoniæ, given by mistake, caused corrosion of the
throat and gullet and obstruction of the bronchial tubes by false
membrane. The œsophagus was completely dissolved at its junction with
the stomach, and there was an aperture in the anterior wall of that
organ such as might have been caused by oil of vitriol.
The _Ammonium Carbonate_ or _Carbonate of Ammonia_ (Hartshorn, Smelling
Salts) has been used as a poison. It may be distinguished from other
salts by its being alkaline, by its entire volatility, and by its
pungent odor. A young woman in a state of unconsciousness, was made to
swallow a quantity of hartshorn. In an hour there was great pain,
sickness, and vomiting of blood. The hæmatemesis continued for some
days, and then feebleness and emaciation set in, death occurring in
three months. On examination the pylorus was found contracted to the
size of a crow-quill, while there was a large cicatrix on the posterior
wall of the stomach.
_Symptoms._—The chief symptoms occasioned by the foregoing poisons are,
an acrid, burning taste, with a sensation of excoriation and burning
extending along the mouth and throat, to the stomach. There soon ensue
exquisite pain in the epigastrium, and tenderness on pressure.
Frequently there is cough, hoarseness, dyspnœa, as well as vomiting
of altered mucus mixed with blood and detached portions of the mucous
membrane. The tongue, mouth, and fauces become swollen, soft, and
flabby, and deglutition is difficult. The surface of the body gets cold
and moist, the pulse small and feeble, and there is great pain over the
abdomen, with diarrhœa. Death took place, in the case of a boy, in
three hours from the time of swallowing a strong solution of carbonate
of potash. Ammonia, by its effect on the air passages, has proved fatal
in four minutes. When recovery from the immediate effects of the poison
has taken place, death has subsequently ensued from stricture of the
œsophagus, producing starvation. By the proper use of bougies, &c.,
life may occasionally be prolonged for many months, or even for years.
In some instances, however, it is almost impossible to effect
dilatation, owing to the whole of the gullet becoming thickened and
contracted, so that the opening into the stomach will hardly admit a
crow-quill. The pylorus may also be contracted in like manner.
_Post-mortem Appearances._—The mucous membrane of the mouth and gullet
is softened and inflamed, and portions of it detached. The coats of the
stomach and intestines are inflamed, stained of a dark color, and
sometimes ulcerated. When death has resulted from ammonia, signs of
inflammation are usually found in the larynx and bronchial tubes. The
other caustic alkalies may also destroy life by producing inflammation
of the glottis, which consequently may be found thus occluded after
death.
_Treatment._—The object must be to neutralize the poison, which may be
effected by a weak acid. Vinegar and water is perhaps the best
antidote, and that most readily procurable; its administration may be
followed up by freely allowing acidulated demulcent drinks, orange
juice, &c. The use of oil has been recommended, on the principle that it
converts the alkali into a soap. But that its efficacy is doubtful has
been in some measure shown by the death of two young children from
swallowing a mixture of ammonia and oil. In one of these cases nearly
two ounces of linimentum ammoniæ (made of one part of liquor ammonia to
two of olive oil) were poured down an infant’s throat by a child five
years old. Were, however, the oil given in much greater abundance, the
result would probably be different. At all events, its administration
should not be neglected.
_Tests._—The specific character of these substances is their strongly
marked alkalinity, ammonia possessing, over and above, that of
volatility. Potash is known from soda by being precipitated of a creamy
yellow by platinum perchloride, soda remaining unaffected by that
reagent.
II.—SIMPLE IRRITANTS.
CHAPTER IX.
SALTS OF THE ALKALIES AND ALKALINE EARTHS.
POTASSIUM NITRATE or NITRATE OF POTASH (_Nitre_, _Saltpetre_,
_Salprunelle_) is a more dangerous poison than is commonly supposed,
provided the dose be large. It has ordinarily been given in mistake for
other salts as a purgative, and in one instance, caused death in about
two hours, in another such instance, referred to by Orfila, an ounce
proved fatal in three hours. It produces symptoms of irritation in the
alimentary canal, vomiting, and diarrhœa. There is generally also
severe pain at the pit of the stomach, trembling of the limbs, scanty
urine, and collapse. Marks of violent inflammation are found after death
in the stomach and along the intestinal canal.
POTASSIUM SULPHATE or SULPHATE OF POTASH (_Sal Polychrest_, _Sal de
Duobus_, &c.) has proved fatal when taken in a large dose. It has caused
death in two or three cases when purposely administered to procure
abortion. Taylor quotes an instance of a lady, a week after delivery,
being directed by her medical attendant to take ten drachms of this
salt, in divided doses as a laxative. After the first dose she was
seized with severe pain in the stomach, with vomiting, &c., the symptoms
increasing after each dose, and proving fatal in two hours. At the
post-mortem examination the mucous membrane of the stomach and
intestines was seen to be soft and pale, and the stomach contained a
quantity of reddish-colored liquid. This, on being analyzed, was found
to contain no other irritant but this salt.
BITARTRATE OF POTASS or HYDROGEN POTASSIUM TARTRATE (_Cream of Tartar_,
_Argol_.)—This salt has caused death in one case at least, in which
about an ounce and a half was taken. The symptoms were those of an
irritant poison, with paralysis of the lower extremities. Death occurred
within forty-eight hours.
SULPHURET OF POTASSIUM (_Liver of Sulphur_) has also caused death as an
irritant poison.
_Treatment._—As no antidotes are known to these salts the treatment
must consist in producing vomiting as speedily as possible by means of
emetics; or the stomach-pump may be used. Demulcent drinks should be
freely given subsequently, with soothing applications to the bowels. Ice
may be given in any quantity.
LIME acts as an irritant poison, though a feeble one, when taken into
the stomach or applied to a vital part. One fatal instance is reported,
where a boy swallowed some lime in an apple-pie. He died in nine days,
after suffering from a burning pain in the abdomen, great thirst, and
obstinate constipation. Unslaked or imperfectly slaked lime may also
prove fatal by being inhaled, and so giving rise to inflammation of the
glottis.
BARIUM SALTS.—Two preparations of barium have caused death, viz., the
chloride and the carbonate. These may also give rise to specific nervous
symptoms, as cramps and convulsions.
_Chloride of Barium_ is found crystallized in irregular plates or
tables, which are permanent in the air, soluble in water, and of a
disagreeable bitter taste. Half an ounce has proved fatal in two hours,
after causing symptoms of irritation, with vertigo, paralysis and
convulsions.
_Carbonate of Baryta_ or _Barium Carbonate_, in its native state, occurs
in massive radiated crystals, very heavy, and nearly colorless.
Artificially prepared, as sold in the shops, it is a fine, tasteless,
odorless powder, almost insoluble in hot or cold water. One drachm is
said to have destroyed life, but recovery has taken place after a much
larger dose.
_Treatment._—The sulphate of soda or sulphate of magnesia, or some
earthy sulphate, should be speedily administered, by which the poison
will be converted into an inert insoluble sulphate of baryta. Emetics
should also be given, or the stomach-pump used.
CHAPTER X.
SALTS OF THE METALS: ZINC—SILVER—TIN—BISMUTH—CHROME—IRON.
Two preparations of ZINC must be noticed:
SULPHATE OF ZINC (_White Vitriol_, _White Copperas_.)—This is a very
mild irritant, resembling in its appearance Epsom salts and oxalic acid.
It is very useful as an emetic in scruple or half-drachm doses,
dissolved in any thin fluid.
In one case an ounce was accidentally taken. Great pain in the stomach,
vomiting, and prostration, soon set in. Subsequently there was
gastritis, and recovery only occurred after a prolonged convalescence.
_Treatment._—Vomiting is to be encouraged by milk or albuminous fluids;
after which remedies containing tannin (strong tea, decoction of oak
bark, or tincture of Peruvian bark) are to be given.
CHLORIDE OF ZINC.—A solution of chloride of zinc forms a valuable
disinfectant, but is also a dangerous irritant, or, if sufficiently
strong, a corrosive poison. Sir William Burnett’s Fluid consists of gr.
xxv of this salt to the drachm of water. It has been taken in mistake
for fluid magnesia, pale ale, &c., and has caused death.
_Symptoms._—A burning sensation in the mouth and throat is immediately
produced. This is followed by nausea, vomiting, and signs of collapse.
Death has occurred in less than four hours.
_Post-mortem Appearances._—The mucous membrane of the throat and
stomach has been found corrugated, hard, and leathery. In the case of a
sailor who died from about half a pint of Burnett’s solution, the body
was livid, the neck swollen, the cerebral vessels were engorged, and the
lungs were congested. The mucous coat of the stomach was of a purple
red, and partially corroded, while the pyloric orifice looked as if
caustic had been applied to it. There were patches of congestion in
different parts of the small intestines.
_Treatment._—Albuminous drinks, followed by some preparation of tannin,
will be needed.
_Tests._—Zinc is distinguished from all other substances by giving a
white precipitate with sulphuretted hydrogen. The solution containing it
must not be too acid or no precipitate will be formed. Zinc also gives
white precipitates with ferrocyanide of potassium and ammonia.
NITRATE OF SILVER (_Lunar Caustic_).—This is a powerful irritant, and
has proved fatal in at least two instances. The antidote is common salt,
which must be given immediately, followed by emetics.
TIN.—The chlorides of tin being employed in dyeing, color-making, &c.,
may lead to their being used as poisons, or being taken accidentally.
Death from their use is rare. They are decomposed by magnesia, which
should therefore be freely administered, followed by albuminous and
mucilaginous drinks.
BISMUTH.—The nitrate or magistery of bismuth has caused death in nine
days, after a dose of two drachms. The symptoms were those of a strong
irritant, but in all probability were caused by some impurity in the
substance. Arsenic is frequently present in this way. As no antidote is
known, vomiting must be promoted and emollient drinks freely given.
CHROME.—The bichromate of potassium is found in the form of orange-red
crystals, which yield a yellow acid solution. It is used as a dye, and
has caused death in more than one instance. Emetics and magnesia or
chalk, must be the remedies employed.
It is well to know that this substance is apt to produce troublesome
sores on the hands of those engaged in its manufacture. Some slight
abrasion begins the lesion, which does not heal, but forms on its
surface a tough slough, which separating, leaves a foul ulcer with hard
edges, and most untractable, behind it.
SULPHATE OF IRON (_Green Vitriol_, _Copperas_).—Although not a powerful
irritant, sulphate of iron has proved fatal when taken in a large dose.
It is sometimes given to procure abortion. The _perchloride of iron_
has also produced alarming symptoms, after being taken for the same
purpose. Dr. Christison relates the case of a man who died in five weeks
from an ounce and a half of the tincture. Magnesia and diluents, freely
administered, must constitute the treatment.
CHAPTER XI.
SIMPLE VEGETABLE AND ANIMAL IRRITANTS.
This division of the class of simple irritants is an important one, on
account of the substances composing it consisting in considerable part
of ordinary remedies or drugs, which given in over doses, may produce
symptoms of poisoning. They chiefly give rise to vomiting and purging.
VEGETABLE IRRITANTS.
The most important are _aloes_, _colocynth_, _jalap_, _gamboge_,
_scammony_, _elaterium_, _croton oil_, _castor oil seeds_, various
species of _arum_, _euphorbium_, _bryony_, _mesereon_, _physic nut_, and
others less commonly known. Dr. Taylor says that aloes and colocynth are
the basis of _Morrison’s pills_, which in many instances have induced
fatal purging. In _Holloway’s pills_, aloes is the chief ingredient. A
favorite remedy with nurses for promoting the catamenia is _hierapicra_,
a brown powder consisting of four parts of aloes to one of canella bark.
This may give rise to dangerous symptoms.
The _symptoms_ induced by these substances are those of irritation of
the intestinal canal, severe pain, vomiting, diarrhœa, tenesmus, &c.;
followed by collapse, cold sweats, and occasionally convulsions. These
effects may also be produced by diseased and decayed vegetables.
The _treatment_ must be directed to the removal of the injurious
substance by emetics, &c., unless spontaneous vomiting has freely taken
place, when it need merely be encouraged by the use of diluents. If the
irritant has passed out of the stomach into the intestines it must be
carried off by purgatives, especially castor oil. The inflammatory
symptoms should be cautiously combated, on account of the great
prostration usually caused by these poisons. Opiates, emollient enemata,
and fomentations to the abdomen will subsequently be found useful.
SIMPLE ANIMAL IRRITANTS.
The substances which require consideration under this head, though few,
are important.
_Poisonous Fish._—Several kinds of fish are constantly poisonous, while
some only act injuriously on particular constitutions. The chief effects
are sickness and vomiting, irritation of the eyes, depression, and
severe urticaria or nettle-rash. In this country the different varieties
of shell-fish are those most frequently injurious, especially cockles,
mussels, crabs and such-like.
_Poisonous Meat._—The flesh of animals which have died of disease has
produced serious symptoms when eaten, and has even destroyed life.
Several substances, as sausages, cheese, bacon, &c., also become
poisonous from putrefaction.
The _treatment_ in these instances should consist in the use of emetics,
purgatives, and diluents. The vital power must be supported by
stimulants, tonics, nutritious diet, &c.
CHAPTER XII.
IRRITANT GASES.
The chief are chlorine, sulphurous-acid gas, nitrous-acid gas, and
hydrochloric-acid gas. When diluted, they admit of being inhaled; not so
when pure.
_Chlorine._—This gas has a greenish-yellow color, and a powerful
suffocating odor. It is used to fumigate buildings, being a valuable
disinfectant. Chlorine is employed by the calico-printer and paper-maker
for its bleaching properties. The men who work in an atmosphere slightly
impregnated with it suffer from dyspepsia, but are long-lived, and it
has been supposed to be actually beneficial to consumptives. Any attempt
to inspire chlorine in its concentrated state would at once prove fatal
by closing the glottis and causing asphyxia. When diluted it excites
excessive irritation of the air-passages, cough, difficulty of
breathing, and inflammation.
In poisoning by chlorine, the inhalation of a small quantity of
sulphuretted hydrogen appeared to afford relief in a case reported by
Christison, but with that, or any other of the irritant gases, our
treatment must chiefly consist in the instant removal of the sufferer to
pure air. Then the cautious inhalation of ammonia, sulphuric ether, or
the vapor of warm water, will be useful.
_Sulphurous Acid Gas_ is one of the products formed by the combustion of
ordinary coal. It possesses bleaching and antiseptic properties; and is
very irritating when inspired.
_Nitrous Acid Gas_ is a very violent poison when inhaled, producing
inflammation of the lungs, &c. It has proved fatal in several
instances, when given off by nitric acid.
_Hydrochloric Acid Gas_ is irrespirable in its concentrated state, and
when diluted produces great irritation of the lungs and air-passages.
This gas, which is a waste product in the manufacture of washing soda,
is the chief cause of the barrenness which surrounds soda works where it
is allowed to escape, it being extremely destructive to vegetable life.
_Ammonia._—It has been already noticed (p. 48) that the vapor of
ammonia is poisonous, exciting inflammation of the larynx, bronchitis,
and pneumonia. Serious symptoms have sometimes arisen from its
indiscriminate application in cases of syncope, &c.
III.—SPECIFIC IRRITANT POISONS.
By Specific Irritant Poisons we mean those which, taken internally,
produce local inflammation or irritation, these being of course
indicated by certain constitutional symptoms; but over and above these,
which may be the result of ordinary inflammation, there are certain
specific signs of the action of a poison, in most instances peculiar,
and frequently pointing directly to the poison employed. This group is
one of the utmost importance in Toxicology, and includes substances
acting in many different ways, all, however, giving rise to the common
symptoms of gastric irritation.
CHAPTER XIII.
SPECIFIC MINERAL IRRITANTS.
IODINE AND IODIDE OF POTASSIUM.
IODINE is obtained from kelp (the ash of marine plants) and is a bluish
black scaly substance. It strikes an intense blue color with starch, and
when heated gives off an irritating purple vapor. It likewise imparts a
yellowish-brown stain to the skin (which may be removed by liquor
potassæ) and mucous membranes, and slowly corrodes these tissues.
Iodine is an active poison, although its effects are variable. Some
constitutions are violently affected by two or three grains, whereas
others are uninjured by ten or twenty. Iodine is commonly employed in
medicine in combination with potassium (iodide of potassium). Of this
substance very large doses may be given (thirty grains or more, three
times a day) in tertiary syphilis, with none but good effect.
The _symptoms_ of poisoning by iodine consist of an acrid taste,
tightness about the throat, epigastric pain, vomiting, and purging,
especially if much has been taken. In a case which came under
observation, a man took an ounce of the compound tincture of iodine, in
mistake for a purgative draught. He was immediately seized with an
intense burning pain in the throat and epigastrium, and vomiting,
followed by great thirst, headache, and syncope. The vomiting was
encouraged, large quantities of arrowroot given, starch enemata
administered, and in twelve hours all the symptoms had disappeared,
leaving him in a state of exhaustion, from which he recovered in a few
days.
In chronic poisoning (iodism) there are signs of irritation of the
alimentary canal, often a measly eruption, ptyalism, running from the
nose and eyes, mental and bodily depression, and loss of flesh. Nothing
leads to the belief that it causes absorption of the testicles or mammæ,
as is often asserted.
The _post-mortem appearances_ would be those due to an irritant poison,
namely, inflammation and softening of the stomach; the mucous membrane
being detached in different parts, and stained of a yellow color.
The _treatment_ should consist in the encouragement of vomiting, and
the free administration of amylaceous fluids, as gruel, arrowroot,
boiled starch, &c. This should be continued until the matters vomited
are of their natural color; for as long as any iodine remains they will
be rendered blue, iodide of starch being formed.
The crystals _of iodide of potassium_ are white cubes, very soluble in
water, and permanent in the air; though when impure they have a
yellowish tinge, and are deliquescent. In a few instances this valuable
medicine appears to have given rise to troublesome symptoms, even when
administered in small doses. Mr. Erichsen has reported a remarkable
case, in which five grains produced coryza, conjunctivitis, difficulty
of breathing, and other serious effects, promptly ceasing with the
discontinuance of the medicine. The _treatment_ must consist in emptying
the stomach by emetics or the stomach-pump, and administering starchy
diluents.
_Tests._ 1. Iodine may be readily detected by the blue color it gives to
starch.
Iodide of potassium gives the same when the iodine is set free by an
acid, such as sulphuric acid.
2. It also forms a scarlet precipitate with perchloride of mercury; and
3. It gives a yellow precipitate with acetate of lead.
CHAPTER XIV.
PHOSPHORUS.
