cisterns, articles for domestic use, alloys, &c., is well known; oxide
of zinc enters largely into the composition of india-rubber. Sulphide of
zinc has been employed as a substitute for white lead, and may possibly
supersede it. Zinc white is further employed as a pigment, and, mixed
with albumen, is an agent in calico-printing; it is also used in the
decoloration of glass, in the polishing of optical glasses, and in the
manufacture of artificial meerschaum pipes.[948]
[948] Artificial meerschaum pipes are composed of zinc white, magnesia
usta, and caseine ammonium.
=Chromate of Zinc= (ZnCrO₄) is used in calico-printing, and there is
also in commerce a basic chromate known as _zinc yellow_. Zinc green, or
Rinman’s green, is a beautiful innocuous colour, formed by igniting a
mixture of dry zincic and cobaltous carbonates.
The use of zinc vessels in the preparation of foods may occasionally
bring the metal under the notice of the analyst. When exposed to a moist
atmosphere, zinc becomes covered with a thin film of oxide, perfectly
insoluble in ordinary water; but, if the water should be charged with
common salt, a considerable quantity may be dissolved. It may generally
be laid down as a rule that the solvent power of water on zinc has a
direct relation to the chlorides present, whilst carbonate of lime
greatly diminishes this solubility.[949]
[949] Ziurek, indeed, found in a litre of water contained in a zinc
cistern no less than 1·0104 grm. of zinc, and the same water showed only
0·074 grm. of common salt to the litre.--_Vierteljahrsschr. für gericht.
Medicin_, 1867, Bd. 6, p. 356.
Milk may become contaminated by zinc; for, it is a matter of common
knowledge, that milk contained in zinc vessels does not readily turn
sour. This may be explained by the zinc oxide combining with the lactic
acid, and forming the sparingly soluble lactate of zinc 2(C₃H₅O₃)Zn +
3H₂O, thus withdrawing the lactic acid as fast as it is formed,
preventing the coagulation of the casein. With regard to this important
practical subject, MM. Payne and Chevallier made several experiments on
the action of brandy, wine, vinegar, olive oil, soup, milk, &c., and
proved that zinc is acted on by all these, and especially by alcoholic,
acetic, and saline liquids. M. Schaufféle has repeated these
experiments, and determined the amount of zinc dissolved in fifteen
days by different liquids from a galvanised iron as well as a zinc
vessel.
The amount found was as follows:--
The liquid from
The liquid from the galvanised
the zinc vessel, iron vessel,
grms. per litre. grms. per litre.
Brandy, 0·95 0·70
Wine, 3·95 4·10
Orange-flower water, 0·50 0·75
Vinegar, 31·75 60·75
Fatty soup, 0·46 1·00
Weak soup, 0·86 1·76
Milk, 5·13 7·00
Salt water, 1·75 0·40
Seltzer water, 0·35 0·30
Distilled water, traces. traces.
Ordinary water, traces. traces.
Olive oil, none. none.
§ 862. =Effects of Zinc, as shown by Experiments on Animals.=--Harnack,
in experiments with sodium-zinc oxide pyrophosphate, has shown that the
essential action of zinc salts is to paralyse the muscles of the body
and the heart, and, by thus affecting the circulation and respiration,
to cause death; these main results have been fully confirmed by Blake,
Letheby, and C. Ph. Falck. For rabbits the lethal dose is ·08 to ·09
grm. of zinc oxide, or about ·04 per kilogrm. The temperature during
acute poisoning sinks notably--according to F. A. Falck’s researches on
rabbits, from about 7·3° to 13·0°. Zinc is eliminated mainly by the
urine, and has been recognised in that fluid four to five days after the
last dose. It has also been separated in small quantity from the milk
and the bile.
§ 863. =Effects of Zinc Compounds on Man=--(=a=) =Zinc Oxide=.--The
poisonous action of zinc oxide is so weak that it is almost doubtful
whether it should be considered a poison. Dr. Marcett has given a pound
(453·6 grms.) during a month in divided doses without injury to a
patient afflicted with epilepsy; and the workmen in zinc manufactories
cover themselves from head to foot with the dust without very apparent
bad effects. It is not, however, always innocuous, for Popoff has
recorded it as the cause of headache, pain in the head, cramps in the
calves of the legs, nausea, vomiting, and diarrhœa; and he also obtained
zinc from the urine of those suffering in this manner.[950] Again, a
pharmacy student[951] filled a laboratory with oxide of zinc vapour, and
suffered from well-marked and even serious poisonous symptoms,
consisting of pain in the head, vomiting, and a short fever. It must be
remembered that, as the ordinary zinc of commerce is seldom free from
arsenic, and some samples contain gallium, the presence of these metals
may possibly have a part in the production of the symptoms described.
[950] The so-called “zinc fever” has only been noticed in the founding
of brass; it is always preceded by well-marked shivering, the other
symptoms being similar to those described.
[951] Rust’s _Magazin_, Bd. xxi. § 563.
§ 864. (=b=) =Sulphate of Zinc.=--Sulphate of zinc has been very
frequently taken by accident or design, but death from it is rare. The
infrequency of fatal result is due, not to any inactivity of the salt,
but rather to its being almost always expelled by vomiting, which is so
constant and regular an effect, that in doses of 1·3 grm. (20 grains),
sulphate of zinc is often relied upon in poisoning from other substances
to quickly expel the contents of the stomach. In a case reported by Dr.
Gibb, an adult female swallowed 4·33 grms. (67 grains), but no vomiting
occurred, and it had to be induced by other emetics; this case is
unique. It is difficult to say what would be a fatal dose of zinc
sulphate, but the serious symptoms caused by 28 grms. (1 oz.) in the
case of a groom in the service of Dr. Mackenzie, leads to the view that,
although not fatal in that particular instance, it might be in others.
The man took it in mistake for Epsom salts: a few minutes after he was
violently sick and purged, and was excessively prostrated, so that he
had to be carried to his home; the following day he had cramps in the
legs, and felt weak, but was otherwise well.
In a criminal case related by Tardieu and Roussin, a large dose of zinc
sulphate, put into soup, caused the death of an adult woman of sixty
years of age in about thirty hours.[952] The symptoms were violent
purging and vomiting, leading to collapse. From half of the soup a
quantity of zinc oxide, equal to 1·6 grm. of zinc sulphate, was
separated. Zinc was also found in the stomach, liver, intestines, and
spleen--(see also a case of criminal poisoning recorded by
Chevallier).[953]
[952] Taylor notices this case, but adds that she died in three days.
This is a mistake, as the soup was taken on the 12th of June, probably
at mid-day, and the woman died on the 13th, at 8 P.M.
[953] “Observations toxicologiques sur le zinc,” _Annales d’Hygiène
Publique_, July 1878, p. 153.
§ 865. (=c=) =Zinc Chloride.=--Chloride of zinc is a powerful poison,
which may kill by its primary or secondary effects; its local action as
a caustic is mainly to be ascribed to its intense affinity for water,
dehydrating any tissue with which it comes in contact. The common use of
disinfecting fluids containing zinc chloride, such as Burnett’s fluid,
leads to more accidents in England than in any other European country.
Of twenty-six cases of poisoning by this agent, twenty-four occurred in
England, and only two on the Continent. Death may follow the external
use of zinc chloride. Some years ago, a quack at Barnstaple, Devon,
applied zinc chloride to a cancerous breast; the woman died with all
the general symptoms of poisoning by zinc, and that metal was found in
the liver and other organs.
The symptoms observed in fatal cases of chloride of zinc poisoning
are--immediate pain in the throat, and burning of the lips, tongue, &c.
There is difficulty in swallowing, an increase in the secretion of
saliva, vomiting of bloody matters, diarrhœa, collapse, coma, and death.
In some cases life has been prolonged for days; but, on the other hand,
death has been known to occur in a few hours. In those cases in which
either recovery has taken place, or in which death is delayed, nervous
symptoms rarely fail to make their appearance. In a case recorded by Dr.
R. Hassall, 3 ounces of Burnett’s fluid were swallowed. The usual
symptoms of intense gastro-intestinal irritation ensued, but there was
no purging until the third day; after the lapse of a fortnight, a train
of nervous symptoms set in, indicated by a complete perversion of taste
and smell. In other cases, aphonia, tetanic affections of groups of
muscles, with great muscular weakness and impairment of sight, have been
noticed. Very large doses of zinc chloride have been recovered from,
_e.g._, a man had taken a solution equivalent to about 13 grms. (200
grains) of the solid chloride. Vomiting came on immediately, and there
was collapse, but he recovered in sixteen days. On the other hand, ·38
grm. (6 grains) has destroyed life after several weeks’ illness.
§ 866. =Post-mortem Appearances.=--In poisoning by sulphate of zinc, the
appearances usually seen are inflammation, more or less intense, of the
mucous membrane of the stomach and bowels. In the museums of the London
hospitals, I could only find (1882) a single specimen preserved
illustrating the effects of this poison. This preparation is in St.
George’s Hospital Museum, and shows (ser. ix. 43 and 198) the stomach of
a man who died from zinc sulphate, and whose case is reported in the
_Lancet_, 1859. The mucous membrane is wrinkled all over like a piece of
tripe; when recent it was vascular and indurated, but uniformly of a
dirty grey colour; the lining membrane of the small intestine is very
vascular, and in the duodenum and upper part of the jejunum the colour
is similar to that of the stomach, but in a less marked degree; the
stomach and intestines are contracted.
The pathological appearances after chloride of zinc vary according to
the period at which death takes place. When it has occurred within a few
hours, the lining membrane of the mouth and gullet shows a marked change
in texture, being white and opaque, the stomach hard and leathery, or
much corrugated or ulcerated. In cases in which life has been prolonged,
contractions of the gullet and stomach may occur very similar to those
caused by the mineral acids, and with a similar train of symptoms. In a
case which occurred under Dr. Markham’s[954] observation, a person died
ten weeks after taking the fatal dose, the first symptoms subsiding in a
few days, and the secondary set of symptoms not commencing for three
weeks. They then consisted mainly of vomiting, until the patient sank
from exhaustion. The stomach was constricted at the pyloric end, so that
it would scarcely admit a quill.
[954] _Med. Times and Gazette_, June 11, 1859, p. 595.
In Guy’s Hospital there is a good preparation, 1799³⁵, from the case of
S. R., aged 22; she took a tablespoonful of Burnett’s fluid, and died in
about fourteen weeks. There were at first violent vomiting and purging,
but she suffered little pain, and in a day or two recovered sufficiently
to move about the house; but the vomiting after food continued,
everything being ejected about five minutes after swallowing. Before
death she suffered from pneumonia. The stomach is seen to be much
contracted--5 inches in length; it is ulcerated both near the pylorus
and near the gullet; at the latter part there is a pouch-like portion of
the mucous membrane of the stomach adherent to the spleen, which
communicates by a perforation with an abscess formed and bounded by the
stomach, diaphragm, and spleen; it contained 3 ozs. of dirty-looking
pus. At the pylorus, in the centre, there is a second perforation, but
extravasation of the contents is prevented by the adherent omentum and
transverse colon. The muscular coats are thickened.
§ 867. =Detection of Zinc in Organic Liquids or Solids.=--In cases where
the poison has been expelled from the stomach by vomiting, the muscles
and bones would appear to be the best tissues to examine chemically; for
Matzkewitsch investigated very carefully a dog poisoned by 100 parts of
zinc, subcutaneously injected in the form of acetate, and found it
distributed over the several organs of the body in the following
ratios:--Muscles 60·5, bones 24·41, stomach and intestines 4·63, skin
3·70, place of injection 2·19, liver 1·75, lungs and heart 1·68,
kidneys, bladder, and urine 1·14.
The only certain method of detection is to produce the sulphide of zinc,
best effected by saturating a neutral or feebly acid liquid with hydric
sulphide. If an organic liquid, which can be easily filtered, is
operated upon, it may be strongly acidulated with acetic acid, and at
once treated with hydric sulphide. If, however, zinc is sought for as a
part of a systematic examination (as will most likely be the case), the
solution will have been treated with hydrochloric acid, and already
tested for arsenic, antimony, lead, &c., and filtered from any
precipitate. In such a case the hydrochloric acid must first be replaced
by acetic, which is effected by adding a slight excess of sodic acetate;
the right quantity of the latter is easily known, if the hydrochloric
acid originally added was carefully measured, and its specific gravity
ascertained; 3·72 of crystallised sodic acetate saturating one of HCl.
Lastly, should the distillation process, given at p. 49, have been
adopted, the contents of the retort will only require to be treated
with water, filtered, and saturated with sulphuretted hydrogen. In any
of the above cases, should a white, dirty white or lightish-coloured
precipitate (which is not sulphur) be thrown down, zinc may be
suspected; it will, however, be absolutely necessary to identify the
sulphide, for there are many sources of error. The most satisfactory of
all identifications is the production of Rinman’s green. The supposed
sulphide is dissolved off the filter with hot nitric acid, a drop or
more (according to the quantity of the original precipitate) of solution
of cobalt nitrate added, the solution precipitated with carbonate of
soda and boiled, to expel all carbonic anhydride; the precipitate is
then collected on a filter, washed, dried, and ignited in a platinum
dish. If zinc be present in so small a proportion as 1·100,000 part, the
mass will be permanently green.
