injected hypodermically may give rise to alarming symptoms. These are
intense pallor, faintness, giddiness, dilatation of pupils, paroxysmal
dyspnoea, rapid, intermittent, and weak pulse, nausea and vomiting,
intense prostration verging on collapse, and convulsions. The patient
may recover if allowed to remain in a recumbent position, but stimulants
by mouth--_e.g._, ammonia--and the hypodermic injection of brandy or
ether may be necessary, with the inhalation of nitrite of amyl.
For care in the prescribing of cocaine see under the 'Dangerous Drugs
Act, 1920' (p. 82).
The =Cocaine Habit= consists in the self-administration of the drug
hypodermically. It induces excitement, which is followed by prostration.
In time melancholia or mania develops, with great irritation of the skin
('cocaine bugs').
XXXII.--CAMPHOR
The liniment, oil, and spirit have been poisonous in large dose.
_Symptoms._--Odour of breath, languor, giddiness, faintness, dimness of
vision, difficulty of breathing, delirium, convulsions, with hot skin,
flushed face, and dilated pupils.
_Fatal Dose._--Thirty grains.
=Cocculus Indicus.=--The fruit of _Anamirta cocculus_. Contains a
poisonous active principle, picrotoxin; used to adulterate beer, and by
poachers to stupefy fish.
_Symptoms._--Convulsions, followed by stupor and complete loss of
voluntary power.
XXXIII.--TETRACHLORETHANE, ETC.
=Tetrachlorethane= ('Cellon').--Acetylene tetrachloride; vapour has
caused poisoning in aeroplane ('dope') and cinema film works.
_Symptoms._--Gastric symptoms and marked jaundice. This may be followed
in days or weeks by stupor, coma, death.
_Post-Mortem._--Fatty degeneration of internal organs, chiefly liver.
=Trinitrotoluene (T.N.T.).=--An explosive solid which stains the skin an
orange colour; may be absorbed through skin or be inhaled.
_Symptoms._--Shortness of breath, headache, drowsiness. Later, skin
irritation, gastritis, jaundice, blood degeneration.
_Treatment._--Remove from work, rest in bed, diuretics, purgatives,
alkalies.
XXXIV.--ALCOHOL, ETHER, AND CHLOROFORM
Alcohol, ether, and chloroform, induce general anæsthesia, often
preceded by delirious excitement, and followed by nausea and vomiting.
When they cause death, it is by inducing a state like apoplexy or by
paralyzing the heart.
=Alcohol.=--Absolute alcohol is ethyl hydroxide (C_{2}H_{5}OH) with not
more than 1 per cent. by weight of water. Rectified spirit (spiritus
rectificatus) contains 90 per cent. of alcohol. Methylated spirit
consists of rectified spirit with 10 per cent. of wood spirit. Proof
spirit contains a little over 49 per cent. of absolute alcohol; brandy
or whisky, 53 per cent.; port wine, 20 to 25 per cent.; ales and stout,
4 to 6 per cent.
_Symptoms._--Acute poisoning; confusion, giddiness, staggering gait,
headache, passing into stupor, with subnormal temperature, and coma.
Vomiting may occur and recovery ensue, otherwise collapse sets in.
Pupils usually dilated.
Dipsomaniacs suffer from indigestion, vomiting and purging, jaundice,
albuminuria, diabetes, cirrhosis of liver, degeneration of kidneys,
congestion of brain, peripheral neuritis, alcoholic insanity, and
various forms of paralysis. In the acute form delirium tremens is the
most common manifestation.
_Post-Mortem Appearances._--Deep red colour of lining membranes of
stomach. Sometimes congestion of cerebral vessels and meninges. Lungs
congested, blood fluid. Rigor mortis persistent.
_Fatal Dose._--Death from 1/2 pint of gin and from two bottles of port,
but recovery from larger quantities.
_Fatal Period._--Average about twenty-four hours.
_Treatment._--Stomach-tube, cold affusion, electricity, injection of a
pint of hot coffee into the rectum. Give chloride of ammonium in 30
grain doses to prevent delirium; strychnine or digitalin
hypodermically.
_Method of Extraction from the Stomach._--Neutralize the contents of the
stomach, if acid, with sodium carbonate; place them in a retort and
carefully distil. Collect the distillate, mix with chloride of calcium
or anhydrous sulphate of copper, and again distil. Agitate distillate
with dry potassium carbonate, and draw off some of the supernatant fluid
for testing.
_Tests._--Odour. Dissolves camphor. With dilute sulphuric acid and
bichromate of potassium turns green, and evolves aldehyde. Product of
combustion makes lime-water white and turbid.