This substance is sold in a pure state in small wax-like cylinders,
which must be preserved under water. It is soluble in oil, alcohol,
ether, and chloroform, and still more so in carbon disulphide; it is
luminous in the dark, and it ignites at a very low temperature, giving
off a dense white smoke. Phosphorus is much more frequently used as a
poison abroad than in England; but since restrictions have been put on
the sale of poisons, and rat poisons containing it have been more
common, cases of poisoning have more frequently occurred, and are likely
to do so even oftener in future. The cases which have occurred show that
it is a very powerful irritant, and capable of causing death when taken,
even in small doses. One grain has caused death; the shortest period in
which it has followed the administration of the poison being four hours.
The phosphorous paste sold consists of flour, sugar, and fat, with
phosphorous, ordinarily colored with Prussian blue. Coloring matter is
also generally present in lucifer-match tops, which contain phosphorus
and chlorate of potash, or nitre; hence, the vomited matters after
either of these has been swallowed may be variously colored. In the
so-called “safety matches” the phosphorus is on the box and not on the
match. Phosphorus does not readily lend itself to the purposes of the
criminal, its luminosity, its taste, and its garlic odor rendering it
difficult of concealment.
The _symptoms_ of poisoning by phosphorus are very varied, often
insidious. At first there may be merely the ordinary signs of irritant
poisoning. The vomited matters are luminous in the dark, sometimes
bilious, sometimes bloody. There is very great prostration, and there
may be diarrhœa with bloody stools. These symptoms sometimes abate,
and everything seems going on well, when suddenly a new train of
symptoms, still more serious, develop themselves. These are such as
would occur in the worst forms of blood poisoning: harsh, dry, yellow
skin, with discharges of blood from the various passages, and the
formation of extravasations below the skin. The urine is ordinarily
retained or suppressed, what little there is being albuminous or
bile-stained. Finally, acute delirium with convulsions sets in; the
patient dies comatose a few hours after taking the poison, or it may be
as many months.
The _post-mortem appearances_ after death by phosphorus are very
peculiar. If the case has proved rapidly fatal there will be the
ordinary signs of irritant poisoning, with, in addition, softening of
the stomach, bloody or gangrenous patches, blood in the intestines and
bladder, and bloody serum in the peritoneal cavity. In many respects the
lesions resemble those of the worst forms of sea scurvy; but the most
marked changes are the remarkable fatty degeneration of the liver,
kidneys, heart and other muscles, especially of the first, which is
often greatly atrophied.
The diagnosis will depend on the peculiar odor of garlic exhaled by the
patient and the luminosity of the vomited matters, in addition to the
other signs referred to.
_Treatment._—There is no regular antidote for phosphorus; early
evacuation by the stomach-pump and the free promotion of vomiting are
the main points. Magnesia or its carbonate should be given freely in
mucilaginous fluids. Oils had better be avoided, except for the purpose
of removing all traces of the poison by the stomach-pump. Prompt
treatment is all in all.
_Detection._—There is but one really satisfactory plan for detecting
phosphorus in organic mixtures, that invented by Mitscherlich. The
suspected material is introduced into a retort, and acidulated with
sulphuric acid. The stem of the retort is conducted into a glass vessel
kept cool by a stream of water on the outside. The retort is heated, and
distillation allowed to go on in the dark. If phosphorus be present it
passes over as vapor, and is condensed in the cool vessel beyond. At
each condensation a flash of light is perceived, which is the test
relied on.
CHRONIC POISONING by phosphorus used to be exceedingly common among
match manufacturers, but is now, comparatively speaking, rare,
allotropic or amorphous phosphorus being much more generally employed
than it used to be, and the ventilation of the workshops being better.
Its subjects used to be attacked with caries of the gums, gradually
extending and implicating the jaw, and giving rise to great deformity.
CHAPTER XV.
ARSENIC.
ARSENIC is by far the most important of metallic poisons, whether we
consider the deadliness of its effects or the fatal frequency with which
they are made manifest. Arsenic exists as an impurity in several
metallic ores, notably in iron pyrites, which being commonly employed as
a material for the manufacture of sulphuric acid, renders arsenic one of
the most frequent impurities of commercial oil of vitriol. This should
never be forgotten in testing any substance for the poison. To the
common medicinal preparation of arsenic, consisting of _arsenious
acid_, or _arsenites_, and the so-called _chloride of arsenic_, must be
added the _arseniates of potash and soda_; the sulphides of arsenic—as,
the _red sulphide_, or _realgar_, and the _yellow sulphide_, or
_orpiment_; the _arsenite of copper_, or _Scheele’s green_, and others.
They all produce similar symptoms, and poisoning by either of them
requires nearly the same treatment.
According to Von Tschudi, some of the peasants in parts of Styria and
Hungary eat arsenic, taking from two to five grains daily; the men doing
so in order that they may gain strength, and be able to endure fatigue,
the women that they may improve their complexions. These statements are
so contrary to all that we know of the power of this poison, that they
have been regarded as unworthy of credit. Evidence has, however, been
brought forward by Dr. Craig Maclagan, of Edinburgh, which shows clearly
that arsenic-eating is something more than a mere fiction. This
gentleman gave, and saw a Styrian eat, a piece of arsenious acid,
weighing over four grains, and afterwards determined the presence of
arsenic in urine passed in his presence by the said peasant. Advantage
was taken of these reports in the trial of Miss Madeline Smith
(Edinburgh, July, 1857), when the court was asked to believe that
arsenic found in the possession of the prisoner was used by her as a
cosmetic.
_Arsenite of Copper_, in one form or another, either as Scheele’s green,
emerald green, Brunswick green, &c., is unfortunately largely employed
in the manufacture of green paper-hangings, artificial flowers, toys,
and even some kinds of confectionery. Too many cases of ill-health
caused by this practice have been recorded to permit any doubt as to its
deleterious effects. These may be manifested by people living in rooms
furnished with such paper-hangings. The chief symptoms are, sneezing,
lachrymation, frontal headache, nausea, and loss of appetite, with
colicky pains, thirst, &c. Among those employed in preparing the
paper-hangings more serious symptoms manifest themselves. The irritation
of the pigment gives rise to circular patches of ulceration on the alæ
of the nose, in the folds of the arm, in the groin and scrotum—in
short, wherever dirt tends to lodge. These prove very untractable,
except the employment be abandoned. In November, 1861, a young woman
died in London from the poisonous effects of arsenite of copper used in
dusting wax leaves. The workmen who employ the pigment in its dry state
suffer, while those who use it in a moist condition are probably
unaffected by it. A simple method for roughly detecting arsenite of
copper in these fabrics was published in the _Chemical News_ (vol. 1, p.
12). A small portion of the suspected material is to be put into a test
tube with strong ammonia. If a blue tint be produced, a salt of copper
is shown to be present. Withdraw the object, and drop a piece of nitrate
of silver into the ammonia; if arsenic be there, the nitrate of silver
will be covered with a yellow coating of arseniate of silver, which will
disappear on stirring. On igniting arsenical paper and allowing it to
smoulder, the odor of garlic may be detected in the fumes given off.
Another mode in which the noxious effects of arsenic are produced is by
the use of bright green tarlatans as ball dresses. One could hardly
conceive a more deadly amusement than dancing in an arsenicated dress,
sweeping against an arsenicated wall-paper. When both are lightly
adherent the arsenic is scattered in showers about the room.
ARSENIOUS ACID (_White Oxide of Arsenic_, _White Arsenic_,
_Arsenic_).—This is the preparation of arsenic most frequently used as
a poison; the facility with which it used to be procured, its cheapness
(twopence an ounce), and the ease with which it may be administered, all
tended to recommend it to the murderer or suicide. According to a
parliamentary report, the number of fatal cases of poisoning in England
in the years 1837, 1838, amounted to 543, of which no less than 186 were
caused by arsenic, 185 arising from the use of the arsenious acid, and 1
from orpiment or yellow arsenic.
Since the Act of 1851 (14 Vict. cap. xiii.) the deaths from this agent
have greatly decreased. This statute chiefly enacts that arsenic is not
to be sold without the seller entering the transaction in a proper book,
without a witness, nor without its being mixed with soot or indigo,
unless such admixture would render it unfit for the purchaser’s
business.
Arsenious acid is found in commerce in the form of a white powder or in
small opaque cakes. It is very feebly acid, tasteless, or slightly sweet
in small doses, though not very soluble, an ounce of cold water
dissolving about one grain. The quantity so held in solution may,
however, be increased by dissolving the arsenic in boiling water and
allowing it to cool. The shortest period within which it was believed
arsenic would cause death was two hours; but Dr. Taylor gives a case
where death with tetanic symptoms followed the fatal dose in twenty
minutes. The smallest quantity known to have proved fatal is two grains.
Two grains and a half killed a girl nineteen years of age in thirty-six
hours. Half a grain will produce alarming symptoms; and yet recovery
has ensued after doses of half an ounce or an ounce.
_Symptoms._—These commence within half an hour or an hour of swallowing
the poison. There is faintness, nausea, incessant vomiting, and a
burning pain in the epigastrium, increased on pressure, and gradually
extending over the whole abdomen, followed by headache, diarrhœa, a
sense of constriction and heat in the fauces and throat, great thirst,
and catching, painful respiration. The heart’s action becomes depressed,
the pulse is quick and feeble; there is great restlessness and anxiety;
cold, clammy skin, and perhaps coma are present; and death usually
occurs within twenty-four hours.
These symptoms are liable to great variety, the pain and vomiting being
occasionally absent, and the patient being affected as if by a narcotic
poison. In some instances there is troublesome tenesmus, with heat and
excoriation about the anus. Convulsive movements in the extremities
often occur, with cramp in the legs, especially if the diarrhœa is
severe. Death sometimes takes place calmly from collapse, sometimes it
follows on convulsions.
The vomited matters may be red or brown from admixture with blood or
bile; or they may be blue or black, if the arsenic has been colored with
indigo or soot. Although the vomiting, pain, &c., are generally
continuous, yet sometimes all the symptoms remit, and the patient
rallies for a time, only to sink more rapidly.
The symptoms of _chronic_ poisoning by arsenic are loss of appetite, a
silvery coating to the tongue, thirst, nausea, colicky pains,
diarrhœa, frontal headache, langor, sleeplessness, cutaneous
eruptions, soreness of the edges of the eyelids, emaciation, anæmia,
convulsions, and death. In some cases, when small doses have been
administered for many days in succession, with the intent to destroy
life, the symptoms have been masked by other substances. The most marked
results of this practice have been sickness and vomiting, pain in the
bowels, nervous irritability, and emaciation. The practitioner must be
careful not to mistake these symptoms for those due to simple gastritis
or enteritis.
Arsenic is not a poison that accumulates in the system, but is slowly
eliminated from it especially by the kidneys, but partly also by the
bile.
The local application of arsenic to the mucous membranes, to wounds, or
to surfaces deprived of their cuticle, produces constitutional effects
similar to those just described. The only difference is that the
symptoms show themselves more slowly. Not a few lives have been
sacrificed from the application by ignorant quacks of a mixture of
arsenious acid, realgar, and oxide of iron to ulcerating cancers.
Cases of compound poisoning have been met with. When arsenic is taken
mixed with opium, the symptoms produced by the former are masked.
_Post-mortem Appearances._—Arsenic appears to exercise a specific
influence over the alimentary canal, and more especially over the
stomach; for in whatever manner it may have been introduced into the
system, it is to this organ that we must look for its effects. These
effects consist in the signs of acute inflammation commencing in this
viscus, and often extending along the duodenum, small intestines, and
colon. In acute cases the stomach is the viscus most affected; but in
chronic cases the whole alimentary canal is found inflamed and
ulcerated, particularly the duodenum and rectum. When death has
occurred within five hours of taking the poison, the stomach has been
found intensely inflamed in an adult; while the same result was
witnessed in a child who died at the end of two hours. The stomach often
contains a dark grumous fluid, occasionally tinged with blood. On
removing the contents the mucous membrane is seen red and inflamed, the
inflammation being most intense around certain spots. On examining these
spots, particles of arsenic will probably be found adhering to the walls
of the stomach and surrounded by a zone of inflammatory redness.
Sometimes also blood is effused into the visceral walls, giving rise to
an appearance resembling gangrene. Ulceration of any of the coats of the
stomach is rare, and perforation is still more so.
In a few exceptional cases there has been no appearance of inflammation
in the stomach or bowels.
Putrefaction of the body is said to be remarkably retarded after death
from arsenic.
_Treatment._—The first object must be to expel the poison from the
stomach, for which purpose the stomach-pump may be advantageously
employed, or emetics of sulphate of zinc, mustard, or ipecacuan
administered, unless vomiting is already present. The sickness must be
promoted by the free use of albuminous or mucilaginous diluents. Raw
eggs beaten up in milk are particularly useful, as is likewise a mixture
of albumen, milk, and limewater. Taylor advises equal parts of oil and
limewater, for the oil invests the poison, and the lime renders it less
soluble. A large dose of castor oil (℥j to ℥ij) may be given, to
carry off any of the poison which may have passed into the intestines,
as soon as sickness has subsided. Animal charcoal, calcined magnesia,
&c., when taken in large quantities, may be of service by enveloping the
arsenic, and preventing its contact with the mucous membrane of the
stomach; but oil or milk will act more efficiently in this manner. The
hydrated peroxide of iron[B] should be administered moist, and in large
doses, after the stomach-pump has been used; or indeed, mixed with
water, it may be first introduced and then expelled, thus washing out
the stomach by means of the stomach-pump. This is the most efficient
antidote known.
The subsequent treatment must be conducted on general principles,
according to the severity of the symptoms; but the great depression of
the nervous and vascular systems must not be overlooked in combating any
inflammatory action. Henbane or opium, in many instances combined with
stimulants, ice internally, and hot fomentations externally, will
frequently be found of great service.
_Tests._—In its _solid state_ arsenious acid may be known by the
following properties. Heated on platinum foil or on the point of a
penknife, it produces a white smoke and is entirely volatilized. If some
of the powder be heated in a small test tube, it will be sublimed, and
small octahedral crystals, visible to the naked eye or by a lens,
obtained. If arsenious acid be mixed with freshly-burnt powdered
charcoal, and heated in a small test tube, a ring of shining metallic
arsenic of a grey color will be found on the cool portion of the tube,
and an odor of garlic is perceptible. If this deposit be driven about
from place to place it will gradually become oxidized, and octahedral
crystals of arsenious acid formed. Further, if the tube be divided and
the part containing the arsenious acid be washed out with distilled
water, the liquid tests may be applied to the solution. This is called
the Reduction test. It is very delicate, detecting according to
Christison, the 300th part of a grain.
_In solution_, this substance may be detected by what are called the
liquid tests. A solution of arsenic in water is colorless, almost
tasteless, and has a very slightly acid reaction. If a few drops be
evaporated on a glass slide and examined by the microscope, numerous
minute and mostly imperfect octahedral crystals, or an amorphous
deposit, will be seen, presenting triangular surfaces by reflected
light.
1. The _ammonio-nitrate of silver_ (prepared by adding a few drops of
liquor ammoniæ to a solution of nitrate of silver, till the brown oxide
of silver at first precipitated is nearly redissolved) throws down with
arsenious acid a rich yellow deposit of arsenite of silver.
2. The _ammonio-sulphate of copper_ (formed by adding liquor ammoniæ to
a solution of sulphate of copper till the bluish-white oxide of copper
is almost redissolved) produces a pale green precipitate, arsenite of
copper, or Scheele’s green. Care must be taken not to add too much of
the test in the first instance, otherwise its blue may overpower the
green of the precipitate.
3. _Sulphuretted hydrogen water_ precipitates a yellow deposit of
sulphide of arsenic. It is better, however, to use pure and well-washed
sulphuretted hydrogen generated in the usual manner. Care must be taken
that the liquid is not alkaline, or no precipitate will be produced,
even though arsenic be present. For this reason yellow sulphide of
ammonium will not precipitate arsenic until acidulated with pure
hydrochloric or some such acid. The precipitate should be collected,
carefully washed, and dried. It should then be mixed with black flux or
dry ferrocyanide of potassium and reduced, as already described.
These tests are so delicate, especially the first, that they will detect
the 8000th part of a grain of arsenic in solution; they should be
employed successively. There are several other processes which require
to be noticed, namely, Marsh’s process, the process known as Reinsch’s
process, Fresenius’s process, and the Destillation process.
_Marsh’s Test or Process._—This process is founded on the decomposition
of arsenious acid by nascent hydrogen, and the formation of arsenuretted
hydrogen gas, which possesses the following properties: It burns with a
bluish-white flame, and white smoke (arsenious acid), possessing a
slight garlic odor. If a piece of glass or porcelain be held in the
flame a blackish metallic stain will be deposited upon it, consisting of
metallic arsenic. This stain might be confounded with one produced by
antimony under similar circumstances. But the antimonuretted hydrogen
gas does not burn with the odor of the arsenuretted hydrogen; while the
antimonial stain is sooty, and has not a metallic lustre. The arsenical
stain is further readily dissolved by a solution of chloride of lime
(bleaching powder), whilst the antimonial stain is not affected. To the
stain may be added a few drops of strong nitric acid; it will dissolve
the arsenic; if this be allowed to evaporate, and the acid be
neutralized, a few drops of nitrate of silver solution will give a
brick-red precipitate of arseniate of silver.
Marsh’s test is thus accomplished: a flask furnished with a cork through
which pass a funnel and a long bent tube drawn to a point, is prepared
so that the funnel reaches almost to its bottom. Several pieces of pure
zinc are introduced, and then some sulphuric acid is poured through the
funnel. In this way hydrogen gas is produced and escapes by the bent
tube. When all the air has been expelled the gas should be ignited as it
escapes, and a piece of cool porcelain held over the flame. If there be
no deposit it is plain that neither the zinc nor the sulphuric acid,
contains arsenic. A portion of the suspected fluid is next introduced
into the flask by the funnel, and the issuing gas again tested. Should a
stain giving the characters alluded to above be produced, the fluid
contains arsenic in some form or other.
_Reinsch’s Process._—The suspected liquid is boiled with from one-sixth
to one-eighth of its bulk of pure hydrochloric acid, and a bright slip
of copper introduced. If arsenic be present the copper will be coated
with it in the form of an iron-grey deposit. Next after removing the
copper, washing it with distilled water, and drying it between folds
of blotting paper, cut it into slips, and introduce it into a
reduction-tube and apply heat; arsenious acid will be sublimed and
deposited on the sides of the tube, in the form of minute octahedral
crystals. These may be dissolved in water and tested in the usual way.
Before resorting to this test, the acid must be examined to make sure of
its purity. This is easily effected by boiling the copper with a mixture
of the hydrochloric acid and distilled water before adding the suspected
liquid. In conducting the analysis in the case of Smethurst (Cent.