§ 868. Other methods of procedure are as follows:--The supposed zinc
sulphide (after being well washed) is collected in a porcelain dish, and
dissolved in a few drops of sulphuric acid, filtered, nitric acid added,
evaporated to dryness, and heated to destroy all organic matter. When
cool, the mass is treated with water acidulated by sulphuric acid, and
again filtered. The solution may contain iron as well as zinc, and if
the former (on testing a drop with ferrocyanide of potash) appears in
any quantity, it must be separated by the addition of ammonia in excess
to the ammoniacal filtrate; sodic carbonate is added in excess, the
liquid well boiled, and the precipitate collected on a filter and
washed. The carbonate of zinc thus obtained is converted into zinc oxide
by ignition, and weighed. If oxide of zinc, it will be yellow when hot,
white when cold: it will dissolve in acetic acid; give a white
precipitate with sulphuretted hydrogen; and, finally, if heated on
charcoal in the oxidising flame, and moistened with cobalt nitrate
solution, a green colour will result. Zinc may also be separated from
liquids by electrolysis. The simplest way is to place the fluid under
examination in a platinum dish of sufficient size, acidify, and insert a
piece of magnesium tape. The metallic film so obtained may be dissolved
by hydrochloric acid, and the usual tests applied.
2. NICKEL--COBALT.
§ 869. The salts of nickel and cobalt have at present no toxicological
importance, although, from the experiments of Anderson Stuart,[955] both
may be classed as poisonous. The experiments of Gmelin had, prior to
Stuart’s researches, shown that nickel sulphate introduced into the
stomach acted as an irritant poison, and, if introduced into the blood,
caused death by cardiac paralysis. Anderson Stuart, desiring to avoid
all local irritant action, dissolved nickel carbonate in acid citrate of
soda by the aid of a gentle heat; he then evaporated the solution, and
obtained a glass which, if too alkaline, was neutralised by citric acid,
until its reaction approximated to the feeble alkalinity of the blood;
the cobalt salt was produced in the same way. The animals experimented
on were frogs, fish, pigeons, rats, guinea-pigs, rabbits, cats, and
dogs--in all 200. The lethal dose of nickelous oxide, when
subcutaneously injected in the soluble compound described, was found to
be as follows:--frogs, ·08 grm. per kilogram; pigeons, ·06; guinea-pigs,
·030; rats, ·025; cats, ·01; rabbits, ·009; and dogs, ·007. The
cobaltous oxide was found to be much less active, requiring the above
doses to be increased about two-thirds. In other respects, its
physiological action seems to be very similar to that of nickelous
oxide.
[955] “Nickel and Cobalt; their Physiological Action on the Animal
Organism,” by T. P. Anderson Stuart, M.D., _Journ. of Anat. and
Physiol._, vol. xvii., Oct. 1882.
§ 870. =Symptoms--Frogs.=--A large dose injected into the dorsal lymph
sac of the frog causes the following symptoms:--The colour of the skin
all over the body becomes darker and more uniform, and not infrequently
a white froth is abundantly poured over the integument. In an interval
of about twenty minutes the frog sits quietly, the eyes retracted and
shut; if molested, it moves clumsily. When quiet, the fore limbs are
weak, and the hind legs drawn up very peculiarly, the thighs being
jammed up so against the body, that they come to lie on the dorsal
aspect of the sides of the frog, and the legs are so much flexed that
the feet lie on the animal’s back, quite internal to the plane of the
thighs. Soon fibrillary twitchings are observed in the muscles of the
abdominal wall, then feeble twitchings of the fingers, and muscles of
the fore limbs generally; lastly, the toes are seen to twitch, and then
the muscles of the hind limbs--this order is nearly always observed; now
spasmodic gaping and incoördinate movements are seen, and the general
aspect is not unlike the symptoms caused by picrotoxin. After this,
tetanus sets in, and the symptoms then resemble those of strychnine; the
next stage is stupefaction and voluntary motor paresis; the respiratory
movements become feeble, and the paresis passes into paralysis. The
heart beats more and more slowly and feebly, and death gradually and
imperceptibly supervenes. The _post-mortem_ appearances are well marked,
_i.e._, rigor mortis, slight congestion of the alimentary tract, the
heart with the auricle much dilated and filled with dark blood, the
ventricle mostly small, pale, and semi-contracted. For some time after
death, the nerve trunks and muscles react to the induction current.
=Pigeons.=--In experiments on pigeons the symptoms were those of dulness
and stupor, jerkings of different sets of muscles, and then death
quietly.
=Guinea-pigs.=--In guinea-pigs there were dulness and stupefaction, with
some weakness of the hind limbs.
=Rats.=--The symptoms in rats were almost entirely nervous; they became
drowsy and apathetic, and there was paralysis of the hind legs.
=Rabbits.=--In rabbits, also, the symptoms were mainly those caused by
an affection of the nervous system. There was paralysis, which affected
either the hind legs only, or all four limbs. The cervical muscles
became so weak that the animal was unable to hold its head up. Diarrhœa
occurred and persisted until death. If the dose is not large enough to
kill rapidly, the reflex irritability is decidedly increased, so that
the slightest excitation may cause the animal to cower and tremble all
over. Now appear twitchings and contractions of single groups of
muscles, and this excitement becomes general. The respirations also
become slower and more difficult, and sometimes there is well-marked
dilatation of the vessels of the ears and _fundi oculi_. Convulsions
close the scene.
§ 871. =Circulation.=--The effect of the salt on the frog’s heart was
also studied in detail. It seems that, under the influence of a soluble
salt of nickel, the heart beats more and more slowly, it becomes smaller
and paler, and does not contract evenly throughout the whole extent of
the ventricle; but the rhythm of the ventricular and auricular
contractions is never lost.
It is probable that there is a vaso-motor paralysis of the abdominal
vessels; the blood-pressure falls, and the heart is not stimulated by
the blood itself as in its normal state. In support of this view, it is
found that, by either pressing on the abdomen or simply inverting the
frog, the heart swells up, fills with blood, and for a time beats well.
=Nervous System.=--The toxic action is referable to the central nervous
system, and not to that of peripheral motor nerve-endings or motor
nerve-fibres. It is probable that both nickel and cobalt paralyse to
some extent the cerebrum. The action on the nerve-centres is similar to
that of platinum or barium, and quite different from that of iron.
§ 872. =Action on Striped Muscle.=--Neither nickel nor cobalt has any
effect on striped muscle. In this they both differ from arsenic,
antimony, mercury, lead, and iron--all of which, in large doses,
diminish the work which healthy muscle is capable of performing.
§ 873. =Separation of Nickel or Cobalt from the Organic Matters or
Tissues.=--It is very necessary, if any case of poisoning should occur
by either or both of these metals, to destroy completely the organic
matters by the process already detailed on p. 51. Both nickel and cobalt
are thrown down, if in the form of acetate, from a neutral solution by
sulphuretted hydrogen; but the precipitation does not take place in the
presence of free mineral acid; hence, in the routine process of
analysis, sulphuretted hydrogen is passed into the acid liquid, and any
precipitate filtered off. The liquid is now made almost neutral by
potassic carbonate, and then potassic acetate added, and a current of
sulphuretted hydrogen passed through it. The sulphides of cobalt and
nickel, if both are present, will be thrown down; under the same
circumstances zinc, if present, would also be precipitated. Cobalt is
separated from zinc by dissolving the mixed sulphides in nitric acid,
precipitating the carbonates of zinc and cobalt by potassic carbonate,
collecting the carbonates, and, after washing, igniting them gently in a
bulb tube, in a current of dry hydrochloric acid; volatile zinc chloride
is formed and distils over, leaving cobalt chloride.
§ 874. To estimate cobalt, sulphide of cobalt may be dissolved in nitric
acid, and then precipitated by pure potash; the precipitate washed,
dried, ignited, and weighed; 100 parts of cobaltous oxide (Co₃O₄) equals
73·44 of metallic cobalt. Cobalt is separated from nickel by a method
essentially founded on one proposed by Liebig. The nitric acid solution
of nickel and cobalt (which must be free from all other metals, save
potassium or sodium) is nearly neutralised by potassic carbonate, and
mixed with an excess of hydrocyanic acid, and then with pure caustic
potash. The mixture is left exposed to the air in a shallow dish for
some hours, a tripotassic cobalticyanide (K₃CoCy₆) and a
nickelo-potassic cyanide (2KCy, NiCy₄) are in this way produced. If this
solution is now boiled with a slight excess of mercuric nitrate,
hydrated nickelous oxide is precipitated, but potassic cobalticyanide
remains in solution, and may be filtered off. On carefully neutralising
the alkaline filtrate with nitric acid, and adding a solution of
mercurous nitrate, the cobalt may then be precipitated as a mercurous
cobalticyanide, which may be collected, washed, dried, decomposed by
ignition, and weighed as cobaltous oxide. After obtaining both nickel
and cobalt oxides, or either of them, they may be easily identified by
the blowpipe. The oxide of nickel gives, in the oxidising flame with
borax, a yellowish-red glass, becoming paler as it cools; the addition
of a potassium salt colours the bead blue. In the reducing flame the
metal is reduced, and can be seen as little greyish particles
disseminated through the bead. Cobalt gives an intense blue colour to a
bead of borax in the oxidising flame.
IV.--PRECIPITATED BY AMMONIUM SULPHIDE.
Iron--Chromium--Thallium--Aluminium--Uranium.
1. IRON.
§ 875. It was Orfila’s opinion that all the salts of iron were
poisonous, if given in sufficient doses; but such salts as the
carbonate, the phosphate, and a few others, possessing no local action,
may be given in such very large doses, without causing disturbance to
the health, that the statement must only be taken as applying to the
more soluble iron compounds. The two preparations of iron which have any
forensic importance are the perchloride and the sulphate.
§ 876. =Ferric Chloride= (Fe₂Cl₆ = 325).--Anhydrous ferric chloride will
only be met with in the laboratory. As a product of passing dry chlorine
over red-hot iron, it sublimes in brown scales, is very deliquescent,
and hisses when thrown into water. There are two very definite
hydrates--one with 6 atoms of water, forming large, red, deliquescent
crystals; and another with 12 of water, less deliquescent, and
crystallising in orange stellate groups.
The pharmaceutical preparations in common use are:--
=Stronger Solution of Perchloride of Iron= (=Liquor Ferri Perchloridi
Fortior=).--An orange-brown liquid of specific gravity 1·42, and
containing about 58 per cent. of ferric chloride.
=Tincture of Perchloride of Iron= (=Tinctura Ferri Perchloridi=), made
by diluting 1 part of the strong solution with 1 volume of rectified
spirit, and adding distilled water to measure 4.
=Solution of Perchloride of Iron= (=Liquor Ferri Perchloridi=).--Simply
5 volumes of the strong solution made up to 20 by the addition of water;
hence, of the same strength as the tincture.
§ 877. =Effects of Ferric Chloride on Animals.=--A very elaborate series
of researches on rabbits, dogs, and cats was undertaken a few years ago
by MM. Bérenger-Féraud and Porte[956] to elucidate the general symptoms
and effects produced by ferric chloride under varying conditions. First,
a series of experiments showed that, when ferric chloride solution was
enclosed in gelatine capsules and given with the food of the animal, it
produced either no symptoms or but trifling inconvenience, even when the
dose exceeded 1 grm. per kilogrm.; anhydrous ferric chloride and the
ferric chloride solution were directly injected into the stomach, yet,
when food was present, death did not occur, and the effects soon
subsided. In animals which were fasting, quantities of the solution
equal to ·5 grm. per kilogrm. and above caused death in from one hour to
sixteen hours, the action being much accelerated by the addition of
alcohol--as, for example, in the case of the tincture: the symptoms were
mainly vomiting and diarrhœa, sometimes the vomiting was absent. In a
few cases the posterior extremities were paralysed, and the pupils
dilated: the urine was scanty or quite suppressed; death was preceded by
convulsions.
[956] “Étude sur l’empoisonnement par le perchlorure de fer,” par MM.
Bérenger-Féraud et Porte, _Annales d’Hygiène Publique_, 1879.
§ 878. =Effects on Man.=--Perchloride of iron in the form of tincture
has been popularly used in England, from its supposed abortive property,
and is sold under the name of “steel drops.” It has been frequently
taken by mistake for other dark liquids; and there is at least one case
on record in which it was proved to have been used for the purpose of
murder. The latter case[957] is peculiarly interesting from its great
rarity; it occurred in Martinique in 1874-1876, no less than four
persons being poisoned at different dates. All four were presumed to
have had immoral relations with a certain widow X----, and to have been
poisoned by her son. In three of the four cases, viz., Char----,
Duf----, and Lab----, the cause of death seems pretty clear; but the
fourth, Ab----, a case of strong suspicion, was not sufficiently
investigated. All three took the fatal dose in the evening, between
eight and nine o’clock--Lab---- the 27th of December 1874, Duf---- the
22nd of February 1876, and Char---- on the 14th of May 1876. They had
all passed the day in tippling, and they all had eaten nothing from
mid-day, so that the stomach would, in none of the three, contain any
solid matters. The chloride was given to them in a glass of “punch,” and
there was strong evidence to show that the son of the widow X----
administered it. Char---- died after about thirteen hours’ illness,
Duf---- and Lab---- after sixty-five hours’ illness; Ab---- lived from
three to four days. With Char---- the symptoms were very pronounced in
an hour, and consisted essentially of violent colicky pain in the
abdomen and diarrhœa, but there was no vomiting; Duf---- had also great
pain in the abdomen and suppression of the urine. Lab---- had most
violent abdominal pains; he was constipated, and the urinary secretion
was arrested; there was besides painful tenesmus. According to the
experiments of Bérenger-Féraud and Porte,[958] the perchloride in the
above cases was taken under conditions peculiarly favourable for the
development of its toxic action, viz., on an empty stomach and mixed
with alcohol.