=Methyl Alcohol: Wood Naphtha.=--Used to produce intoxication by
painters, furniture-polishers, etc.
_Symptoms_ are those of alcoholic poisoning, but vomiting and delirium
are more persistent. Total or partial blindness may follow as a sequel
of optic atrophy. A fatal result not infrequently follows.
The following table gives the points of distinction between concussion
of brain, alcoholic poisoning, and opium poisoning:
CONCUSSION OF BRAIN. ALCOHOL. OPIUM.
1. Marks of violence 1. No marks of violence, 1. As alcohol.
on head. unless person has
fallen. History will
be of use.
2. Stupor, sudden. 2. Excitement precedes 2. Symptoms slow.
sudden stupor. Drowsiness, stupor,
lethargy.
3. Face pale, cold; 3. Face flushed; pupils 3. Face pale; pupils
pupils sluggish, generally dilated. contracted.
sometimes dilated.
4. Remission rare. 4. Partial recovery may 4. Remission rare.
Patient recovers occur, followed by
slowly. death.
5. No odour of alcohol 5. Odour of alcohol 5. Odour of opium in
in breath. in breath. breath.
=Ether= is a volatile liquid prepared from ethylic alcohol by
interaction with sulphuric acid. It contains 92 per cent. of ethyl oxide
(C_{2}H_{5})O. It was formerly called 'sulphuric ether.' It is a
colourless, inflammable liquid, having a strong and characteristic
odour, specific gravity 0.735. =Purified ether= from which the ethylic
alcohol has been removed by washing with distilled water, and most of
the water by subsequent distillation in the presence of calcium chloride
and lime. It is this preparation which is used for the production of
general anæsthesia. It has a specific gravity of 0.722 to 0.720, and its
vapour is very inflammable.
_Symptoms._--When taken as a liquid, same as alcohol. When inhaled as
vapour, causes slow, prolonged, and stertorous breathing; face becomes
pale, lips bluish, surface of body cold. Pulse first quickens, then
slows. Pupils dilated, eyes glassy and fixed, muscles become flabby and
relaxed, profound anæsthesia. Then pulse sinks and coma ensues,
sensation being entirely suspended. Nausea and vomiting not uncommon.
_Post-Mortem Appearances._--Brain and lungs congested. Cavities of heart
full of dark, liquid blood. Vessels at upper part of spinal cord
congested.
_Treatment._--Exposure to pure air, cold affusion, artificial
respiration, galvanism.
_Method of Extraction from the Contents of the Stomach._--Same as for
alcohol. During distillation pass some of the vapour into concentrated
solution of bichromate of potash, nitric and sulphuric acids, and note
reaction as for alcohol.
_Tests._--Vapour burns with smoky flame, depositing carbon. Sparingly
soluble in water. With bichromate of potash and sulphuric acid same as
alcohol.
=Chloroform.=--A colourless liquid, specific gravity 1.490 to 1.495,
very volatile, giving off dense vapour. Sweet taste and pleasant odour.
_Symptoms._--When swallowed, characteristic smell in breath, anxious
countenance, burning pain in the throat, stomach, and region of the
abdomen, staggering gait, coldness of the extremities, vomiting,
insensibility, deepening into coma, with stertorous breathing, dilated
pupils, and imperceptible pulse. When inhaled, much the same as ether,
but produces insensibility and muscular relaxation more rapidly. It
would be impossible to instantly render a person insensible by holding a
pocket-handkerchief saturated with chloroform over the face. Statements
such as this, which are often made in cases of robbery from the person
and in cases of rape, are incredible.
_Delayed Chloroform-Poisoning._--Death may take place in from four to
seven days after chloroform has been administered, especially in the
case of children. The internal organs are found to be fattily
degenerated, and death is thought to be due to acetonuria.
_Post-Mortem Appearances._--Cerebral and pulmonary congestion. Heart
empty, or right side distended with dark blood.
_Treatment._--Stomach-tube and free lavage; cold affusion; drawing
forward tongue; artificial respiration; galvanism and suspension with
head downward. Inhalation of nitrite of amyl; strychnine hypodermically.
_Fatal Dose._--When swallowed, from 1 to 2 ounces.
_Method of Extraction from the Stomach._--By distillation at 120° F. The
vapour, as it passes along a glass tube, may be decomposed by heat into
chlorine, hydrochloric acid, and carbon--the first shown by setting free
iodine in iodide of starch, the second by reddening blue litmus-paper,
and the last by its deposit.
_Tests._--Taste, colour, weight; burns with a green flame; dissolves
camphor, guttapercha, and caoutchouc.