Crim. Court, Aug. 1859) Taylor and Odling found that all the varieties
of copper in common use for Reinsch’s process contained arsenic. A
copper of ascertained purity must therefore be used.
_Arsenic in Organic Matters._—The following process, which has been
introduced by Dr. Taylor, is a very convenient one. The suspected
matters are to be thoroughly dried in a water-bath or otherwise, taking
care not to use too great a heat. They are then to be introduced into a
flask fitted with a long bent tube; to the dried material is to be added
a quantity of strong hydrochloric acid, proved free from arsenic,
sufficient to drench it, and the whole allowed to digest for some hours.
At the end of that time heat is to be applied to the flask by means of a
sand-bath, and a receiver fitted to the bent tube. The receiver should
contain a little water, and both it and the bent tube should be kept
cool. As distillation goes on the arsenic passes over in the form of
chloride of arsenic, and is collected in the receiver beyond. A second
portion of hydrochloric acid may be used to remove any last traces of
arsenic in the organic material. The arsenic may be recovered from the
chloride by boiling with pure polished copper, as in Reinsch’s process.
The process of Fresenius and Von Babo given at page 31 is especially
adapted for the recovery of arsenic from organic admixture.
Several cases of poisoning by arsenuretted hydrogen are on record, some
proving fatal.
CHAPTER XVI.
ANTIMONIAL COMPOUNDS.
In its metallic state antimony is not regarded as poisonous. Two of its
preparations, however, claim attention; namely, tartar emetic, and
chloride of antimony.
TARTAR EMETIC (_Tartrated_ or _Tartarised Antimony_, _Potassio-Tartrate
of Antimony_, _Tartar Emetic_).—Since the trials of Palmer, Dove,
Smethurst, and Pritchard, poisoning by this compound has attracted much
attention. In large doses it has been administered without any serious
result, a circumstance which may be accounted for by the promptitude
with which it excites vomiting and purging. Given in small doses,
frequently repeated, the effects of tartar emetic may be made to
simulate, in some degree, those due to natural disease.
Three quarters of a grain killed a child; and a dose of two grains has
destroyed an adult, under circumstances which favored its action. Dr.
Taylor says that from ten to twenty grains taken at once might prove
fatal to an adult; while in divided doses a smaller quantity might
suffice. It is plain, therefore, that the quantity necessary to cause
death must vary with the condition of the patient.
_Symptoms._—In acute poisoning by this agent there is a metallic taste,
nausea, and violent vomiting, burning heat with pain in the stomach, and
purging. Difficulty in swallowing, thirst, cramps, cold perspiration,
and great debility soon set in. Should the case terminate fatally, death
may be preceded by giddiness, insensibility, difficult respiration,
utter prostration, with violent spasms, tonic or clonic; but even when
matters appear to be most critical, symptoms of improvement are often
manifested, and recovery gradually follows.
The effects of _chronic_ poisoning are, constant nausea, frequent
attacks of vomiting and purging, a loathing for food, a weak frequent
pulse, loss of muscular power, cold clammy sweats and fatal exhaustion.
The symptoms are of course aggravated after each administration of the
poison, whether given in food or medicine.
Tartar emetic ointment applied to the skin produces a pustular eruption
like that of smallpox; while, if much be absorbed, there will be nausea,
sickness, &c. Sometimes this same eruption appears in the throat and on
the skin after swallowing a large dose.
_Post-mortem Appearances._—The most common are inflammation of the
throat, stomach, and intestines. Sometimes the mucous membrane of the
stomach is softened and infiltrated with blood. The cæcum and large
intestine are also inflamed, especially if life has been prolonged after
the dose, as in chronic poisoning. The brain and lungs have been found
congested.
_Treatment._—Vomiting should be encouraged by warm greasy water, milk,
&c. Liquids containing tannin, as tea without milk or sugar, decoction
of oak bark, &c., must be freely given. Cinchona bark in tincture or
powder may be advantageously prescribed. Afterwards opiates may be
administered.
_Tests._—Tartar emetic is soluble in water but not in alcohol.
In solution tartar emetic may be thus detected:
1. A drop evaporated on a glass slide leaves microscopic crystals,
either tetrahedra or cubes, with the edges bevelled off.
2. The solution may further be proved to contain antimony by passing
through it sulphuretted hydrogen or adding to it sulphide of ammonium,
either of which throws down an orange-red precipitate of sulphide of
antimony. This precipitate is soluble in strong hydrochloric acid, which
being diluted, throws down a white precipitate.
3. The three dilute mineral acids (nitric is best) throw down a white
precipitate with tartar emetic, which is soluble in excess of the acid
used or in tartaric acid.
The metal may be separated from organic substances by Marsh’s or
Reinsch’s process.
CHLORIDE OF ANTIMONY (_Terchloride_ or _Butter of Antimony_) is a
powerfully corrosive liquid. It produces violent inflammation and
corrosion of the whole intestinal canal; occasionally also drowsiness,
as from the use of a narcotic.
Dr. Taylor has collected the histories of four cases of poisoning by
butter of antimony, three of which recovered. The fourth, in which a
gentleman took from two to three ounces, proved fatal in ten hours and a
half, after producing great prostration, nausea, violent griping pain,
and tenesmus, followed by a tendency to sleep. On inspection, the whole
of the inside of the alimentary canal was blackened, as if it had been
charred; there was but little mucous membrane remaining, and the parts
were much softened.
_Treatment._—Magnesia must be administered in milk, together with the
remedies recommended in poisoning by tartar emetic.
CHAPTER XVII.
MERCURY AND ITS COMPOUNDS.
Of the preparations of mercury, corrosive sublimate is the most
important to the toxicologist; for although they all possess in a
greater or less degree poisonous properties, yet the instances in which
the other compounds have been used to destroy life are extremely rare.
The treatment in all cases must be the same. It is worthy of remark that
mercury, whilst in the metallic state, is destitute of injurious
properties, but if oxidized or otherwise rendered fit for absorption, it
may give rise to dangerous symptoms. Thus, workers in mercurial mines
suffer much, as did those who were employed in silvering looking-glasses
by the old process. Large doses (from half a pound to two pounds) have
been given in obstinate cases of constipation, intussusception, &c.,
without any remarkable effect.
CORROSIVE SUBLIMATE (_Oxymuriate of Mercury_, _Chloride of Mercury_,
_Bichloride of Mercury_).—This preparation of Mercury, which, more
strictly speaking, belongs, like the chlorides of zinc and antimony, to
the class Corrosives, is usually met with in the form of imperfect
crystalline masses, or as a white powder. It has an acrid, coppery
taste, so powerful that but little could be swallowed without the
individual becoming aware of it. It is very soluble in water. Three
grains is the smallest quantity that has been known to prove fatal; and
from this to five grains may probably be stated as the average dose
necessary to destroy life. Recovery has taken place after as much as
eighty grains had been swallowed. Death has occurred in less than half
an hour; while, in some instances, life has been maintained until the
sixth day, and in one instance (where between three and four scruples
had been swallowed) until the twelfth day. It is probable that the
average duration of fatal cases is from twenty-four to thirty-six hours.
_Symptoms._—In the majority of cases the symptoms commence immediately,
with an acrid metallic taste, often described as coppery, and a sense of
constriction and burning heat in the throat and stomach. The burning
pain gradually extends over the abdomen, and is much increased by
pressure. There is nausea, with vomiting of the contents of the stomach.
These matters are sometimes mixed with blood and stringy masses of
mucus. The sickness is accompanied by diarrhœa or dysentery, swelling
of the abdomen, and increased pain. The countenance becomes flushed and
often swollen, though it is occasionally pallid and anxious; the lips
and tongue get white and shrivelled; there is frequently some
dyspnœa, while the pulse is small, or wiry and frequent; and death is
preceded by faintness, cramps, insensibility, or convulsions.
Should these effects not prove rapidly fatal, the pain will gradually
become lessened, though attacks of colic and nausea may come on at
intervals for several days. Often the secretion of urine is almost, or
even quite, suppressed. After a time there are symptoms of hectic fever,
with much depression. The gums and salivary glands also become swollen,
there is a coppery taste in the mouth, the breath is very fœtid, and
there is severe ptyalism or salivation. This latter effect is the most
prominent feature in the _chronic_ form of poisoning, where small and
frequently-repeated doses have been given: it often proceeds to such an
extent as to cause death, when the patient would otherwise probably
recover.
It must not be forgotten that salivation sometimes arises where no
mercurial of any kind has been given. Thus arsenic, bismuth, lead,
iodide of potassium, opium, &c., may induce it in some very peculiar
constitutions. Small medicinal doses (as a few grains of calomel) may
also excite it in certain susceptible individuals; and especially in
persons suffering from renal disease. It may also occur spontaneously,
as in stomatitis or inflammation of the mouth; and very troublesome
examples of it may occur in pregnant women.
It is strange that neither in acute nor chronic mercurial poisoning do
we observe any marked loss of muscular power. Yet workers in quicksilver
(owing to the absorption of the fumes of mercury during respiration) are
very apt to suffer from a peculiar kind of paralysis; which commences
with inability to direct the hands and arms, and goes on to a shaking or
trembling of all parts of the body.
_Post-mortem Appearances._—The appearances produced by corrosive
sublimate are confined chiefly to the digestive canal. The mucous
membrane of the mouth, fauces, and œsophagus is softened and of a
whitish or bluish-grey color. The stomach also presents marks of violent
inflammation; beneath the mucous membrane numerous patches of
extravasated blood are seen, and frequently corrosion or ulceration has
been found. The large and small intestines, the peritoneum, and
especially the urinary organs, often appear inflamed. In many instances
the bladder has been much contracted.
_Treatment._—This must consist in the removal of the poison and the
administration of antidotes. Vomiting is best promoted by administering
copious draughts of fluids containing albumen: but if necessary
ipecacuan may be given. The white and the yolk of raw eggs with milk
should be abundantly administered. Gluten has been much recommended, and
may readily be prepared by washing flour in a muslin bag under a stream
of water; but on an emergency it will be best to exhibit the flour at
once, made into a paste with milk or water. The free use of demulcent
drinks, milk, and ice will be very grateful to the patient’s feelings.
Gargles of alum or borax do some good. Opiates may be given in small
doses, if there be much pain, and we should allow only a milk or
farinaceous diet. Sucking chlorate of potash has been recommended to
check the salivation. The most useful remedy, however, is the iodide of
potassium; for this salt destroys the compounds formed by the union of
mercury with certain of the tissues, and eliminates the poison through
the kidneys.
_Tests._—Corrosive sublimate is completely volatilized by heat.
1. Liquor potassæ added to its solution gives a yellow precipitate. This
precipitate, if washed, dried, and heated in a test tube, gives a ring
of metallic mercury in the form of globules in the cool part of the
tube. In like fashion corrosive sublimate itself may be reduced and
volatilized if heated with black flux.
2. On adding a solution of iodide of potassium to a small quantity of
the solution, a bright scarlet precipitate, soluble in excess of iodide
of potassium, is produced.
3. If a drop or two of a solution of corrosive sublimate, slightly
acidulated with hydrochloric acid, be placed on a sovereign, and the
solution and the gold be touched with a piece of zinc or an iron key,
the mercury will be deposited as a bright silvery stain on the gold.
CALOMEL (_Subchloride_ or _Chloride of Mercury_) is a heavy white
powder, which is usually regarded as a safe medicine. Yet, in some
peculiar constitutions, it has caused excessive salivation and death,
even though only a few grains have been given. In large doses it may be
regarded as an irritant poison. It is distinguished from corrosive
sublimate by forming a black precipitate with caustic potash and by its
insolubility in water.
AMMONIO CHLORIDE OF MERCURY (_White Precipitate_).—This substance is a
chalky looking powder, containing about eighty per cent. of mercury. It
produces vomiting, purging, great pain in the stomach, cramps, and
convulsions. Out of fourteen cases, collected by Dr. Taylor, in which
from a few to forty grains were taken, only two proved fatal.
The remaining preparations of mercury, which in rare instances have been
used as poisons, are the _Red Oxide of Mercury_ (red precipitate); the
_Red Sulphuret of Mercury_ (cinnabar or vermilion); the _Cyanide of
Mercury_; the _Nitrates of Mercury_; and _Turpeth Mineral_.
Mercury may be separated from organic admixture by Reinsch’s method.
CHAPTER XVIII.
PREPARATIONS OF LEAD.
Lead, in its metallic state, is not injurious. It is, however, really
acted on by acids, exposure to the atmosphere, &c., and converted into
carbonate of lead. The chief compounds of this metal which have been
found to produce poisonous effects are the acetate, subacetate, and the
carbonate.
ACETATE OF LEAD (_Sugar of Lead_).—This is sold as a glistening white
powder, or in the form of crystalline masses resembling loaf sugar. It
is more frequently used as a poison than either of the other compounds.
It is very soluble in water and has a sweetish metallic taste. Three or
four instances are recorded in which recovery has taken place after an
ounce of this substance has been taken in solution.
Mr. Bancks, of Stourbridge, has reported the particulars of a series of
cases of poisoning by the acetate of lead (_Lancet_, 5th May, 1849). It
appears that thirty pounds of this substance were accidentally mixed at
the miller’s with eighty sacks of flour. This was made into bread, from
eating which 500 persons suffered severely. The chief symptoms were a
sense of constriction in the throat and at the pit of the stomach,
crampy pains round the navel, stiffness of the abdominal muscles,
paralysis of the lower extremities, constipation, scanty urine, and the
formation of a deep blue line round the gums. Although in many cases
there was great prostration with other alarming symptoms, yet under the
use of purgatives all recovered. It was noticed that after a temporary
convalescence many of the symptoms returned in an aggravated form
without any apparent cause. Sometimes there has been vomiting and
purging, and there is great prostration, with cramps and convulsions.
_Post-mortem Appearances._—They are not usually very distinct. The
stomach and intestines have been found inflamed, and the surface of the
former softened and, in the case of animals, corroded. There may be no
characteristic signs in chronic poisoning.
SUBACETATE OF LEAD (_Goulard’s Extract_).—This substance is known to
have proved fatal in three or four instances, after having caused great
agony. It is a more powerful poison than the acetate. It is found in the
shops as a whitish-colored liquid.
CARBONATE OF LEAD (_White Lead_, _Ceruse_, _&c._).—This is sold in
heavy white masses, looking like chalk. It is readily acted on by acids,
but is very insoluble in water.
Dr. Snow has reported an instance in which a child ate a portion, about
the size of a marble, mixed up with oil; it died on the fourth day.
Carbonate of lead derives its greatest interest from the chronic form of
poisoning which it produces among white lead manufacturers, painters,
&c., known as “the painters’ colic,” which too often terminates in “lead
palsy.” In these instances the lead finds its way into the system by
absorption from the digestive canal, the lungs, or the skin; producing
its characteristic effects when a sufficient amount has been absorbed.
It is this salt which is formed by the action of air and water upon
lead.
The other preparations of this metal do not require any separate notice.
_Treatment._—The sulphates of soda or magnesia should be freely given
dissolved in water. Milk, or milk and eggs will be useful. If vomiting
is absent, an emetic of sulphate of zinc should be administered, or the
stomach-pump may be advantageously employed.
For a chemical antidote in poisoning by carbonate of lead Dr. Taylor
recommends a mixture of vinegar and sulphate of magnesia.
_Tests._—The presence of a salt of lead in solution may be thus
ascertained:—1. On passing sulphuretted hydrogen through it, or on
adding a few drops of sulphide of ammonium, a black precipitate is
given. 2. A white precipitate results from the use of liquor potassæ or
liquor ammoniæ. 3. Dilute sulphuric acid gives a similar precipitate,
which is insoluble in nitric acid. 4. Iodide of potassium affords a
bright yellow deposit (iodide of lead).
CHRONIC LEAD POISONING.—The chronic and insidious effects produced by
lead upon the constitution are deserving of careful attention. Water
impregnated with this metal in its passage through lead pipes or
cisterns, acquires poisonous properties. Lead-pigments are sometimes
improperly used to color cheese, lozenges, snuff, &c. The endemic colic
of Devonshire was due to the absorption of lead contained in cider,
which had been made in leaden vessels; and in the wine district of
Poictou attacks of colic were so common, from the impregnation of wine
with this metal, that we still speak of “colica Pictonum.”
The pernicious influence of lead is manifested among those engaged in
the manufacture or use of lead compounds, especially painters, lead
smelters, plumbers, color grinders, shot manufacturers, workers in sugar
of lead, potters, compositors, enamellers of cards, &c. These artisans
should be advised to prevent disease by great cleanliness, by avoiding
intoxicating liquors, and by drinking freely of sulphuric acid lemonade.
The substitution of moist for dry grinding has proved useful.
The most prominent _symptoms_ of chronic poisoning by lead are as
follows: A blue line around the gums, and the liability of the latter
to bleed from any slight cause; emaciation, a pallid tint of the
complexion, poorness of blood, and a feeble quick pulse; obstinate
constipation, with attacks of colic relieved by pressure; diminution of
the renal secretion and rheumatic pains; afterwards comes weakness of
the hands, wrists, and arms, ending in paralysis of the extensors, or
“dropped wrists,” creeping up the arms.
The _treatment_ of these cases must consist in the first instance in the
use of purgatives; none being better than sulphate of magnesia with the
dilute sulphuric acid. But the remedy of all others is the iodide of
potassium, in five or ten grain doses thrice daily; this agent acting
most beneficially when employed in conjunction with galvanism to the
paralysed limbs.
CHAPTER XIX.
SALTS OF COPPER.
Poisoning with the salts of copper is of comparatively rare occurrence;
when it happens, it is generally the result of accident. The metal
itself is not poisonous, but the action of the gastric juice may produce
a very deleterious salt. Copper coins, when swallowed, sometimes on this
account prove mischievous; though usually any ill effects which ensue
are due to their mechanical action. Salts of copper have been
accidentally introduced into the system by means of food which has been
cooked in copper saucers. The most important substances of this class
to the toxicologist are the following:
SULPHATE OF COPPER (_Blue Vitriol_).—Blue-stone is met with in large
crystals, which are very soluble in water and possess an acrid metallic
taste. In doses of half an ounce it acts as a powerful irritant. It has
been administered to procure abortion. In the case of a child sixteen
months old, who sucked some pieces of blue-stone with which she was
playing, death occurred in four hours.
SUBACETATE OF COPPER (_Verdigris_).—This preparation is met with in
masses, or in the form of a greenish powder. It possesses a powerful
astringent metallic taste. It is often produced by allowing substances
to stand in coppers. It has proved fatal in half ounce doses.
ARSENITE OF COPPER (_Mineral Green_).—The effects of this salt have
been already referred to.
