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MEMORANDA ON POISONS.
WORKS BY THE SAME AUTHOR.
_Tanner's Practice of Medicine._
Fifth American from the Sixth London Edition. Greatly Enlarged and
Improved.
Price, bound in cloth, $6 00; in leather, $7 00.
_Tanner's Practical Treatise on The Diseases of Infancy and Childhood._
Third American Edition, Revised and Enlarged, by Alfred Meadow, M.
D.
Octavo. Cloth, $3 50.
_Tanner's Index of Diseases and their Treatment._
With upwards of 500 Formulae for Medicines, Baths, Mineral Waters,
Climates for Invalids, etc., etc.
Octavo. Price, $3 00.
MEMORANDA
ON
POISONS.
BY THE LATE
THOMAS HAWKES TANNER, M.D., F.L.S.
_THIRD AND COMPLETELY REVISED EDITION._
PHILADELPHIA:
LINDSAY & BLAKISTON.
1872.
HENRY B. ASHMEAD, PRINTER.
EDITOR'S PREFACE.
The present edition of Dr. Tanner's "Memoranda on Poisons" is in some
respects almost a new book. It was, as will be seen by the Author's
Preface to the last Edition, Dr. Tanner's object to furnish the
practitioner with a useful guide to his duties in cases of poisoning.
Experience has, however, shown that the book is more useful to the
student than to the practitioner; and, with a view to render it still
more valuable to the former, it has in great measure been remodelled.
Whilst, therefore, due attention has been paid to what might be called
the clinical aspects of poisoning, its chemical bearings have been more
closely attended to; and the more important and reliable tests have in
each instance been given, as have also the more important processes for
separating poisons from organic admixture. Sick of the old and
clumsy classification of poisons into Irritants, Narcotics, and
Narcotico-Irritants, the editor has endeavored to form some more
rational groups of toxic agents. These groups are, it is true, quite
provisional; and they are somewhat similar to those adopted by Dr. Guy
in his admirable textbook on Forensic Medicine. They have, however, been
worked out independently, whether they be worth anything or no. Briefly
they are these:--
Corrosives.--Simple Irritants, Mineral, Vegetable, and Animal.--Irritant
Gases.--Specific Irritants, Mineral, Vegetable, and Animal.--Neurotics:
subdivided into Narcotics, Anaesthetics, Inebriants, Delirants,
Convulsives, Hyposthenisants, Depressants, Asphyxiants,--and Abortives.
Such a grouping is far from perfect; but it would be impossible to have
anything worse than that still in general use. It is with the hope of
rendering this little volume more generally useful these changes have
been made: a reason at all times all-powerful with its lamented Author.
A. S.
AUTHOR'S PREFACE
TO THE SECOND EDITION.
These Memoranda are intended to refresh the memory of the practitioner
on a subject which is not brought under his notice so frequently as many
other departments of medicine. They are especially adapted to show at a
glance the treatment to be adopted in each particular instance of
poisoning to which a medical man is liable to be summoned.
There seems reason to fear that the crime of slow poisoning is more
extensively practised in the present day than is generally believed. The
study of the following pages will, it is hoped, put the physician on his
guard; and prevent his attributing to natural disease symptoms due to
the villainous administration of deadly drugs.
HENRIETTA STREET, CAVENDISH SQUARE.
CONTENTS.
CHAPTER I.
PAGE
Definition and Mode of Action of Poisons 13
CHAPTER II.
Diagnosis of Poisoning--Duties of the Practitioner 19
CHAPTER III.
Duties of the Practitioner--Treatment of Poisoning 24
CHAPTER IV.
Detection of Poisons 28
CHAPTER V.
Classification of Poisons 32
CHAPTER VI.
The Concentrated Mineral Acids 36
CHAPTER VII.
The Corrosive Vegetable Acids 43
CHAPTER VIII.