[957] Fully reported in Bérenger-Féraud’s paper, _loc. cit._
[958] _Dub. Med. Press_, February 21, 1849.
There have been several cases of recovery from large doses of the
tincture, _e.g._, that of an old man, aged 72, who had swallowed 85 c.c.
(3 ozs.) of the tincture; the tongue swelled, there were croupy
respiration and feeble pulse, but he made a good recovery. In other
cases,[959] 28·3 c.c. (an ounce) and more have caused vomiting and
irritation of the urinary organs. The perchloride is not unfrequently
used to arrest hæmorrhage as a topical application to the uterine
cavity--a practice not free from danger, for it has before now induced
violent inflammation and death from peritonitis.
[959] _Provincial Journal_, April 7 and 21, 1847, p. 180; see also
Taylor’s _Principles and Practice of Medical Jurisprudence_, vol. i. p.
320, 2nd Edition.
§ 879. =Elimination of Iron Chloride.=--Most of the iron is excreted in
the form of sulphide by the fæces, and colours them of a black hue; a
smaller portion is excreted by the urine.
§ 880. =Post-mortem Appearances.=--In the experiments on animals already
referred to, the general changes noted were dryness, pallor, and
parchment-like appearance of the cavity of the mouth, the mucous
membrane being blackened by the contact of the liquid. The gullet was
pale and dry, not unfrequently covered with a blackish layer. The mucous
membrane of the stomach was generally healthy throughout; but, if the
dose was large and very concentrated, there might be one or more
hyperæmic spots; otherwise, this did not occur. The internal surface of
the intestines, similarly, showed no inflammation, but was covered with
brownish coating which darkened on exposure to the air. The liver, in
all the experiments, was large and gorged with black and fluid blood;
there were ecchymoses in the lungs and venous congestion. The kidneys
were usually hyperæmic, and contained little hæmorrhages. There was also
general encephalic engorgement, and in one experiment intense congestion
of the meninges was observed. Few opportunities have presented
themselves for pathological observations relative to the effects
produced by ferric chloride on man. In a case related by Christison, in
which a man swallowed 42·4 c.c. (1½ oz.) of the tincture, and died in
five weeks, there was found thickening and inflammation of the pyloric
end of the stomach.
The case of Char----, already alluded to, is that in which the most
complete details of the autopsy are recorded, and they coincide very
fairly with those observed in animals; the tongue was covered with a
greenish fur, bordered at the edges with a black substance, described as
being like “mud”; the lining membrane of the gullet was pale, but also
covered with this dark “mud.” The stomach contained a greenish-black
liquid; the liver was large and congested; the kidneys were swollen,
congested, and ecchymosed; the cerebral membranes were gorged with
blood, and the whole brain hyperæmic.
§ 881. =Ferrous Sulphate, Copperas, or Green Vitriol=, FeSO₄7H₂O = 152 +
126; specific gravity, anhydrous, 3·138; crystals, 1·857; composition in
100 parts, FeO, 25·92; SO₃, 28·77; H₂O, 45·32.--This salt is in
beautiful, transparent, bluish-green, rhomboidal prisms. The crystals
have an astringent, styptic taste, are insoluble in alcohol, but
dissolve in about 1·5 times their weight of water; the commercial
article nearly always responds to the tests, both for ferrous and ferric
salts, containing a little persalt. The medicinal dose of this salt is
usually given as from ·0648 to ·324 grm. (1 to 5 grains), but it has
been prescribed in cases requiring it in gramme (15·4 grains) doses
without injury. Sulphate of iron has many technical applications; is
employed by all shoemakers, and is in common use as a disinfectant. The
salt has been employed for criminal purposes in France, and in this
country it is a popular abortive. In recorded cases, the symptoms, as
well as the pathological appearances, have a striking resemblance to
those produced by the chloride. There are usually colic, vomiting, and
purging; but in one case (reported by Chevallier), in which a man gave a
large dose of sulphate of iron to his wife, there was neither vomiting
nor colic; the woman lost her appetite, but slowly recovered. Probably
the action of ferrous sulphate, like that of the chloride, is profoundly
modified by the presence or absence of food in the stomach. Anything
like 28·3 grms. (an ounce) of sulphate of iron must be considered a
dangerous dose, for, though recovery has taken place from this quantity,
the symptoms have been of a violent kind.
§ 882. =Search for Iron Salts in the Contents of the Stomach,
&c.=--Iron, being a natural component of the body, care must be taken
not to confound the iron of the blood or tissues with the “iron” of a
soluble salt. Orfila attempted to distinguish between the two kinds of
iron by treating the contents of the stomach, the intestines, and even
the tissues, with cold acetic acid, and allowing them to digest in it
for many hours before filtering and testing for iron in the filtrate,
and this is generally the process which has been adopted. The acid
filtrate is first treated with sulphuretted hydrogen, which gives no
precipitate with iron, and then with sulphide of ammonium, which
precipitates iron black. The iron sulphide may be dissolved by a little
hydrochloric acid and a drop of nitric acid, and farther identified by
its forming Prussian blue when tested by ferrocyanide of potash, or by
the bulky precipitate of oxide, when the acid liquid is alkalised by
ammonia. In the case of Duf----, the experts attempted to prove the
existence of foreign iron in the liver by taking 100 grms. of Duf----’s
liver and 100 grms. of the liver of a non-poisoned person, and
destroying each by nitro-muriatic acid, and estimating in each acid
solution the ferric oxide. Duf----’s liver yielded in 100 parts ·08
mgrm. of ferric oxide, the normal liver ·022--nearly three times less
than Duf----’s.
To obtain iron from the urine, the fluid must be evaporated down to a
syrup in a platinum dish, a little nitric acid added, heated, and
finally completely carbonised. The residue is dissolved in hydrochloric
acid. Normal urine always contains an unweighable trace of iron; and,
therefore, any quantity, such as a mgrm. of ferric oxide, obtained by
careful precipitation of the hydrochloric acid solution out of 200 to
300 c.c. of urine, would be good evidence that a soluble salt of iron
had been taken. The hydrochloric acid solution is first precipitated by
ammonia and ammonic sulphide. The precipitate thus obtained will not be
pure iron sulphide, but mixed with the earth phosphates. It should be
redissolved in HCl, precipitated by sodic carbonate, then acidified by
acetic acid and sodic acetate added, and the solution well boiled; the
iron will then be precipitated for the most part as oxide mixed with a
little phosphate of iron.
Since, as before mentioned, a great portion of the iron swallowed as a
soluble salt is converted into insoluble compounds and excreted by the
fæces, it is, in any case where poisoning by iron is suspected, of more
importance to examine chemically the fæces and the whole length of the
alimentary canal, than even the contents of the stomach. In particular,
any black material lying on the mucous membrane may be sulphide of iron
mixed with mucus, &c., and should be detached, dissolved in a little
hydrochloric acid, and the usual tests applied.
In the criminal cases alluded to, there were iron stains on certain
linen garments which acquired an importance, for, on dissolving by the
aid of nitric acid, they gave the reactions of chlorine and iron. Any
stains found should be cut out, steeped in water, and boiled. If no iron
is dissolved the stain should then be treated with dilute nitric acid,
and the liquid tested with ferrocyanide of potash, &c. It need scarcely
be observed that iron-mould is so common on shirts and any fabric
capable of being washed, that great care must be exercised in drawing
conclusions from insoluble deposits of the oxide.
2. CHROMIUM.
§ 883. The only salts of chromium of toxicological importance are the
neutral chromate of potash, the bichromate of potash, and the chromate
of lead.
=Neutral Chromate of Potash=, CrO₃K₂O = 194·7, containing 56·7 per cent.
of its weight of chromic anhydride, CrO₃.--This salt is in the form of
citron-yellow rhombic crystals, easily soluble in water, but insoluble
in alcohol. Its aqueous solution is precipitated yellow by lead acetate
or basic acetate; the precipitate being insoluble in acetic acid. If
chromate of potash in solution is tested with silver nitrate, the red
chromate of silver is thrown down; the precipitate is with difficulty
soluble in dilute nitric acid.
§ 884. =Potassic Bichromate=, CrO₃K₂O = 295·2, containing 68·07 per
cent. of its weight of chromic anhydride, CrO₃.--This salt is in
beautiful large, red, transparent, four-sided tables; it is anhydrous
and fuses below redness. At a high temperature it is decomposed into
green oxide of chromium and yellow chromate of potash. It is insoluble
in alcohol, but readily soluble in water. The solution gives the same
precipitates with silver, lead, and barium as the neutral chromate. On
digesting a solution of the bichromate with sulphuric acid and alcohol,
the solution becomes green from the formation of chromic oxide.
§ 885. =Neutral Lead Chromate=, PbCrO₄ = 323·5, composition in 100
parts, PbO, 68·94, CrO₃, 31·06.--This is technically known as “_Chrome
Yellow_,” and is obtained as a yellow precipitate whenever a solution of
plumbic acetate is added, either to the solutions of potassic chromate
or bichromate; by adding chrome yellow to fused potassic nitrate,
“chrome red” is formed; it has the composition CrO₃2PbO. Neutral lead
chromate is insoluble in acids, but may be dissolved by potassic or
sodic hydrates.
§ 886. =Use in the Arts.=--Potassic bichromate is extensively used in
the arts--in dyeing, calico-printing, the manufacture of porcelain, and
in photography; the neutral chromate has been employed to a small extent
as a medicine, and is a common laboratory reagent; lead chromate is a
valuable pigment.
§ 887. =Effects of some of the Chromium Compounds on Animal Life.=--In
the chromates of potash there is a combination of two poisonous metals,
so that it is not surprising that Gmelin found the chloride of chromium,
CrCl₃, less active than the neutral chromate of potash; 1·9 grm. of the
last, administered to a rabbit by the stomach, caused death within two
hours, while 3 grms. of chromous chloride had no action. Subcutaneous
doses of ·2 to ·4 grm. of neutral chromate (according to the experiments
of E. Gergens[960] and Carl Posner[961]) act with great intensity on
rabbits. Immediately after the injection the animals are restless, and
show marked dyspnœa; death often takes place within a few hours.
[960] _Arch. f. experiment. Pathol. u. Pharmakol._, Bd. 6, Hft. 1 and 2,
§ 148, 1875.
[961] Virchow’s _Archiv f. path. Anat._, Bd. 79, Hft. 2, § 333, 1880.
Diarrhœa does not seem, as a rule, to follow when the salt is
administered by subcutaneous injection to animals; but Gmelin’s rabbits
had considerable diarrhœa when 1·9 grm. was introduced into the stomach.
The same quantity, injected beneath the skin of a dog, caused loss of
appetite, and, after six days, there was a dry exanthem on the back, and
the hair fell off in patches; there was, however, neither diarrhœa nor
vomiting. Bichromate of potash causes (according to the researches of
Pelikan)[962] symptoms similar to those produced by arsenic or corrosive
sublimate; it acts as a powerful irritant of the stomach and intestinal
canal, and may even cause inflammation; on its absorption a series of
symptoms are produced, of which the most prominent are albuminuria,
bloody urine, and emaciation. From ·06 to ·36 grm. (1-5½ grains) is
fatal to rabbits and dogs.
[962] _Beiträge zur gerichtl. Medicin, Toxikol. u. Pharmakodynamik_,
Würzburg, 1858.
§ 888. =Effects of some of the Chromium Salts on Man--Bichromate
Disease.=--In manufacturing potassic bichromate, the workmen exposed to
the dust have suffered from a very peculiar train of symptoms, known
under the name of “bichromate disease.” It was first described in
England by Sir B. W. Richardson.[963] It appears that if the workmen
inspire the particles chiefly through the mouth, a bitter and
disagreeable taste is experienced, with an increase of saliva. This
increase of the buccal secretion gets rid of most of the poison, and in
that case but little ill effect is experienced; but those who keep the
mouth closed and inspire by the nose, suffer from an inflammation of the
septum, which gradually gets thin, and ultimately ulcerated; finally the
whole of the septum is in this way destroyed. It is stated that when a
workman has lost his nasal septum, he no longer suffers from nasal
irritation, and has a remarkable immunity from catarrh. The Chemical
Works Committee of Inquiry report (1893) that the manufacture of
bichromate of potash or soda is practically in the hands of three firms
at Glasgow, Rutherglen, and Falkirk, and that they visited all of them,
and found “that almost all the men working where dust was prevalent,
more especially between the furnaces and the dissolving tanks, had
either perforation of the septum of the nose, or had lost the
septum altogether.” The bichromate also causes painful skin
affections--eruptions akin to eczema or psoriasis; also very deep and
intractable ulcerations. These the workers call “chrome holes.” These
cutaneous maladies start from an excoriation; so long as the skin is not
broken, there seems to be little local effect, if any. The effects of
the bichromate are also seen in horses employed at the factories; the
salt getting into a wound or crack in the leg, produces ulceration:
horses may even lose their hoofs.