_Symptoms._—Pain in the epigastrium, gradually extending over the
abdomen, violent vomiting—the vomited matters being of a blue or green
color—and diarrhœa, are the symptoms which set in the most speedily.
Then there is usually dyspnœa, great depression, coldness of the
extremities, headache with giddiness, and slight tetanic convulsions.
Sometimes there is suppression of urine. Jaundice very frequently
occurs—a symptom the more important, as it is rarely met with in most
other forms of poisoning. Occasionally stupor, coma, and paralysis
supervene. Should death ensue, it may occur within a few hours, or not
for several days.
The salts of copper taken in very small doses, for several days, give
rise to a metallic taste in the mouth, thirst, debility, cramps and
colicky pains, with symptoms of dysentery. In some instances there has
been found retraction of the gums with the formation of a purple line,
very distinct from the blue mark due to lead.
_Post-mortem Appearances._—Evidences of inflammation are usually found
in the stomach and intestines, the mucous membrane being often ulcerated
and of a blue-green color. Particles of the poison may sometimes be
found adhering to the coats of the bowel. Perforation of the intestines
has occurred.
_Treatment._—Vomiting sets in spontaneously, and is to be encouraged by
the use of warm water. The stomach pump will rarely be needed. The only
effectual antidote is albumen. The whites and yolks of several eggs
should therefore be given, followed immediately by milk or mucilaginous
drinks.
_Tests._—Solutions of the sulphate and nitrate of copper are blue; the
chloride is green. The salts of copper may be thus identified:
1. A polished knife or needle introduced into the solution is soon
covered with a coating of copper.
2. Ammonia produces with a salt of copper a bluish precipitate, readily
soluble in excess of ammonia, and forming a splendid blue solution.
3. Ferrocyanide of potassium gives a claret-colored gelatinous
precipitate, if the copper be abundant; otherwise the deposit is of a
light brown.
4. Sulphuretted hydrogen gas yields a deep-brown precipitate.
5. A few drops of the copper solution are to be placed on platinum foil,
and slightly acidulated; on touching the foil, through the solution,
with a strip of zinc, metallic copper is deposited on the patinum.
CHAPTER XX.
SPECIFIC VEGETABLE IRRITANTS.
LABURNUM (_Cytisus laburnum_).—Every portion of this plant is
poisonous. The seeds are frequently eaten by children, and give rise to
vomiting and purging, with dilatation of the pupils, rigors, rigid
limbs, &c.
_Œnanthe crocata_, _Phellandrinum aquaticum_, _Æthusa Cynapium_,
_&c._, strictly speaking, belong to this group.
BLACK HELLEBORE (_Helleborus niger_) or _Christmas Rose_, grows in shady
woods, and bears a large flower in January. The leaves and root when
eaten give rise to abdominal pain, vomiting and purging, vertigo, cold
sweats, and collapse, resembling that of malignant cholera. An infusion
of this plant is sometimes administered by quacks to destroy intestinal
worms. It has proved fatal to children under these circumstances.
Several other substances variously grouped for the sake of convenience
should come under this heading.
CHAPTER XXI.
SPECIFIC ANIMAL IRRITANTS.
CANTHARIDES (_Spanish Flies_).
This poison is well known, and is usually administered in the form of
powder or tincture. Of the former, twenty-four grains have destroyed
life; of the latter, one ounce. This poison has been employed as an
aphrodisiac and to induce abortion, by persons ignorant of its dangerous
effects. This is, perhaps, the most frequent cause of poisoning by
cantharides. Applied externally it has proved fatal, as in the case of a
girl affected with scabies, who anointed the whole of her body with
cantharides ointment in mistake for that of sulphur. She died in five
days, after suffering from the symptoms of poisoning by cantharides.
It produces an acrid taste, vomiting, purging, burning heat in the
stomach, pain in the loins, severe strangury, bloody urine, and
priapism. Then there is faintness with giddiness, the limbs become
rigid, and delirium with convulsions precede death. Sometimes the
matters ejected from the stomach or passed in the stools contain shining
golden or green particles, the remains of the wing cases of the beetles,
which constitute the drug, readily seen with a lens, or even with the
naked eye.
After death, marks of inflammation are found in the alimentary canal,
kidneys and bladder, and the genital organs.
_Tests._—The detection of Spanish flies, if taken solid, depends mainly
on the presence of the shining particles already alluded to, in the
stomach, or in the vomited matters. To make their nature certain,
however, an extract of the suspected materials should be prepared and
treated repeatedly with chloroform or ether. This fluid is to be allowed
to evaporate till only a few drops are left, which may be applied on
lint to some portion of the body where the skin is fine, as the fore
arm, the part being covered by a bit of isinglass plaster, or
goldbeaters’ skin. The vesication produced is the test of the presence
of cantharides.
No antidote is known. Vomiting must be excited or encouraged; and
linseed tea, and gum water, or gruel copiously administered. The warm
bath will afford great relief. Oil must be avoided, on account of its
being a solvent of the active principle (cantharidine) of this poison.
IV.—NEUROTIC POISONS.
CHAPTER XXII.
NARCOTICS.
NEUROTICS, ACTING ON THE BRAIN AND PRODUCING SLEEP.
OPIUM.
OPIUM is the inspissated juice of the unripe capsules of the _Papaver
somniferum_, or white poppy, and is a very complex substance. Its
principal properties, however, are due to the presence of _morphia_, as
meconate of morphia; but others of its constituent substances
undoubtedly modify its action.
It is sometimes used as a poison in its crude state, but more frequently
in solution in alcohol, forming tincture of opium, or laudanum.
Unfortunately, opium is the powerful ingredient of most soothing syrups
for children, to whom opium is at all times especially dangerous; and
many who do not die from its direct effects, do from the wasting
indirectly produced.
Of domestic quieting physic the chief preparations are Godfrey’s
Cordial, supposed to consist of one grain of opium in two ounces; and
Dalby’s Carminative, which is one-fourth weaker.
The smallest quantity of _laudanum_ which is known to have proved fatal
to an adult is two drachms, from which death occurred within twelve
hours. The exact quantity taken was, however, doubtful. Two grains and a
half of the _extract_, a quantity said to be equal to four grains of
crude opium, have produced a similar result. Much larger doses are,
however, taken with impunity on many occasions, more especially by those
habituated to the use of this drug, who remain almost unaffected by
surprisingly large quantities. De Quincey, the English opium-eater, once
found in a pirated edition of “Buchan’s Domestic Medicine,” a caution
against taking more than “twenty-five _ounces_” of laudanum at one dose.
He says that he always bore this _excellent_ advice in mind; and it does
not appear that he ever took more than sixteen ounces of the tincture of
opium as his daily allowance. In certain diseases, patients quite
unaccustomed to the use of sedatives can take excessive amounts without
narcotism being produced. In some cases of tetanus, for example, upwards
of four ounces of laudanum have been given daily for a week, without any
marked effect.
On the other hand, it must not be forgotten that not a few individuals
are unable to take even one-third of a grain without being narcotised.
Young children are particularly susceptible of its effects; the tenth
and twelfth parts of a grain having respectively proved fatal to infants
two and five days old. Dr. Edward Smith has even recorded the case of an
infant seven days old, who died comatose eighteen hours after having had
administered to it about the twelfth of a grain of opium, or the
quantity contained in one drop of laudanum.[C] The smallest fatal dose
for a child on record is one of paregoric elixir equivalent to about
one-_ninetieth_ of a grain of opium. On the other hand, they sometimes
recover from very large doses indeed.
The duration of a fatal case is generally from seven to twelve hours.
The shortest period recorded is three-quarters of an hour; the longest,
twenty-four hours. If the patient survives twelve hours there is good
hope of recovery.
The quantity of MORPHIA found in opium varies from two to ten per cent.
The chief salts of this alkaloid are the _acetate_, the _hydrochlorate_,
and the _sulphate_, all being very energetic poisons. They cause
symptoms similar to those about to be described as produced by opium.
But, in addition, there has been especially noticed great itching of the
skin, convulsive twitchings of the muscles of the face and limbs, and
occasionally tetanus. Small doses of any of the salts of morphia may
cause death. In a delicate woman half a grain is supposed to have proved
fatal; in several instances one grain has proved fatal; and certainly a
dose of two grains might kill a healthy adult unaccustomed to opiates.
Nevertheless, under the influence of custom, large quantities may be
taken. A young lady, who has long been under notice, has for the last
three years taken daily fifteen grains of the hydrochlorate of morphia,
without obtaining more than two or three hours’ sleep from it; while for
many days in succession, when suffering much pain, she increases the
quantity to one scruple. From attempts to diminish the dose, made
without the patient’s knowledge, only mischief has resulted.
Others of the opium alkaloids are poisonous; but instances of poisoning
by their means have not occurred, except one doubtful instance of
poisoning by narcotine, recorded by Sonnenschein.
_Symptoms._—When a large dose of opium or its tincture has been taken
the symptoms usually manifest themselves in about twenty or thirty
minutes. They commence with giddiness, drowsiness, and stupor; then
ensues insensibility. The patient appears as if in a sound sleep, from
which he can be roused by a loud noise, &c., although he quickly
relapses. As the poisoning progresses the breathing becomes slow and
stertorous, the pulse weak and feeble, and the countenance livid. The
eyes are closed, while the pupils are generally contracted, often almost
to the size of a pin’s point, and insensible to the stimulus of light.
In some instances the skin is cold and livid, in others it is bathed in
sweat. So also the countenance may be either ghastly or placid, the
pupils may even be dilated, and the pulse may be unaffected, or so small
and frequent as to be scarcely appreciable. Vomiting sometimes occurs,
with slight reaction, so that hopes of recovery are entertained. But
frequently there is a relapse, the comatose state returns, and death
quickly follows, occasionally preceded by convulsions.
The possibility of rousing a patient during the earlier portion of the
progress of these symptoms will assist in diagnosing the effects of
poisoning by opium from those due to apoplexy, epilepsy, &c. The
contracted condition of the pupil will also assist; but it must not be
forgotten that in lesion of the pons Varolii the pupils are also
contracted. When permanent recovery ensues it is complete; but it is
usually preceded for a day or two by severe nausea, a sense of
weariness, constipation, and headache.
The habitual use of opium is most injurious. Dr. Oppenheim, in his
description of the state of medicine in Turkey, tells us that persons
seldom attain the age of forty who have begun the practice early. The
opium-eater may be known by his attenuated body, withered yellow
countenance, stooping posture, and glassy, sunken eyes. He has no
appetite, his bodily powers are destroyed, and he is obliged continually
to increase the dose of his “grief-assuaging remedy” to obtain the
wished-for effect.
_Post-mortem appearances._—The appearances in acute poisoning by opium
are not very characteristic. The most prominent are, great turgescence
of the vessels of the brain, with effusion of serum into the ventricles
and at the base. The turgid condition of the vessels often continues
down the spinal cord, &c. The lungs are usually gorged with fluid blood,
and the skin is of a livid hue.
_Treatment._—The first object is to remove all the poison from the
stomach, and this cannot be effected in any way so well as by the
stomach-pump. In the absence of this instrument, emetics of half a
drachm of sulphate of zinc, or a tablespoonful of mustard, must be
employed. The patient at the same time is to be prevented as far as
possible from going to sleep. When the stomach has been thoroughly
emptied, every means must be adopted to keep the patient roused. This is
to be effected by dashing cold water over his head and chest, walking
him up and down or shaking him between two attendants in the open air,
irritating his legs by flagellation with a wet towel, applying
electro-magnetic shocks to the spine, and administering strong coffee.
Bleeding has been recommended; but it is only to be used after the
poison has been removed from the stomach, and when from the coma and
full pulse we are sure that there is cerebral congestion. In extreme
cases artificial respiration must be tried.
The remedies recommended must be perseveringly used, remembering that as
long as life lasts hope of recovery is not to be banished. In the great
majority of cases the treatment is successful.
_Tests._—There are no direct means by which opium may be detected. We
endeavor therefore to obtain evidence of the presence of morphia and
meconic acid. The two substances may be separated from organic admixture
by the following process: The suspected matters should be well boiled
with distilled water, and spirit acidulated with acetic acid, and
strained. To the fluid which has passed through, acetate of lead is to
be added until precipitation ceases, and the whole, after standing, is
to be thrown on a filter. The insoluble meconate of lead remains on the
filter, the morphia passing through as acetate. To separate the meconic
acid the substance on the filter is to be diffused through water, and
sulphuretted hydrogen passed for a time. Sulphide of lead is thus thrown
down and may be separated by filtration, the meconic acid remaining in
solution. On concentration this should give the requisite reactions.
In the search for morphia the filtered fluid above referred to is also
to be treated with sulphuretted hydrogen, to secure the precipitation of
all acetate of lead, &c., which is next to be carefully separated from
it by further filtration. The fluid now passing through, containing the
acetate of morphia, is next to be concentrated by evaporation over a
water bath, and carefully neutralized by bicarbonate of potass, if it be
desired to obtain the pure alkaloid; but this is not necessary, as the
acetate responds to all reagents. The acetate may be dissolved out of
the mass in dilute alcohol (it is not soluble in ether), again filtered,
the filtrate being finally evaporated to dryness and tested.
MORPHIA.—The best tests for this alkaloid, in substance or in solution
(substance is preferable) are:
1. Nitric acid, which strikes an orange red color, varying in intensity
with the strength of the acid and the concentration of the morphia
solution. Ruddy fumes are also developed.
2. Neutral perchloride of iron, strikes a rich blue color with morphia
when added in small quantity; if added in excess, the yellow of the
test, combining with the blue, may produce a green. This blue is
destroyed by acids and by heat. Nitric acid not only destroys the blue
produced by this test, but replaces it with the orange-red color; so
that the nitric acid test may be applied to the same portion of morphia
after the iron test, but not _vice versâ_.
3. Iodic acid. This acid becomes decomposed, owing to the reducing
action of morphia, setting free the iodine. The latter is detected by
its brown color, and the blue which it strikes with starch. The iodic
acid should be previously tested to ascertain its purity, as it
occasionally contains free iodine.
4. Bichromate of potassium gives a green with morphia, passing to a
dingy brown.
MECONIC ACID.—This is obtained from solutions of opium, in the form of
little scaly crystals of a reddish tint, which are decomposed by heat
and partly sublimed. In solution it may be detected by its acquiring a
blood-red color on the addition of the perchloride of iron. A similar
color is produced by sulphocyanide of potassium, as found in the saliva;
but the color of the meconate is not discharged by chloride of gold; the
sulphocyanide is.
NARCOTINE dissolves in sulphuric acid with a yellow color, converted
into a carmine red by the addition of a trace of nitric acid.
CHAPTER XXIII.
ANÆSTHETICS.
NEUROTICS ACTING ON THE BRAIN AND PRODUCING INSENSIBILITY.
CHLOROFORM—CHLORAL—BICHLORIDE OF METHYLENE—ETHER—AMYLENE—NITROUS
OXIDE.
The anæsthetics which have hitherto been employed in the practice of
medicine are chloroform, sulphuric ether (or a mixture of these),
bichloride of methylene and nitrous oxide, and amylene. Any of these
agents may cause death when introduced into the system by inhalation.
CHLOROFORM is a colorless, heavy, volatile liquid; having a fruity
ethereal odor and a sweet pungent taste. It is formed by the union of
chlorine and marsh gas, but more commonly by the action of bleaching
powder on ethylic or methylic alcohol. It is readily soluble in alcohol,
but very sparingly so in water. Chloroform is a good solvent of
caoutchouc, gutta-percha, camphor, wax, resin, some of the alkaloids,
&c.
The _symptoms_ produced by the vapor of chloroform may be divided into
three groups of varying intensity; briefly they are these: First, a
degree of relief from pain, the senses being but slightly affected;
second, a stage of excitement and incoherence, wherein the patient is
prone to struggle; and thirdly, a stage of which the most marked
features are complete insensibility and narcotism, with relaxation of
the muscular system. At first the patient is conscious of all that is
passing around him, but there is dizziness and singing in the ears. Then
the mental functions are impaired, there is often excitement, the saliva
is increased, the patient pushes away the inhaler, rigidity and spasms
of the muscles may occur, and there is incoherent talk. In the next
stage there is insensibility to pain, and the conjunctiva may be touched
without causing flinching. If the use of this anæsthetic be pushed
further the breathing becomes stertorous, the muscles quite relaxed, and
the pupils dilated; while a still further increase of the chloroform
embarrasses and then stops the breathing and arrests the heart’s action.
Many cases of death from the vapor of chloroform have occurred, the
fatal effect sometimes happening very rapidly from shock, syncope, or
convulsions. The vapor of only thirty drops has destroyed life in one
minute. Death under the influence of chloroform must not be confounded
with death from its effects. The smallest fatal dose when the drug has
been swallowed is one drachm in a boy aged four.
The effects of chloroform taken by the mouth are of the same description
as those which follow the inhalation of this agent; with this
exception, that the fatal result seems to be longer deferred. A case
reported in the _Medical Times and Gazette_, 10th May, 1862, illustrates
the symptoms, &c., in a clear way. Mr. M., thirty-four years of age, a
highly-gifted restless man, was in the habit of inhaling chloroform on
account of sleeplessness. He was very sensitive to its action. At about
12.30 A.M. on the 7th October, 1861, he drank some chloroform; the
quantity being uncertain, though it may be inferred that it was about
one ounce. At 7.15 he was in such a profound sleep that his wife felt
uneasy, and she sent for Dr. Axel Lamm. This gentleman found his patient
in a tranquil sleep, the respiration being somewhat hurried and audible,
the pulse full but slow, the body warm, and the pupils dilated and
insensible. There was a perceptible smell of chloroform in the breath
and in the air of the room. The window was opened, ice was applied to
the head, cold affusions were used along the spine, and an enema was
administered. At 9.30 A.M., the patient was paler, breathing less
audibly, and with a weaker pulse. Artificial respiration was employed by
means of electricity, an ammonia lavement was given, and aspersions of
iced water to the chest and pit of the stomach were used alternately
with warm coverings. The stupor continued, the respired air smelt
distinctly of chloroform, the abdomen was tympanitic, and the pupils
began to contract. About 9 P.M. the eyes began to move, the pupils
seemed sensible to light, the pulse was 160, there was abundant
perspiration, and the patient sat up for a few moments and looked
surprised. Exhaustion, however, set in, and death occurred just before
midnight, nearly twenty-four hours after swallowing the poison.
