may only be sold if on the bottle, box, or package there is affixed a
label with the name of the article, the word 'Poison,' and the name and
address of the seller. It is not necessary to enter the transaction in a
register.
Chemists are required to keep poisons in specially distinguishable
bottles, and these in a special room or locked cupboard.
=Dangerous Drugs Act, 1920.=--The regulations restrict the manufacture
and sale of opium, morphine, cocaine, and heroin so as to prevent their
abuse. Preparations containing less than 1/5 per cent. of the first two
or less than 1/10 per cent. of the last two are excluded. Prescriptions
containing the above drugs must be dated and signed with the full name
and address of the prescriber, and must have also those of the patient.
The total amount of the drug to be supplied must be stated, and it must
not be dispensed more than once; the dispenser retains the prescription.
Special books must be kept recording the purchase and sale of these
drugs.
=Proprietary Medicines Bill= (introduced in 1920, and likely soon to
become law).--The sale of any unregistered proprietary medicine
purporting to cure certain diseases or produce abortion is made an
offence. A register of proprietary medicines, etc., is established. The
object is to protect the public against quack remedies.
=Notification of Poisoning.=--Every case of poisoning which occurs in
any industry (lead, arsenic, anthrax, etc.) must be notified by the
medical attendant to the Chief Inspector of Factories (Factory and
Workshops Act, 1895).
III.--ACTION OF POISONS; CLASSIFICATION OF POISONS
=Action of Poisons.=--They may act either locally or only after
absorption into the system.
1. _Local Action_, as seen in (a) corrosive poisons; (b) irritant
poisons, causing congestion and inflammation of the mucous
membranes--_e.g._, metallic and vegetable irritants; (c) stimulants or
sedatives to the nerve endings, as aconite, conium, cocaine.
2. _Remote Action._--This may be of reflex character, as seen in the
shock produced by the pain caused by corrosive poisons, or the poison
may exert a special action on certain structures, as belladonna on the
cells of the brain, strychnine on the motor nerve cells of the spinal
cord.
3. _In Both Ways._--Certain poisons, as carbolic or oxalic acids, act in
this way.
Age, idiosyncrasy, tolerance, and disease, all exert modifying
influences on the action of a poison. The form in which the poison is
swallowed and the quantity also determine its action. In the gaseous
form, poisons act most rapidly and fatally. When in solution and
injected hypodermically, they also act very rapidly. In the solid form
they act as a rule slowly, and may even set up vomiting, and so may be
entirely ejected by vomiting. Poisons act most energetically when the
stomach is empty. If taken when the stomach already contains food,
solution and absorption may be greatly delayed.
Some poisons are cumulative in their action, and thus, even if
infinitesimal doses be swallowed each day, there is a certain amount of
storage in the tissues (though a certain percentage of the poison is
being constantly eliminated), and at last symptoms of poisoning show
themselves.
=Classification of Poisons.=--As an aid to memory, the following
classification is perhaps the best:
I. _Inorganic._
1. Corrosive acids and alkalies, and caustic salts (carbolic and
oxalic acids also).
2. Irritant--practically all the metals and the metalloids (I. Cl.
Br. P.).
II. _Organic._
{ Animal--venomous bites, food poisoning, cantharides.
1. Irritant { Vegetable--all strong purgatives, hellebores, savin,
{ yew, ergot, hemlock, laburnum, bryony, etc.
2. Neuronic.
(a) Somniferous--opium and its alkaloids.
(b) Deliriant--belladonna, hyoscyamus, stramonium, cannabis,
cocaine, cocculus, camphor, fungi.
(c) Inebriants--alcohol, ether, chloral, carbolic acid (weak),
benzol, aniline, nitro-glycerine.
3. Sedative or depressant.
(a) Neural--conium, lobelia, tobacco, physostigma.
(b) Cerebral--hydrocyanic acid.
(c) Cardiac--aconite, digitalis, colchicum, veratrum.
4. Excito-motory or convulsives--nux vomica, strychnine.
5. Vulnerants--powdered glass.
III. _Asphyxiants._
Poisonous and irrespirable gases.
IV.--EVIDENCE OF POISONING
It may be inferred that poison has been taken from consideration of the
following factors: Symptoms and post-mortem appearances, experiments on
animals, chemical analysis, and the conduct of suspected persons.
1. _Symptoms_ in poisoning usually come on suddenly, when the patient is
in good health, and soon after taking a meal, drink, or medicine. Many
diseases, however, come on suddenly, and in cases of slow poisoning the
invasion of the symptoms may be gradual.
2. _Post-Mortem Appearances._--These in many poisons and classes of
poisons are characteristic and unmistakable. The post-mortem appearances
peculiar to the various poisons will be described in due course.
3. _Experiments on Animals._--These may be of value, but are not always
conclusive.
4. _Chemical Analysis._--This is one of the most important forms of
evidence, as a demonstration of the actual presence of a poison in the
body carries immense weight. The poison may be discovered in the living
person by testing the urine, the blood abstracted by bleeding, or the
serum of a blister. In the dead body it may be found in the blood,
muscles, viscera--especially the liver--and secretions. Its discovery in
these cases must be taken as conclusive evidence of administration. If,
however, it be found only in substances rejected or voided from the
body, the evidence is not so conclusive, as it may be contended that the
poison was introduced into or formed in the material examined after its
rejection from the body, or if the quantity be very minute it will be
argued that it is not sufficient to cause death. A poison may not be
detected in the body, owing to defective methods, smallness of the dose
required to cause death, or to its ejection by vomiting or its
elimination by the excretions.
5. _Conduct of Suspected Persons._--A prisoner may be proved to have
purchased poison, to have made a study of the properties and effects of
poison, to have concocted medicines or prepared food for the deceased,
to have made himself the sole attendant of the deceased, to have placed
obstacles in the way of obtaining proper medical assistance, or to have
removed substances which might have been examined.
V.--SYMPTOMS AND POST-MORTEM APPEARANCES OF DIFFERENT CLASSES OF POISONS
Whilst recognizing the fact that toxic agents cannot be accurately
classified, the following grouping may for descriptive purposes be
admitted with the view of saving needless repetition:
1. =Corrosives.=--Characterized by their destructive action on tissues
with which they come in contact. The principal inorganic corrosives are
the mineral acids, the caustic alkalies, and their carbonates; the
organic are carbolic acid, strong solutions of oxalic acid, and acetic
acid.
_Symptoms._--Burning pain in mouth, throat, and gullet, strong acid,
metallic or alkaline taste; retching and vomiting, the discharged
matters containing shreds of mucus, blood, and the lining membrane of
the passages. Inside of mouth corroded. There are also dysphagia,
thirst, dyspnoea, small and frequent pulse, anxious expression, shock.
Death may result from shock, destruction of the parts--_e.g._,
perforation of stomach or duodenum, suffocation; or some weeks
subsequently death may be due to cicatricial contraction of the gullet,
stomach, or pylorus.
_Post-Mortem Appearances._--Those of corrosion, with corrugation from
strong contraction of muscular fibres, and followed by inflammation and
its consequences. The mouth, gullet, and stomach, and in some cases the
intestines, may be white, yellow, or brown, shrivelled and corroded. The
corrosions may be small, or may extend over a very large surface.
Sometimes considerable portions of the lining membrane of the gullet or
stomach may be discharged by vomiting or by stool. Beyond the corroded
parts the textures are acutely inflamed. The stomach is filled with a
yellow, brown, or black gelatinous liquid or black blood, and may in
rare cases be perforated.
2. =Irritants.=--These are substances which inflame parts to which they
are applied. The class includes mineral, animal, and vegetable
substances, and contains a larger number of poisons than all the other
classes together. Irritants may be divided into two groups: (1) Those
which destroy life by the irritation they set up in the parts to which
they are applied; (2) those which add to local irritation peculiar or
specific remote effects. The first group includes the principal
vegetable irritants, some alkaline salts, some metallic poisons, etc.;
and the second comprises the metallic irritants, the metalloids
(phosphorus and iodine), and one animal substance, cantharides.
_Symptoms._--Burning pain and constriction in throat and gullet, pain
and tenderness of stomach and bowels, intense thirst, nausea, vomiting,
purging and tenesmus, with bloody stools, dysuria, cold skin, and feeble
and irregular pulse. The vomit consists at first of the food, then it
becomes bile-stained, and later dark coffee-grounds in appearance, due
to extravasation of blood from the over-distended vessels in the gastric
mucous membrane. Death may occur from shock, convulsions, collapse,
exhaustion, or from starvation on account of chronic inflammation of the
gastro-intestinal mucous membrane.
_Post-Mortem Appearances._--Those of inflammation and its consequences.
Coats of stomach, fauces, gullet, and duodenum, may be thickened,
black, ulcerated, gangrenous, or sloughing. Vessels filled with dark
blood ramify over the surface. Acute inflammation is often found in the
small intestines, with ulceration and softening of mucous membrane. The
rectum is frequently the seat of marked ulceration.
3. =Poisons Acting on the Brain.=--Three classes: The opium group,
producing sleep; the belladonna group, producing delirium and illusions;
and the alcohol group, causing exhilaration, followed by delirium or
sleep.
_Symptoms._--Of the opium group, giddiness, headache, dimness of sight,
contraction of the pupils, noises in the ears, drowsiness and confusion,
passing into insensibility. Of the belladonna group, delirium, illusions
of sight, dilated pupils, dry mouth, thirst, redness of skin, coma. Of
the alcohol group, excitement of circulation and of cerebral functions,
want of power of co-ordination and of muscular movement, double vision,
mania, followed by profound sleep and coma. In the chronic form,
delirium tremens.