[963] _Brit. and For. Med. Chirurg. Review_, Oct. 1863. See also a paper
by the same writer, read before the Medical Society, reported in the
_Lancet_, March 11, 1882.
§ 889. Acute poisoning by the chromates is rare. In the ten years ending
1892, in England and Wales, 4 accidental deaths are ascribed to potassic
bichromate and 1 to chromic acid. Falck has, however, been able to find
in medical literature 17 cases, 6 of which were suicidal, 10 accidental,
and in 1 the bichromate was used as an abortive. In a case of poisoning
by the chromate of potash (related by Maschka),[964] in which a woman,
aged 25, took for a suicidal purpose a piece of potassic chromate, which
she described as the size of a hazel-nut (it would probably be at least
6 grms. in weight), the chief symptoms were vomiting, diarrhœa, pain in
the stomach, and rapid collapse; death took place fourteen hours after
swallowing the poison.
[964] _Prager Vierteljahrsschr. f. d. prakt. Heilk._, Bd. 131, § 37,
1877; Schmidt’s _Jahrb._ 1878, Bd. 178, § 237. See also Schuchardt in
Maschka’s _Handbuch_, Bd. ii. p. 3.
In poisoning by potassic bichromate, there may be much variety in the
symptoms, the more usual being those common to all irritant poisons,
_i.e._, vomiting, diarrhœa, and collapse, with cramps in the limbs and
excessive thirst; and the rarer affecting more especially the nervous
system, such as narcosis, paralysis of the lower limbs, and dilatation
of the pupils; occasionally there is slight jaundice.
In a case recorded by Dr. Macniven,[965] a man took a lump of bichromate
of potash, estimated to be over 2 drachms (7·7 grms.). The symptoms
commenced in fifteen minutes, and consisted of lightness in the head,
and a sensation of great heat in the body, which was followed by a cold
sweat; in twenty minutes he vomited; he then suffered from great pain in
the stomach, giddiness, specks before the eyes, a devouring thirst, and
there was loss of power over the legs. These symptoms, again, were
followed by severe rigors and great coldness of the extremities. On the
patient’s admission to hospital, two hours after taking the poison, it
was noted that the pupils were dilated, the face pale and cold, and the
pulse feeble. He complained of intense epigastric pain, and a feeling of
depression; there was some stupor; the stomach was emptied by emetics
and by the stomach-pump, and the patient treated with tepid emollient
drinks, whilst subcutaneous doses of sulphuric ether were administered.
He made a good recovery.
[965] “On a Case of Poisoning with Bichromate of Potash,” by Ed. O.
Macniven, M.B., _Lancet_, Sept. 22, 1883.
In a case recorded by Mr. Wilson,[966] a man, aged 64, was found dead in
his bed twelve hours after he had gone to rest. During the night he was
heard to snore loudly; there were no signs of vomiting or purging, and
bichromate of potash was found in the stomach.[967]
[966] _Med. Gazette_, vol. 33, 734.
[967] See also cases recorded by Dr. M’Lachlan, _Glasgow Med. Journ._,
July 1881; Dr. M’Crorie, _ibid._, May 1881; Dr. R. A. Warwick, _Lancet_,
Jan. 31, 1880; and Dr. Dunbar Walker, _ibid._, Sept. 27, 1879--a summary
of all of which may be found in Dr. Macniven’s paper, _loc. cit._
§ 890. Chromate of lead has also caused death. In one case[968] the
breathing of chromate of lead dust seems to have been fatal; and there
is also a double poisoning recorded by Dr. Linstow,[969] of two
children, aged three and a half and one and three-quarter years
respectively, who ate some yellow ornaments,[970] which were used to
adorn a cake, and which contained chrome yellow (chromate of lead). The
younger died in two and the elder in five days. The symptoms were
redness of the face, dulness, and an inclination to sleep; neither
complained of pain; the younger one had a little diarrhœa, but the elder
neither sickness nor purging.
[968] _Ueber tödtliche Vergiftung durch Einathmen des Staubes von mit
Chromsäuren Blei-Oxyde gefärbten Garne.--Vierteljahrsschr. f. ger.
Med._, 1877, Bd. xxvii. Hft. i. p. 29.
[969] _Ibid._, Bd. xx. s. 60, 1874.
[970] The ornaments were imitations of bees; each contained ·27 grm. gum
tragacanth, ·0042 grm. neutral lead chromate.
§ 891. =Post-mortem Appearances.=--We possess some very exact
researches[971] upon the pathological changes induced by subcutaneous
injections of solutions of potassic bichromate on animals, and
especially on the changes which the kidneys undergo. If the animal is
killed, or dies a few hours after the injection, there are apparently no
striking appearances, but a closer microscopical examination shows
considerable changes. The epithelium of the tubuli contorti exhibits a
yellow cloudiness, and the outline of the cells is irregular and jagged.
The glomeruli are moderately injected, and their capsules contain an
albuminous exudation; the canaliculi are filled with round cells
imbedded in a fluid which, on heating, coagulates, and is therefore
albuminous or fibrinous; probably this is the first stage of the
formation of fibrinous casts.
[971] C. Posner, _op. cit._
In the case quoted of the woman who poisoned herself with potassic
chromate, very striking changes were found in the stomach and
intestines. The stomach contained above a litre of dark chocolate fluid
of alkaline reaction; the mucous membrane, in the neighbourhood of the
cardiac and pyloric extremities, was swollen and red in sharply defined
patches; portions of the epithelial layer were detached, the rest of the
mucous membrane was of a yellow-brown colour, and the whole intestine,
from the duodenum to the sigmoid flexure, was filled with a partly
bloody, partly treacly-looking fluid; the mucous membrane, throughout
its entire extent, was swollen, with numerous extravasations, and in
places there were losses of substance. Similar appearances to these have
been found in other instances; the anomalous case recorded by Mr. Wilson
(_ante_) is an exception. In this instance a pint of inky, turbid
liquid, which yielded to analysis potassic bichromate, was found in the
stomach; but there were no marked changes anywhere, save a slight
redness of the cardiac end of the gullet. In Linstow’s two cases of
poisoning by lead chromate, there were found in both fatty degeneration
of the liver cells, and red points or patches of redness in the stomach
and intestines. In the elder boy the changes in the duodenum were very
intense, the mucous membrane was swollen and easily detached, in the
upper part strongly injected with blood; in one place there was a
perforation, and in several places the membrane was extremely thin. In
the younger boy the kidneys seem to have been normal, in the elder
congested and containing pus. Although it was clear that the two
children died from lead chromate, a chemical analysis gave no result.
§ 892. =Detection of the Chromates and Separation of the Salts of
Chromium from the Contents of the Stomach, &c.=--If in the methodical
examination of an acid liquid, which has been already filtered from any
precipitate that may have been obtained by sulphuretted hydrogen, this
liquid is made alkaline (the alkali only being added in slight excess),
and hydrated chromic oxide is thrown down mixed, it may be with other
metals of the second class, the precipitate may then be fused with nitre
and potassic carbonate, and will yield potassic chromate, soluble in
water, and recognised by the red precipitate which it gives with silver
nitrate, the yellow with lead acetate, and the green colour produced by
boiling with dilute sulphuric acid and a little alcohol or sugar. If by
treating a complex liquid with ammonium hydrosulphide, sulphides of
zinc, manganese, and iron are thrown down mixed with chromic oxide, the
same principles apply. If a chromate is present in the contents of the
stomach, and the organic fluid is treated with hydrochloric acid and
potassic chlorate, chromic chloride is formed, and dissolving imparts a
green colour to the liquid--this in itself will be strong evidence of
the presence of a chromate, but it should be supplemented by throwing
down the oxide, and transforming it in the way detailed into potassic
chromate.
A general method of detecting and estimating both chromium and barium in
organic matters has been worked out by L. de Koningh.[972] The
substances are burnt to an ash in a platinum dish. The ash is weighed;
to the ash is added four times its weight of potassium sodium carbonate
and the same amount of potassium nitrate; and the whole is fused for
fifteen minutes. The fused mass is boiled with water and filtered; if
chromium is present, the filtrate is of a more or less pronounced yellow
colour, but manganese may produce a green colour and mask the yellow;
this colour is removed by boiling with a little alcohol. The liquid is
concentrated down to 20 c.c., filtered into a test-tube, and a
colorimetric estimation made of the chromium present by imitating the
colour by a solution of potassium chromate of known strength. To prove
that the colour is really due to chromium, acetic acid and lead acetate
are added, when the yellow chromate of lead is at once thrown down. (If
lead was in the ash, a yellow precipitate may appear on the addition of
acetic acid.) To the portion of ash insoluble in water strong
hydrochloric acid is added, and to the acid solution a large excess of
calcium sulphate is added; this precipitates barium as sulphate free
from lead sulphate, for, if the latter should be present, it does not,
under the circumstances, come down, being soluble in strong hydrochloric
acid.
[972] _Arch. Pharm._ (3), xxvii. 944.
3. THALLIUM.
§ 893. Thallium was discovered by Crookes in 1861. Its atomic weight
is 204; specific gravity, 11·81 to 11·91; melting-point, 290°. It is
a heavy diamagnetic metal, very similar to lead in its physical
properties. The nitrate and sulphate of thallium are both soluble in
water, the carbonate less so, requiring about 25 parts of water for
solution, while the chloride is sparingly soluble, especially in
hydrochloric acid.
§ 894. =Effects.=--All the salts of thallium are poisonous. One of
the earlier experimenters on the physiological action, Paulet, found
1 grm. (15·4 grains) of thallium carbonate sufficient to kill a
rabbit in a few hours; there were loss of muscular power, trembling
of the limbs, and death apparently from asphyxia. Lamy[973] used
thallium sulphate, and found that dogs were salivated, and suffered
from trembling of the limbs, followed by paralysis. The most
definite results were obtained by Marmé,[974] who found that ·04 to
·06 grm. of a soluble thallium salt, injected subcutaneously or
directly into the veins, and ·5 grm. administered through the
stomach of rabbits, caused death. The action is cumulative, and
something like that of mercury: there are redness and swelling of
the mucous membrane of the stomach, with mucous bloody discharges;
hæmorrhage may also occur from the lungs. Thallium is eliminated
through the urine, and is also found in the fæces; it passes into
the urine from three to five minutes after injection: the
elimination is slow, often taking as long as three weeks. It has
been found in the milk, in the tears, in the mucous membrane of the
mouth, of the trachea, in the secretion of the gastric mucous
membrane, and in the pericardial fluid; and in these places, whether
the poison has been introduced by subcutaneous injection, or by any
other channel. It seems probable that the reason of its being
detected so readily in all the secretions is the minute quantity
which can be discovered by spectroscopic analysis.
[973] _Chem. News_, 1863.
[974] _Göttinger Gelehrt. Nachrichten_, Aug. 14, No. 20.
§ 895. =Separation of Thallium from Organic Fluids or Tissues.=--The
salts of thallium, if absorbed, would only be extracted in traces
from the tissues by hydrochloric acid, so that, in any special
search, the tissues are best destroyed by either sulphuric or nitric
acid, or both. In the ordinary method of analysis, when an acid
liquid is first treated with sulphuretted hydrogen, and then made
alkaline by ammonia and ammonic sulphide, thallium would be thrown
down with the manganese and iron of the blood. From the mixed
sulphides, thallium may be separated by oxidising and dissolving the
sulphides with nitric acid, evaporating off the excess of acid,
dissolving in a very little hot water, and precipitating thallous
chloride by solution of common salt. The ease, however, with which
thallium may be separated from solutions of its salts by galvanism
is so great as to render all other processes unnecessary: the best
way, therefore, is to obtain a deposit of the metal on platinum by a
current from one or more cells, and then to examine the deposit
spectroscopically. Thallium gives, when heated in a Bunsen flame, a
magnificent green line, the centre of which corresponds with wave
length 534·9; a second green line, the centre of which coincides
with W.L. 568, may also be distinguished.
4. ALUMINIUM.
§ 896. =Aluminium and its Salts.=--A strong solution of acetate of
alumina has irritant properties, and has given rise to accidents. The
term alum, in a chemical sense, is given to a class of bodies of the
type of AlKSO₄. Common alum is at the present time ammonia alum,
NH₄Al(SO₄)₂ + 12H₂O; when made anhydrous by heat it is known by the name
of burnt alum, and possesses caustic properties.
§ 897. =Action of Alum Salts.=--Death or illness has hitherto only taken
place from the ingestion of large doses of alum or the acetate, and the
symptoms in these cases have been those of an irritant poison; we are,
however, indebted to Paul Siem[975] for a research on the absorbed
substance, in which the local effects as far as possible have been
reduced.
[975] _Ueber die Wirkungen des Aluminiums u. Berylliums, Inaug. Diss._,
Dorpat, 1886; Schmidt’s _Jahrbuch_, vol. ccxi. 128.