A second interesting case (_Medical Times and Gazette_, 31st May, 1862)
also deserves attention. A gentleman, fifty years of age, swallowed two
ounces of pure chloroform at 8 A.M. He was not seen until 3 P.M., when
he was found in a state of deep coma. His breath smelt strongly of
chloroform, the pupils were widely dilated and insensible, the pulse
slow and feeble, the surface colder than natural, the movements of the
thorax scarcely perceptible, and sensation generally abolished. Ammonia,
sinapisms, bottles of hot water, and cold affusion did no good; but on
using a stomach-pump a quantity of chloroform mixed with watery mucus
was withdrawn, and in less than an hour the patient was able to answer
questions. For three or four days he complained of a burning sensation
in the throat and epigastrium, and then got well. A consideration of the
treatment employed in this instance cannot but suggest the idea that the
first patient might have had a better chance of recovery had the
stomach-pump been used when Dr. Lamm was first called in; though it is
difficult to conceive how any quantity of chloroform could remain in the
stomach for seven hours, without all of it being absorbed.
Various plans have been suggested for the administration of chloroform
with safety, but this must be remembered: the use of anæsthetics is at
all times attended with risk, and we can only at best diminish the
danger. Apparatus may be used so as to reduce the risk to a minimum; but
this is plain, any contrivance which in itself requires much attention,
and thereby diverts it from the patient, is bad. More lives have been
lost by bungling in its administration than from the noxious character
of the drug.
In the _treatment_ of poisoning by the vapor of any of the anæsthetics
mentioned in this chapter, we must expose the patient to a current of
pure air, use cold affusion, and employ artificial respiration until
the poison is eliminated. Galvanism may be employed to keep up the
action of the diaphragm, either directly or through the phrenics. As
these agents are got rid of through the lungs, the purity of the expired
air is one test of the elimination being complete; though of course
inferior to the evidence afforded by the subsidence of the symptoms. In
poisoning by liquid chloroform or ether the stomach-pump ought to be
promptly used.
CHLORAL HYDRATE, which with an alkali is converted into chloroform, has
of late been much used as a narcotic and for easing pain. No details of
any case of poisoning by its agency have yet been published.
BICHLORIDE OF METHYLENE has been used for anæsthetic purposes. It is
supposed to be safer than chloroform. Practically they act much alike,
and death happens with the one as with the other.
_Test._—Chloroform at a red heat is decomposed, and chlorine and
hydrochloric acid are formed. Hence, to detect it the substance supposed
to contain it may be heated so as to expel the chloroform, which should
be conducted away from it by a tube at right angles; to this heat should
be applied sufficient to decompose the vapor, and its products searched
for by the ordinary tests. The smell is a valuable criterion.
SULPHURIC ETHER.—Sulphuric ether, or ether, is a clear colorless
liquid, very inflammable, soluble in alcohol, and less so in water. It
is usually obtained by distilling common alcohol with sulphuric acid.
The effects produced by the inhalation of ether are similar to those
which result from chloroform. It is, however, without doubt a much safer
agent, but its effects are longer in manifesting themselves; it is more
irritating to the air-passages, and much more of it is required. Deaths
have occurred under its influence as under that of chloroform.
AMYLENE.—This is a colorless, volatile liquid, made by distilling
amylic alcohol (obtained from crude fusel oil, or oil of potato spirit)
with chloride of zinc.
Dr. Snow found that amylene, like chloroform, is capable of causing
sudden death by inducing over-narcotism of the heart, and paralysis of
this organ. He had two deaths from it, and it has since been entirely
given up as an anæsthetic.
NITROUS OXIDE.—Comparatively recently the laughing gas of Sir Humphrey
Davy has been introduced as an anæsthetic agent. Its successful use
depends on the total exclusion of air from the lungs during its
exhibition. It can only be used for a short time, hence it is chiefly
employed in dental operations, although it has been given for a
considerable length of time consecutively by allowing the patient to
return to the verge of sensibility before giving a fresh dose.
CHAPTER XXIV.
INEBRIANTS.
NEUROTICS ACTING ON THE BRAIN AND PRODUCING INTOXICATION.
ALCOHOL—NITRO-BENZOLE—COCCULUS INDICUS—FUNGI, ETC.
ALCOHOL.—Spiritous liquors, when taken in large quantities, not
unfrequently produce fatal effects.
Two wineglassfuls of brandy proved fatal to a boy, seven years old, in
thirty hours. Dr. Taylor mentions the case of a man who drank two
bottles of port wine (containing eleven ounces of alcohol) in less than
two hours. He speedily became intoxicated and utterly helpless, never
rallied, and died from congestion of the brain and lungs. Another man
who swallowed a bottle of gin for a wager died in half an hour, although
much of the spirit was removed by the stomach-pump. A common cause of
acute alcohol poisoning is “sucking the monkey,” as practised in the
docks by laborers having access to spirit casks.
The _symptoms_ generally come on rapidly, the individual appearing
confused, and unable to walk steadily. This degree of intoxication soon
passes into the stage of complete stupor and coma, and unless there is
vomiting collapse soon sets in. In some cases a remission of the
symptoms has occurred, death being postponed for a day or longer.
As the alcohol is eliminated by the lungs, stupor from drink may be
detected by the odor of the breath. The countenance is usually flushed,
and the pupils are dilated, but in cases of acute poisoning the patient
may be deadly pale. The pupils are not contracted, as in poisoning by
opium; moreover, the individual may generally be roused for a few
moments by a loud noise, &c.; a circumstance which may prevent
intoxication being mistaken for concussion of the brain.
Diluted spirits produce a state of excitement, terminating in stupor. It
must be remembered that alcoholic liquids have been frequently made the
vehicles of more virulent poisons.
As regards _treatment_, it is only necessary to say that the poison is
to be removed as quickly as possible by the stomach-pump. Cold affusion
should be employed, and the diluted liquor ammoniæ, or carbonate of
ammonia, administered. Subsequently warmth must be promoted.
NITRO-BENZOLE AND ANILINE.—A compound, made from the rectified products
of coal tar and nitric acid, and known as _nitro-benzole_, is sometimes
used as a substitute for essential oil of almonds. It is sold to
perfumers under the name of “essence of mirbane.” A lad employed in some
chemical works in the early part of 1862, finding a syphon did not act,
sucked through it some of the fluid, which happened to be nitro-benzole.
No immediate effect resulted, but in a few hours he felt as if he were
drunk. Stupor came on, and ended in death twelve hours after swallowing
the poison. Another product of the destructive distillation of coal in
gas-making is _aniline_ (into which nitro-benzole is converted in the
human body) a colorless, limpid, acrid, and poisonous liquid. It has
given rise to very alarming symptoms when swallowed, as well as when
inhaled in vapor. It produces a remarkable blue or purple discoloration
of the body, particularly the lips and nails.
COCCULUS INDICUS.—The kernel of the berry of the Menispermum cocculus,
or Levant nut, imported from the East Indies, contains from one to two
per cent. of a poisonous principle named _picrotoxine_. Thieves
sometimes mix a decoction or extract of the berries with spirits or
beer, to give these drinks an intoxicating property (hocussing).
Dishonest publicans, too, first reduce their beer by means of salt and
water, and afterwards give it intoxicating properties by adding cocculus
extract. The same substance is used by poachers to destroy fish. The
symptoms produced appear to be a peculiar stupor, a complete loss of
voluntary power, with a consciousness of passing events.
DARNEL SEEDS (_Lolium temulentum_).—The seeds of this plant, which is
often found growing with corn crops, when accidentally mixed in
considerable quantity with wheat or rye, and ground into flour, have
caused gastric pain, severe giddiness, vomiting, and other symtoms of
intoxication. The sufferers complained that everything seemed of a green
color. A wet season is said to encourage the growth of darnel with the
varieties of corn.
CAMPHOR.—This substance is very variable in its action. It has given
rise to alarming symptoms on some occasions, and once it has destroyed
life. In scruple and half-drachm doses, it seems to have produced
giddiness, difficulty in walking, dimness of sight, difficulty of
breathing, delirium, and insensibility.
The stomach-pump or emetics must be employed. If the effects are not
very severe they will generally cease spontaneously after a time. The
odor would lead to the detection of the poison.
FUNGI.—According to Berkeley there are now upwards of 2380 recognised
species of British fungi, a considerable proportion of which are
doubtless poisonous. But the type of the class may be taken as the
Amanita muscaria. This is an autumn fungus of an orange-red color, and
is used among the Siberian tribes, especially the Koraks, as an
intoxicating agent, and produces symptoms somewhat similar to those of
alcohol.
The Agaricus campestris and esculentus are those most frequently used as
articles of food, on account of their savory properties; but even these
are indigestible. They occasionally produce diarrhœa, with a
pruriginous or exanthematous rash in dyspeptics; and should only be
eaten in great moderation.
_Ketchup_, the juice of the mushroom flavored with salt and spices, has
produced faintness, nausea and colic, lasting for some hours.
There are some positive characters by which the wholesome fungi can be
distinguished from the unwholesome. Moreover those which may be eaten
with impunity by some individuals prove destructive to others. Thus, a
French officer and his wife died from breakfasting off mushrooms which
others in the house ate without inconvenience. As a general rule highly
colored mushrooms, with an astringent styptic taste, a forbidding
pungent odor, and which grow in dark and shady places, should be
avoided.
The symptoms produced by poisonous fungi are not unfrequently those
indicative of gastro-intestinal irritation, with a disordered condition
of the nervous system, and considerable depression; but, again, they may
act much more like pure narcotics. In treating these case, the stomach
and intestines must be thoroughly emptied, and then the prominent
symptoms are to be relieved according to their urgency.
CHAPTER XXV.
DELIRANTS.
NEUROTICS ACTING ON THE BRAIN AND PRODUCING DELIRIUM.
HYOSCYAMUS—BELLADONNA—STRAMONIUM—DATURA ALBA—NIGHTSHADE.
Most of these are not very important substances, as they have rarely
been employed as poisons in this country. Serious symptoms have,
however, resulted from their accidental use.
HENBANE (_Hyoscyamus niger_).—All parts of this plant are poisonous;
but the seeds are more powerful than the root or leaves. In medicinal
doses it is a feeble narcotic. It owes its powers to an alkaloid
(_hyoscyamia_) it contains.
In very large doses henbane produces giddiness, flushings, excitement,
and a sense of weight in the head; the limbs tremble, and there is
general loss of power, the pupils get dilated, there is double vision,
flashing of light before the eyes, and great drowsiness. If vomiting
supervene these symptoms generally pass off; otherwise we may find
fierce delirium, loss of speech, complete loss of power over the limbs,
cold sweats, and exhaustion.
In some instances, when the roots have been eaten by mistake for
parsnips, the symptoms have been those of drunkenness and delirium. Dr.
Houlton states (_Lancet_, 6th July, 1844) that this error was committed
one night at a monastery. The monks who partook of the roots had such
hallucinations that the establishment resembled a lunatic asylum. They
rang the bell for matins at midnight, and those who attended were unable
to read, or they read that which was not in the book. In another
reported case (_Edin. Med. and Surg. Journal_, p. 562, October, 1844),
the roots were put into soup, of which nine persons partook. Although no
unpleasant flavor was noticed at the time of eating, yet very shortly
afterwards all complained of an acrid taste, nausea, indistinctness of
vision, restlessness, delirium, and great somnolency, which continued
some time.
The appearances found after death consist chiefly of great congestion of
the venous system. The lungs and brain have especially been found loaded
with dark-colored blood.
To prevent a fatal result from the use of henbane or others of this
group, we must trust to stimulant emetics, as sulphate of zinc, and full
doses of castor oil, so as to get rid of the offending substance.
_Test._—The only test for hyoscyamus is the botanical characters of the
plant, when taken in substance, and its power (common to all in this
group) of dilating the pupil.
ATROPA BELLADONNA (_Deadly Nightshade_).—Two other plants known under
the name of Nightshade will hereafter be referred to. The Deadly
Nightshade, now to be noticed, is indigenous, and grows in woods and
gardens. The root, leaves, and berries are poisonous, this property
being due to the presence of an alkaloidal principle—_Atropia_.
_Symptoms._—Dryness of the mouth and throat, thirst which nothing
allays, nausea and vomiting, great dilatation of the pupils with
indistinct or double vision, giddiness, palpitation of the heart,
physical and mental depression, perversion of the sense of taste, and
delirium followed by stupor, form the chief symptoms. They may set in
within from half an hour to three or four hours of swallowing the
poison. Sometimes strangury and bloody urine, a scarlatinal kind of rash
upon the skin, a disposition to laugh and talk wildly, fanciful
delusions, a rapid flow of ideas, and difficulty in walking, have been
observed.
A large detachment of French soldiers, halting near Dresden, ate freely
of the belladonna berries. Shortly afterwards they were seized with
nausea, thirst, dryness of the throat, difficult deglutition,
insensibility of the eye, great dilatation of the pupil, delirium, and
coma. Many of the men died before assistance could be rendered to them.
_Post-mortem Appearances._—Congestion of the cerebral vessels, dilated
pupils, red patches at different parts of the alimentary canal, and a
dyed purple hue of the gastric mucous membrane, if the berries have been
eaten, are the most common appearances.
_Treatment._—Stimulant emetics, castor oil, and animal charcoal are the
remedies to trust to.
Dr. Taylor refers to one case in which a young man poisoned himself with
two grains of _atropia_. He took the dose on going to bed, was heard to
snore heavily during the night, and was found dead at seven o’clock in
the morning.
As a means of diagnosing poisoning by belladonna it has been recommended
to introduce a few drops of urine into the eye of an animal, to see if
dilatation of the pupil takes place.
_Test._—There is no very certain test for _Atropia_ beyond its effect
on the pupils and on vision.
STRAMONIUM (_Datura Stramonium_, _Thorn-Apple_) is an indigenous plant
found in waste places. The fruit and seeds are the most poisonous parts
of the plant. The active alkaloid, named Daturia, has properties
resembling those of atropia, with which it would seem to be almost
identical.
The poisonous effects of stramonium are the same as those of belladonna,
and are to be relieved by similar remedies. When this drug is prescribed
as a medicine it should be immediately discontinued if it produce
dryness of the throat and dilatation of the pupils.
_Dhatoora._—In India the seeds of the Datura alba, a plant which grows
abundantly in most parts, are frequently used for the purpose of
hocussing travellers, in order that they may be robbed with impunity.
The seeds, which closely resemble those of the capsicum, are mixed with
food, and give rise to total insensibility on the part of the recipient,
often with noisy delirium or delusions. Death is not unfrequent after a
large dose, although it would seldom seem to be administered for that
purpose. Its effect may be for the time being to completely alter the
disposition of the individual, and to cause him to give way to all kinds
of foolish notions and antics.
NIGHTSHADE.—The _Solarium dulcamara_ (Bittersweet, or Woody Nightshade)
and the _Solanum nigrum_ (Garden Nightshade) contain an active principle
known as Solania. The red berries of the first-named plant, and the
black berries of the second, have been eaten by mistake; and have given
rise to great thirst, headache, giddiness, dimness of vision, dilated
pupils, convulsions, vomiting, and purging. Orfila relates the cases of
three children who died from eating the berries of the Solanum nigrum,
after suffering from vertigo, dilated pupils, nausea, colic, stertorous
breathing, and convulsions.
CHAPTER XXVI.
CONVULSIVES.
NEUROTICS PRODUCING CONVULSIONS.
NUX VOMICA—BRUCIA—STRYCHNIA.
The plants which yield the alkaloid Strychnia are, the _Strychnos nux
vomica_, a native tree of Coromandel, Ceylon and Bengal: the _Strychnos
Ignatii_, which abounds in the Philippine Islands, and furnishes the
hard seed, about the size of a filbert, known as the bean of St.
Ignatius; the _Strychnos tieute_, a large climbing shrub of Java; the
_Strychnos toxifera_, of Guiana; and the _Strychnos colubrina_, or
_Snakewood_, of the East Indies. The effects of these plants are exerted
upon the spinal cord; as is manifest by the violent convulsions and the
tetanic contractions of the muscles which they produce. They have no
effect on the brain, consciousness remaining intact until death.
A powerful juice, used by the Indians of Guiana as an arrow poison, and
variously designated as _curare_, _woorara_, &c., is in all probability
obtained from the Strychnos toxifera. The composition of the arrow
poison varies in different tribes; in some it is a mysterious compound
of many substances, obtained from plants, red and black ants, and the
fangs of venomous snakes; but in all the active ingredient would seem to
be the Strychnos toxifera. It destroys the power of the motor nerves—an
action the reverse of that possessed by strychnia.
NUX VOMICA.—A powder, a tincture, and an extract, obtained from the
seeds of the Strychnos nux vomica, or koochla tree, are used in medical
practice. Thirty grains of the powder have proved fatal, and so have
three grains of the alcoholic extract. Death may occur in from fifteen
minutes to twelve hours. It is possible that nux vomica may accumulate
in the system, as serious symptoms have arisen from the long-continued
use of small doses. Thus a lady took nine grains of the powder daily, in
divided doses, for sixteen days. As purging then set in with colic, the
medicine was withdrawn. Five days after the withdrawal there was ringing
in the ears, with drowsiness, impairment of speech, &c.; on the ninth
day tetanic symptoms set in, with trismus; and on the twelfth day, after
several tetanic convulsions, death took place from exhaustion.
BRUCIA.—The seeds of the nux vomica not only yield strychnia but
brucia, an alkaloid which has the same properties, and causes the same
symptoms as strychnia, though it is much less powerful.
STRYCHNIA.—This alkaloid may very justly be termed a deadly poison. It
is unfortunately the active ingredient of some preparations sold to the
public for destroying vermin: a circumstance which has now led to the
death of several individuals. “Battle’s Vermin Killer” is said by Dr.
Letheby to consist of flour, Prussian blue, sugar, and strychnia in the
proportion of twenty-three per cent. Since the use of strychnia by those
notorious criminals Palmer and Dove, this formidable agent has been
employed by other murderers.
The medicinal dose of strychnia is from the 1/30th to the 1/12th of a
grain twice a day. Dr. Christison communicated a case to Dr. Taylor in
which the 1/16th of a grain caused the death in four hours of a child
between two and three years of age. One quarter of a grain has nearly
proved fatal to adults. A woman twenty-two years of age died in the
Jersey Hospital, from the accidental administration of half a grain.
Death has occurred in twenty minutes from this poison. In eleven cases
analyzed by Dr. Guy two hours and three-quarters were the limits
respectively.
_Symptoms._—The time at which the symptoms commence varies according as
the strychnia has been taken in solution or in a pill. In the first case
a very bitter taste is experienced during swallowing, usually followed
in a few minutes by a sense of suffocation and difficulty of breathing.