_Post-Mortem Appearances._--In the opium group, fulness of the sinuses
and veins of the brain, with effusion of serum into the ventricles and
beneath the membranes. In the belladonna group, nil. In the alcohol
group, signs of inflammation, congestion of brain and membranes,
fluidity of blood, long-continued rigor mortis.
4. =Poisons Acting on the Spinal Cord.=--Strychnine, brucine, thebaïne.
The leading symptom is tetanic spasm.
5. =Poisons Affecting the Heart.=--These kill by sudden shock, syncope,
or collapse. They comprise prussic acid, dilute solution of oxalic acid
and oxalates, aconite, digitalis, strophanthus, convallaria, and
tobacco.
6. =Poisons Acting on the Lungs.=--These have for their type carbonic
acid gas and coal gas. The fumes of ammonia are intensely irritating,
and may give rise to laryngitis, bronchitis, and even pneumonia. Nitric
acid fumes sometimes produce no serious symptoms for an hour or more,
but there may then be coughing, difficulty of breathing, and tightness
in the lower part of the throat, followed by capillary bronchitis (see
p. 120).
VI.--DUTY OF PRACTITIONER IN SUPPOSED CASE OF POISONING
If called to a case supposed or suspected to be one of poisoning, the
medical man has two duties to perform: To save the patient's life, and
to place himself in a position to give evidence if called on to do so.
If life is extinct, his duty is a simple one. He should make inquiries
as to symptoms, and time at which food or medicine was last taken. He
should take possession of any food, medicine, vomited matter, urine, or
fæces, in the room, and should seal them up in clean vessels for
examination. He should notice the position and temperature of the body,
the condition of rigor mortis, marks of violence, appearance of lips and
mouth. He should not make a post-mortem examination without an order in
writing from the coroner. In making a post-mortem examination, the
alimentary canal should be removed and preserved for further
investigation. A double ligature should be passed round the oesophagus,
and also round the duodenum a few inches below the pylorus. The gut and
the gullet being cut across between these ligatures, the stomach may be
removed entire without spilling its contents. The intestines may be
removed in a similar way, and the whole or a portion of the liver should
be preserved. These should all be put in separate jars without any
preservative fluid, tied up, sealed, labelled, and initialled. All
observations should be at once committed to writing, or they will not be
admitted by the court for the purpose of refreshing the memory whilst
giving evidence. If the medical practitioner is in doubt on any point,
he should obtain technical assistance from someone who has paid
attention to the subject.
In a case of attempted suicide by poisoning, is it the duty of the
doctor to inform the police? He would be unwise to do so. He had much
better stick to his own business, and not act as an amateur detective.
VII.--TREATMENT OF POISONING
The modes of treatment may be ranged under three heads: (1) To eliminate
the poison; (2) to antagonize its action; (3) to avert the tendency to
death.
1. The first indication is met by the administration of emetics, to
produce vomiting, or by the application of the stomach-tube. The best
emetic is that which is at hand. If there is a choice, give apomorphine
hypodermically. The dose for an adult is 10 minims. It may be given in
the form of the injection of the Pharmacopoeia, or preferably as a
tablet dissolved in water. Apomorphine is not allied in physiological
action to morphine, and may be given in cases of narcotic poisoning.
Sulphate of zinc, salt-and-water, ipecacuanha, and mustard, are all
useful as emetics. Tickling the fauces with a feather may excite
vomiting.
In using the elastic stomach-tube, some fluid should be introduced into
the stomach before attempting to empty it, or a portion of the mucous
membrane may be sucked into the aperture. The tube should be examined to
see that it is not broken or cracked, as accidents have happened from
neglecting this precaution. The bowels and kidneys must also be
stimulated to activity, to help in the elimination of the poison.
2. The second indication is met by the administration of the appropriate
antidote. Antidotes are usually given hypodermically, or, if by mouth,
in the form of tablets. In the absence of a hypodermic syringe, the
remedy may be given by the rectum. In the selection of the appropriate
antidote, a knowledge of pharmacology is required, especially of the
physiological antagonism of drugs. Antidotes may act (1) chemically, by
forming harmless compounds, as lime in oxalic acid poisoning; (2)
physiologically, the drug which is administered neutralizing more or
less completely the poison which has been absorbed; (3) physically, as
charcoal. Every doctor should provide himself with an antidote case. The
various antidotes will be mentioned under their respective poisons.
3. To avert the tendency to death, we must endeavour to palliate the
symptoms and neutralize the effects of the poison. Pain must be relieved
by the use of morphine; inflamed mucous membrane soothed by such
_demulcents_ as oils, milk, starch; stimulants to overcome collapse;
saline infusions in shock, etc. In the case of narcotics and depressing
agents, stimulants, electricity, and cold affusions, may be found
useful. We should endeavour to promote the elimination of the poison
from the body by stimulating the secretions.
VIII.--DETECTION OF POISONS
Notice the smell, colour, and general appearance, of the matter
submitted for examination. The odour may show the presence of prussic
acid, alcohol, opium, or phosphorus. The colour may indicate salts of
copper, cantharides, etc. Seeds of plants may be found.
This examination having been made, the contents of the alimentary canal,
and any other substances to be examined, must be submitted to chemical
processes.
Simple filtration will sometimes suffice to separate the required
substance; in other cases dialysis will be necessary, in order that
crystalloid substances may be separated from colloid bodies.
In the case of volatile substances distillation will be required. The
poisons thus sought for are alcohol, phosphorus, iodine, chloral,
ether, hydrocyanic acid, carbolic acid, nitro-benzol, chloroform, and
anilin. The organic matters are placed in a flask, diluted with
distilled water if necessary, and acidulated with tartaric acid. The
flask is heated in a water-bath, and the vapours condensed by a Liebig's
condenser. In the case of phosphorus the condenser should be of glass,
and the process of distillation conducted in the dark, so that the
luminosity of the phosphorus may be noted.
For the separation of an alkaloid, the following is the process of
Stas-Otto. This process is based upon the principle that the salts of
the alkaloids are _soluble in alcohol and water_, and _insoluble in
ether_. The pure alkaloids, with the exception of morphine in its
crystalline form, are _soluble_ in ether. Make a solution of the
contents of the stomach or solid organs minced very fine by digesting
them with acidulated alcohol or water and filtering. The filtrate is
shaken with ether to remove fat, etc., the ether separated, the watery
solution neutralized with soda, and then shaken with ether, which
removes the alkaloid in a more or less impure condition. The knowledge
of these facts will help to explain the following details, which may be
modified to suit individual cases: (1) Treat the organic matter, after
distillation for the volatile substances just mentioned, with twice its
weight of absolute alcohol, free from fusel oil, to which from 10 to 30
grains of tartaric or oxalic acid have been added, and subject to a
gentle heat. (2) Cool the mixture and filter; wash the residue with
strong alcohol, and mix the filtrates. _The residue may be set aside for
the detection of the metallic poisons, if suspected._ Expel the alcohol
by careful evaporation. On the evaporation of the alcohol the resinous
and fatty matters separate. Filter through a filter moistened with
water. Evaporate the filtrate to a syrup, and extract with successive
portions of absolute alcohol. Filter through a filter moistened with
alcohol. Evaporate filtrate to dryness, and dissolve residue in water,
the solution being made distinctly acid. Now shake watery solution with
ether. (3) Ether from the acid solution dissolves out _colchicin_,
_digitalin_, _cantharidin_, and _picrotoxin_, and traces of _veratrine_
and _atropine_. Separate the ethereal solution and evaporate. Hot water
will now dissolve out _picrotoxin_, _colchicin_, and _digitalin_, but
not cantharidin. (4) The remaining acid watery liquid, holding the other
alkaloids in solution or suspension, is made strongly alkaline with
soda, mixed with four or five times its bulk of ether, chloroform, or
benzole, briskly shaken, and left to rest. The ether floats on the
surface, holding the alkaloids, except morphine, in solution. (5) A part
of this ethereal solution is poured into a watch-glass and allowed to
evaporate. If the alkaloid is volatile, oily streaks appear on the
glass; if not volatile, crystalline traces will be visible. If a
volatile alkaloid, add a few pieces of calcium chloride to ethereal
solution to absorb the water; draw off the ethereal solution with a
pipette, allow it to evaporate, and test the residue for the alkaloids,
conine and nicotine.
If a fixed alkaloid, treat the acid solution with soda or potash and
ether, evaporate ethereal solution after separation, when the solid
alkaloid will be left in an impure state. To purify it, add a small
quantity of dilute sulphuric acid, and, after evaporating to
three-quarters of its bulk, add a saturated solution of carbonate of
potash or soda. Absolute alcohol will then dissolve out the alkaloid,
and leave it on evaporation in a crystalline form.
_General Reactions for Alkaloids._--(1) Wagner's reagent (iodine
dissolved in a solution of potassium iodide) yields a reddish-brown
precipitate; (2) Mayer's reagent (potassio-mercuric iodide) gives a
yellowish-white precipitate; (3) phospho-molybdic acid gives a yellow
precipitate; (4) platinic chloride, a brown precipitate; (5) tannic
acid, etc.
In order to isolate an inorganic substance from organic matter,
Fresenius's method is adopted. Boil the finely divided substance with
about one-eighth its bulk of pure hydrochloric acid; add from time to
time potassic chlorate until the solids are reduced to a straw-yellow
fluid. Treat this with excess of bisulphate of sodium, then saturate
with sulphuretted hydrogen until metals are thrown down as sulphides.
These may be collected and tested. From the acid solution, hydrogen
sulphide precipitates copper, lead, and mercury, _dark_; arsenic,
antimony, and tin, _yellowish_. If no precipitate, add ammonia and
ammonium sulphide, iron, _black_, zinc, _white_, chromium, _green_,
manganese, _pink_. The residue of the material after digestion with
hydrochloric acid and potassium chlorate may have to be examined for
silver, lead, and barium.