Siem’s research was made on frogs, cats, and dogs. For frogs he employed
a double salt, consisting of sodic and aluminic lactate, to which he
ascribed the formula Al₂(C₃H₅O₃)₃(C₃H₄NaO₃)₃, equal to 15·2 per cent. of
Al₂O₃. Twenty to thirty mgrms., administered by subcutaneous injection
to frogs, caused death in from ten to twenty-four hours. After the
injection there was restlessness, and, ultimately, general paralysis of
the central nervous system. The circulation was not affected; the heart
was the last to die.
For warm-blooded animals he used the double tartrate of sodium and
aluminium. Beginning with a small dose subcutaneously administered, he
gradually increased it, and found, under these circumstances, that the
lethal dose for rabbits was 0·3 grm. per kilo. of body weight; for dogs
0·25 grm., and for cats 0·25 to 0·28 grm.; if, however, a single dose
was administered, then cats could be killed by 0·15 grm. per kilo. The
symptoms commenced ten to twelve hours after the injection of a large
dose, but with a medium dose the symptoms might be delayed for from
three to four days, then there was loss of appetite, constipation,
emaciation, languor, and a disinclination to move. Vomiting and loss of
sensation to pain followed, the power of swallowing even saliva was
lost, and a condition supervened similar to bulbar paralysis. However
true this picture may be when large doses are given subcutaneously, it
does not follow that hydrate of alumina in small doses, given by the
mouth, mixed with food, produces any symptoms whatever.
Alum baking-powders, containing from 30 to 40 per cent. of alum mixed
with carbonate of soda, are in commerce, and have been for a long time,
many tons being sold yearly. When water is added to such powders
decomposition takes place, the result being sodic sulphate and aluminic
hydrate, carbonic acid being given off. Were the hydrate, in small
doses, capable of producing indigestion or disease of the central
nervous system, it seems astonishing that, considering the enormous
number of persons who use alum baking-powders, there should not be some
definite evidence of its effect. The author and his family for months
together have used alum baking-powders without any apparent injury, and
there is little doubt that alumina hydrate passes out of the system
mainly by the bowel, without being absorbed to any great extent. In a
trial with regard to an alum baking-powder at Pontypridd (1893), the
prosecution advanced the theory, and supported it by eminent scientific
opinion, that aluminium hydrate was dissolved by the hydrochloric acid
of the gastric juice, forming chloride of aluminium, some of which might
be absorbed and enter the circulation; that which was not absorbed in
the stomach passed on, and, meeting the alkaline fluids of the
intestines, was again separated as aluminium hydrate, and as such
absorbed.
If this does occur, still there is no direct evidence of its toxic
influence in the small quantities used in baking-powder. It may be
pointed out, also, that with regard to the possible lethal effect of a
non-corrosive salt of alum, presuming that the lethal dose for man is
the same as that for a cat, the amount of alumina to kill a
68-kilogramme man would have to be equal to 17 grms., or about 3 ozs. of
ammonia alum. This important question can only be settled by careful
feeding of animals carried on for a long period of time.
§ 898. =Post-mortem Appearances.=--In the few cases in which persons
have been killed by large doses of alum or its salts there have been
found corrosion of the mouth, throat, and stomach, and hyperæmia of the
kidneys and intestine. In the animals experimented upon by Paul Siem,
hyperæmia of the intestine, fatty degeneration of the liver and hyaline
degeneration of the kidneys were the chief changes noted.
§ 899. =Detection of Alumina.=--In all operations for the detection of
alumina, glass and porcelain vessels are to be avoided. The substances
should be burned to an ash in a platinum dish, the ash treated with
hydrochloric acid, the acid driven off by heat, and a few drops of
nitric acid added, and dissolved in hydrochloric acid, and the solution
boiled and filtered. If organs of the body are operated upon, iron and
phosphoric acid will be present in the ash; this will, indeed, be the
case with most organic substances. The filtered solution is boiled, and,
while boiling, poured into a strong solution of sodic hydrate contained
in a silver or platinum dish; the iron will now separate as oxide, and
can be filtered off. To the filtrate is added a little sodic phosphate;
it is then feebly acidified with hydrochloric acid, and ammonia added
just sufficient to render it alkaline; a light whitish cloud of alumina
phosphate, should alumina be present, is thrown down, and can be
collected, thoroughly washed, dried, ignited, and weighed as alumina
phosphate.[976] The alumina phosphate is then fused with sodic sulphate
in a platinum dish or crucible, and the fused mass treated with hot
water; the sodic phosphate dissolves, and the alumina oxide may be
filtered off and dissolved in a little hydrochloric acid or sulphuric
acid.
[976] One part of al. phosphate is equal to 0·42 Al₂O₃, 3·733 ammonia
alum, and 4·481 potash alum.
A solution thus prepared has the following properties:--
Ammonium sulphide; white precipitate of hydroxide.
Potash or soda; white precipitate, soluble in excess.
Ammonia; white precipitate, only slightly soluble in excess.
There is also a blowpipe-test: if a little of the hydroxide be
collected, moistened with cobalt nitrate, and heated on charcoal by the
oxidising flame, alumina, under these circumstances, becomes of a blue
colour.
5. URANIUM.
§ 900. =Uranium.=--The salts of uranium are intensely poisonous. The
nitrate of uranium is used in photography and the arts, and is a
common reagent in chemical laboratories.
According to Kowalewsky,[977] the acetate of uranium possesses an
unusual power of uniting with albumin; the other soluble uranium
salts act also in a similar way. Hence concentrated solutions of
uranium salts corrode the mucous membranes, transforming, for
example, the walls of the stomach into a dead uranic albuminate. If
a non-corrosive salt of uranium is injected subcutaneously,
glycosuria is produced, with fatty degeneration of the walls of the
blood-vessels, and fatty changes in the kidneys, liver, &c. The
animal wastes and ultimately dies; 0·5 to 2·0 mgrms. of UO₃ per
kilogrm. will kill a cat, dog, or rabbit, if injected
subcutaneously. The nitrate or acetate, when given by the mouth,
produces gastro-enteritis and nephritis, with hæmorrhages in the
substance of the kidney. Uranium is not used in medicine.
[977] _Ztschr. f. Anal. Chemie_, xxiv., 1885, p. 551.
§ 901. =Detection and Estimation of Uranium.=--Uranium forms uranous
and uranic salts. Both classes of salts are not precipitated by SH₂,
but are precipitable by ammonium sulphide, and, therefore, in
toxicological analyses are likely to be met with in conjunction with
iron.
The sulphides of iron and uranium may be dissolved in strong
hydrochloric acid, boiled to expel SH₂, and the solution then
oxidised with a little nitric acid; the solution is now alkalised
with ammonium carbonate, which precipitates the iron as oxide and
leaves the uranium in solution. On now acidifying with nitric acid
in slight excess, a solution of sodic phosphate will precipitate
uranium phosphate as a white precipitate, alkalies will give a
yellow precipitate, alkaline carbonates a yellow precipitate soluble
in excess. Barium carbonate also gives a precipitate, and is useful
in separations. Uranium oxide gives a green glass in the oxidising
flame with borax or with sodic metaphosphate.
V.--ALKALINE EARTHS.
Barium.
§ 902. The soluble salts of barium are undoubtedly poisonous, and are of
frequent occurrence in the arts. The chloride of barium is used in the
staining of wool, the nitrate and the chlorate in the green fires of the
pyrotechnist, the oxide and the carbonate in the manufacture of glass.
The chromate is used by artists under the name of “yellow ultramarine,”
while the sulphate, technically known as “permanent white,” is, on
account of its weight and cheapness, occasionally used as an adulterant
of white powders and other substances. Barium sulphide, under various
names, such as Bottcher’s depilatory, Thompson’s hair destroyer, _Poudre
épilatoire_, and other names, is in commerce, and has caused poisonous
symptoms.[978]
[978] Barium carbonate and sulphate are usually enumerated as occasional
adulterants of bread, but there is no modern authentic instance of this.
§ 903. =Chloride of Barium=, BaCl₂2H₂O 208 + 36; anhydrous, Ba, 65·86
per cent., Cl, 34·14; specific gravity, 3·75, is in commerce in the form
of white, four-sided, tabular crystals; water dissolves about half its
weight at ordinary temperatures, three-fourths at 100°. Its solution
gives a white precipitate with sulphuric acid, quite insoluble in water
and nitric acid.
The salt imparts a green hue to an otherwise colourless flame; viewed by
the spectroscope, green bands will be visible. We may note that chloride
of barium gives two different spectra--the one at the moment of the
introduction of the salt, the other when the substance has been exposed
for some time to a high temperature. This is caused by a rapid loss of
chlorine, so that the first spectrum is due to BaCl₂, with a variable
mixture of BaCl, the second to BaCl alone.
§ 904. =Baric Carbonate=, BaCO₃ = 197; specific gravity, 4·3; BaO, 77·69
per cent., CO₂, 22·31, in its native form termed _Witherite_, is a
dense, heavy powder, insoluble in pure water, but dissolving in acetic,
nitric, and hydrochloric acids, the solution giving the reactions of
barium.
A rat-poison may be met with composed of baric carbonate, sugar, and
oatmeal, flavoured with a little oil of aniseed and caraway.
§ 905. =Sulphate of Barium=, BaSO₄; specific gravity, 4·59; BaO, 65·66
per cent., SO₃, 34·34 per cent., is a pure white powder when recently
precipitated, absolutely insoluble in water, and practically insoluble
in cold dilute acids. It is quite unalterable in the air at a red heat;
on ignition with charcoal, it may be converted almost entirely into
sulphide of barium; and by ignition with CaCl₂ into chloride.
§ 906. =Effects of the Soluble Salts of Barium on Animals.=--One of the
early notices of the poisonous characters of barium compounds was by
James Watt,[979] who found that _witherite_, given to dogs, produced
vomiting, diarrhœa, and death in a few hours. Sir Benj. Brodie[980]
administered barium chloride, and noticed its paralysing effect on the
heart. Orfila[981] made several experiments, and observed that 4 grms.
of the carbonate produced death in dogs in periods varying from one to
five hours; but in these experiments the gullet was tied. The later
investigators have been Gmelin, Onsum, Cyon, and Böhm.[982] Gmelin
found barium carbonate and barium chloride act in a very similar manner;
and, indeed, it is improbable that barium carbonate, _as_ carbonate, has
any action, but, when swallowed, the hydrochloric and other acids of the
stomach form with it soluble compounds. J. Onsum made eight experiments
with both barium carbonate and chloride on animals. The respiration was
quickened and, at the same time, made weak and shallow; the heart’s
action was accelerated; the animals became restless: and there was great
muscular prostration, with paralytic symptoms; convulsions did not occur
in any one of the eight animals. He found, on _post-mortem_ examination,
the right side of the heart full of blood from backward engorgement; he
describes a plugging of the small arteries with little fibrinous
coagula, having an inorganic nucleus, with constant hæmorrhagic
extravasations. Onsum seems to have held the theory that the baryta
salts circulated in the blood, and then formed insoluble compounds,
which were arrested in the lungs, causing minute emboli, just in the
same way as if a finely-divided solid were introduced directly into the
circulation by the jugular vein.
[979] _Memoirs of the Literary and Philosophical Society of Manchester_,
1790, vol. iii. p. 609.
[980] _Phil. Trans._, 1812.
[981] _Traité des Poisons_, 3rd ed., t. i., Paris, 1826.
[982] Gmelin, C. G., _Versuche über die Wirkungen des Baryts,
Strontians, Chroms, Molybdäns, Wolframs, Tellurs, u. s. w. auf den
thierischen Organismus_, Tübingen, 1824; Onsum, J., Virchow’s _Archiv_,
Bd. 2, 1863; Cyon, M., _Archiv f. Anatomie, Physiologie, &c._, 1866;
Böhm, _Archiv f. experiment. Pathol._, Bd. 3, 1874.
Onsum stands alone in this view. Cyon found no emboli in the lungs, and
refers the toxic effect to a paralysing influence on the heart and
voluntary muscles, and also on the spinal cord. Cyon, to settle the
embolic theory, injected into the one jugular vein of a rabbit barium
chloride, and into the other sodic sulphate, but the small arteries and
capillaries of the lungs remained clear. Böhm, operating on frogs, found
a great similarity between the action of small doses of barium salts and
that of certain organic poisons; as, for example, cicutoxin, ·012 to ·02
grm. subcutaneously injected into frogs, acted as a heart-poison. So
also Blake[983] found the heart slowed, and concluded that barium
chloride had a direct action on the cardiac muscle, and also a toxic
influence on the nervous system. F. A. Falck, in experiments on rabbits,
found a great reduction of temperature after poisoning with barium
chloride (3° to 12·6°).
[983] _Journ. of Anat. and Physiol._ 2nd series, 1874.
§ 907. =Effects of the Salts of Barium on Man.=--There were about
fifteen cases of poisoning by barium salts on record by the end of
1883--three of which were suicidal, but most of them were due to
accident or mistake. In three cases, barium chloride was taken instead
of Glauber’s salts; in one, instead of Carlsbad salts; in another, a
mixture of barium nitrate and sulphur, instead of pure sulphur; in a
sixth case, a mixture of barium acetate and raspberry syrup, instead of
sodic ethylsulphate; in a seventh, a chemist put a larger dose than was
ordered by the prescription; and in four cases barium carbonate had been
mixed with flour, and this flour used in the making of pastry. Of the
fifteen cases, nine, or 60 per cent., proved fatal; the fifteen cases
have now (1894) been increased to twenty-six.