Then there are twitchings of the muscles, jerking movements of the
limbs, and a quivering of the whole frame. The limbs become rigid, the
head is bent back, while the body is stiffened and arched, so that it
rests on the head and heels (opisthotonos). The difficulty of breathing
causes the face to become dusky, the eyeballs prominent, and the lips
livid. The features assume a peculiar grin (risus sardonicus); there is
much thirst, but perhaps inability to drink from spasm of the jaws;
while the sufferer is quite conscious, is much alarmed, and is impressed
with the idea that death is surely stealing upon him. As the attacks of
spasms are commencing the patient cries out, and warns those about him
of the approach of the seizure; he begs for help, and perhaps asks to be
held, or rubbed, or turned over; and when the seizure passes off, at
the end of forty or sixty seconds, he is exhausted, and bathed in sweat.
The more he is disturbed or excited the shorter is the intervals between
the attacks; and though a firm grasp seems to afford relief, yet a
slight touch, a gust of air, or opening a door, will increase the
suffering. As death approaches the tetanic spasms rapidly succeed each
other; and the patient sinks, suffocated during an attack, or exhausted
during an interval, in about two hours from the beginning of the
symptoms.
When the strychnia has been taken in a pill two hours have elapsed
before any effects have been produced. A case is also reported (_Glasgow
Medical Journal_, July, 1856) where a medical man took three grains of
strychnia dissolved in spirits of wine and diluted sulphuric acid. He
went to bed and slept for an hour and a half, and then awoke with a
spasm. Under treatment he recovered.
There is commonly a wide difference between tetanus arising from a wound
or from disease and that provoked by strychnia. In the former case some
exciting cause can be detected; the symptoms come on gradually, and only
attain their full development at the end of several hours; the rigidity
of the muscles is more or less permanent, there being no intervals of
relaxation as there are in poisoning; and death has hardly been known to
occur in less than twenty-four hours, while frequently it is deferred
for two or three days.
_Post-mortem Appearances._—Although the body may be relaxed at the time
of death it usually quickly stiffens—frequently in the course of ten or
fifteen minutes. The rigor mortis is persistent for some time: in the
case of Cook, poisoned by Palmer, the rigidity of the body and limbs was
said not to have passed off after two months’ interment. This is not
however invariable, as a body may be flaccid or stiff after death from
this cause as from any other. The hands are often clenched, and the
soles of the feet arched and inverted. The membranes of the brain and of
the upper part of the spinal cord are congested; and there is often
considerable serous effusions under the spinal arachnoid. The lungs are
generally loaded with dark fluid blood. The heart is usually contracted,
but sometimes the right cavities are distended like the pulmonary
vessels. The blood has been found black and liquid.
_Treatment._—Emetics are to be given at once, and repeated until very
free vomiting is induced. If the tetanic spasms have not commenced, the
stomach-pump ought to be used. Chloroform is to be given to relieve
spasm and pain, but the patient should be disturbed as little as
possible, as the least thing induces the tetanic attack. There is no
very suitable antidote, but tannic acid, in the form of green or black
tea, &c., might be given.
Iodine forms a crystallizable compound with strychnia. Dr. Bennett, of
Sydney, has recorded an instance in which he attributed recovery to the
employment of tincture of iodine. Hence from thirty minims to a drachm
of this tincture combined with the iodide of potassium may be exhibited.
In its absence, three or four ounces of animal charcoal, diffused
through water, ought to be given.
To prevent the spasms by paralyzing the motor nerves, a solution of
curare has been recommended by Dr. George Harley to be injected under
the skin; or, if it could be obtained, the active principle of this
substance, curarina, would perhaps be deserving of trial.
The patient is to be kept warm and quiet.
To separate strychnia from organic admixture the process modified from
Stas, given in the beginning of this book, is the most useful.
_Tests._—Strychnia is a white crystalline solid, very insoluble in
water, soluble in alcohol or chloroform or weak acids, and having an
intensely bitter taste.
1. Pure strychnia is not changed in color when treated with iodic acid
or with either of the strong mineral acids; but as this alkaloid
generally contains brucia, nitric acid reddens it.
2. Dissolved in sulphuric acid no change ensues; but on adding a
fragment of bichromate of potass to the solution a series of blue,
violet, purple and red tints are produced. The same result is brought
about by using ferricyanide of potassium, permanganate of potassium, the
peroxide of lead, or the black oxide of manganese.
3. If the skin of a frog be dried, and a few drops of a solution
containing strychnia applied to it, strong tetanic convulsions will
ensue, and be reproduced every time the animal is touched or irritated.
According to Dr. Marshall Hall this strychnoscopic test will detect the
1/5000th of a grain, or even less.
4. An exceedingly useful class of tests for many poisons has been
introduced by Dr. Guy; we mean the crystalline appearances presented on
subliming the substance and condensing it on a cool microscopic slide,
or the crystalline form observed as modified by various reagents. Thus
the strychnine sublimate, touched with a drop of carbazotic acid, forms
groups of arborescent crystals, each branch forming part of a circle,
when seen under the microscope.
CHAPTER XXVII.
HYPOSTHENISANTS.
NEUROTICS PRODUCING DEATH BY SYNCOPE.
ACONITE—PRUSSIC ACID.
ACONITE (_Aconitum Napellus_, _Monkshood_, _Wolfsbane_, _Blue
Rocket_).—This beautiful plant is found in most parts of Europe.
_Aconitia_, the alkaloidal base of the plant, is the most deadly poison
known; the fiftieth part of a grain having nearly caused death.
The chief _symptoms_ of poisoning by aconite are numbness and tingling
in the mouth and throat, giddiness, abolition of muscular power, pain in
the abdomen, with vomiting and purging. Sometimes delirium and slight
stupor have been noticed. The pupils are usually dilated, the skin is
cold, the pulse exceedingly feeble, the breathing oppressed, and there
is a dread of approaching dissolution. Frequently the sufferer is
perfectly conscious, though paralyzed, till death suddenly occurs after
two or three hurried gasps. According to Dr. Fleming, death may be due
to a sedative impression on the nervous system, or to asphyxia from
paralysis of the respiratory muscles, or to syncope.
A fatal mistake is not very uncommonly made in eating the root of
aconite for that of horseradish. The sense of tingling and numbness
produced by the former is so different from the pungent taste of the
latter that with due care no mistake should occur, except the plants be
allowed to grow together, which should never be done.
A case occurred in Ireland where a woman poisoned one man and nearly
killed another by sprinkling powdered aconite root over a dish of
greens.
Of the root one drachm, of the tincture one drachm, and of the alcoholic
extract four grains, have caused death. Death follows a considerable
dose in less than an hour, but sometimes a longer period elapses.
The Bikh poison, formerly much used in India, and still not unfrequently
employed, has as its basis the Aconitum ferox, a still more dangerous
drug than our indigenous plant.
_Treatment._—No time must be lost in the use of remedies. In addition
to emetics, castor oil, and animal charcoal, benefit may be derived from
administering strong coffee. Brandy or ammonia should also be given,
while the limbs and back are well rubbed with hot towels. Artificial
respiration might prove useful.
There is no good test for aconitia.
HYDROCYANIC ACID (_Prussia Acid_), on account of its energetic and rapid
action, is one of the most formidable poisons with which we are
acquainted. In its concentrated state it is a limpid colorless liquid;
possessing a somewhat acrid taste, and having an odor, when diffused
through the air, resembling that of oil of bitter almonds. When diluted
with water, it forms the acid kept by the druggist. The properties of
this variety are similar to those of the pure form; except that, if kept
in the dark, it is not so readily decomposed. It is in this condition
that it is used as a poison. The diluted acid of the British
Pharmacopœia contains about 2 per cent., and that known as Scheele’s
from 4 to 5 per cent., of the strong acid; but all vary greatly with
keeping.
One of the salts of hydrocyanic acid, the _cyanide of potassium_, claims
a short notice, since it is largely employed by photographers, workers
in electrotype, &c. It has been taken as a poison. This salt is sold in
the form of deliquescent white crystals, or in crystalline masses, which
are very soluble in water, and possess the odor of prussic acid. From
three to five grains will destroy life almost as rapidly as prussic acid
itself, and in the same manner: a dose of five grains has proved fatal.
Several vegetable substances yield prussic acid, such as the kernels of
the peach, apricot, nectarine, cherry, &c., the leaves of the cherry
laurel, and the pips of apples and pears. Cases of alarming illness have
occurred from eating _bitter almonds_ too freely; while the essential
oil obtained by distilling the pulp of these almonds with water is a
powerful poison. This _essence_ or _oil of bitter almonds_ contains
about ten per cent. of anhydrous prussic acid; and it is probable that
from ten to thirty drops would prove fatal to an adult. The prussic acid
may, however, be separated from it, and leave the oil harmless.
A distilled water obtained from the leaves of the cherry laurel, which
was formerly employed in medicine, proved dangerous from its very
variable strength; it has been used as a poison. In the well-known case
of Sir Theodosius Boughton, poisoned by Captain Donellan in 1781,
_laurel water_ produced death within half an hour after two ounces had
been swallowed.
The smallest quantity of prussic acid which has been known to
destroy life is nine-tenths of a grain of the anhydrous acid, equal
to forty-five minims of the diluted preparation of the British
Pharmacopœia; and it is probable that this would, in most instances,
prove fatal. In the case referred to death occurred in twenty minutes;
but from a larger dose it has ensued much earlier. The period may be
said to vary from two to five and forty minutes. Insensibility may,
however, come on in a few seconds. In the case of seven epileptics
accidentally poisoned at the Bicêtre, death occurred in the first within
twenty minutes, in the last after three-quarters of an hour, though the
dose of the acid was the same in each instance.
_Symptoms._—These will vary with the dose and the mode of exhibition.
Inhalation of the vapor of anhydrous prussic acid would immediately
cause death. The vapor of the diluted acid has given rise to serious
symptoms with great rapidity. Scheele is said to have been suddenly
killed by respiring the vapor of the dilute acid while making his
experiments.
When the diluted acid is taken in a large dose the symptoms may commence
during swallowing, death following so quickly that scarcely any effects
can be observed. The chief symptoms, perhaps, are insensibility, slow
gasping, or convulsive respiration, a clammy cold skin, fixed and
glistening eyes, dilated pupils, spasmodic closure of the jaws, an
almost imperceptible pulse, and sometimes convulsions of the limbs and
trunk. The rapidity with which consciousness is lost is well exemplified
in an instance recorded by Hufeland, where a man about to be apprehended
as a thief took an ounce of the acid, staggered a few steps and fell
apparently lifeless. In a few moments a single violent respiration was
made, and within five minutes of taking the poison he was dead.
Insensibility is not, however, in all instances, immediately produced;
many an authenticated case having occurred in which the symptoms were
protracted for some minutes, the individual performing several acts
indicating consciousness, such as replacing the cork in the bottle,
adjusting the bed-clothes, or even running some distance to summon help.
The utterance of a shriek has been said to be characteristic of
poisoning by this acid; but toxicologists know that such has not been
observed in the human subject, and that there is merely a gasping for
breath, or perhaps a call for help.
A small dose produces faintness, insensibility, difficulty of breathing,
involuntary evacuations, loss of muscular power, convulsions, and
temporary paralysis. If the proper treatment be employed, recovery may
often be effected.
_Post-mortem Appearances._—The body is generally livid, the countenance
pallid, or sometimes livid and bloated, the jaws firmly closed, and the
hands clenched. There is frequently blood or froth about the mouth, and
the eyes are sometimes described as prominent and glistening. There is
often an odor of prussic acid about the body, which is more perceptible
on opening the stomach. The venous system is usually gorged with blood;
and the brain, lungs, heart, liver, spleen, and kidneys have been found
congested with dark-colored fluid blood.
_Treatment._—There is no chemical antidote to this poison which can be
relied upon. Chlorine and the mixed oxides of iron have been
recommended; but even if one of these agents happened to be at hand, it
is doubtful if its employment could be timely enough to be advantageous.
Attempts must be made to restore animation by cold affusion, stimulating
frictions to the chest and abdomen, warmth to the surface, and the
application of ammonia to the nostrils. Cold affusion over the head and
neck has proved most efficacious when promptly resorted to, and repeated
at short intervals so as to cause a shock. The direct injection of
liquor ammoniæ into the veins, as proposed by Professor Halford, for
snake bite, might be tried if the means were at hand. As soon as
possible ammonia should be given internally and the stomach emptied.
If recovery ensue from the immediate effects, vomiting should be
produced by emetics or otherwise, after which strong coffee, with
brandy, ought to be administered.
_Tests._—The best are the following:
When hydrocyanic acid has to be separated from organic substances, such
as the contents of the stomach, it is usual to take advantage of its
ready volatility. If the acid be not in combination it may be given off
so readily as to be detected by a watch glass moistened with nitrate of
silver held over the vessel containing the acid; but in order to make
sure of its presence or absence the following process should be adopted.
The suspected material should be acidulated with pure sulphuric acid so
as to insure the prussic acid being in a free state. The substances thus
acidulated are to be placed in a retort, distilled over a water bath,
and the distillate collected in a cool receiver containing some caustic
potass. About one-sixth of the fluid substance should in this way be
distilled over, when the liquid in the receiver may be tested by the
silver or iron tests, or the vapor as it passes over may be tried with
the sulphur test.
1. The peculiar _odor_ of prussic acid is well known, and is a very
delicate test, taken in conjunction with others, of its presence.
2. _The Silver Test._—Nitrate of silver yields, with hydrocyanic acid
or cyanide of potassium, a white clotted precipitate, (cyanide of
silver,) insoluble in cold but soluble in boiling nitric acid. If this
precipitate be well dried and heated, cyanogen gas will be given off,
which may be known by its burning with a purplish flame. This test is
very delicate.
3. _The Iron Test._—Of the liquid collected in the receiver
above-mentioned, or the suspected acid liquid, saturated with a few
drops of caustic potass, a portion is to be taken, and to this is to be
added a small quantity of a solution of sulphate of iron. A dirty
brownish or greenish precipitate will fall, consisting of a mixture of
the oxide of iron and prussian blue. On adding a few drops of diluted
sulphuric or hydrochloric acid, and thus dissolving the oxides, the
prussian blue will immediately be made clear if hydrocyanic acid be
present.
4. _The Copper Test._—Sulphate of copper added to prussic acid rendered
slightly alkaline by potass, gives a greenish-white precipitate, which
becomes white by the addition of a few drops of hydrochloric acid to
dissolve the blue precipitated oxide of copper.
5. _The Sulphur Test._—One of the most useful tests for prussic acid,
whether in the fluid or volatile state, is the so-called sulphur or
Liebig’s test. It is best adapted for detecting the acid in a state of
vapor, and to this end a drop of yellow sulphide of ammonium in a
watch-glass is held over the suspected liquid, which may be warmed by
the hand to facilitate the evolution of the acid. In this position the
watch-glass should be allowed to remain for some little time, after
which a drop of solution of perchloride of iron is to be added, which
will give rise to a blood-red color not discharged by corrosive
sublimate.
If the acid is in the liquid form a drop of the prussic acid and the
yellow sulphide may be mixed and heated until they thoroughly combine. A
drop of sulphate of iron is then added as before, but all the sulphide
must be decomposed or a black sulphide of iron will be produced, even
though prussic acid be present, instead of the ordinary blood-red color.
Other substances give a similar reaction with iron; but their color is
discharged by corrosive sublimate.
CHAPTER XXVIII.
DEPRESSANTS.
NEUROTICS PRODUCING MARKED DEPRESSION OF THE HEART’S ACTION.
DIGITALIS—CALABAR BEAN—TOBACCO—HEMLOCK.
DIGITALIS PURPUREA (_Purple Foxglove_).—The seeds, leaves, and root of
this indigenous hedge-plant are poisonous. _Digitalin_ is the principle
which these parts contain. The officinal infusion of digitalis, made
from the dried leaves, is used in doses of ʒij, ℥ss, or more; of
the tincture m. v to m. xl are usually given. On the recommendation of
the late Mr. Jones, of Jersey, half an ounce of the tincture is
sometimes administered in cases of delirium tremens; this dose being
repeated a second or even a third time, in the course of six or eight
hours.
Digitalis is very uncertain in its action. When given medicinally its
effects should be watched, as in some cases it probably accumulates in
the system, but in others, especially in heart disease, it may be given
for months or years without hurt, and even with advantage. A poisonous
dose seems to produce vomiting, purging, colic, headache, slowness and
extreme irregularity of pulse, dimness of vision, dilated pupils,
lethargy, prostration, convulsions, and coma. In two instances death
occurred within twenty-two hours. The appearances found afterwards have
been chiefly congestion of the cerebral vessels and slight inflammation
of the stomach.
_Digitalin_ has acquired a certain importance from the trial and
execution of De La Pommerais for poisoning the widow Pauw by its means.
The facts were altogether inconsistent with his innocence, and though
digitalin was not separated from the woman’s body, yet extracts of the
vomited matters killed dogs with the symptoms of poisoning by digitalis.
The extracts obtained from the stomach and bowels did not prove fatal.
Tardieu and Roussin, who were engaged on the case, came to the
conclusion that the woman had been poisoned by some vegetable poison,
probably digitalin. The woman’s symptoms, which were not, however,
carefully noted, were violent vomiting and extreme depression.
In addition to the administration of emetics and castor oil, some
infusion containing tannin, as strong tea, &c., should be given as an
antidote in poisoning by digitalis. Substances containing tannin render
the digitalin inert. Strong tea or coffee, with brandy, will likewise be
needed, to lessen the depression and exhaustion.
CALABAR BEAN (_Physostigma venenosum_).—This bean, which grows on the
West Coast of Africa, is generally used as an ordeal. According to the
superstition of the natives the innocent vomit and are safe, the guilty
die. Its most characteristic effect is contraction of the pupil. It
seems to act by paralyzing the motor muscles, leaving the senses intact.
There is great interference with the heart’s action, it beating
tumultuously, but death seems to follow paralysis of the muscles of
respiration. In some cases, one fatal, occurring in Liverpool, there was
much vomiting.
TOBACCO (_Nicotiana tabacum_).—All parts of this plant are very
poisonous. An infusion of the leaves, exhibited as an enema, has, on
several occasions, speedily proved fatal. Persons in attempting to
acquire the habit of smoking often suffer from severe nausea, vomiting,
great prostration, and insensibility; while in some instances, more
severe effects have ensued. Symptoms very much resembling those of
apoplexy have also been produced by the excessive use of snuff. A
celebrated French poet died in fourteen hours, from swallowing the
contents of his snuff-box, which had been mixed with his wine, as a
joke. Snuff or tobacco is also sometimes used for drugging persons with
a view to nefarious purposes, as robbery and such like.