For the detection of minute quantities, the microscope must be used, and
Guy's and Helwig's method of sublimation will be found advantageous.
Crystalline poisons may be recognized by their characteristic forms.
IX.--THE MINERAL ACIDS
These are sulphuric, nitric, and hydrochloric acids.
_Symptoms of Poisoning by the Mineral Acids._--Acid taste in the mouth,
with violent burning pain extending into the oesophagus and stomach, and
commencing immediately on the poison being swallowed; eructations,
constant retching, and vomiting of brown, black, or yellow matter
containing blood, coagulated mucus, epithelium, or portions of the
lining membrane of the gullet and stomach. The vomited matters are
strongly acid in reaction, and stain articles of clothing on which they
may fall. There is intense thirst and constipation, with scanty or
suppressed urine, tenesmus, and small and frequent pulse; the lips,
tongue, and inside of the mouth, are shrivelled and corroded. Exhaustion
succeeds, and the patient dies either collapsed, convulsed, or
suffocated, the intellect remaining clear to the last. After recovering
from the acute form of poisoning, the patient may ultimately die from
starvation, due to stricture of the oesophagus, stomach, etc.
_Post-Mortem Appearances Common to the Mineral Acids._--Stains and
corrosions about the mouth, chin, and fingers, or wherever the acid has
come in contact. The inside of the mouth, fauces, and oesophagus, is
white and corroded, yellow or dark brown, and shrivelled. Epiglottis
contracted or swollen. Stomach filled with brown, yellow, or black
glutinous liquid; its lining membrane is charred or inflamed, and the
vessels are injected. Pylorus contracted. Perforation, when it takes
place, is on the posterior aspect; the apertures are circular, and
surrounded by inflammation and black extravasation. The blood in the
large vessels may be coagulated.
Avoid mistaking gastric or duodenal ulcer, with or without perforation,
for the effects of a corrosive poison.
_Treatment._--Calcined magnesia or the carbonate or bicarbonate of
sodium, mixed with milk or some mucilaginous liquid, are the best
antidotes. In the absence of these, chalk, whiting, milk, oil,
soap-suds, etc., will be found of service. The stomach-pump should not
be used. If the breathing is impeded, tracheotomy may be necessary.
Injuries of external parts by the acid must be treated as burns.
X.--SULPHURIC ACID
=Sulphuric Acid=, or oil of vitriol, may be concentrated or diluted. It
is frequently thrown over the person to disfigure the features or
destroy the clothes. Parts of the body touched by it are stained, first
white, and then dark brown or black. The presence of corrosion of the
mouth is as important as the chemical tests. Black woollen cloths are
turned to a dirty brown, the edges of the spots becoming red in a few
days, due to the dilution of the acid from the absorption of moisture;
the stains remain damp for long, owing to the hygroscopic property of
the acid.
_Method of Extraction from the Stomach._--The contents of the stomach or
vomited matter should, if necessary, be diluted with pure distilled
water and filtered. The stomach should be cut up into small pieces and
boiled for some time in water. The solution, filtered and concentrated,
is now ready for testing. Blood, milk, etc., may be separated by
dialysis, and the fluid so obtained tested. A sulphate may be present.
Take a portion of the liquid, evaporate to dryness, and incinerate; a
sulphate, if present, will be obtained, and may be tested.
_Caution._--Sulphuric acid may not be found even after large doses, due
to treatment, vomiting, or survival for several days. In all cases every
organ should be examined. Vomited matters and contents of stomach should
not be mixed, but each _separately_ examined. This rule holds good for
all poisons. On _cloth_ the stain may be cut out, boiled in water, the
solution filtered, and tested with blue litmus and other tests.
_Post-Mortem Appearances._--Where the acid has come in contact with the
mucous membranes there are dark brown or black patches. The stomach is
greatly contracted, the summits of the mucous membrane ridges being
charred and the furrows greatly inflamed; the contents are black or
brown.
_Tests._--Concentrated acid chars organic matter; evolves heat when
added to water, and sulphurous fumes when boiled with chips of wood,
copper cuttings, or mercury. Dilute acid chars paper when the paper is
heated; gives a white precipitate with nitrate or chloride of barium,
and is entirely volatilized by heat. Dilute solutions give a white
precipitate with barium nitrate, insoluble in hydrochloric acid even on
boiling.
_Fatal Dose._--In an adult, 1 drachm.
_Fatal Period._--Shortest, three-quarters of an hour; average period
from onset of primary effects, eighteen to twenty-four hours.
XI.--NITRIC ACID
=Nitric Acid=, or aqua fortis, is less frequently used as a poison than
sulphuric acid. The fumes from nitric acid have caused death from
pneumonia in ten or twelve hours.
_Method of Extraction from the Stomach._--The same as for sulphuric
acid. In beer, etc., the mixture may be neutralized with carbonate of
potassium, dialyzed, the fluid concentrated and allowed to crystallize,
when crystals of nitrate of potassium may be recognized.
_Post-Mortem Appearance._--The mucous membranes are rendered yellow or
greenish if bile be present; they are also thickened and hardened.
_Tests._--Concentrated acid gives off irritating orange-coloured fumes
of nitric acid gas. When poured on copper, it gives off red fumes and
leaves a green solution of nitrate of copper. It gives a red colour with
brucine, turns the green sulphate of iron black, and with hydrochloric
acid dissolves gold. A delicate test for the acid, free or in
combination, is to dissolve in the suspected fluid some crystals of
ferrous sulphate, and then to gently pour down the test-tube some strong
sulphuric acid. Where the two liquids meet, if nitric acid be present, a
reddish-brown ring will be formed. It turns the skin bright yellow, and
does the same with woollen clothes, from the formation of _picric_ acid.
_Fatal Dose._--Two drachms.
_Fatal Period._--Shortest, one hour and three-quarters in an adult; in
infants in a few minutes, from suffocation.
XII.--HYDROCHLORIC ACID
=Hydrochloric Acid=, muriatic acid, or spirit of salt, is not uncommonly
used for suicidal purposes, being fifth in the list.
_Method of Extraction from the Stomach._--The same as for sulphuric
acid. As hydrochloric acid is a constituent of the gastric juice, the
signs of the acid must be looked for.
_Post-Mortem Appearances._--The mucous membranes are dry, white, and
shrivelled, and often eroded.
_Tests._--The concentrated acid yields dense white fumes with ammonia.
When warmed with black oxide of manganese and strong sulphuric acid it
gives off chlorine, recognized by its smell and bleaching properties.
Diluted it gives with nitrate of silver, a white precipitate, which is
insoluble in nitric acid and in caustic potash, but is soluble in
ammonia, and when dried and heated melts, and forms a horny mass. Stains
on clothing are reddish-brown in colour.
_Fatal Dose._--Half an ounce.
_Fatal Period._--Shortest, two hours; average, twenty-four hours. Death
may occur after an interval of some weeks from destruction of the
gastric glands and inability to digest food.
XIII.--OXALIC ACID
=Oxalic Acid= is used by suicides, though not often by murderers. The
crystals closely resemble those of Epsom salts or sulphate of zinc;
oxalic acid has been taken in mistake for the former. It is in common
use for cleansing brass, in laundry work, for dyeing purposes, and
especially for bleaching straw hats.
_Symptoms._--If a concentrated solution be taken, it acts as a
corrosive, causing a burning acid, intensely sour taste, which comes on
immediately, great pain and tenderness and burning at pit of stomach,
pain and tightness in throat. Vomiting of mucus, bloody or dark
coffee-ground matters, purging and tenesmus, followed by collapse,
feeble pulse, cyanosis and pallor of the skin; also swelling of tongue,
with dysphagia. In some cases cramps and numbness in limbs, pain in head
and back, delirium and convulsions. May be tetanus or coma. If taken
freely diluted, the nervous symptoms predominate, and may resemble
narcotic poisoning. Sometimes almost instant death.
_Post-Mortem Appearances._--Mucous membrane of mouth, throat, and
gullet, white and softened, as if they had been boiled; there are often
black or brown streaks in it. Stomach contains dark, grumous matter, and
is soft, pale, and brittle. Intestines slightly inflamed, stomach
sometimes quite healthy.
_Treatment._--Warm water, then chalk, carbonate of magnesium, or
lime-water, freely. Not alkalies, as the oxalates of the alkalies are
soluble and poisonous. Castor-oil. Emetics, but not stomach-pump.
_Fatal Dose._--One drachm is the smallest, but half an ounce is usually
fatal.
_Method of Extraction from the Stomach._--Mince up the coats of the
stomach and boil them in water, or boil the contents of the stomach and
subject them to dialysis. Concentrate the distilled water outside the
tube containing the vomited matters, etc., and apply tests.
_Tests._--White precipitate with nitrate of silver, soluble in nitric
acid and ammonia. When the precipitate is dried and heated on
platinum-foil, it disperses as white vapour with slight detonation.
Sulphate of lime in excess gives a white precipitate, soluble in nitric
or hydrochloric acid, but insoluble in oxalic, tartaric, acetic, or any
vegetable acid.
=Oxalate or Binoxalate of Potash= (salts of sorrel or salts of lemon) is
almost as poisonous as the acid itself.
XIV.--CARBOLIC ACID
=Carbolic Acid, Phenic Acid, or Phenol=, is largely employed as a
disinfectant, and is often supplied in ordinary beer-bottles without
labels.
_Symptoms._--An intense burning pain extending from the mouth to the
stomach and intestines. Indications of collapse soon supervene. The skin
is cold and clammy, and the lips, eyelids, and ears, are livid. This is
followed by insensibility, coma, stertorous breathing, abolition of
reflex movements, hurried and shallowed respiration, and death. The
pupils are usually contracted, and the urine, if not suppressed, is dark
in colour, or even black. Patients often improve for a time, and then
die suddenly from collapse. When the poison has been absorbed through
the skin or mucous membranes, a mild form of delirium, with great
weakness and lividity, are the first signs.