The Caustic Alkalies and their Carbonates: Potash, Soda,
Ammonia 48
CHAPTER IX.
Salts of the Alkalies and Alkaline Earths 52
CHAPTER X.
Salts of the Metals: Zinc--Silver--Tin--Bismuth--Chrome--Iron 54
CHAPTER XI.
Simple Vegetable and Animal Irritants 57
CHAPTER XII.
Irritant Gases 59
CHAPTER XIII.
Iodine and Iodide of Potassium 61
CHAPTER XIV.
Phosphorus 63
CHAPTER XV.
Arsenic and its Compounds 66
CHAPTER XVI.
Antimonial Compounds 78
CHAPTER XVII.
Mercury and its Compounds 81
CHAPTER XVIII.
Preparations of Lead 85
CHAPTER XIX.
Salts of Copper 89
CHAPTER XX.
Specific Vegetable Irritants 92
CHAPTER XXI.
Specific Animal Irritants.--Cantharides 92
CHAPTER XXII.
Narcotics.--Neurotics, acting on the Brain and producing
Sleep: Opium 95
CHAPTER XXIII.
Anaesthetics.--Neurotics acting on the Brain and producing
Insensibility: Chloroform--Chloral--Bichloride of
Methylene--Ether--Amylene--Nitrous Oxide 102
CHAPTER XXIV.
Inebriants.--Neurotics acting on the Brain and producing
Intoxication: Alcohol--Nitro-Benzole--Cocculus
Indicus--Fungi, &c. 108
CHAPTER XXV.
Delirants.--Neurotics acting on the Brain and producing
Delirium: Hyoscyamus--Belladonna--Stramonium--Datura
alba--Nightshade 112
CHAPTER XXVI.
Convulsives.--Neurotics producing Convulsions: Nux
Vomica--Brucia--Strychnia 116
CHAPTER XXVII.
Hyposthenisants.--Neurotics producing Death by Syncope:
Aconite--Prussic Acid 122
CHAPTER XXVIII.
Depressants.--Neurotics producing marked depression of the
Heart's Action: Digitalis--Calabar Beans--Tobacco--Hemlock 129
CHAPTER XXIX.
Asphyxiants.--Noxious Gases, producing Neurotic Symptoms 134
CHAPTER XXX.
Abortives.--Substances producing Abortion 137
APPENDIX 139
INDEX 151
TOXICOLOGICAL MEMORANDA.
INTRODUCTION.
CHAPTER I.
DEFINITION AND MODE OF ACTION OF POISONS.
Toxicology ({~GREEK SMALL LETTER TAU~}{~GREEK SMALL LETTER OMICRON~}{~GREEK SMALL LETTER XI~}{~GREEK SMALL LETTER IOTA~}{~GREEK SMALL LETTER KAPPA~}{~GREEK SMALL LETTER OMICRON WITH VARIA~}{~GREEK SMALL LETTER NU~} poison, and {~GREEK SMALL LETTER LAMDA~}{~GREEK SMALL LETTER OMICRON WITH TONOS~}{~GREEK SMALL LETTER GAMMA~}{~GREEK SMALL LETTER OMICRON~}{~GREEK SMALL LETTER FINAL SIGMA~} discourse,) is that branch of
medical science which treats of the nature, properties, and effects of
poisons.
It appears scarcely possible to give any definition of a poison which
will bear a critical examination; insomuch that some have preferred to
deal with the evil effects of any substance, that is _poisoning_, rather
than with the substance itself, the so-called _poison_. Most medicines
are poisonous in improper doses; and even common salt (chloride of
sodium) has caused death.[A] Dr. Guy defines a poison to be any
substance which, when applied to the body externally, or in any way
introduced into the system, without acting mechanically, but by its own
inherent qualities, is capable of destroying life. A cherrystone may
cause death by becoming arrested in the vermiform appendix, and thus
producing peritonitis; boiling water may cause death also; but neither
are poisons: the one acting mechanically, the other by its heat merely.