_Nicotin_, the alkaloid of tobacco, is as deadly a poison as prussic
acid. It is an acrid, volatile, oily liquid, of a pale amber color. In
1858 a chemist of rising reputation committed suicide with this
substance. He was seen by one of the attendants at the Museum in Jermyn
Street, in the act of falling forwards out of a water-closet in which he
had concealed himself. The attendant raised him up, and with the aid of
another man endeavored to carry him to a table, but he heaved a deep
sigh and died in their arms. The appearances afterwards found were great
congestion of the membranes of the brain and a dark fluid state of the
blood.
The only other case of importance on record was the occasion of the
_cause célèbre_ Bocarmé. This man, a Belgian count, studied chemistry,
apparently, with a view to the preparation of this substance, made it in
quantity, and with the help of his wife poisoned her brother. The count
was condemned and executed. M. Stas was engaged to search for the
poison, and thus was introduced his process, so often referred to.
CONIUM (_Conium maculatum_, _Common or Spotted Hemlock_).—This
indigenous plant, which grows abundantly in hedges and wild
places, belongs to the order Umbelliferæ. The following common
umbelliferous plants are likewise poisonous: viz., the _Cicuta virosa_
or water-hemlock, the roots of which have been eaten in mistake for
parsnips; the _Œnanthe crocata_, or the water-dropwort, one of the
most virulent of English vegetables; the _Æthusa cynapium_, or
fool’s parsley, sometimes gathered in mistake for parsley; and the
_Phellandrium aquaticum_, or fine-leaved water-hemlock, popularly known
as water-parsnip. They have all given rise to accidents.
The seeds, leaves, and root of the _Conium maculatum_ are all poisonous.
The effects are rather variable, sometimes consisting chiefly of
delirium, stupor, coma, and convulsions; on other occasions, the action,
being chiefly exerted on the spinal cord, gives rise to gradually
extending paralysis, the lower limbs being first affected, afterwards
the arms and chest, thus producing death by apnœa from paralysis of
the muscles of respiration. Probably, however, could artificial
respiration be kept up, the heart would continue to beat much longer.
The alkaloid of hemlock is a pale yellow, volatile, acrid oily-looking
liquid, known as _conia_, _conein_ or _conicina_. It is a potent poison,
occasioning general paralysis without loss of sensibility. This
alkaloid, which is found in all parts of the plant, may be readily
recognized by rubbing with caustic potass. This sets free the alkaloid
from its combination, and being readily volatile its mouse-like odor
becomes at once apparent. Chemically it is allied to ammonia, and gives
many of the reactions of that substance.
In many respects _curare_ (referred to under _Nux vomica_) acts
similarly to _conia_.
LOBELIA INFLATA (_Indian Tobacco_).—This plant is a native of North
America; and its powdered leaves and seeds have been much used as a
remedy for asthma. In one instance, in which a quack prescribed a drachm
of the leaves, pain, vomiting, unconsciousness, feebleness of pulse, and
contraction of the pupils supervened, and death occurred in thirty-six
hours. Ignorant imposters, calling themselves “medical botanists” (more
appropriately known as “Coffinites”), have poisoned several simple
individuals, both in England and America, by physicing them with this
mischievous and powerful drug.
COLCHICUM (_Colchicum autumnale_, _Meadow Saffron_).—This plant grows
in most damp meadows. Its noxious properties are due to the active
principle _Colchicia_, which in its effects is allied to that contained
in white hellebore, _Veratria_. In two instances less than half a grain
of colchicia proved fatal to adults.
_White Hellebore_ (_Veratum album_) is a poisonous plant which, when
taken internally, has caused violent sickness, purging, dilatation of
the pupils, great prostration, and lowering of the heart’s action, cold
sweats, convulsions, and death. At the same time it is powerful in
relieving pain. Its properties are due to _veratria_, an alkaloid, which
may also be prepared from the seeds of the Asagræa officinalis, or
Cevadilla seeds, and from Veratrum viride.
Gentle emetics, purgatives, and stimulants are the means employed to
prevent death in poisoning by any of these vegetable substances. They
all produce extreme depression, hence stimulants must be freely used.
CHAPTER XXIX.
ASPHYXIANTS.
NOXIOUS GASES, PRODUCING NEUROTIC SYMPTOMS.
The most important of these asphyxiant noxious gases are carbonic oxide,
carbonic acid, sulphuretted hydrogen, and carburetted hydrogen.
CARBONIC OXIDE is a much more dangerous poison than is carbonic acid,
but poisoning with it in a pure state is rare. It constitutes an
ingredient in most vapors produced by burning coke or carbon, especially
if the combustion is imperfect. It forms with the coloring matter of the
blood a remarkably stable compound of a light red color; in point of
fact it is the impossibility of exchanging carbonic acid for oxygen in
the lungs which causes death. After death the blood is bright red in
hue.
CARBONIC ACID GAS.—This heavy inodorous gas is the cause of numerous
accidents, owing to the variety of sources from which it is produced.
It is formed from burning fuel, from the calcination of limestone or
chalk, and it is a product of respiration. It is diffused through wells,
coal-mines, and caverns. During fermentation it is largely given off,
and accumulates in beer vats. The vapor of charcoal partly owes its
poisonous properties to carbonic acid gas, as does that arising from
lime and brick-kilns.
In this country suicides rarely resort to carbonic acid gas to
accomplish their ends; in France they very frequently do so.
_Symptoms._—In its pure state this gas causes death by asphyxia, the
glottis becoming spasmodically closed the moment the vapor comes in
contact with it. When sufficiently diluted to be inspired it acts by
absorption, giving rise to giddiness, headache, vomiting, a tendency to
sleep, and loss of muscular power. The heat of the body continues, and
the limbs are usually flexible. The countenance gets livid, the
respiration becomes hurried and stertorous, and complete insensibility
ensues; while the heart’s action, which was at first rapid, soon ceases.
_Post-mortem Appearances._—The body is generally swollen and livid,
especially about the face. The countenance is not always bloated,
sometimes being calm and pale. The limbs are often rigid, the skin is
marked with livid patches, and the abdomen is distended with gas. The
right cavities of the heart, the lungs, and large veins, are found
gorged with venous blood; while the brain and its membranes are usually
very vascular, and occasionally there is serious effusion.
_Treatment._—Prompt removal to the pure air, cold affusion, and
stimulating applications to the chest and extremities, are the best
means for resuscitation. If the countenance is bloated, venesection may
be performed. Artificial respiration, galvanism, and the inhalation of
oxygen gas, have been found useful.
SULPHURETTED HYDROGEN.—This gas is a very active poison, but from its
offensive odor (resembling that of rotten eggs) it is not so liable to
be accidentally inhaled as is carbonic acid. It is usually met with
combined with other gases, resulting from the putrefaction of animal
matter. When breathed in a diluted state, it speedily produces
insensibility and death. Workmen long engaged in drains and sewers, or
in any atmosphere contaminated with sulphuretted hydrogen gas, suffer
from giddiness, nausea, and weakness; these symptoms ending at length in
a kind of fever, which is often fatal.
In acute cases there will be little hope of recovery, unless the
individual can be quickly removed into the open air, and stimulants,
&c., applied. Chlorine gas, well diluted with common air, might be
employed, as it breaks up the gas.
CARBURETTED HYDROGEN (_Coal Gas_).—The symptoms produced by this gas,
when mixed with air and inhaled, are those of asphyxia. If the person
breathing it should be roused before a fatal quantity has been inhaled,
the chief effects may be intense headache, labored and oppressed
respiration, quickened action of the heart, sickness, and great loss of
power.
In 1841 a family in Strasburg were poisoned by being in an atmosphere
contaminated with coal gas, for forty hours. Of the six members, four
were found dead, while the father died in twenty-four hours; but the
mother recovered. The gas escaped from a pipe which passed under the
cellar of the house where this family resided; so that it probably
poisoned the air gradually, and gave rise to no suffering to warn the
unfortunates.
CHAPTER XXX.
ABORTIVES.
SUBSTANCES PRODUCING ABORTION.
This group, though far from a natural one, is nevertheless convenient.
It comprehends a great variety of substances, first among which comes.
ERGOT OF RYE (_Spurred Rye_, _Secale cornatum_).—The grain of wheat,
barley, oats, and rye is apt to be attacked by a parasitic fungus which
imparts to it specific properties. This substance has the power of
inducing contraction of unstriped muscular fibre, especially in the
smaller arteries and uterus. Ergotised grain, in full doses, gives rise
to lassitude, headache, nausea, and diarrhœa. From small quantities,
frequently repeated, gangrene of the extremities has resulted. The
peculiar influence of ergot on the muscular coat of the uterus renders
this agent a valuable medicine when we wish to induce powerful
contractions, but in the hands of the ill-intentioned it is frequently
used to procure abortion; but its action in this way is far from
certain, and at all times dangerous.
Savin and its oil are irritant poisons, only indirectly affecting the
uterus; nevertheless, they not unfrequently are used to induce
miscarriage.
Oil of Tansy has also been employed in America as an abortive agent, and
in three instances, at least, has caused death.
The Yew (_Taxus baccata_), which has acquired in certain districts a
reputation as an abortive, acts as do some others, by producing
irritation of the bowels, and so communicating a kind of stimulus to
the uterus. The leaves and berries of the yew have both proved fatal,
commonly with irritant symptoms; but those of coma have also been
observed.
In America extract of Cotton-wood has a reputation as an abortive.
APPENDIX.
I. BITES OF VENOMOUS REPTILES.—The poisonous reptiles provided with
fangs are the Ophidia, or Serpents.
Accidents from serpents’ bites rarely, of course, happen in this
country, but are of frequent occurrence in India, Australia, and
America.
On the morning of the 20th October, 1852, one of the keepers at the
Zoological Gardens in the Regent’s Park, was wounded by a cobra, which
he had removed from its cage and was playing with. For twenty minutes
after the animal bit him at the root of the nose no peculiar symptoms
were manifested, and the part was merely bathed with water. Forty
minutes afterwards the man was admitted into University College
Hospital, his face then being livid, respiration impeded, and the power
of locomotion imperfect. He pointed to his throat as the seat of pain,
but could not speak, and was unable to swallow. Artificial respiration
was employed for fifty minutes, and subsequently galvanism; but stupor
rapidly succeeded to faintness, and the patient died comatose fifty-five
minutes after admission. The chief appearances found on dissection were
an unnatural fluidity and blackness of the blood, with great congestion
of the lungs and spleen.
The only poisonous reptile indigenous to this country is the _common
viper_ or _adder_. It is found on the heaths and in the dry woods of all
parts of England, Scotland, and Wales, and is much feared on account of
its venom. Very few cases are known in which the bite of this animal has
proved fatal. In May, 1862, a little boy, at Burgess Hill, near
Brighton, clambered up a bank, to examine a bird’s nest. Groping with
his hand among the moss, he felt, as he thought, a sharp prick from a
thorn. It turned out to be a bite from an adder. As the real cause of
the wound was not suspected, the swelling of the hand and arm was not
properly attended to until too late, and the poor child died on the
second day.
The poison apparatus of the viper consists of a gland placed by the side
of the head, a duct, and a fang or pointed curved tooth, moulded in the
form of a tube on either side. On being bitten, the person has pain in
the wounded part, which quickly becomes severe and extends up the
adjoining tissues. The limb swells greatly, becomes red and livid; while
faintness soon sets in, and the pulse gets rapid and small. Bilious
vomitings, dyspnœa, profuse cold sweats, jaundice, delirium, and
convulsions, have also been noticed. In a few days the symptoms usually
amend; but in weak sickly individuals gangrene of the limb may follow,
or death may occur in the course of two or three days.
The _treatment_ of the bites of venomous reptiles must be local and
constitutional. Immediately the wound is inflicted it should be sucked
freely and perseveringly. If the patient is too faint to do this for
himself, a bystander may fearlessly help him; for it is well known that
these poisons may be smeared upon the lips and tongue, or even
swallowed, with impunity. At the same time a ligature is to be placed
around the limb, above the wound; or if this be impossible, from its
situation, the textures around are to be compressed. Then, the bitten
part may be excised; or it may be destroyed by the actual cautery,
nitric acid, the strong liquor ammoniæ, or nitrate of silver.
Professor Halford, of the University of Melbourne, in a paper published
at the commencement of 1869, recommended the injection of liquor ammoniæ
into the veins for snake bite. Of twenty cases of snake bite since
treated in this manner, by different practitioners, recovery occurred in
seventeen. The snakes were all venomous, and included the tiger snake,
the brown and black snake of Australia, &c. These, according to
Professor Halford, are as deadly as the cobra and rattlesnakes of India.
The plan of proceeding is to expose the vein, and then to pierce its
coats with the sharp point of a hypodermic syringe containing the
officinal liquor ammoniæ—sp. grav. 0·959. At least thirty minims are to
be employed; the dose being repeated as the power of the preceding
injection is expended. Professor Halford formerly thought that in
consequence of the entrance of the snake poison into the blood a rapid
growth of new cells occurred, which took up and exhausted the fibrin and
oxygen of the blood, and rendered them incapable of ministering to the
wants of the system. He now thinks that the new corpuscles are only the
white corpuscles of the blood altered and enlarged, the change in them
being caused by an alteration in the liquor sanguinis; this alteration
being, in fact, a disappearance of the fibrin under the action of the
poison. The ammonia is believed to counteract this power, and in favor
of this view many Australian physicians have spoken strongly. Dr.
Fayrer, however, has found the proceeding a failure in India. This
gentleman is of opinion that the activity of the poison in some Indian
snakes is so great that it is impossible to counteract it by any
method.
The constitutional remedies are derived chiefly from the class of
diffusible stimulants. No agent is more generally recommended than
ammonia; and therefore the officinal compound tincture of ammonia
(formerly known as eau de luce) should be given in half-drachm doses,
well diluted; or the aromatic spirits of ammonia may be administered in
the proportion of two drachms to an ounce and a half of water. Supposing
that no ammonia is at hand, brandy will prove an excellent substitute.
Transfusion of blood has been likewise recommended; but I do not know of
any instance in which it has been resorted to.
II. BITES OF RABID ANIMALS.—As the subject of Hydrophobia is fully
treated of in Dr. Tanner’s work on “The Practice of Medicine,” remarks
are here confined to the treatment to be adopted directly a person is
bitten by a rabid animal. This is briefly as follows:—The tissues round
the seat of injury are to be compressed by a ligature or otherwise, to
prevent absorption. Then the wounded part is to be excised as soon as
possible; taking care to remove every portion touched by the animal’s
teeth, and to obtain a clean raw surface. The wound should then be
thoroughly washed by a stream of water, long poured over it, and lunar
caustic afterwards applied. Mr. Youatt prefers the nitrate of silver,
freely used, to every other caustic; and he also recommends that after
its application the wound should be quickly healed, though many
authorities advise that it be kept open by irritating ointments. As
these operations are very painful, there is no objection to the patient
being placed under the influence of chloroform. He should afterwards be
assured that everything has been done to prevent any subsequent
mischief; and to give him greater confidence and to banish all fear from
his mind, it may be as well to administer ammonia and bark for some days
after the accident.
III. STINGS OF BEES, ETC.—The poison apparatus of the common bee
consists of glands, and a sting placed at the extremity of the body. The
effect of the bite is usually slight, and the pain quickly passes off.
In some few instances, however, there have resulted swelling and
erysipelas, or suppuration and gangrene, or even death.
In the month of August, 1819, John Trevalli, of Pennsylvania, was stung
by a bee in the middle finger of his right hand. He immediately became
faint and insensible to surrounding objects; his complexion was livid,
his breathing slow, and the perspiration saturated his clothes. At the
end of an hour and a half he was bled, and recovered. On the 21st July,
1820, he was stung in the temple by a bumble bee. His wife was present
and gave him some water, but in ten minutes he was dead.—(_American
Journal of Medical Sciences_, Vol. 19, p. 265. Philadelphia, 1836.) Two
other rapidly fatal cases are noticed in the same journal, as well as
two examples of death from the sting of a wasp and one from the bite of
a spider.
Mr. C. Hanbury has recorded a case of death from the sting of a bee
(_Medical Times and Gazette_, p. 232. 10th March, 1860); and has also
given short abstracts of several examples collected by Dr. Crisp, where
severe symptoms have resulted from the same injury. Sir Benjamin Brodie
(_Lectures on Pathology and Surgery_, p. 286. London, 1846) says he has
seen a case in which sloughing of the cellular tissue followed from a
leech bite, and another in which similar mischief followed the sting of
a bee. Both the patients died.
And again, in a communication from Montbard (_La Patrie_, 19th
September, 1858) it is stated that a youth sixteen years of age was
drinking from a bottle, when a wasp, which he had not seen, got into his
throat and wounded him. He died suffocated by the swelling, before any
assistance could be procured.
According to Messrs. Kirby and Spence (_Introduction to Entomology_,
Seventh Edition, p. 76, London, 1856), serious effects are sometimes
produced on peculiar constitutions by eating freely of honey or from
partaking of mead—a drink made by fermenting honey and water. These
authors state that they knew a lady upon whom such things acted like
poison, and they had heard of instances in which death was the
consequence. Sometimes, when the bees have extracted their sweets from
poisonous plants, these injurious results have not been confined to
individuals of a particular habit. Thus, according to Dr. Barton
(_American Philosophical Transactions_, vol. 5), there were numerous
deaths in the autumn and winter of 1790 from eating honey collected in
the neighborhood of Philadelphia, which, on inquiry, was found to be due
to this substance having been extracted from the beautiful but poisonous
flowers of the Kalmia latifolia.
* * * * *
The following Table from Dr. Garrod’s “Materia Medica” shows the
proportions in which some of the more important drugs of the
“Pharmacopœia” are contained in the Officinal Preparations.
ANTIMONY.
(TARTAR EMETIC.)
1/4 gr. of tartarated antimony is contained in 1 fl. drm. of vinum
antimoniale.
1 gr. of tartarated antimony is contained in 5 gr. of unguentum
antimonii tartarati.
(OXIDE OF ANTIMONY.)
1 gr. of oxide of antimony is contained in 3 gr. of pulvis
antimonialis.
ARSENIC.
(ARSENIOUS ACID, WHITE ARSENIC.)
1/24 gr. of arsenious acid is contained in 5 min. of liquor
arsenicalis.
1/24 gr. of arsenious acid is contained in 5 min. of liquor arsenici
hydrochloricus.
(ARSENIATE OF SODA.)
1/24 gr. of arseniate of soda (dried) is contained in 5 min. of liquor
sodæ arseniatis.
MERCURY.
(METALLIC.)
1 gr. of mercury is contained in 3 gr. of hydrargyrum cum cretâ.
1 gr. of mercury is contained in 3 gr. of pilula hydrargyri.
1 gr. of mercury is contained in 2 gr. of unguentum hydrargyri.
(HYDRARGYRI PERCHLORIDUM.)