_Post-Mortem._--If strong acid has been swallowed, the lips and mucous
membranes are hardened, whitened, and corrugated. In the stomach the
tops of the folds are whitened and eroded, while the furrows are
intensely inflamed.
_Treatment._--Soluble sulphates which form harmless sulpho-carbolates in
the blood should be administered at once. An ounce of Epsom salts or of
Glauber's salts dissolved in a pint of water will answer the purpose
admirably. After this an emetic of sulphate of zinc may be given. White
of egg and water or olive-oil may prove useful. Warmth should be applied
to the body.
_Fatal Dose._--One drachm, but recovery has taken place after much
larger quantities, if well diluted or taken after a meal.
_Tests_ are not necessary, as the smell of carbolic acid is
characteristic.
_Local action_ of carbolic acid produces anæsthesia and necrosis.
Accidents sometimes happen from too strong lotions applied as surgical
dressings.
=Lysol= is a compound of cresol and linseed-oil soap, and is much less
toxic than carbolic acid.
XV.--POTASH, SODA, AND AMMONIA
=Caustic Potash= occurs in cylindrical sticks, is soapy to the touch,
has an acrid taste, is deliquescent, fusible by heat, soluble in water.
=Liquor Potassæ= is a strong solution of caustic potash, and has a
similar reaction. =Carbonate of Potassium=, also known as potash,
pearlash, salt of tartar, is a white crystalline powder, alkaline and
caustic in taste, and very deliquescent. The bicarbonate is in
colourless prisms, which have a saline, feebly alkaline taste, and are
not deliquescent.
_Symptoms._--Acrid soapy taste in mouth, burning in throat and gullet,
acute pain at pit of stomach, vomiting of bloody or brown mucus, colicky
pains, bloody stools, surface cold, pulse weak. These preparations are
not volatile, so that there is not much fear of lung trouble. In chronic
cases death occurs from stricture of the oesophagus causing starvation.
_Post-Mortem Appearances._--Soapy feeling, softening, inflammation, and
corrosion of mucous membrane of mouth, pharynx, oesophagus, stomach, and
intestines. Inflammation may have extended to larynx.
_Method of Extraction from the Stomach._--If the contents of the stomach
have a strong alkaline action, dilute with water, filter, and apply
tests.
_Tests._--The carbonates effervesce with an acid. The salts give a
yellow precipitate with platinum chloride, and a white precipitate with
tartaric acid. They are not dissipated by heat, and give a violet colour
to the deoxidizing flame of the blowpipe. Stains on dark clothing are
red or brown.
_Treatment._--Vinegar and water, lemon-juice and water, acidulated
stimulant drinks, oil, linseed-tea, opium to relieve pain, stimulants in
collapse. Do not use the stomach-tube. The glottis may be inflamed, and
if there is danger of asphyxia, tracheotomy may have to be performed.
=Carbonate of Sodium= occurs as _soda_ and _best soda_, the former in
dirty crystalline masses, the latter of a purer white colour. It is also
found as 'washing soda.'
_Symptoms, Post-Mortem Appearances, Treatment, and Extraction from the
Stomach._--As for potash.
_Tests._--Alkaline reaction, effervesces and evolves carbonic acid when
treated with an acid; crystallizes, gives yellow tinge to blowpipe
flame. No precipitate with tartaric acid, nor with bichloride of
platinum.
=Ammonia= may be taken as _liquor ammoniæ_ (harts-horn), as carbonate of
ammonium, as 'Cleansel,' or as 'Scrubb's Cloudy Ammonia.'
_Symptoms._--Being volatile, it attacks the air-passages, nose, eyes and
lungs, being immediately affected; profuse salivation; lips and tongue
swollen, red, and glazed. The urgent symptoms are those of suffocation.
Inhalation of the fumes of strong ammonia may lead to death from
capillary bronchitis or broncho-pneumonia. Death may result from
inflammation of the larynx and lungs. When swallowed in solution, the
symptoms are similar to those of soda and potash.
_Post-Mortem Appearances._--Similar to other corrosives.
_Method of Extraction from the Stomach._--The contents of the stomach,
etc., must be first distilled, the gas being conveyed into water free
from ammonia.
_Tests._--Nessler's reagent is the most delicate, a reddish-brown colour
or precipitate being produced, but ammonia may be recognized by its
pungent odour, dense fumes given off with hydrochloric acid, and strong
alkaline reaction.
_Treatment._--Vinegar and water. Other treatment according to symptoms.
_Fatal Dose._--One drachm of strong solution.
_Fatal Period (Shortest)._--Four minutes.
XVI.--INORGANIC IRRITANTS
=Nitrate of Potassium (Nitre, Saltpetre)--Bitartrate of Potassium (Cream
of Tartar)--Alum (Double Sulphate of Alumina and Potassium)--Chlorides
of Lime, Sodium, and Potassium.=--All these are irritant drugs, and give
the usual symptoms.
XVII.--CHLORATE OF POTASSIUM, ETC.
=Chlorate of Potassium= produces irritation of stomach and bowels;
hæmaturia; melæna; cyanosis, weakness, delirium, and coma.
_Post-Mortem._--Blood is chocolate-brown in colour, and so are all the
internal organs; gastro-enteritis; nephritis.
_Tests._--Spectroscope shows blood contains methæmoglobin; the drug
discharges the colour of indigo in acid solution with SO_{2}.
_Treatment._--Transfusion of blood or saline fluid; stimulants.
=Sulphuret of Potassium= (liver of sulphur) occurs in mass or powder of
a dirty green colour; has a strong smell of sulphuretted hydrogen.
_Symptoms._--Of acute irritant poisoning, with stupor or convulsions.
Excreta smell of sulphuretted hydrogen.
_Post-Mortem Appearances._--Stomach and duodenum reddened, with deposits
of sulphur. Lungs congested.
_Treatment._--Chloride of sodium or lime in dilute solution, and
ordinary treatment for irritant poisoning.
_Fatal Period (Shortest)._--Fifteen minutes.
XVIII.--BARIUM SALTS
=Chloride of Barium= occurs crystallized in irregular plates, like
magnesium sulphate, soluble in water and bitter in taste. =Carbonate of
Barium= is found in shops as a fine powder, tasteless and colourless,
insoluble in water, but effervescing with dilute acids, and readily
decomposed by the free acids of the stomach. =Nitrate of Barium= occurs
in octahedral crystals, soluble in water.
_Method of Extraction from the Stomach._--Dialysis as for other soluble
poisons.
_Tests._--Precipitated from its solutions by potassium carbonate or
sulphuric acid. Burnt on platinum-foil, it gives a green colour to the
flame.
_Symptoms._--Besides those of irritants generally, violent cramps and
convulsions, headache, debility, dimness of sight, double vision, noises
in the ears, and beating at the heart. The salts of barium are also
cardiac poisons.
_Post-Mortem Appearances._--As of irritants generally. Stomach may be
perforated.
_Treatment._--Wash out stomach with a solution of sodium or magnesium
sulphate, or of alum, and give stimulants by the mouth and
hypodermically.
XIX.--IODINE--IODIDE OF POTASSIUM
=Iodine= occurs in scales of a dark bluish-black colour. It strikes blue
with solution of starch, and stains the skin and intestines
yellowish-brown. Liquid preparations, as the liniment or tincture, may
be taken accidentally or suicidally.
_Symptoms._--Acrid taste, tightness of throat, epigastric pain, and then
symptoms of irritant poisons generally. Chronic poisoning (iodism) is
characterized by coryza, salivation, and lachrymation, frontal headache,
loss of appetite, marked mental depression, acne of the face and chest,
and a petechial eruption on the limbs.
_Post-Mortem Appearances._--Those of irritant poisoning with corrosion,
and staining of a dark brown or yellow colour.
_Treatment._--Stomach-pump and emetics, carbonate of sodium, amylaceous
fluids, gruel, arrowroot, starch, etc.
_Analysis of Organic Mixture containing Iodine._--Add bisulphide of
carbon, and shake. The iodine may be obtained on evaporation as a
sublimate. It will be recognized by the blue colour which it gives with
starch.
=Iodide of Potassium.=--Colourless, generally opaque, cubic crystals,
soluble in less than their weight of cold water.
_Symptoms._--Not an active poison, but even small doses sometimes
produce the effects of a common cold, including those symptoms already
mentioned as occurring with iodine.
_Analysis._--Iodide of potassium in solution gives a bright yellow
precipitate with lead salts; a bright scarlet with corrosive sublimate;
and a blue colour with sulphuric or nitric acid and starch.
XX.--PHOSPHORUS
=Phosphorus= is usually found in small, waxy-looking cylinders, which
are kept in water to prevent oxidation. It may also occur as the
amorphous non-poisonous variety, a red opaque infusible substance,
insoluble in carbon disulphide. Ordinary phosphorus is soluble in oil,
alcohol, ether, chloroform, and carbon disulphide; insoluble in water.
It is much used in rat poisons, made into a paste with flour, sugar,
fat, and Prussian blue. Yellow phosphorus is not allowed to be used in
the manufacture of lucifer matches, and the importation of such is
prohibited. In 'safety' matches the amorphous phosphorus is on the box.