Any substance which can injure the health or destroy life is regarded as
a poison, if given with the _intent_ to do mischief. The words of the
statute (1 Vict. c. 85, sec. 2) are--"Whoever shall administer, or cause
to be taken by any person, any poison, or other destructive thing, with
intent to commit murder, shall be guilty of felony, and being convicted
thereof shall suffer death." Sometimes poisons are administered, not for
the purpose of destroying life, but of causing some slight injury or
annoyance. An Act passed in March, 1860 (23 Vict. c. 8), provides for
the punishment of a guilty person under these circumstances. If life be
endangered, or "grievous bodily harm" result, the administrator may be
found guilty of felony, and sentenced to penal servitude for a term not
exceeding ten years. If the intent be only to "injure, aggrieve, or
annoy," the crime is reduced to a misdemeanor, punishable with an
imprisonment for not more than three years.
In accordance with the Pharmacy Act certain substances have been defined
as poisons within the meaning of the Act, so as to put some restriction
on their sale to the public.
Poisons may be introduced into the body in various ways and in various
forms. Thus they may be administered by the mouth or by the rectum, and
they may be given in the form of solids, liquids, or gases, uncombined,
or mixed with various matters. Some agents are more readily absorbed
than others; whilst some textures permit of absorption taking place more
quickly through them than other tissues. Thus, the most diffusible
poisons prove most rapidly fatal, especially when introduced directly
into the circulation by a wound in a vein, or when they are injected
into the subcutaneous connective tissue. Their action is also speedy
when applied either in a gaseous state to the pulmonary air-cells, or as
a fluid to that of the stomach or intestines. The serous membranes, too,
possess an activity of absorption almost superior to that of the mucous
membranes; while absorption through the skin is slow, on account of the
cuticle. Poisons taken into the stomach when that viscus is empty,
necessarily act much more speedily than when it is full. It is
remarkable that the agents which most affect the nervous system do not
appear to act at all when applied directly to the brain or trunks of
nerves. There are also some poisons, as that of the viper, which,
although most deadly when introduced into the blood through a wound, are
harmless when swallowed.
The effects of poisons may be considered as _local_ and _remote_.
The _local_ effects are mainly of three kinds, viz., _corrosion_, or
chemical decomposition, as is seen in the effects of the strong mineral
acids and alkalies; _irritation_ or _inflammation_, varying from simple
redness, in its mildest, to ulceration and gangrene, in its most severe
degree, such as may result from the use of corrosive sublimate; and _a
local specific effect_, produced on the sentient extremities of the
nerves, as is felt on the local application of prussic acid, aconite,
&c.
The _remote_ effects are those influencing organs remote from the part
to which the poison has been applied. These may be either common
or specific; _common_, such as the constitutional indications
of inflammatory fever, however produced; _specific_, like the
constitutional effects of opium over and above its local influences in
relieving pain, &c. Various narcotic poisons produce but little local
change, though their remote effects are very remarkable. For example,
belladonna, in whatever way it may be introduced into the system,
paralyzes the ciliary nerves and so causes dilatation of the pupil. Many
substances have both a local and remote action, as is well seen in the
influence of cantharides upon the part to which they are applied, and
their remote effects upon the urinary organs.
These remote effects must be induced by one of two modes, or, as some
contend, by both: by _absorption_, that is, by the passage of the
poisonous particles into the blood; or by _sympathy_, that is, by an
impression transmitted through the nerves.
In the present day every one allows that poisons may become absorbed,
and that, provided they produce poisonous effects at all, they are
absorbed, in whatever way they may have been applied to the body. But it
is sometimes asked, Is this absorption necessary for their action? The
following evidence may be briefly noticed as in some degree affording an
affirmative answer to this question. Magendie divided all the parts of
one of the posterior extremities of a dog, the artery and vein being
reconnected by quills, so as to preclude the possibility of the effects
being conveyed by the nervous filaments supplying the coats of the
vessels; on applying a portion of upas tieute to a wound in the foot,
the symptoms of poisoning occurred, and death took place in ten minutes.