1/16 gr. of perchloride of mercury is contained in 1 fl. drm. of liquor
hydrargyri perchloridi.
(HYDRARGYRI SUBCHLORIDUM, OR CALOMEL.)
1 gr. of subchloride of mercury (calomel) is contained in 5 gr. of
pilula hydrargyri subchloridi composita.
1 gr. of subchloride of mercury (Calomel) is contained in about 6-1/2
gr. of unguentum hydrargyri subchloridi.
ACONITE.
1 gr. of dried aconite root is contained in about 9 min. of tinctura
aconiti.
ACONITIA.
8 gr. of aconitia are contained in one oz. of unguentum aconitiæ.
ATROPIA.
1 gr. of atropia is contained in 2 fl. drm. of liquor atropiæ.
1 gr. of sulphate of atropia in 2 fl. drm. of liquor atropiæ sulphatis.
8 gr. of atropia are contained in 1 oz. of unguentum atropiæ.
BELLADONNA.
1 gr. of dried belladonna is contained in about 22 min. of tinctura
belladonnæ.
Each fluid part of linimentum belladonæ contains the active portion of
a solid part of the dried root.
CANNIBIS INDICA.
1 gr. of alcoholic extract of Indian hemp is contained in about 22 min.
of tinctura cannabis Indicæ.
CANTHARIDES.
1 gr. of cantharides is contained in about 88 min. of tinctura
cantharidis.
COLCHICUM.
1 gr. of dried corm of colchicum is contained in about 5-1/2 min. of
vinum colchici.
1 gr. of colchicum seeds is contained in about 9 min. of tinctura
colchici.
DIGITALIS.
1 gr. of dried leaves of digitalis is contained in about 9 min. of
tinctura digitalis.
HEMLOCK.
1 gr. of hemlock fruit is contained in about 9 min. of tinctura conii.
IPECACUANHA.
1 gr. of ipecacuanha root is contained in about 22 min. of vinum
ipecacuanhæ.
1 gr. ipecacuanha root is contained in _twelve_ morphia and ipecacuanha
lozenges.
1 gr. of ipecacuanha root is contained in 4 ipecacuanha lozenges.
NUX VOMICA.
1 gr. of nux vomica seed is contained in about 11 min. of tinctura
nucis vomicæ.
(STRYCHNIA.)
1 gr. of strychnia is contained in 2 fl. drm. of liquor strychniæ.
OPIUM.
(ACETATE OF MORPHIA.)
1/4 gr. of acetate of morphia is contained in 30 min. of liquor morphiæ
acetatis.
(HYDROCHLORATE OF MORPHIA.)
1/4 gr. of hydrochlorate of morphia is contained in 30 min. of liquor
morphiæ hydrochloratis.
1/4 gr. of hydrochlorate of morphia is contained in _nine_ morphia
lozenges.
1/4 gr. of hydrochlorate of morphia is contained in _nine_ morphia and
ipecacuanha lozenges.
1/2 grain of hydrochlorate of morphia is contained in _each_ morphia
suppository.
(OPIUM DRIED SUFFICIENTLY TO BE POWDERED.)
1 gr. of opium is contained in 14-1/2 min. of tinctura opii.
1 gr. of opium is contained in 14-1/2 min. of vinum opii.
1 gr. of opium is contained in 1/2 fl. oz. of tinctura camphoræ
composita.
1 gr. of opium is contained in 96 min. of tinctura opii ammoniata.
1 gr. of opium is contained in 1 fl. oz. of enema opii.
1 gr. of opium is contained in 5 gr. of pilula saponis composita.
1 gr. of opium is contained in 8 gr. of pilula plumbi cum opio.
1 gr. of opium is contained in 10 gr. of pulvis ipecacuanhæ compositus.
1 gr. of opium is contained in 20 gr. of pulvis kino compositus.
1 gr. of opium is contained in 40 gr. of pulvis cretæ aromaticus cum
opio.
1 gr. of opium is contained in 10 gr. of pulvis opii compositus.
1 gr. of opium is contained in about 13-1/2 gr. of unguentum gailæ cum
opio.
1 gr. of opium is contained in _ten_ opium lozenges.
1 gr. of opium equals about 1/2 gr. of extractum opii.
1 gr. of extract of opium is contained in 22 min. of extractum opii
liquidum.
INDEX.
Absorption of poisons, 16
Acetate of lead, 86
morphia, 97
Acetic acid, 47
Acid of sugar, 43
Acids, mineral, 35
vegetable, 43
Aconite, 122
Aconitia, 122
Action of poisons, 16
Adder, the common, 139
Æthusa cynapium, 132
Agaricus campestris, 111
esculentus, 111
Alcohol, 108
Alkalies, poisoning by the, 52
Almonds, bitter, 124
Aloes, 57
Amanita, muscaria, 111
Ammonia, 48
Ammonio-chloride of mercury, 85
Amylene, 107
Anæsthetics, 102
Aniline, 109
Animal irritants, 58
Antidotes, 26
Antimonial compounds, 78
Aqua fortis, 38
regia, 40
reginæ, 40
Argol, 53
Arrow-poison, 116
Arseniate of potash, 67
soda, 67
Arsenic, 66
Arsenic eating, 67
Arsenious acid, 69
Arsenite of copper, 67
potash, 67
Arum maculatum, 57
Asagræa officinalis, 134
Asp, bite of the, 140
Atropa belladonna, 113
Atropia, 113
Bacon, rancid, 58
Baryta and its salts, 53
Bees, stings of, 143
Belladonna, 113
Bichloride of mercury, 81
Bichromate of potash, 56
Binoxalate of potash, 43
Bismuth, 56
Bisulphide of arsenic, 67
Bisulphuret of mercury, 85
Bitartrate of potash, 53
Bites of rabid animals, 142
venomous reptiles, 139
Bitter almonds, 124
Bitter-sweet, 115
Black hellebore, 92
Blistering flies, 92
Blue vitrol, 90
Brick-kilns, vapor from, 135
Brucia, 117
Bryony, 57
Burnett’s solution, 55
Butter of antimony, 80
Calomel, 85
Camphor, 110
Cantharides, 92
Carbonate of baryta, 54
lead, 87
potash, 48
soda, 48
Carbonic acid gas, 134
Carburetted hydrogen, 136
Castor oil seeds, 57
Caustic soda, 48
Ceruse, 87
Cevadilla seeds, 134
Champignons, 111
Charcoal vapor, 135
Cheese, decayed, 58
Chloride of antimony, 80
arsenic, 77
barium, 53
mercury, 85
zinc, 55
Chlorides of tin, 56
Chlorine, 59
Chloroform, 102
Chrome, 56
Chronic antimonial poisoning, 79
arsenical poisoning, 70
copper poisoning, 89
lead poisoning, 88
mercurial poisoning, 82
Cicuta virosa, 132
Cinnabar, 85
Classification of poisons, 32
Coal gas, 136
Cocculus Indicus, 110
Cockles, 58
Colchicia, 133
Colchicum, 133
Colic, 88
Colocynth, 57
Common hemlock, 132
salt, 13
Confectionery, poisonous, 67
Conia, 133
Conium, 132
Copper, arsenite of, 67
salts of, 89
Copperas, 56
Corrosive sublimate, 81
Crabs, 58
Cream of tartar, 53
Croton oil seeds, 57
Curare, 116
Cyanide of mercury, 85
potassium, 124
Cytisus laburnum, 92
Darnel seeds, 110
Daturia, 115
Datura stramonium, 115
Deadly nightshade, 113
Definition of a poison, 13
Diagnosis of poisoning, 19
Digitalin, 129
Digitalis purpurea, 129
Duties of the medical practitioner, 19
Eating of arsenic, 67
opium, 96
Effects of poisons, 15
Elaterium, 57
Emetics, 25
Ergot of rye, 137
Essence of bitter almonds, 124
mirbane, 109
Essential salt of lemons, 43
Ether, 106
Euphorbium, 57
Fish, poisonous, 58
Fool’s parsley, 132
Foxglove, 129
Fungi, 111
Gamboge, 57
Garden-nightshade, 115
Gaseous test for arsenic, 74
Gases, irritant, 59
Goulard’s extract, 87
Green vitrol, 56
Hartshorn, 49
Hellebore, black, 92
Hemlock, 132
Hemlock, water-dropwort, 132
Henbane, 112
Hierapicra, 51
Hocussing, 115
Holloway’s pills, 57
Hydrochlorate of morphia, 97
Hydrochloric acid, 39
Hydrocyanic acid, 123
Hydrogen, carburetted, 136
sulphuretted, 136
Hydrophobia, 142
Hyoscyamus niger, 112
Indian tobacco, 133
Indigo, sulphate of, 40
Investigation of cases, 19
Iodide of potassium, 63
Iodine, 61
Iodism, 62
Iron, sulphate of, 56
Irritant gases, 59
poisons, 34
Jalap, 57
Ketchup, 111
Laburnum, 92
Laudanum, 95
Laurel water, 124
Lead and its preparations, 85
palsy, 88
Lemons, essential salt of, 43
Levant nut, 110
Lime, 53
Liquid mercury, 81
tests for arsenic, 74
Liquor ammoniæ, 48
potassæ, 48
Lobelia inflata, 133
Local action of poisons, 15
Lolium temulentum, 110
Lunar caustic, 56
Magistery of bismuth, 56
Marsh’s test for arsenic, 75
Meadow saffron, 133
Meats, poisonous, 58
Meconic acid, 101
Medical witness, the duty of, 19
Medico-legal reports, 21
Menispermum cocculus, 110
Mercurial paralysis, 83
Mercury and its compounds, 81
Mesereon, 57
Metallic antimony, 78
arsenic, 66
lead, 85
Metals, compounds of the, 66
Mineral acids, 36
green, 67
Mirbane, essence of, 109
Mixed acids, 41
Monkshood, 122
Morphia, 97
Morrison’s pills, 57
Muriatic acid, 39
Mushrooms, 111
Mussels, 58
Narcotic poisons, 95
Nicotiana tabacum, 131
Nicotin, 131
Nightshade, 115
Nitrate of bismuth, 56
potash, 52
silver, 56
mercury, 85
Nitre, 52
Nitric acid, 38
Nitro-benzole, 109
Nitro-muriatic acid, 40
Nitro-sulphuric acid, 40
Nitrous-oxide gas, 107
Nux-vomica, 117
Œnanthe crocata, 132
Œsophagus, stricture of the, 41
Oil of bitter almonds, 124
vitrol, 36
Opium, 95
Opium-eating, 96
Orpiment, 67
Oxalate of lime, 43
Oxalic acid, 43
Oxalis acetosella, 43
Oxides of lead, 87
Painter’s colic, 87
Paralysis from lead, 86
mercury, 83
Pearlash, 48
Phellandrinum aquaticum, 132
Phosphorus, 63
Picrotoxine, 110
Poison, definition of a, 13
Poisoning, diagnosis of, 19
treatment of, 27
Poison of vipers, 140
Poisonous confectionery, 67
fungi, 111
Poisons, absorption of, 14
classification of, 32
mode of action of, 14
sympathetic action of, 17
Potash, 48
arsenite of, 67
bichromate of, 56
binoxalate of, 43
bitartrate of, 53
carbonate of, 48
nitrate of, 52
sulphate of, 52
Potassa fusa, 48
Potassio-tartrate of antimony, 78
Potassium, iodide of, 63
Prussic acid, 123
Ptyalism, 83
Purple foxglove, 129
Rabid animals, bites of, 142
Realgar, 67
Red arsenic, 67
oxide of mercury, 85
precipitate, 85
spirit of nitre, 38
Reduction test for arsenic, 73
Reinsch’s test for arsenic, 76
Remote effects of poisons, 15
Reptiles, bites of, 140
Rhubarb, 43
St. Ignatius’ bean, 116
Sal de duobus, 52
Salivation, 83
Sal polychrest, 52
Salprunelle, 52
Salt of sorrel, 43
Saltpetre, 52
Salts of copper, 89
Sausages, 58
Savin, 137
Scammony, 57
Scheele’s green, 67
hydrocyanic acid, 123
Secale cornutum, 137
Serpents, poisonous, 140
Sesquicarbonate of ammonia, 49
Shell-fish, 58
Silver, nitrate of, 56
Smelling-salts, 49
Soap-lees, 48
Soda, carbonate of, 48
Solania, 115
Solanum dulcamara, 115
nigrum, 115
Soothing syrups, 95
Sorrel, 43
salt of, 43
Spanish flies, 92
Spirit of salt, 39
Spiritous liquors, 108
Spotted hemlock, 132
Spurred rye, 137
Stings of bees, 143
Stomach-pump, 24
Stramonium, 115
Strychnia, 117
Subacetate of copper, 90
lead, 87
Subchloride of mercury, 85
Sugar, acid of, 43
of lead, 86
Sulphate of copper, 90
indigo, 40
iron, 56
potash, 52
zinc, 54
Sulphides of arsenic, 67
Sulphuretted hydrogen, 136
Sulphuric acid, 36
Sulphuric ether, 106
Sulphurous-acid gas, 59
Sympathetic action of poisons, 17
Symptoms of poisoning, 20
Tartar emetic, 78
Tartaric acid, 47
Tartarized antimony, 78
Taxus baccata, 137
Tersulphide of arsenic, 67
Thorn-apple, 115
Ticunas, 116
Tin, 56
Toadstools, 111
Tobacco, 131
Treatment of poisoning, 24
Vapor of ammonia, 49
Vegetable acids, 43
irritants, 57
Venomous reptiles, 140
Veratria, 133
Verdigris, 90
Vermilion, 85
Viper, the common, 139
Wasps, stings of, 143
Water-hemlock, 132
Water, impregnated with lead, 88
Water-parsnip, 132
White arsenic, 69
hellebore, 133
lead, 87
oxide of arsenic, 69
precipitate, 85
vitriol, 54
Wine containing lead, 88
Wolfsbane, 122
Wood sorrel, 43
Woody nightshade, 115
Woorara, 116
Yellow arsenic, 66
Yew, 137
Zinc, chloride of, 55
sulphate of, 54
THE END.
FOOTNOTES:
[A] In the year 1839, a young lady residing in the north of England took
about half a pound of salt to rid herself of worms. Very soon afterwards
she began to suffer from all the effects of an irritant poison, with
general paralysis; and in spite of the use of the stomach pump and of
antidotes, she died in a few hours. Dr. Christison has recorded two
somewhat similar cases.
[B] If not kept prepared, the remedy may be speedily got ready in any
chemist’s shop in the following way: Mix together the contents of the
bottles containing tincture of the muriate of iron (the liquor ferri
perchloridi does as well) and liquor ammoniæ fortior. Run the mixture
through a loose filter, saving the precipitate; turn filtering paper or
tow, if that has been used, and all into a vessel containing water,
agitate well, and use the precipitate by spoonfuls as it falls to the
bottom.
[C] Considering the reprehensible way in which pseudo-medical advice is
given in some newspapers and cheap periodicals, it is only surprising
that more cases of poisoning do not occur. Take the following example
(_Sunday Times_, 3d October, 1847), of a cure for dysentery: “Half a
noggin of logwood, well boiled and strained, half a glass of port wine,
and twenty drops of laudanum, have proved successful in checking
dysentry in adults. For children only fifteen drops of laudanum should
be used.”
Transcriber’s notes:
The following is a list of changes made to the original.
The first line is the original line, the second the corrected one.
penal servitude for a term not exceding ten years.
penal servitude for a term not exceeding ten years.
wound in the foot, the symptons of poisoning
wound in the foot, the symptoms of poisoning
the symptons of poisoning do not occur.
the symptoms of poisoning do not occur.
must not be forgetten that sometimes a poisonous
must not be forgotten that sometimes a poisonous
of the nervous sysem; and in a third, a combination
of the nervous system; and in a third, a combination
acid is given off, after which sulphretted
acid is given off, after which sulphuretted
indentity; arsenic and antimony may thus be readily
identity; arsenic and antimony may thus be readily
some on certain nerves only, or on the basomotor
some on certain nerves only, or on the vasomotor
In classification table:
Strychina.
Strychnia.
rhubarb (Rheum Rhaponticum.) It can hardly be
rhubarb (Rheum Rhaponticum). It can hardly be
with oxalic acid (oxalate of copper,) which is
with oxalic acid (oxalate of copper), which is
intestines were found much inflammed.
intestines were found much inflamed.
found in commerce, is int he form of grey-colored
found in commerce, is in the form of grey-colored
pain in the stomach, with vomiting, &c., the symtoms
pain in the stomach, with vomiting, &c., the symptoms
perchloride of mecury; and
perchloride of mercury; and
Arsenic is not a poison that accmulates in the
Arsenic is not a poison that accumulates in the
become oxydized, and octahedral crystals
become oxidized, and octahedral crystals
mucous membrance of the stomach; but oil or
mucous membrane of the stomach; but oil or
which require to be noticed, mamely, Marsh’s process,
which require to be noticed, namely, Marsh’s process,
is almost, or even quite, suppresed. After a time
is almost, or even quite, suppressed. After a time
that thirty pounds of this substance were accidently
that thirty pounds of this substance were accidentally
often terminates in “lead palsy.” In these instaces
often terminates in “lead palsy.” In these instances
CHLOROFORM—CHLORAL—BICHLORIDE OF METHLYENE—ETHER—AMYLENE—NITROUS
CHLOROFORM—CHLORAL—BICHLORIDE OF METHYLENE—ETHER—AMYLENE—NITROUS
“sucking the monkey,” as practiced in the docks
“sucking the monkey,” as practised in the docks
very insoluble in water, soluable in alcohol or
very insoluble in water, soluble in alcohol or
and though digitaline was not separated
and though digitalin was not separated
digitaline. The woman’s symptoms, which were
digitalin. The woman’s symptoms, which were
TOBACCO (_Nicotiana tabacum_)—All parts of this
TOBACCO (_Nicotiana tabacum_).—All parts of this
of the pupils surpervened, and death occurred
of the pupils supervened, and death occurred
themselvers “medical botanists” (more appropriately
themselves “medical botanists” (more appropriately
causes are noticed in the same journal, as well as
cases are noticed in the same journal, as well as
1 gr. of alcholic extract of Indian hemp is contained
1 gr. of alcoholic extract of Indian hemp is contained
1 gr. of died corm of colchicum is contained in
1 gr. of dried corm of colchicum is contained in
cretæ aro maticus cum opio.
cretæ aromaticus cum opio.
In Index:
Detura
Datura
Deturia
Daturia
Nicotina
Nicotin
Nitro-benzol
Nitro-benzole
Phellandrium
Phellandrinum
Picrotoxin
Picrotoxine
Secale cornutum
Secale cornatum
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