_Symptoms._--At first those of an irritant poison, but days may elapse
before any characteristic symptoms appear, and these may be mistaken for
those of acute yellow atrophy of the liver. The earliest signs are a
garlicky taste in the mouth and pain in the throat and stomach. Vomited
matter luminous in the dark, bile-stained or bloody, with garlic-like
odour. Great prostration, diarrhoea, with bloody stools. Harsh, dry,
yellow skin, purpuric spots with ecchymoses under the skin and mucous
membranes, retention or suppression of urine, delirium, convulsions,
coma, and death. Usually there are remissions for two to three days,
then jaundice comes on, with enlargement of the liver; hæmorrhages from
the mucous surfaces and under the skin; later, coma and convulsions. In
chronic cases there is fatty degeneration of most of the organs and
tissues of the body. The inhalation of the fumes of phosphorus, as in
making vermin-killers, etc., gives rise to 'phossy-jaw.'
_Post-Mortem Appearances._--Softening of the stomach, hæmorrhagic spots
on all organs and under the skin, fatty degeneration of liver, kidneys,
and heart, blood-stained urine, phosphorescent contents of alimentary
canal.
_Treatment._--Early use of stomach-pump and emetics, followed by the
administration of permanganate of potassium or peroxide of hydrogen to
oxidize the phosphorus. Oil should not be given. Sulphate and carbonate
of magnesium, mucilaginous drinks. Sulphate of copper is a valuable
antidote, both as an emetic and as forming an insoluble compound with
phosphorus.
_Fatal Dose._--One grain and a half.
_Fatal Period._--Four hours; more commonly two to four days.
_Detection of Phosphorus in Organic Mixtures._--Mitscherlich's method is
the best. Introduce the suspected material into a retort. Acidulate with
sulphuric acid to fix any ammonia present. Distil in the dark, through
a glass tube kept cool by a stream of water. As the vapour passes over
and condenses, a flash of light is perceived, which is the test.
XXI.--ARSENIC AND ITS PREPARATIONS
=Arsenic= is the most important of all the metallic poisons. It is much
used in medicine and the arts. It occurs as metallic arsenic, which is
of a steel-grey colour, brittle, and gives off a garlic-like odour when
heated; as arsenious acid; in the form of two sulphides--the red
sulphide, or realgar, and the yellow sulphide, or orpiment; and as
arsenite of copper, or Scheele's green. It also exists as an impurity in
the ores of several metals--iron, copper, silver, tin, zinc, nickel, and
cobalt. Sulphuric acid is frequently impregnated with arsenic from the
iron pyrites used in preparing the acid. It is a constituent of many rat
pastes, vermin or weed killers, complexion powders, sheep dips, etc.
=Arsenious Acid= (White Arsenic, Trioxide of Arsenic).--Colourless,
odourless, and almost tasteless. It occurs in commerce as a white powder
or in a solid cake, which is at first translucent, but afterwards
becomes opaque. Slightly soluble in cold water; 1 ounce of water
dissolves about 1/2 grain of arsenic. Fowler's solution is the
best-known medicinal preparation of arsenic, and contains 1 grain of
arsenious anhydride in 110 minims.
_Symptoms._--Commence in from half to one hour. Faintness, nausea,
incessant vomiting, epigastric pain, headache, diarrhoea, tightness and
heat of throat and fauces, thirst, catching in the breath, restlessness,
debility, cramp in the legs, and convulsive twitchings. The skin becomes
cold and clammy. In some cases the symptoms are those of collapse, with
but little pain, vomiting, or diarrhoea. In others the patient falls
into a deep sleep, while in the fourth class the symptoms resemble
closely those of English cholera. The vomited matters are often blue
from indigo, or black from soot, or greenish from bile, mixed with the
poison. Should the patient survive some days, no trace of arsenic may be
found in the body, as the poison is rapidly eliminated by the kidneys.
In all suspected cases the urine should be examined.
The symptoms of _chronic_ poisoning by arsenic are loss of appetite,
silvery tongue, thirst, nausea, colicky pains, diarrhoea, headache,
languor, sleeplessness, cutaneous eruptions, soreness of the edges of
the eyelids, emaciation, falling out of the hair, cough, hæmoptysis,
anæmia, great tenderness on pressure over muscles of legs and arms, due
to peripheral neuritis, and convulsions.
Pigmentation is common; the face becomes dusky red, the rest of the body
a dark brown shade. This darkening is most marked in situations normally
pigmented and in parts exposed to pressure of the clothes, such as the
neck, axilla, and inner aspect of the arms, the extensor aspects being
less marked than the flexor. The pigmentation resembles the bronzing of
Addison's disease, but there are no patches on the mucous membranes, and
the normal rosy tint of the lips is not altered. The skin over the feet
may show marked hyperkeratosis.
The nervous system is notably affected. The sensory symptoms appear
first: numbness and tingling of the hands and feet, pain in the soles of
the feet on walking, pain on moving the joints, and erythromelalgia.
Then come the motor symptoms, with drop-wrist and drop-foot. The patient
suffers severely from neuritis, and there may be early loss of patellar
reflex. The nervous symptoms come on later than the cutaneous
manifestations.
_Post-Mortem Appearances._--Signs of acute inflammation of stomach,
duodenum, small intestines, colon, and rectum. Stomach may contain dark
grumous fluid, and its mucous coat presents the appearance of crimson
velvet. Ulceration is rare, and cases of perforation still less common,
the patient dying before it occurs. If life has been preserved for some
days, there is extensive fatty degeneration of the organs. There may be
entire absence of _post-mortem_ signs. Putrefaction of the body is
retarded by arsenic.
_Treatment._--The stomach-pump, emetics, then milk, milk and eggs, oil
and lime-water. Inflammatory symptoms, collapse, coma, etc., must be
treated on ordinary principles. As an antidote, the best when the poison
is in solution is the hydrated sesquioxide of iron, formed by
precipitating tinctura ferri perchloridi with excess of ammonia, or
carbonate of soda. This is filtered off through muslin and given in
tablespoonful doses. It forms ferric arsenate, which is sparingly
soluble. Colloidal iron hydroxide may be used instead. Dialyzed iron in
large quantities is efficacious.
_Fatal Dose (Smallest)._--Two grains. Exceptionally, recovery from very
large doses if rejected by vomiting.
_Fatal Period (Shortest)._--Twenty minutes. Exceptionally, death as late
as the sixteenth day. The effects of arsenic are modified by tolerance,
some persons being able to take considerable quantities. The peasants of
Styria are in the habit of eating it.
_Method of Extraction from the Stomach._--The coats of the stomach
should be examined with a lens for any white particles. These, if
present, may be collected, mixed with a little charcoal in a test-tube,
and heated. If arsenic is present, a metallic ring will be formed in the
cooler parts of the tube. If this ring be also heated, octahedral
crystals of arsenic will be deposited farther up the tube, and are
easily recognized by the microscope. The contents of the stomach, or the
solid organs minced up, should be boiled with pure hydrochloric acid and
water, then filtered. The filtrate can then be subjected to Marsh's or
Reinsch's process.
_Tests._--In _solution_, arsenic may be detected by the liquid tests.
(1) Ammonio-nitrate of silver gives a yellow precipitate (arsenite of
silver). (2) Ammonio-sulphate of copper gives a green precipitate
(Scheele's green). (3) Sulphuretted hydrogen water gives a yellow
precipitate.
_Marsh's Process._--Put pure distilled water into a Marsh's apparatus
with metallic zinc and sulphuric acid. Hydrogen is set free, and should
be tested by lighting the issuing gas and depressing over it a piece of
white porcelain. If no mark appears, the reagents are pure, and the
suspected liquid may now be added. The hydrogen decomposes arsenious
acid, and forms arseniuretted hydrogen. The gas carried off by a fine
tube is again ignited. A piece of glass or porcelain held to the flame
will have, if arsenic be present, a deposit on it having the following
characters: In the centre a deposit of metallic arsenic, round this a
mixture of metallic arsenic and arsenious acid, and outside this another
ring of arsenious acid in octahedral crystals. The deposit is dissolved
by a solution of chloride of lime, turned yellow by sulphide of ammonium
after evaporation; on the addition of strong nitric acid, evaporated and
neutralized with ammonia and nitrate of silver added, a brick-red colour
is produced--arseniate of silver.
_Reinsch's Process._--Boil distilled water with one-sixth or one-eighth
of hydrochloric acid, and introduce a slip of bright copper. If, after a
quarter of an hour's boiling, there is no stain on the copper, add the
suspected liquid. If arsenic be present, it will form an iron-grey
deposit. If this foil be dried, cut up, put in a reduction-tube, and
heated, crystals of arsenious trioxide will be deposited on the cold
part of the tube.
These tests are difficult to apply, but as arsenic is a ubiquitous
poison, and as there are many sources of fallacy, it would be well, when
possible, to obtain the services of an expert.
_Biological Test._--Put the substance to be tested into a flask with
some small pieces of bread, sterilize for half an hour at 120° C. When
cold, inoculate with a culture of _Penicillium brevicaule_, and keep at
a temperature of 37° C. If arsenic is present, a garlic-like odour is
noticed in twenty four hours, due to arseniuretted hydrogen or an
organic combination of arsenic. This test is delicate, and will detect
1/1000 of a milligramme, but it is not quantitative.
=Other Preparations of Arsenic.=--These are arsenite of potash (Fowler's
solution), cacodylate of sodium, and arsenite of copper (Scheele's
green), the last frequently used for colouring dresses and wall-papers.
Persons using these preparations may suffer from catarrhal symptoms,
rashes on the neck, ears, and face, thirst, nausea, pain in stomach,
vomiting, headache, perhaps peripheral neuritis and loss of patellar
reflex. The cacodylates, although formerly employed in the treatment of
phthisis, should be used with the utmost caution. The arsenites give the
reactions of arsenious acid.
Arsenic is eliminated not only by the kidneys and bowels, but by the
skin, and in women by the menses. It may be detected in the sweat, the
saliva, the bronchial secretion, and, during lactation, in the milk.