=Fatal Dose.=--The recorded cases of poisoning have not satisfactorily
settled the question as to the least fatal dose of the barium salts. 6·5
grms. (about 100 grains) of the chloride have destroyed the life of an
adult woman in fifteen hours; 14 grms. (½ oz.) of the nitrate of baryta
have killed a man in six and a half hours; and the carbonate of baryta
has destroyed a person in the relatively small dose of 3·8 grms. (60
grains). On the other hand, certain Continental physicians have
prescribed barium chloride in large medicinal doses; for example,
Pirondi[984] and Lisfranc[985] have gradually raised the dose of barium
chloride from 4 decigrams up to 3 grms. (48 grains) daily, given, of
course, in divided doses. Pirondi himself took in a day 7·7 grms. (119
grains) without bad effect.
[984] _De la Tumeur Blanche de Genou_, éd. 2, Paris, 1836.
[985] _Gaz. Med. de Paris_, 1835, No. 14.
§ 908. =Symptoms.=--The local action of barium salts must be sharply
distinguished from the action of the absorbed salts. Kobert divides the
symptoms into seven groups:--
(1) Local, consisting in _malaise_, nausea, salivation, vomiting, and
pain in the stomach. This group merges so much into the next as hardly
to admit of precise separation.
(2) Excitation of the alimentary canal, both of the nervous and muscular
apparatus. Hence vomiting, painful colic, and acute diarrhœa. All these
phenomena may be produced in animals by subcutaneous injection, and,
therefore, do not depend alone upon local action.
(3) Excitation of the brain motor centres, which leads to convulsions,
or may result in paralysis. About half the recorded cases of barium
poisoning in the human subject have been convulsed; the other half
paralysed. In one case mania resulted.
(4) Weakness or destruction of the power of muscular contraction; this
produces in frogs, when the muscular test movements are recorded
graphically, a veratrin-like convulsion curve. In the human subject the
effect is that of great muscular weakness.
(5) Digitalin-like influence on the heart and blood-vessels, showing
itself in great slowing of the pulse, præcordial anxiety, and strong
beating of the heart (not only sensible to the patient, but which can be
heard and felt by the bystanders). The arteries are incompressible and
rigid, the blood-pressure strikingly raised. The blood-vessels of old
people do not stand the pressure, hence hæmorrhages in the lungs,
stomach, and other organs. Frogs die with the heart in systole.
(6) Catarrhal affection of the conjunctiva, the mucous membrane of the
respiratory tract, and the nose.
(7) Formation of insoluble baryta salts in the blood-vessels, according
to Onsum. This has not been observed in man, and the fact is disputed
(see _ante_).
In Dr. Tidy’s case,[986] in which a man, suffering from rheumatism, but
otherwise healthy, took a mixture of barium nitrate, flowers of sulphur,
and potassic chlorate, instead of sulphur, the symptoms were blisters on
the tongue, a burning pain in the gullet and stomach, with vomiting,
diarrhœa, convulsions, aphonia, and coldness of the extremities. A case,
copiously detailed by Seidel,[987] in which a pregnant woman,
twenty-eight years old, took carbonate of baryta for the purpose of
self-destruction, is interesting. She probably took the poison some
little time before six in the evening; she vomited and had great pain in
the stomach, but slept during the night without further sickness. The
next morning, after drinking some coffee, the sickness was renewed;
nevertheless, at 7 A.M., she repaired to her employment, which was
distant an hour’s walk; she probably suffered much on the way, for she
did not arrive until 9 A.M. The vomiting, accompanied by diarrhœa,
continuing, she was sent to bed at 2 P.M. She was very cold, and
complained of great weakness; the vomiting now ceased. At 8 P.M. she
shivered violently, could scarcely swallow, and the respiration was
oppressed. At 11 she seemed a little improved; but at 3 A.M. she was
found much worse, breathing rapidly, but fully conscious; at 4 A.M. she
was again seen, but found dead; she thus lived about thirty-four hours
after taking the fatal dose.
[986] _Pharm. Journ._, June 1868.
[987] Eulenberg’s _Vierteljahrsschrift f. ger. Med._, Bd. 27, § 213.
§ 909. =Distribution of Barium in the Body.=--Neumann has shown that,
after repeated injection of insoluble barium sulphate into the veins of
rabbits, barium is to be found in the liver, kidneys, spleen, and spinal
cord, but not in the muscles, thymus, or brain. G. Linossier[988] has
made a similar series of experiments, but with the more soluble
carbonate, and this salt was injected into animals for a period of
thirty days. All the organs contained some barium; lungs, muscles, and
the heart only contained traces, the liver rather more, the kidneys,
brain, and spinal cord still more, and, lastly, the bones a considerable
quantity, as much as 0·056 per cent.
[988] _Compt. rend. Soc. Biol._ (8), iv. 122-123.
§ 910. =Post-mortem Appearances.=--The _post-mortem_ appearances are
usually changes in the stomach and intestinal tract, but there are only
rarely traces of great inflammation. It is true, that in a case recorded
by Wach,[989] perforation of the stomach was found; but, since there was
old-standing disease of both liver and stomach, it is not clear that
this is to be attributed entirely to poison. In the case of suicide just
detailed, the mucous membrane of the stomach was much ecchymosed; over
the whole were strewn little white grains, sticking to the mucous
membrane, and there were also ecchymoses in the duodenum.
[989] Henke’s _Zeitschrift f. Staatsarzneik._, 1835, Bd. 30, Hft. 1, §
1.
§ 911. =The Separation of Barium Salts from Organic Solids or Fluids,
and their Identification.=--In the usual course of examination of an
unknown substance, the matter will already have been extracted by
hydrochloric acid, and the solution successively treated with hydric and
ammonic sulphides. The filtrate from any precipitate, after being
boiled, would in such a case give a precipitate if treated with
sulphuric acid, should a salt of barium soluble in hydrochloric acid be
present.
If there, however, should be _special_ grounds to search for baryta in
particular, it is best to extract the substances with pure boiling
water, to concentrate the solution, and then add sulphuric acid,
collecting any precipitate which may form. If the latter is found to be
sulphate of baryta, it must be derived from some soluble salt, such as
the nitrate or the chloride. The substances which have been exhausted
with water are now treated with hydrochloric acid, and to the acid
filtrate sulphuric acid is added. If sulphate of baryta is thrown down,
the baryta present must have been a salt, insoluble in water, soluble in
acids--probably the carbonate. Lastly, the organic substances may be
burnt to an ash, the ash fused with carbonate of soda, the mass, when
cool, dissolved in HCl, and the solution precipitated with sulphuric
acid. Any baryta now obtained was present, probably in the form of
sulphate; nevertheless, if obtained from the tissues, it would prove
that a soluble salt had been administered, for (so far as is known)
sulphate of barium is not taken up by the animal fluids, and is
innocuous.
The sulphate of barium is identified as follows:--
(1) A part of the well-washed precipitate is boiled with distilled
water, filtered, and to the filtrate a solution of chloride of barium
added. If there is no precipitate, the sulphate can be none other than
baric sulphate, for all the rest, without exception, are soluble enough
to give a slight cloud with baric chloride.
(2) The sulphate may be changed into sulphide by ignition on charcoal,
the sulphide treated with HCl, the solution evaporated to dryness, and
the resulting chloride examined spectroscopically; or, the sulphide may
be mixed with chloride of calcium, taken up on a loop of platinum wire,
heated strongly in the flame of a Bunsen burner, and the flame examined
by the spectroscope.
(3) A solution of the chloride of barium obtained from (2) gives a
yellow precipitate with neutral chromate of potash, insoluble in water,
but soluble in nitric acid.
APPENDIX.
Treatment by Antidotes or otherwise of Cases of Poisoning.
§ 912. All medical men in practice are liable to be summoned hastily to
cases of poisoning. In such emergencies not a moment is to be lost, for
valuable lives have ere this been sacrificed simply from the delay
caused by searching for medicines and instruments, and visiting the
patient unprovided with suitable remedies. Hence it is far the safest
plan for every medical man to provide himself with an “_antidote bag_,”
which, to be complete, should be furnished with the following
requisites:--
I. INSTRUMENTS:--
(1.) A =stomach-pump= or =tube=,[990] with proper mouth gags.
[990] The stomach-tube is simply a tube of india-rubber, from 6 to 8
feet in length, one end of which should be a little stiff, and
have a solid rounded extremity pierced with two lateral oval
holes--catheter-like; but, on an emergency, any india-rubber tube of a
suitable length will do. It is used by passing the proper end gently
down the throat into the stomach; if the patient is insensible, or, as
in some determined suicides, obstinate, the jaws must be forcibly opened
by the handle of a spoon, and some solid substance placed between the
teeth so as to give sufficient room for the entry of the tube. If the
tube is now passed in the median line well into the grasp of the
pharynx, it is actually drawn down into the stomach by the pharyngeal
muscles, so that the operator has, as it were, only to “pay out” a
sufficient quantity of the tubing. Holding the tube in a perpendicular
position, it may then be filled with water by means of a small funnel.
When full, the end must be pinched and brought down to the ground to
deliver in a basin; it will then act as a syphon and the contents of the
stomach will be syphoned off. The tube is elevated again above the body,
and the stomach filled with water; this syphoned off, and the process
repeated. Coffee, also, or antidotes may be conveniently introduced. If
the recumbent position is necessary, the patient must, of course, be
placed on a bed or table, in order that there should be sufficient fall
for the syphon.
(2.) A =hypodermic syringe=.
(3.) An ordinary bleeding =lancet=.
(4.) A =glass-syringe= with suitable canula, which may, in case of
necessity, be used for transfusion.
(5.) =Bistoury=, =forceps= and =tubes= suitable for performing
=tracheotomy=.
A small =battery= (interrupted current).
II. EMETICS:--
(1.) _Sulphate of zinc._
(2.) _Apomorphine._
(3.) _Mustard._
(4.) _Ipecacuanha._
The _sulphate of zinc_ may either be carried in 30-grain powders or in
the ordinary solid crystalline state, together with a little measure
made out of a small pill-box which, when exactly full, is found to
contain from 25 to 30 grains.
A still more convenient form is that of the compressed tablets, sold as
a speciality by one or more firms. The same remarks apply to
_ipecacuanha._
The _apomorphine hydrochlorate_ should be in solution, a suitable
strength is 2 per cent.; a few drops of this substance, injected
hypodermically, will cause vomiting in a few minutes.
Besides the above list, the bag should be furnished with a selection of
the so-called antidotes.
III. ANTIDOTES:--
(_a._) _Chemicals neutralising the poison._
=Acetic acid= and =calcined magnesia=.
(_b._) _Precipitants of alkaloids._
=Tannin=--A solution of =iodine in potassic iodide=.
(_c._) _Narcotics, or anæsthetics,_ for the treatment of the tetanic
class.
=Chloral=--chloroform.
(_d._) _Substances which act physiologically._
=French oil of turpentine.=--A solution of =atropine sulphate= for
hypodermic use (strength ·8 per cent.); hypodermic dose from 5 to 6
drops.
Solution of =nitrate of pilocarpine= (strength 5 per cent.); dose, 10
drops or more.
=Muscarine=--a solution in water (strength 5 per cent.); dose, 10 drops.
=Morphine meconate= in solution (strength 10 per cent.); dose, from 5
drops.
A solution of =nitrate of strychnine= (strength 2 per cent.); hypodermic
dose, from 2 to 3 drops.
=Potassium Permanganate= in crystals.
To these may be added a bottle of =Wyeth’s dialysed iron= for use in
arsenic poisoning, a flask of =brandy=, some =chloric ether=, =aromatic
spirits of ammonia=, and some really good =extract of coffee=.
TREATMENT.
§ 913. ACID CARBOLIC.
Use the =stomach-tube= or =pump=, unless there is great destruction of
the mucous membrane. In the latter case, excite vomiting by injecting
subcutaneously from 5 to 6 drops of the =apomorphine= solution; or give
an emetic of =zinc sulphate=, =ipecacuanha=, or =mustard=.
The stomach may, by the aid of the tube, be washed out with a weak
alkaline solution of =soda=; =albumen= may also be given, and such
stimulants as =brandy= and =water=, =chloric ether=, and =aromatic
spirits of ammonia=.
It is important to apply warmth to the extremities.
Inject subcutaneously from 2 to 3 drops of the =atropine hypodermic=
solution.
=Nitrite of amyl= by inhalation is said to have been useful.
In desperate cases =bleeding=, followed by =transfusion=, is to be
considered.
ACIDS--MINERAL, including SULPHURIC, NITRIC, HYDROCHLORIC, GLACIAL
ACETIC ACIDS.
=Stomach-tube= or =pump=, inadmissible.
Neutralise by calcined =magnesia=, =lime=, =chalk=, or =soda,= but not
with potash, if there is choice.
If no neutralising agent can be immediately procured, then dilute with
plenty of water.
Other remedies are--=oil=, =milk=, =white of eggs=, =gruel=.