If the veins leading from a poisoned part be tied, the arterial and
nervous communication being complete, the symptoms of poisoning do not
occur. Mr. Blake introduced some prussic acid into the stomach of a dog,
through an opening in its parietes, after he had ligatured the vessel
entering the liver (the vena portae, which, directly or indirectly,
receives the gastric veins); no effect ensued until the removal of the
ligature, within one minute of which proceeding the poison began to act.
And lastly, not only has prussic acid been discovered in the blood of an
animal which perished in thirty-five seconds, but in some experiments
made by Mr. Erichsen, in a case of extroversion of the bladder,
prussiate of potass was found in the urine within one minute of its
being swallowed on an empty stomach.
The chief argument in favor of a _sympathetic_ or direct nerve action,
is the almost instantaneous manner in which some poisons act; fatal
effects occurring, it is said, before sufficient time has elapsed to
allow of absorption. It has, however, been proved that the round of the
circulation may be accomplished much more speedily than has been
imagined. Thus, the ferrocyanide of potassium injected into the jugular
vein of a horse was discovered throughout the entire venous system in
twenty-seconds; and Mr. Blake has inferred from his experiments that a
poison may be diffused through the body in nine seconds. It may
therefore be concluded that in most instances poisons act by being
absorbed and conveyed with the blood to the different organs which they
impair, or the nerve centres which rule the functions of these; some
paralyzing the heart when they reach it, some affecting the brain or the
spinal cord, some stopping the play of the lungs and others acting upon
the different glands. Nevertheless, in view of the extreme rapidity with
which death is brought about in a few instances, the possibility of a
direct shock to the nervous system causing death must not be overlooked.
The action of a poison may be variously modified, and the modifying
circumstances must be carefully taken into consideration in the
formation of a prognosis and in suggesting a line of treatment.
The _quantity_ or _dose_ is the most important of these; many substances
which are deadly in large doses being exceedingly useful as remedies in
small quantities; such are prussic acid, opium, digitalis, arsenic, &c.
Then again, the _mechanical_ and _chemical_ state of aggregation are
all-important; a solid being usually much less active than a fluid or a
gas, and a pure substance much more active than one mixed with insoluble
materials. Even more important is the chemical constitution of the
poisonous agent; as already pointed out, poisonous effects result from
absorption of the poisoning body and absorption implies solution; the
more soluble, therefore, the compound is, the more speedy are its
effects, whilst compounds insoluble in water or any of the juices of the
body are inert. It is not, however, enough that the substance be
insoluble in water; it must be so also in the gastric juice, or it may
give rise to characteristic symptoms. Thus, calomel is insoluble in
water, yet it is a powerful medicine; orpiment is insoluble in water,
yet when swallowed, it may give rise to symptoms of arsenical poisoning,
and so on. As already pointed out, the mode in which the poison is
introduced into the body is of great consequence in estimating its
effects. Then again the _mental_ and _bodily condition_ of the recipient
must be taken into account. Thus, in excited maniacs doses of medicines
may be given without producing any effect which in ordinary individuals
might give rise to serious consequences. The bodily condition,
especially as influenced by habit, is still more important. It may be
broadly stated, that by gradually increasing the dose of a substance
ordinarily poisonous, in course of time enormous quantities may be borne
without producing immediate ill effects. This is especially seen in the
practice of opium eating and smoking, and in a less degree in arsenic
eating, as practised in Styria. The latter instance is, however,
contrary to the usual rule; for whereas with vegetable substances, such
as opium the dose requires to be constantly increased to keep up the
effects, with minerals, the contrary seems to be the case, especially
with antimony and mercury, which cannot be long given without danger to
the recipient.