The sale of arsenic and its preparations to the public is properly
hedged round with restrictions of all kinds. It is included in Part I.
of the Poisons and Pharmacy Act (8 Edward VII., c. 55). No arsenic may
be sold to a person under age, nor may it be sold unless mixed with soot
or indigo in the proportion of 1 ounce of soot or 1/2 ounce of indigo at
the least to every pound of arsenic.
=Arseniuretted Hydrogen= (arsine, AsH_{3}) is an extremely poisonous
gas, and is evolved in various chemical and manufacturing processes.
When damp, _Ferro-silicon_ evolves AsH_{3} and PH_{3}, both very lethal
gases. _Ferrochrome_ is used in making steel, and it also evolves
PH_{3}, and in such extreme dilution as 0.02 per cent. may cause death.
XXII.--ANTIMONY AND ITS PREPARATIONS
=Tartar Emetic= (tartarized antimony, potassio-tartrate of antimony)
occurs as a white powder, or in yellowish-white efflorescent crystals.
Vinum antimoniale contains 2 grains to a fluid ounce of the wine.
_Symptoms._--Metallic taste, rapidly followed by nausea, incessant
vomiting, burning heat and pain in stomach, purging. Dysphagia, sense of
constriction in throat, intense thirst, cramps, faintness, profound
depression; in fatal cases, giddiness and tetanic spasms. In _chronic
poisoning_, nausea, vomiting and purging, weak pulse, loss of appetite,
debility, cold sweats, great prostration, progressive emaciation. The
symptoms in chronic poisoning may simulate gastritis or enteritis.
Externally applied, it produces an eruption not unlike that of smallpox.
_Post-Mortem Appearances._--Inflammation, softening, and an aphthous
condition of the throat, gullet, and stomach, the last reddened in
patches. In chronic poisoning, inflammation also of cæcum and colon.
Brain and lungs may be congested. Decomposition is hindered for long.
_Treatment._--Promote vomiting by warm greasy water, or the stomach-tube
may be used. Cinchona bark or any preparation containing tannin, as tea,
decoction of oak bark, etc. Morphine to allay pain.
_Fatal Dose._--In an adult 2 grains (same as arsenic).
_Fatal Period._--Death follows in eight to twelve hours, from
exhaustion.
_Method of Extraction from the Stomach._--The contents of the stomach or
its coats should be finely cut up and boiled in water, acidulated with
tartaric acid and subjected to dialysis, or strained and filtered. Pass
hydrogen sulphide through the filtered or dialyzed fluid until a
precipitate ceases to fall; collect the sulphide thus formed, wash and
dry it. Boil the orange-coloured sulphide in a little hydrochloric
acid. If the solution be now added to a large bulk of water, the white
oxychloride is precipitated, which is soluble in tartaric acid and
precipitated orange yellow with hydrogen sulphide. The chloride of
bismuth is also precipitated white, but the precipitate is not soluble
in tartaric acid, and the precipitate with hydrogen sulphide is black.
_Tests._--Soluble in water, but not in alcohol.
Heated in substance, it crepitates and chars; and if heat be increased,
the metal is deposited. Treated with sulphuretted hydrogen, a
characteristic orange-red sulphide is formed.
A drop of the solution evaporated leaves crystals, either tetrahedric,
or cubes with edges bevelled off. Sulphuretted hydrogen passed through
gives the orange-red precipitate above named. Dilute nitric acid gives a
white precipitate, soluble in excess, and also in tartaric acid. Marsh's
and Reinsch's processes are applicable for the detection of antimony,
but Reinsch's is the better. Reinsch's process gives a violet deposit
instead of the black, lustrous one of arsenic.
=Chloride of Antimony= (Butter of Antimony).--A light yellow or dark red
corrosive liquid.
_Symptoms._--Violet corrosion and irritation of the alimentary canal,
with the addition of narcotic symptoms. After death the mucous membrane
of the entire canal is charred, softened, and abraded.
_Treatment._--As for tartar emetic; magnesia in milk.
XXIII.--MERCURY AND ITS PREPARATIONS
The most important salt of mercury, toxicologically, is corrosive
sublimate. Other poisonous preparations are red precipitate, white
precipitate, mercuric nitrate, the cyanide and potassio-mercuric iodide.
Calomel has very little toxic action. Metallic mercury is not poisonous,
but its vapour is.
=Corrosive Sublimate= (perchloride of mercury) is in heavy colourless
masses of prismatic crystals, possessing an acrid, metallic taste. It is
soluble in sixteen parts of cold and two of boiling water. Soluble in
alcohol and ether, the latter also separating it from its solution in
water.
_Symptoms_ come on rapidly. Acrid, metallic taste, constriction and
burning in throat and stomach, nausea, vomiting of stringy mucus tinged
with blood, tenesmus, purging. Feeble, quick, and irregular pulse,
dysuria with scanty, albuminous or bloody urine or total suppression.
Cramp, twitches and convulsions of limbs, occasionally paralysis. In
poisoning from the medicinal use of mercury, there may be salivation, a
coppery taste in the mouth, peculiar foetor of breath, tenderness and
swelling of mouth, inflammation, swelling and ulceration of gums
(cancrum oris), a blue line on the gums, and the loosening of teeth.
Mercury is less quickly eliminated from the body than arsenic. In
chronic cases 'mercurialism,' 'hydrargyrism,' 'ptyalism,' or
'salivation,' including most of the symptoms enumerated above. May get
_eczema mercuriale_ and periostitis. Profound anæmia often a prominent
symptom; neuritis not uncommon. If fumes of mercury inhaled, mercurial
tremors develop.
_Post-Mortem Appearances._--Corrosion, softening, and sloughing
ulceration of stomach and intestines. The mucous membrane of the
oesophagus and stomach is often of a bluish-grey colour. The large
intestine and rectum are often ulcerated and gangrenous. Inflamed
condition of urinary organs, with contraction of the bladder.
_Treatment._--Encourage or produce vomiting. Albumin, as white of egg,
gluten, or wheat flour, is the best antidote. Demulcent drinks, milk,
and ice. Stomach-tube to be used with care, owing to softened state of
gullet and stomach.
_Fatal Dose._--Three grains in a child.
_Fatal Period._--Half an hour the shortest.
_Method of Extraction from the Stomach._--A trial test may be made of
the contents of the stomach with copper-foil. If mercury is found, the
contents of the stomach may be dialyzed, the resulting clear fluid
concentrated and shaken with ether, which has the power of taking
corrosive sublimate up, and thus separating it from arsenic and other
metallic poisons. The ether allowed to evaporate will leave the
corrosive sublimate in white silky-looking prisms. Suppose no mercury is
found in the dialyzed fluid, owing to the fact that corrosive sublimate
enters into insoluble compounds with albumin, fibrin, mucous membrane,
gluten, tannic acid, etc., we must dry the insoluble matter, and heat it
with nitro-hydrochloric acid until all organic matter is destroyed and
excess of nitric acid expelled. The residue dissolved in water,
filtered, and tested with copper-foil, etc.
_Tests._--The following table gives the action of corrosive sublimate
with reagents:
1. With iodide of potassium Bright scarlet colour.
2. With potash solution Bright yellow colour.
3. With hydrochloric acid and First a yellowish and then a black
sulphuretted hydrogen colour.
4. Heated in a reduction-tube Melts, boils, is volatilized, and forms
a white crystalline sublimate.
5. With ether Freely soluble; the ethereal solution,
when allowed to evaporate
spontaneously, deposits the salt in
white prismatic crystals.
6. Heated with carbonate of Globules of metallic mercury are
sodium in a reduction-tube produced.
A very simple process for detecting corrosive sublimate is to put a drop
of the suspected solution on a sovereign and touch the gold through the
solution with a key, when metallic mercury will be deposited on the
gold.
XXIV.--LEAD AND ITS PREPARATIONS
=Acetate of Lead= (Sugar of Lead).--A glistening white powder or
crystalline mass. Soluble in water, with a sweetish taste. It is
practically the only lead salt which gives rise to acute symptoms, and
only when taken in large doses.
_Symptoms._--Metallic taste, dryness in throat, intense thirst,
vomiting, colicky pains, cramps, cold sweat, _constipation_ and scanty
urine, severe headache, convulsions.
_Chronic lead-poisoning_ is liable to occur in those who handle lead in
any form--white-lead workers, paint manufacturers, plumbers, pottery
workers, etc.
In chronic lead-poisoning the most prominent symptoms are a blue line on
the gums, anæmia, emaciation, pallor, quick pulse, persistent
constipation, colic, cramps in limbs, and paralysis of the extensor
muscles, causing 'dropped hand.' May get _saturnine encephalopathies_,
of which intense headache, optic neuritis, and epileptiform convulsions,
are the most common. Albumin in urine, tendency to gout, and in women to
abortion.
_Post-Mortem Appearances._--Inflamed mucous membrane of stomach and
intestines, with layers of white or whitish-yellow mucus, impregnated
with the salt of lead.
_Treatment._--Sulphate of sodium or magnesium, or a mixture of dilute
sulphuric acid, spirits of chloroform, and peppermint-water. Milk, or
milk and eggs. As a prophylactic among workers in lead, a drink
containing sulphuric acid flavoured with treacle should be given.
Lavatory accommodation should be provided, and scrupulous cleanliness
should also be enjoined in the workshops. The dry grinding of lead salts
should be prohibited. The ionization method of Sir Thomas Oliver is
most useful both as regards cure and also prevention of chronic
poisoning by lead.
_Fatal Dose and Fatal Period._--Uncertain.
_Method of Extraction from the Stomach._--Dry the contents of the
stomach or portions of the liver, etc., and incinerate in a porcelain
crucible. Treat the ash with nitric acid, dry, and dissolve in water.
The solution of nitrate of lead may now have the proper tests applied.
