DUTIES OF THE PRACTITIONER--TREATMENT OF POISONING.
When the practitioner is called in to a case of poisoning while yet
there is life, he must set himself to preserve it in whatever way he
best can; in this of course he must be guided by circumstances, but
several broad rules may be laid down. All have one end, but the order
may be varied. That is best which is readiest, the grand rule being to
lose no time. Most of the modes of treatment come under one or other of
the three following heads:--1. GET RID OF THE POISON. 2. STOP ITS
ACTION. 3. REMEDY THE MISCHIEF IT HAS DONE.
1. _To get rid of the poison_ is ordinarily the first thing to be done,
but not always. To do so when the poison has been swallowed two means
may be employed: _vomiting_ or the _stomach-pump_.
The latter is one of the most certain means we possess of emptying the
stomach; and by means of it this viscus may be washed out, and the
antidote, if any be known, administered. In speaking hereafter, however,
of the treatment to be adopted in each particular instance it will be
seen that there are some cases, as poisoning by corrosives, in which
this instrument cannot be used; as it might not only cause laceration of
the tissues, but even perforation of the oesophagus or stomach. It is
hardly necessary to mention that in all cases a certain tact is required
in its employment; the tube having, on more than one occasion, been
introduced into the trachea, and the lungs injected with water, &c. It
is a good rule also to withdraw less fluid than is pumped into the
stomach.
Supposing, however, that this instrument is not at hand, or that it is
an improper occasion for its employment, recourse must be had to
vomiting, natural or artificial. Vomiting is, in many instances, one of
the first and most important signs of poisoning, especially by irritant
substances. When such is the case, it is only necessary to foster the
tendency by copious draughts of lukewarm water; but if there be no
vomiting and the stomach pump be not at hand an emetic must be given. Of
these remedies perhaps there is not one which can be generally used with
so much advantage as the sulphate of zinc in scruple doses; for not only
is it more rapid in its action, but its effects are less depressing than
those of any others. This last recommendation will appear the more
desirable when we remember that the absorption of poisons is promoted by
all lowering measures; and consequently, bleeding, the exhibition of
tartarised antimony, and the administration of drastic purgatives, ought
to be avoided. In poisoning by opium and other narcotics, the sulphate
of copper in eight or ten grain doses will often excite the stomach to
act when other emetics have failed. Ipecacuan wine (six or eight
drachms) is a useful agent in many cases; or if a warm stimulating
draught be needed a scruple of powdered ipecacuanha, with the same
quantity of the sesquicarbonate of ammonia, may be administered in a
wineglassful of water. In the absence of these, mustard proves an
excellent substitute; a teaspoonful or two being given in warm water,
and frequently repeated. Even common salt may be used with good effect.
Vomiting may also be excited by tickling the fauces, as well as by the
free administration of warm water or of hot greasy water.
_When the poison has been applied locally_, to prevent its absorption, a
ligature must be applied between the trunk and the wounded part, as near
the latter as possible; while the deleterious substance is to be removed
by free incisions and plentiful washings. Sucking by the mouth or by
cupping-glasses may also be employed.
2. _To stop the action of the poison if it cannot be readily and
immediately removed._--The means whereby this is effected is ordinarily
the administration of an antidote. As no universal antidote is known,
the treatment will of course vary with the substance taken. This will be
fully explained when speaking of each particular poison.
An antidote, according to Orfila, should possess the following
properties:--It should be capable of being taken in a large dose without
danger; it should act upon the poison, whether liquid or solid, at a
temperature equal to or below that of the body; its action should be
quick; it should be capable of combining with the poison, though
shielded by the gastric juice, mucus, bile, or other substances
contained in the stomach; and lastly, it should deprive the poison of
its deleterious properties.
Antidotes mostly operate by forming harmless chemical combinations, or
by producing insoluble compounds, and thus preventing or delaying
absorption. In most cases they have no effect upon the constitution; but
some may be looked upon as a kind of counter-poison. Thus, the
antagonistic action of opium and belladonna seems fairly made out, and
we might perhaps include under this head chloroform, as in some degree,
an antidote to strychnia.
Dr. Garrod has described a series of experiments in which he employed
purified animal charcoal as an antidote. Dogs, rabbits, and guinea-pigs
were the animals experimented on; while the poisons consisted of large
doses of opium, belladonna, aconite, nux vomica, arsenic, and other
drugs. They were given without mischief when sufficient animal charcoal
was administered simultaneously, or, in some instances, before the
peculiar effects of the destructive drug were developed. This substance
seems to act in a great measure mechanically, but it has also a power of
absorbing alkaloids which may render it useful. Such substances as
magnesia and gruel are sometimes given with the view of protecting the
walls of the stomach, with doubtful benefit.
3. _To remedy the mischief done, and obviate the tendency to
death._--Unfortunately, in a great number of instances, too long an
interval has elapsed between the exhibition of the poison and the time
when the first-mentioned indications can be fully carried into effect;
for, as before implied, if absorption has taken place, direct antidotes
will be of little avail.
Our object must then be to palliate the symptoms as they arise, as well
as to neutralize the _effects_ of the poison on the constitution, by
remedies of an opposite character. Thus in poisoning by depressing
agents and narcotics, or such as destroy the nervous force, all lowering
measures must be avoided, and agents used which will exert a contrary
effect, as stimulants, cold effusion, galvanism &c. The shock to the
nervous system must also be taken account, and appropriate remedies
employed to aid it in rallying.
Thus direct injection of liquid ammonia into the veins has been found
successful in the treatment of snake bite in Australia, by Professor
Halford and others.
Claude Bernard has shown the importance of particularly attending to the
way in which the poison destroys life. For example, curare paralyzes the
motor nerves, puts a stop to all motion, suspends respiration, and so
brings on suffocation; yet by keeping up artificial respiration for a
sufficient length of time, life may be preserved till the poison is
eliminated and the danger over. Strychnia attacks the sensitive portion
of the nervous system; but if the external excitement, which perpetually
provokes reflex action and thereby brings on fatal convulsions, be
guarded against, recovery may ensue. A frog, poisoned by strychnia,
rapidly dies if frequently excited; whereas left perfectly quiet under a
bell-glass, it will, caeteris paribus, recover.
Lastly, we must endeavor to promote the elimination of the poison from
the body, by exciting the excreting functions; for which purpose, in
poisoning by arsenic, after the stomach has been well emptied, Orfila
has proposed the employment of diuretics, because it has been found that
this poison, like most others, is carried off in large quantities by the
urine.