It is often recommended in such cases to administer hypodermically a
little =morphine=.
ACONITE--ACONITINE.
Use at once the =stomach-tube= or =pump=, or give emetics of =sulphate
of zinc=, or hypodermic solution of =apomorphine=.
Keep the patient in the recumbent posture.
After the stomach has been emptied, give =atropine=, either by
hypodermic injection or by the mouth, say 4 drops of the P.B. solution;
failing atropine, 20 drops of the tincture of =belladonna=. The dose may
be repeated more or less frequently according to the condition of the
patient.
If there is great tendency to heart-syncope, tincture of =digitalis= in
½-drachm doses by the mouth, or in hypodermic doses of from 10 drops
upwards.
Apply a mustard poultice to the pericardium; aid vomiting and
elimination of the poison by plenty of water, to which may be added
brandy or any form of alcohol.
Inhalations of =nitrite of amyl= are said to have been useful. If the
breathing stops, try =artificial respiration=.
ALCOHOL.
Empty the stomach by the =tube= or =pump=, and then wash it out with
warm coffee; if the stomach-tube is not at hand, then empty the stomach
by hypodermic injection of 5 drops of =apomorphine=, or by a =mustard=
emetic, or =sulphate of zinc=. Keep the body very warm, but the cold
=douche= may be applied to the head.
Endeavours should be made to rouse the patient, if insensible, by
shaking, shouting at him, &c.
Inhalations of =amyl nitrite= are said to be useful.
ALKALIES--AMMONIA--POTASH--SODA.--=Stomach-pump= or =tube= not to be
used.
Vomiting nearly always present, or may be produced by administering
plenty of lukewarm water; after which give =dilute vinegar=, or the
juice of =lemons= or =oranges=; =olive oil=, the =white of eggs=,
=barley water=, =arrowroot=,= and always plenty of =water= may be
administered.
There may be œdema of the glottis, especially if ammonia has been taken.
In such a case, and death threatening from suffocation, perform
=tracheotomy=. In poisoning by ammonia, with croupous respiration, keep
the room warm, and fill it with steam by means of a bronchitis kettle.
Relieve pain by small doses of =morphine= injected subcutaneously.
AMMONIA.--See ALKALIES.
ANTIARIN.--See DIGITALIS.
ANTIMONY--TARTAR-EMETIC--ANTIMONIAL WINE, &C.
The stomach will generally have been emptied by vomiting. In those rare
cases in which this does not take place, use the =stomach-pump= or
=tube=, or give hypodermic injection of =apomorphine=.
Follow this with doses of =strong tea=, or give half-a-drachm of
=tannin= or =gallic acid= in warm water.
Give also demulcent drinks, and stimulants in small doses, frequently
repeated.
Keep the patient very warm by hot blankets and wraps.
The interrupted galvanic current to the heart may be useful.
APOCYNIN.--See DIGITALIS.
ARSENIC.
Use the =stomach-pump= or =tube=, or empty stomach by emetics, such as
hypodermic solution of =apomorphine=, or give =mustard= or =sulphate of
zinc=. The stomach should then be washed out by large quantities of
water, most conveniently administered by the pump or tube.
If the tube or pump is not at hand, then administer at once either
=dialysed iron=, or the freshly-precipitated =hydrated oxide of iron=,
obtained by precipitating the ordinary perchloride by means of carbonate
of soda or ammonia, avoiding excess of the latter. If the operator has
sufficient chemical knowledge to precipitate the iron with fair
exactness, so that there is no great excess of ammonia, or of sodic
carbonate, then filtration is unnecessary. In other cases, filter
through a handkerchief.
=Oil=, =mucilaginous drinks=, the =white of eggs=, and, if faintness
exists, small doses of =stimulants= may all be given.
If the skin is cold, warmth must be applied to the body by means of hot
blankets, &c.
Pain may be relieved by =morphine=.
ATROPINE--BELLADONNA--TINCTURE OF BELLADONNA.
Empty the stomach by means of the =stomach-pump= or =tube=.
Give an enema of =coffee=.
Administer half a grain of =pilocarpine nitrate=; or, if that is not at
hand, =morphine= or =opium= in suitable doses will act to a certain
extent antagonistic to the poison.
A subcutaneous dose of =muscarine= may be administered instead of
pilocarpine, but is not quite so good.
Hot water to the feet, alternate =douches= of cold and hot water are
found useful.
If the respiration seems likely to stop, =artificial respiration= must
be practised.
BELLADONNA.--See ATROPINE.
BENZENE.
If swallowed, then empty the stomach by =pump= or =tube=, or by the
hypodermic injection of =apomorphine=; or give emetics, such as =zinc
sulphate=, =mustard=, or =ipecacuanha=.
If the vapour has been _inhaled_, this is unnecessary.
Plenty of =fresh air=.
A subcutaneous dose of =atropine=, say 1-60th of a grain, or from 30 to
40 drops of =belladonna= tincture.
Alternate =douches= of hot and cold water to the chest, =artificial
respiration=, if necessary. The heart to be maintained by mild
interrupted shocks of the =battery= over the region of the heart.
BICHROMATE OF POTASH.--See CHROMIUM.
BRUCINE.--See STRYCHNINE.
CALABAR BEAN--PHYSOSTIGMINE.
Use =stomach-pump= or =tube=, or emetics, such as =sulphate of zinc=,
=mustard=, or =ipecacuanha=; or, better still, hypodermic solution of
=apomorphine=.
Give hypodermic doses of 1-60th grain =atropine= until the pupils
dilate. This treatment seeming to fail, =chloral= in 10-grain doses,
every quarter of an hour, has been recommended.
In certain cases =strychnine= has been used in hypodermic doses of
1-12th of a grain.
=Stimulants= and =artificial respiration= will probably be necessary in
some cases.
CAMPHOR.
Use =stomach-pump= or =tube=, or empty the stomach by emetics.
Hypodermic injections of =brandy=, inhalations of =ether=, the alternate
hot and cold =douche=, warmth to the extremities by hot blankets, &c.,
seem to be the best methods of treatment.
CANTHARIDES--CANTHARIDINE.
Use =stomach-pump= or =tube=, if the mucous membrane of the throat is
not inflamed; or, administer hypodermic dose of =apomorphine=, or give
emetics--=sulphate of zinc, mustard,= or =ipecacuanha=.
Allay pain with =morphine=. Give plenty of water and =demulcent drinks=.
CHLORAL.
Use =stomach-pump= or =tube=, and, when the stomach is emptied,
introduce by the same means =warm coffee=, or give a hypodermic
injection of =apomorphine=, or administer emetics of =sulphate of zinc=,
or =mustard=, or =ipecacuanha.=
An =enema of coffee= will be useful.
Keep the limbs warm.
Administer hypodermically 2 or 3 drops of the solution of =strychnine=
at intervals of from fifteen to twenty minutes.
Rouse the patient by various means, such as shouting, shaking, flapping
the skin with a wet towel, &c.
Inhalations of =amyl nitrite= are recommended.
=Artificial respiration= may be necessary.
CHLORATE OF POTASH.
Use the same treatment as for =nitrate of potash= (_which see_, p.
696).
CHLORIDE OF ZINC.--See ZINC.
CHLOROFORM--(_Inhaled_).
Give plenty of =fresh air=, pull the tongue forward, and commence at
once =artificial respiration=. If the heart has stopped, strike the
chest two or three times very hard, over the region of the heart; this
has been found occasionally to restore its beat. Apply the =battery=,
but with a weak current only; one pole may be placed on the larynx, the
other at the pit of the stomach.
Inhalations of =nitrite of amyl= are useful. The hot and cold =douche=
may also be used.
CHLOROFORM--(_Swallowed_).
Empty the stomach by =pump= or =tube=, or by emetics, such as 5 drops of
the hypodermic solution of =apomorphine=, or =sulphate of zinc=, or
=mustard=.
Give an enema of =hot coffee=.
Administer large draughts of =water=, which may advantageously contain a
little =sodic carbonate= in solution.
Attempt to rouse the patient. =Nitrite of amyl= inhalations, and, if
necessary, =artificial respiration= may be used.
CHROMATE OF POTASH.--See CHROMIUM.
CHROMIC ACID.--See CHROMIUM.
CHROMIUM--BICHROMATE OF POTASH--CHROMATE OF POTASH--CHROMIC ACID.
Empty the stomach by =pump= or =tube=; administer a subcutaneous
injection of =apomorphine=, or give =sulphate of zinc=, =mustard=, or
=ipecacuanha= as emetics. Follow up by administering, suspended in
water, calcined magnesia, or carbonate of magnesia, or chalk.
=Demulcent drinks=, such as =barley-water=, &c.
COCCULUS INDICUS.--See PICROTOXIN.
COLCHICUM--MEADOW SAFFRON--COLCHICUM WINE, TINCTURE, &C.
Use =stomach-pump= or =tube=, or empty the stomach by emetics, such as
=sulphate of zinc=, or =mustard=, or =ipecacuanha=; or, better than all,
give a hypodermic injection of 4 or 5 drops of the solution of
=apomorphine=.
Give =tannin= or =gallic acid= in ½-drachm doses, or strong tea or
coffee.
Allay the pain in the bowels and purging by small doses of =opium= or
=morphine=.
Keep the extremities warm, apply hot fomentations to the abdomen;
=stimulants= may be used, give plenty of =water= and =demulcent
drinks=.
COLOCYNTH.
Treatment on the same lines as that for COLCHICUM.
CONIUM--HEMLOCK.
Empty the =stomach= by the =pump= or =tube=, or give a hypodermic
injection of 4 or 5 drops of the solution of =apomorphine=, or emetics
of =sulphate of zinc=, or =mustard=.
Keep up the temperature of the body by hot wraps.
Administer, as a drink, strong =tea=, =tannin=, =gallic acids=, or any
harmless vegetable decoction containing tannin.
=Stimulants= may be administered.
If necessary, use =artificial respiration=.
COPPER--SALTS OF.
Empty stomach by =pump= or =tube=, and either inject by the same means
or administer =white of egg= in solution in water; if no white of eggs
can be had, substitute milk; give plenty of =water= and =emollient
drinks=.
Pain may be allayed by =opium= or =morphine=.
CORROSIVE SUBLIMATE--PERCHLORIDE OF MERCURY--NITRATE OF MERCURY.
Empty the stomach by the =tube= or =pump=, and wash the organ out with
plenty of white of egg, dissolved in water or milk. If the stomach-pump
is not at hand, then give emetics, such as the solution of
=apomorphine=, hypodermically, in from 4 to 5-drop doses, or a =zinc
sulphate= emetic, or =mustard=, or =ipecacuanha=. Probably violent
vomiting is already present, then stomach-tube or emetics are
unnecessary: but, in any case, give plenty of albuminous fluids, such as
=white of egg= in water or =milk=. If neither of these is at hand, chop
any =fresh meat= up as finely as can be done in a short space of time,
diffuse in water, and administer. Follow up with =demulcent drinks=,
such as =barley-water=, =flour= and =water=, &c.
Pain may be allayed with a little =opium= or =morphine=.
=Stimulants= are admissible, if necessary.
CROTON OIL.
Empty stomach by means of =tube= or =pump=, or give emetics of =mustard=
or =sulphate of zinc=, or administer hypodermic injection of
apomorphine.
Give 10 drops of =laudanum= every twenty minutes or half hour, until the
pain and purging are somewhat abated, or else inject subcutaneously
small doses of =morphine= at intervals.
Give plenty of =demulcent drinks=.
Two or three drops of =essence of camphor= in milk are useful.
Stimulants, such as =brandy=, =ammonia=, or =chloric ether=, are
admissible.
CYTISINE.--See LABURNUM.
CURARINE--WOORARI--URARI.
The poison is of course introduced by a wound; if any is likely to be
still in the wound apply a =ligature=, =suck the wound=, and then wash
it with a slightly alkaline solution of =potassic permanganate=.
Keep up the =respiration artificially=, give plenty of =water= and a
dose of spirits of nitre, apply warmth to the loins. By these means the
poison will be rapidly separated by the urine; and, if the patient can
only be kept alive by artificial respiration for a little time, he may
recover, for elimination is very rapid.
CYANIDE OF POTASSIUM.--See PRUSSIC ACID.
DIGITALIS GROUP OF HEART POISONS, _including_, besides the DIGITALINS,
ANTIARIN, APOCYNIN, NERIIN, OLEANDRIN, EVONYMIN, THEVETIN, SCILLAIN,
STROPHANTIN, and ERYTHROPHLEIN.
Empty the stomach by the =tube= or =pump=, or administer a subcutaneous
dose (4 drops) of =apomorphine=, or give a tablespoonful of =mustard= in
water, or =sulphate of zinc=.
Follow up with strong =tea=, or half a drachm of =tannin=, or =gallic
acid= in aqueous solution.
A very small dose of =aconitine nitrate= in solution (say 1-200th of a
grain) may be injected subcutaneously and the effect watched; if in a
little time it seems to do good, repeat the dose. On no account let the
patient rise from the recumbent posture, or he may faint to death.
=Stimulants= in small doses may be given frequently by the mouth, or, if
there is vomiting, by the bowel.
ERGOT.