_Tests._--Sulphuretted hydrogen gives a black precipitate; liquor
potassæ, white precipitate; sulphuric acid, white precipitate, insoluble
in nitric acid; iodide of potassium, a bright yellow precipitate. A
delicate test for lead in water is to stir the water, concentrated or
not, with a glass rod dipped in ammonium sulphide: a brown coloration is
produced. One-tenth of a grain of lead in a gallon of water may be
detected.
Chronic lead-poisoning is an 'industrial disease,' and, being an
occupation risk, its victims are entitled to compensation at the hands
of their employers. In case of death, compensation has been awarded even
when at the autopsy the patient has been found to have suffered from
acute tuberculosis of the lungs. The responsibility of apportioning the
monetary value of disablement resulting from the action of the lead
rests with a judge or jury, who are guided by the expert medical
evidence available.
Diachylon, or lead-plaster, is largely used as an abortifacient.
XXV.--COPPER AND ITS PREPARATIONS
Poisoning with copper salts is rare. The most important are the
sulphate, subacetate, and arsenite.
=Sulphate of Copper= (bluestone, blue vitriol) in half-ounce doses is a
powerful irritant. Has been given to procure abortion.
=Subacetate of Copper= (verdegris) occurs in masses, or as a greenish
powder. Powerful, astringent, metallic taste. Half-ounce doses have
proved fatal.
_Symptoms._--Epigastric pain, vomiting of bluish or greenish matter,
diarrhoea. Dyspnoea, depression, cold extremities, headache, purple line
round the gums. Jaundice is common. A _chronic_ form of poisoning may
occur, with symptoms closely resembling those of lead.
_Post-Mortem Appearances._--Inflammation of stomach and intestines,
which are bluish or green in colour.
_Treatment._--Encourage vomiting. Give albumin or very dilute solution
of ferrocyanide of potassium.
_Method of Extraction from the Stomach._--Boil the contents of the
stomach in water, filter, pass hydrogen sulphide, filter, collect
precipitate and boil in nitric acid, filter, dilute filtrate with water
and apply tests. In the case of the solid organs, dry, incinerate,
digest ash in hydrochloric acid, evaporate nearly to dryness, dilute
with water, and test.
_Tests._--Polished steel put into a solution containing a copper salt
receives a coating of metallic copper. Ammonia gives a whitish-blue
precipitate, soluble in excess. Ferrocyanide of potassium gives a rich
red-brown precipitate. Sulphuretted hydrogen gives a deep brown
precipitate.
XXVI.--ZINC, SILVER, BISMUTH, AND CHROMIUM
The salts of zinc requiring notice are the sulphate and chloride.
=Sulphate of Zinc= has been taken in mistake for Epsom salts. In large
doses it causes dryness of throat, thirst, vomiting, purging, and
abdominal pain.
_Post-Mortem Appearances._--Those of inflammation of digestive tract.
_Treatment._--Tea, decoction of oak-bark, carbonate of potassium or
sodium as antidote.
=Chloride of Zinc.=--A solution containing this substance (230 grains to
the ounce) constitutes 'Burnett's disinfecting fluid.' It is a corrosive
poison.
The symptoms are burning sensation in the mouth, throat, stomach, and
abdomen, followed by vomiting, diarrhoea, with tenesmus and distension
of the abdomen. The vomited matter contains shreds of mucous membrane
with blood. There is profound collapse, cold surface, clammy sweats,
weak pulse, with great prostration. The _treatment_ is to wash out the
stomach with large and weak solutions of carbonate of sodium.
Mucilaginous drinks may be given, and hypodermic injections of morphine
are useful to allay the pain.
_Method of Extraction from the Stomach._--Dry and incinerate the tissues
in a porcelain crucible, digest ash in water, apply tests.
_Tests._--Ammonia, a white precipitate soluble in excess, reprecipitated
by sulphuretted hydrogen; ferrocyanide of potassium, a white
precipitate; sulphuretted hydrogen, a white precipitate in pure and
neutral solutions. Nitrate of baryta will show the presence of sulphuric
acid, and nitrate of silver of hydrochloric acid.
=Silver.=--Nitrate of silver is a powerful irritant.
_Tests._--Black precipitate with sulphuretted hydrogen; white with
hydrochloric acid.
_Treatment._--Common salt.
Chronic nitrate of silver poisoning is characterized by _argyria_. The
gums show a blue line, which is darker than that produced by lead, and
the skin presents a greyish hue, which is permanent.
=Bismuth.=--The bismuth salts are not poisonous, but may contain arsenic
as an impurity, although this is far less common than it was some years
ago.
=Chromic Acid, Chromate, Bichromate of Potassium.=--These act as
corrosives when solid or in concentrated liquid forms. In dilute
solutions they act as irritants. Used as dyes; have proved fatal more
than once. Those engaged in their manufacture suffer from unhealthy
ulcers on the nasal septum and hands. The former may to some extent be
prevented by taking snuff. Lead chromate (chrome yellow) is a powerful
irritant poison. Two drachms of the bichromate caused death in four
hours.
_Tests._--Yellow precipitate with salts of lead, deep red with those of
silver.
_Treatment._--Emetics, magnesia, and diluents. Washing out of the
stomach with weak solution of nitrate of silver.
XXVII.--GASEOUS POISONS
=Carbon Dioxide.=--Carbon dioxide is a product of combustion and
respiration, and is generated in many ways during fermentation. It is a
constituent of _choke damp_ due to explosions in coal-mines, and is
given off from lime-kilns, brick-kilns, and cement-works. It is often
met with in dangerous quantities in wells and in brewers' vats. From 10
to 15 per cent. in the atmosphere would prove fatal, but even 2 per
cent. inhaled for long would produce serious symptoms. The proportion
usually present in air is 0.04 per cent.
_Symptoms._--Inhalation of the _pure_ gas causes spasm of the glottis,
insensibility, and death from asphyxia, at once; _diluted_, causes sense
of weight in forehead and back of head, giddiness, vomiting, somnolence,
loss of muscular power. Insensibility, stertorous breathing, lividity of
face and body, and death from asphyxia. Convulsions occasionally.
_Post-Mortem Appearances._--Face swollen and livid, or calm and pale;
lividity is most marked in eyelids, lips, ears, etc.; limbs usually
flaccid, abdomen distended; right side of heart, lungs, and large veins,
gorged with dark-coloured blood. Brain and membranes congested.
_Treatment._--Pure air, cold affusion, stimulants, artificial
respiration, galvanism, inhalation of oxygen, venesection, transfusion.
=Carbonic Oxide.=--This is one of the most poisonous of gases. It is
evolved in the process of burning charcoal and coke in stoves or
furnaces. Water-gas, obtained by passing steam over heated coke,
contains 40 per cent. of the substance, the remainder being chiefly
hydrogen. It forms the chief part of the deadly 'choke damp' after an
explosion in a mine. Two per cent. in the atmosphere is immediately
fatal.
_Symptoms._--When in _large amount_, insensibility comes on at once;
when in _very small amounts_, headache, giddiness, noises in the ears,
nausea, and vomiting, with prostration, insensibility, and coma. There
may be convulsions. Even in cases which recover, permanent impairment of
the brain may result.
_Post-Mortem Appearances._--The blood is bright red in colour, due to
the interaction of carbonic oxide with hæmoglobin. A rosy hue of the
skin-surface and viscera is often noticed. Bright red patches of colour
are found over the surface of the body. The spectrum of the blood is
characteristic.
_Treatment._--Ammonia to the nostrils, inhalation of oxygen, cold douche
in moderation, artificial respiration, transfusion of blood.
=Coal Gas.=--Coal gas contains light carburetted hydrogen or marsh gas,
olefiant gas, ammonia, sulphuretted hydrogen, carbonic acid, carbonic
oxide, free hydrogen, and nitrogen. Coal gas has an offensive odour,
burns with a yellowish-white flame, yielding water and carbonic acid.
Cases of poisoning often due to escape of gas into the room.
_Symptoms._--Headache and giddiness, foaming at mouth, vomiting,
convulsions, tetanic spasms, stertorous breathing, dilated pupil. The
breath smells of gas; there is profound stupor; the patient, if alive,
exhales gas from the lungs when removed into a fresh room or into the
air. Smell of gas in the room and in patient's breath.
_Post-Mortem Appearances._--Pallor of skin and internal tissues; florid
colour of neck, back, and muscles, if much CO present in the coal gas;
fluid florid blood; infiltration of lungs.
_Treatment._--Fresh air, artificial respiration, cold affusion,
diffusible stimulants; inhalation of oxygen freely.
=Sulphuretted Hydrogen= is characterized by its odour, like that of
rotten eggs. It is extremely poisonous.
_Symptoms._--Giddiness, pain and oppression in stomach, nausea, loss of
power; delirium, tetanus, and convulsions.
_Post-Mortem Appearances._--Fluid and black blood (sulph-hæmoglobin),
smell of H_{2}S on opening the body; loss of contractility of muscles,
rapid putrefaction.
_Treatment._--Fresh air, stimulants, inhalation of chlorine.
_Tests._--Acetate of lead throws down a brown or black precipitate
according to the quantity of the gas.
=Sewer Gas.=--Cesspool emanations usually consist of a mixture of
sulphuretted hydrogen, sulphide of ammonium, and nitrogen; but sometimes
it is only deoxidized air with an excess of carbonic acid gas.
_Symptoms._--If poison concentrated, death may ensue at once; if gas
diluted, or exposure only short, insensibility, lividity, hurried
respiration, weak pulse, dilated pupils, elevation of temperature to
104°, tonic convulsions not unlike those of tetanus.
_Treatment._--Fresh air, oxygen, with artificial respiration.
Stimulants, hypodermic of strychnine, and alternate hot and cold douche.