Use =stomach-pump= or =tube=, or empty the stomach by a =mustard= or
=sulphate of zinc emetic=, or give a subcutaneous injection of
=apomorphine=.
Give a purgative, such as a drop of =croton oil=, and assist its action
by plenty of warm drinks.
=Tannin= and =gallic acid= have also been recommended, but are probably
of but little use.
After the bowels have well acted, and the stomach has been emptied, give
small doses of =opium= at intervals.
Dr. Murrell recommends 1-50th of a grain of =nitro-glycerin= every
fifteen minutes.
The recumbent position is necessary, and the circulation should be
maintained by warmth, and, if necessary, by friction.
ERYTHROPHLEIN.--See DIGITALIS.
ETHER.--The same treatment as with CHLOROFORM.
EVONYMIN.--See DIGITALIS.
FUNGI.--See MUSHROOMS.
GELSEMININE.
If seen soon after taking the dose, use the =stomach-pump= or =tube=, or
give a tablespoonful of =mustard=.
Administer a small dose of =atropine= subcutaneously, or give by the
mouth tincture of belladonna in 20-drop doses.
=Stimulants= are admissible.
If necessary, use =artificial respiration=.
Rouse the patient by hot and cold =douches=.
HEMLOCK.--See CONIINE--CONIUM.
HENBANE--HYOSCYAMINE.--The same treatment as for ATROPINE.
HYDROCHLORIC ACID.--See ACIDS, MINERAL.
HYDROCYANIC ACID.--See PRUSSIC ACID.
HYOSCYAMINE.--The same treatment as for ATROPINE.
IODINE.
Empty the stomach by =pump= or =tube=, or administer emetics, such as
the hypodermic solution of =apomorphine=, or give by the mouth =mustard=
or =sulphate of zinc=.
Give plenty of =starch= diffused in warm water, or in the form of a
dilute paste; or give any =farinaceous substance= whatever, such as
=arrowroot=, =boiled rice=, or =flour=, or thin =gruel=.
Inhalations of =amyl nitrite= have been recommended.
Pain may be relieved by =morphine= or =opium=.
JABORANDI.--Treatment the same as PILOCARPINE.
LABURNUM SEEDS--CYTISINE.
Empty stomach by =tube= or =pump=, and wash it out with =tea= or
=coffee=, or give (as an emetic) a hypodermic dose of =apomorphine=, or
(by the mouth) =mustard= or =zinc sulphate=; follow up this treatment by
an enema, or a brisk =purgative=.
=Stimulants= may be administered, the patient may be roused by the hot
or cold =douche=.
LAUDANUM.--See MORPHINE.
LAUREL WATER.--See PRUSSIC ACID.
LEAD--SALTS OF.
Empty stomach by =pump= or =tube=, or administer subcutaneously a dose
of =apomorphine=, 4 to 5 drops; or give by the mouth a =sulphate of
zinc= or =mustard= emetic. Follow up with half a drachm of =dilute
sulphuric acid=, or half an ounce of =magnesic= or =sodic sulphate=.
=Milk= and =albuminous fluids= may be given.
Allay pain with =opium= or =morphine=. Treat colic with hot
fomentations.
MEADOW SAFFRON.--See COLCHICUM.
MERCURY, SALTS OF.--See CORROSIVE SUBLIMATE.
MONKSHOOD.--See ACONITE.
MORPHINE--OPIUM--_Laudanum and preparations in which the OPIUM ALKALOIDS
predominate._
If taken by the mouth, give at once a solution of potassium permanganate
and then empty the stomach, but, if taken by hypodermic injection, both
these would be useless. The stomach in opium-poisoning is best relieved
by the =pump= or =tube,= and should then be well washed out with hot
=coffee=, leaving in the organ a pint or more. If the stomach-pump or
tube is not at hand, a large subcutaneous dose of =apomorphine= (say 10
minims) may be given, or =mustard= or =zinc sulphate=, but there may be
difficulty in obtaining vomiting from any emetic.
Attempt to rouse the patient by the =battery=, if at hand; by flips with
a towel, and by shaking. In all books will be found the usual direction
that you are to keep walking the patient about; but this treatment is
questionable, and likely to favour the toxic action of morphine on the
heart.
=Ammonia= may be applied to the nostrils.
Hot =coffee= may also be introduced into the bowels by an =enema=
apparatus, or by a simple tube.
The alternate =cold and hot douche= to the head is good, but the body
should be kept warm with hot wraps.
Small subcutaneous doses of =atropine= (say 1-20th of a grain) may be
administered, repeating the close every twenty minutes, and watching the
effect.
If necessary, apply =artificial respiration=.
Inhalations of =nitrite of amyl= have been used.
MUSCARINE.--See MUSHROOMS.
MUSHROOMS--MUSCARINE--POISONOUS FUNGI GENERALLY.
Empty stomach by =stomach-pump= or =tube=, or give a subcutaneous dose
of =apomorphine=, or administer by the mouth either =mustard= or =zinc
sulphate=.
Inject as soon as possible a subcutaneous dose of 2 to 4 drops of the
solution of atropine; or, after the stomach has been emptied, give
=tincture of belladonna= every half hour, in from 20 to 30-min. doses.
It is equally important to remove the remains of the fungi from the
intestines, and for this purpose it is well to give a dose of =castor
oil=, and to use an enema.
=Stimulants= may be given. The body should be kept warm.
NERIIN.--See DIGITALIS.
NICOTINE--TOBACCO.
Unless the stomach has been already emptied by vomiting, use
=stomach-pump= or =tube=, or give an emetic of =mustard= and plenty of
water.
Inject subcutaneously a small dose of =strychnine= (say 1-25th of a
grain of the nitrate), or give half a drachm of tincture of =nux
vomica=.
=Stimulants=, such as =brandy=, =chloric ether=, &c., may be given.
Keep the body warm, but the =cold douche= may be applied to the head.
=Tannin= and vegetable infusions containing =tannin= may also be given,
but it is questionable if they are of much use, unless any remnants
remain in the stomach.
Keep the patient lying down for fear of fatal syncope.
NITRE--NITRATE OF POTASH.
Empty the stomach immediately by the =pump= or =tube=, or give a
subcutaneous dose of =apomorphine= (from 2 to 3 drops), or administer by
the mouth a tablespoonful of =mustard=, or a scruple of =sulphate of
zinc=.
Dilute the poison, and attempt to wash it out of the system by giving
plenty of =water= or =mucilaginous drinks=.
Apply hot fomentations to the loins, and keep the patient as warm as
possible.
Stimulants that are likely to increase the kidney congestion are to be
avoided.
Inhalations of =nitrite of amyl= have been recommended.
NITRIC ACID.--See ACIDS, MINERAL.
NITRO-BENZENE.
Empty the stomach at once by the= stomach-pump= or =tube=, and wash the
organ out with plenty of warm water, to which advantageously a little
spirit may be added; or give emetics, such as =zinc sulphate= or
=mustard=.
Administer stimulants, either by the stomach-tube, as an enema, or by
subcutaneous injection.
Keep up the respiration artificially, if necessary, and maintain the
heart’s action by application of weak, interrupted shocks to the
chest-wall, by means of the =battery=.
Rouse the patient by the =douche=.
=Atropine= subcutaneously has been recommended.
NITROUS OXIDE GAS.
The treatment is the same essentially as for chloroform (_which see_).
Inhalations of =oxygen= may do good, but oxygen is very rarely at hand.
NUX VOMICA.--See STRYCHNINE.
OLEANDRIN.--See DIGITALIS.
OPIUM.--See MORPHINE.
OXALIC ACID--BINOXALATE OF POTASH--SODIC OXALATE.
Unless the patient has already vomited freely, empty the stomach at once
by emetics of =zinc sulphate= or =mustard=; or the =stomach-pump= or
=tube= may, in most cases, be used. If the acid has been taken,
neutralise by =chalk=, =lime water=, or, better, by =saccharated lime
water=; but on =no= account neutralise by carbonate of soda or any
alkali, for the alkaline oxalates are extremely poisonous.
Assist elimination by the kidneys by giving plenty of water; apply hot
fomentations to the loins.
An enema may be given, if necessary, to empty the bowels well.
PHOSPHORUS.
Empty the stomach by =tube= or =pump=, and, at the same time, wash the
organ out with water to which has been added a drachm of =French
turpentine=, or give emetics. The best emetic for phosphorus is said to
be =sulphate of copper=, 4 or 5 grains dissolved in water, and given
every ten minutes until vomiting is produced.
In default of sulphate of copper, then =sulphate of zinc= or =mustard=.
Give ½-drachm doses of =turpentine=, floating on water or on mucilage,
every half hour. Inhalations of turpentine vapour, much diluted, are
also of service. The American and German turpentines are said to be of
no avail. Probably the turpentine will freely purge the patient; but, if
not, the bowels should be opened by a suitable purgative, such, for
instance, as =magnesic sulphate=.
PHYSOSTIGMINE.--See CALABAR BEAN.
PICROTOXIN--COCCULUS INDICUS.
Use =stomach-pump= or =tube=, or empty stomach by usual emetics, _e.g._,
=mustard=, =zinc sulphate=, or =apomorphine=, subcutaneously.
=Chloral=, in doses of from 10 to 20 grains, may be given every half
hour to allay or prevent tetanus, the effects being, of course, watched.
For the same purpose =bromide of potassium= has been recommended. In
severe cases, it may be combined with choral, 1 drachm of the bromide
with 20 grains of chloral.
PILOCARPINE.
The best treatment is a subcutaneous dose of =atropine= (say 1-60th of a
grain) or tincture of =belladonna= by the mouth in 20-minim doses, to be
repeated every twenty minutes until the pupils dilate.
POTASH.--See ALKALIES
PRUSSIC ACID.[991]
[991] J. Kossa, considering that potassium permanganate ought,
theoretically, to act as a chemical antidote to potassium cyanide, by
checking the paralysis of the respiratory centres, has performed some
experiments. Rabbits were shown to be fatally affected in a few minutes
by 0·01 grm. of the poison, but if, at the time of administration, 0·5
grm. of permanganate dissolved in 50 c.c. of water was also introduced
into the stomach, doses of cyanide up to 0·1 grm. failed to cause death.
Larger quantities (0·2 grm.) proved fatal under similar conditions, but
the action of the poison was much delayed. Successful experiments were
also performed with aqueous solutions of hydrocyanic acid containing 0·1
per cent. It is suggested, therefore, that, in cases of cyanide
poisoning, ½ to ⅓ litre of a 3 to 5 per cent. solution of permanganate
should be administered immediately (_Vratch_, through _Nouv. rem._, ix.
567).
Use =stomach-pump= or =tube=, or, if not at hand, an emetic of =mustard=
or =sulphate of zinc=.
If the breathing has stopped, try =artificial respiration= and weak
shocks to the heart.
1-60th of a grain of =atropine= subcutaneously is recommended to assist
the heart’s action.
A =brandy enema= may be given, or brandy injected under the skin.
The body must be kept warm, but the cold =douche= may be advantageously
applied to the head.
SALTS OF SORREL.--See OXALIC ACID.
SAVIN.
If the patient has not already emptied the stomach by repeated vomiting,
and the throat is not inflamed, use the =stomach-pump= or =tube=, and
wash the organ out with water, or give any one of the usual
emetics--such as =mustard=, =sulphate of zinc=, or =ipecacuanha=.
If the bowels have not acted well, give a dose of =castor oil=; allay
pain with small doses of morphine.
SCILLAIN.--See DIGITALIS.
SNAKES, BITE OF.
Suck the wound, and apply an alkaline solution of =permanganate of
potash=.
In severe cases of cobra poisoning and other extremely venomous snakes,
death threatening, the only likely means of saving life would be
bleeding at one arm and =transfusing= blood by the other.
=Ammonia= may be given by the mouth, and also smelt.
In cobra poisoning and venoms which kill mainly through the respiration,
the breathing must be kept up artificially; and, should there be signs
of the heart failing, weak, interrupted =galvanic= shocks may be applied
to the walls of the chest.
Lacerda’s plan of injecting permanganate of potash under the skin is not
alone useless but mischievous, for it takes up time which might be more
valuably employed.
SODA CAUSTIC.--See ALKALIES.
SOLANINE--SOLANUM DULCAMARA--BITTER SWEET--WOODY NIGHTSHADE.--The same
treatment as for ATROPINE (_which see_).
STRAMONIUM.--The same treatment as for ATROPINE.
STROPHANTIN.--See DIGITALIS.
STRYCHNINE--BRUCINE--NUX VOMICA.
Empty the stomach as quickly as possible by an emetic of =mustard=, or
=zinc sulphate=, or by a hypodermic solution of =apomorphine= (4 drops).
The =stomach-pump= or =tube= inadmissible; for, if tetanus is present,
it cannot be applied; or, if absent, it is likely to excite a spasm.
Place patient at once under =chloroform= or =ether=, and keep up a
gentle narcosis for several hours, if necessary.
Darken the room, stifle all noise; if in a town, and opportunity permit,
have straw or peat placed at once before the house to deaden noise.
If the spasms threaten the respiration, =artificial respiration= is
absolutely necessary; and, to facilitate this, it would be justifiable,
in a dangerous case, to perform =tracheotomy=, of course under
chloroform.