=Irritant Gases= are--(1) Nitrous acid gas; (2) sulphurous acid gas; (3)
hydrochloric acid gas; (4) chlorine; (5) bromine; (6) ammonia. They have
the common property of causing irritation and inflammation of the eyes,
throat, and air-passages, and may cause spasm of the glottis,
bronchitis, and pneumonia.
=Sulphurous Acid Gas.=--One of the products of combustion of common
coal.
=Hydrochloric Acid Gas.=--Irrespirable when concentrated, and very
irritating when diluted. Very destructive to vegetable life.
=Chlorine.=--Used in bleaching, and as a disinfectant. Greenish-yellow
colour, suffocating odour. In poisoning, inhalation of sulphuretted
hydrogen gives relief.
XXVIII.--VEGETABLE IRRITANTS
The chief vegetable purgatives are aloes, colocynth, gamboge, jalap,
scammony, seeds of castor-oil plant, croton-oil, elaterium, the
hellebores, and colchicum. All these have, either alone or combined,
proved fatal. The active principle in aloes is aloin; of jalap, jalapin;
of white hellebore, veratria; and of colchicum, colchicin. Morrison's
pills contain aloes and colocynth; aloes is also the chief ingredient in
Holloway's pills.
_Symptoms._--Vomiting, purging, tenesmus, etc., followed by cold sweats,
collapse, or convulsions.
_Post-Mortem Appearances._--Inflammation of alimentary canal;
ulceration, softening, and submucous effusion of dark blood.
_Treatment._--Diluents, opium, stimulants, abdominal fomentations, etc.
Certain of these irritant poisons exert a marked influence on the
central nervous system, as the following:
=Laburnum= (_Cytisis Laburnum_).--All parts of the plant are poisonous;
the seeds, which are contained in pods, are often eaten by children.
Contains the alkaloid _cytisine_, which is also contained in arnica. It
has a bitter taste, and is powerfully toxic. Symptoms are purging,
vomiting, restlessness, followed by drowsiness, insensibility, and
convulsive twitchings. Death due to respiratory paralysis. Most of the
cases are in children. Treatment consists of stomach-pump or emetics,
stimulants freely, artificial respiration, warmth and friction to the
surface of the body.
=Yew= (_Taxus baccata_) contains the alkaloid _taxine_. The symptoms are
convulsions, insensibility, coma, dilated pupils, pallor, laboured
breathing, collapse. Death may occur suddenly. Treatment as above.
Post-mortem appearances not characteristic, but fragments of leaves or
berries may be found in the stomach and intestines.
=Arum= (_Arum Maculatum_).--This plant, commonly known as 'lords and
ladies,' is common in the woods, and the berries may be eaten by
children. It gives rise to symptoms of irritant poisoning, vomiting,
purging, dilated pupils, convulsions, followed by insensibility, coma,
and death.
Many plants have an intensely irritating action on the skin, and when
absorbed act as active poisons.
=Rhus toxicodendron= is the poison oak or poison ivy. Poisoning by this
plant is rare in England, though not uncommon in the United States. Mere
contact with the leaves or branches will in many people set up an acute
dermatitis, with much oedema and hyperæmia of the skin. The inflammation
spreads rapidly, and there is formation of blebs with much itching.
There is often great constitutional disturbance, nausea, vomiting,
diarrhoea, and pains in the abdomen. The effects may last a week, and
the skin may desquamate.
=Primula obconica= is another plant which, when handled, gives rise to
an acute dermatitis of an erysipelatous character. The face swells, and
large blisters form on the cheeks and chin.
XXIX.--OPIUM AND MORPHINE
=Opium.=--The inspissated juice of the unripe capsules of the _Papaver
somniferum_. As a poison it is generally taken in the form of the
tincture (laudanum), which contains 1 grain opium in 15 minims. Opium is
found in almost all so-called 'soothing syrups' for children, and in
Godfrey's cordial, Dalby's carminative, and Collis Browne's chlorodyne.
Laudanum contains 1 per cent. morphine, and it, along with all other
preparations (_e.g._, paregoric) which contain 1 or more per cent.
morphine, are included in Part I. of the Schedule of Poisons, and come
under the Dangerous Drugs Regulations.
The most important active principles of opium are the alkaloids morphine
and codeine.
_Symptoms_ usually commence in from twenty to thirty minutes: Giddiness,
drowsiness and stupor, followed by insensibility. Patient seems asleep;
may be roused by loud noise, but quickly relapses. Breathing slow and
stertorous, pulse weak, countenance livid. As coma increases, pulse
becomes slower and fuller. The pupils are contracted, even to a pin's
point; they are insensible to the action of light. In deep, natural
sleep the eyes are turned upwards and the pupils contracted. Bowels
confined, skin cold and livid or bathed in sweat. Temperature subnormal.
Nausea and vomiting are sometimes present. Remissions are not
infrequent, the patient appearing about to recover and then relapsing.
Hæmorrhage into the pons may give rise to contracted pupils. Young
children and infants are specially susceptible to the poison.
_Diagnosis_ is not always easy, and one has to differentiate poisoning
from _cerebral apoplexy_. In the latter one can seldom rouse the
patient, the pupils are often unequal, and hemiplegia is present. In
_compression of the brain_, fracture of the skull may be present,
subconjunctival hæmorrhages may be seen, the pupils are unequal and
dilated, and the paralysis increases. In _uræmic or diabetic coma_ the
urine must be examined.
The habitual use of opium is not uncommon, and opium-eaters are able to
take enormous quantities of the drug. The opium-eater may be known by
his attenuated body, withered yellow countenance, stooping posture, and
glassy, sunken eyes.
_Post-Mortem Appearances._--Not characteristic. Turgescence of cerebral
vessels. There may be effusion under arachnoid, into ventricles, at base
of the brain, and around the cord. Rarely extravasation of blood.
Stomach and intestines usually healthy. Lungs gorged, skin livid.
_Fatal Period._--Usually nine to twelve hours; but in many cases, if
life is prolonged for eight hours, recovery takes place.
_Fatal Dose._--Four grains of opium is the smallest fatal dose in an
adult, or one drachm of laudanum; children are proportionately much more
susceptible to the action of opium than adults.
_Treatment._--Stomach-tube, emetics, strong coffee or tea, ammonia to
nostrils. Give 10 grains of permanganate of potassium in a pint of water
acidulated with sulphuric acid, and repeat the dose every half hour.
Belladonna by mouth, or atropine hypodermically. Patient must be kept
roused by dashing cold water over him, flagellating with a wet towel,
walking about, etc. In conditions of collapse, however, this treatment
must not be continued, but everything should be done to preserve the
strength. Treatment must be continued as long as life remains.
_Method of Extraction from the Stomach._--Opium itself cannot be
directly detected, but we test for morphine and meconic acid. These may
be separated from organic mixtures thus: Boil the organic matter with
distilled water, spirit, and acetic acid; filter, and to the fluid
passed through add acetate of lead till precipitate ceases. Filter.
Acetate of morphine passes through, and meconate of lead remains. The
solution of acetate of morphine may be freed from excess of lead by
hydrogen sulphide and filtered, excess of hydrogen sulphide driven off
by heat, and tests applied. Put the meconate of lead with water into a
beaker and pass hydrogen sulphide; sulphide of lead is formed, and
meconic acid set free. Filter. Concentrate the solution of meconic acid,
allow a portion to crystallize, and apply tests.
_Tests._--Morphine and its acetate give an orange-red colour with nitric
acid, becoming brighter on standing; decompose iodic acid, setting free
iodine; with perchloride of iron, gives a rich indigo-blue; with
bichromate of potassium, a green turning to brown. When the alkaloid is
heated in a watchglass with a drop of strong sulphuric acid until the
acid begins to fume, and is then allowed to get quite cold, a drop of
nitric acid produces a brilliant red colour. The iodic acid test is very
delicate, but requires great care, and may be used in the presence of
organic matter.
Meconic acid gives a blood-red colour with perchloride of iron, not
discharged by corrosive sublimate or chloride of gold. The similar
colour produced by sulpho-cyanide of potassium and perchloride of iron
is discharged by chloride of gold and corrosive sublimate.
=Morphine Habit.=--Individuals who have acquired this habit take the
drug usually by hypodermic injection. The victim suffers from nausea and
vomiting, and becomes so mentally debilitated that asylum treatment is
required.
XXX.--BELLADONNA, HYOSCYAMUS, AND STRAMONIUM
=Belladonna.=--The root, leaves, and berries, of the _Atropa belladonna_
are poisonous from the presence of alkaloid atropine.
_Symptoms._--Dryness of mouth and throat, intense thirst, dysphagia and
dysphonia, quick pulse, noisy delirium and stupor. Strangury and
hæmaturia, and redness of the skin, especially of the face, like that
of scarlatina, have been noticed. Dilatation of the pupil occurs,
whether the poison be taken internally or applied locally to the eye.
_Post-Mortem Appearances._--Congestion of cerebral vessels, dilated
pupils, red patches in alimentary canal.
_Treatment._--Wash out the stomach freely; a hypodermic injection of
apomorphine as an emetic, followed by hypodermic injections of
pilocarpine or morphine. Tea, coffee, or tannin, to precipitate the
alkaloid.
_Tests._--Atropine may be recognized by its action on the pupil. The
chloro-iodide of potassium and mercury precipitates it from very dilute
solutions.
=Hyoscyamus= (Henbane).--_Hyoscyamus niger._
=Stramonium= (Thorn-Apple).--_Datura stramonium._
_Symptoms._--Identical with those of belladonna and hyoscyamus, the
_post-mortem appearances_ and _treatment_ being also the same.
=Cannabis Indica= (Indian Hemp).--When smoked, produces intoxication and
mania. _Hashish_, used in the East as a narcotic, may cause persons to
run 'amok' and commit murder.
XXXI.--COCAINE