=Iodoform.=--Poisoning may result from its use in surgery. It produces
delirium, sleepiness, and coma. It may lead to mental weakness or optic
neuritis.
XXXV.--CHLORAL HYDRATE
It was formerly largely used as a hypnotic, and many fatal consequences
ensued. It is prepared from alcohol and chlorine.
_Symptoms._--Deep sleep, loss of muscular power, diminished or abolished
reflex action and sensibility, followed by loss of consciousness and
marked fall of temperature. Pulse may become quick, and face flushed or
livid and bloated. Prolonged use of this drug may produce a peculiar
eruption on the skin. Supposed to act in the blood by being decomposed
into chloroform and sodium formate. Its effects are due chiefly to
depression of the central nervous system, the medulla being the last
part of the nervous system to be attacked.
_Method of Extraction from the Stomach._--By distillation in strongly
alkaline solutions, when it may be obtained as chloroform and tested as
such.
_Treatment._--Stomach-tube or emetic. Hypodermic injections of
strychnine. Keep patient warm, and inject a pint of hot strong coffee
into the rectum. Nitrite of amyl and artificial respiration.
_Tests._--Heated with caustic potash, it yields chloroform and potassium
formate. The chloroform is readily recognized by its odour, and, if the
solution be concentrated, by separating as a heavy layer at the bottom
of the test-tube.
XXXVI.--PETROLEUM AND PARAFFIN-OIL
Cases of poisoning by petroleum and paraffin are common, and occur
chiefly in children.
=Petroleum= is a natural product, and is a mixture of the higher
saturated hydrocarbons. The crude petroleum is purified by distillation,
and is then free from colour, but retains its peculiar penetrating
odour. Different varieties are sold under the names of cymogene,
gasolene, naphtha, petrol, and benzoline. Benzoline is highly
inflammable, and is often called mineral naphtha, petroleum naphtha, and
petroleum spirit. Benzoline is not the same as benzene or benzol, which
is one of the products of the dry distillation of coal.
From its very general use as a fuel in motor-cars many accidents have
happened from inhaling the vapour of petrol. It gives rise to coldness,
shallow respiration, syncope, and insensibility, but seldom death.
=Paraffin=, also known as kerosene and mineral oil, is a mixture of
saturated hydrocarbons obtained by the distillation of shale.
By the retailer the terms 'petroleum' and 'paraffin' oil are used
indifferently, and each is sold for the other without prejudice.
_Symptoms._--These substances are not very active poisons, and, as a
rule, even children recover. The breath has the odour of paraffin, the
face is pale and cyanotic, hot and dry, and there may be vomiting. Death
may result from gastro-enteritis or from coma.
_Fatal Dose._--In the case of an adult, 1/2 pint should not prove
lethal, and patients have recovered after drinking a pint.
_Treatment._--Emetics, purgatives, and stimulants.
XXXVII.--ANTIPYRINE, ANTIFEBRIN, PHENACETIN, AND ANILINE
Many of the synthetical coal-tar products now so largely employed as
analgesics are powerful toxic agents.
=Phenazone, Antipyrine, or Analgesin=, is a complex benzene derivative
prepared from aniline, aceto-acetic ether, and methyl iodide. It is in
colourless, inodorous, scaly crystals, which have a bitter taste. It is
soluble in its own weight of water.
_Tests._--Can be extracted from an alkaline solution of chloroform. The
residue left on the evaporation of chloroform should be employed for
testing. If heated with strong nitric acid and allowed to cool, a purple
colour is produced. Ferric chloride gives a blood-red coloration,
destroyed by the addition of mineral acids.
_Treatment._--Stimulants freely, inhalation of oxygen, patient to be
kept in the recumbent position.
=Acetanilide, Antifebrin, Phenylacetamide= (a constituent of 'Daisy' or
'headache' powders), is obtained by the interaction of acetic acid and
aniline. It is in colourless, inodorous, lamellar crystals, which have a
slight pungent taste. It is insoluble in water.
_Tests._--May be extracted from acid solutions by ether or chloroform.
If heated with solution of potassium hydroxide, odour of aniline is
given off; if liquid, when it is warmed with a few drops of chloroform,
a penetrating and unpleasant odour of isocyanide.
_Treatment._--Emetics, stimulants, inhalation of ether, recumbent
position.
=Phenacetin, Phenacetinum=, is produced by the interaction of glacial
acetic acid and para-phenetidin. It is in white, tasteless, inodorous,
glistening, scaly crystals, insoluble in water. Of all the members of
the group, it most rarely produces toxic symptoms.
_Treatment._--As for the other members of this group.
=Exalgin, Aspirin, etc.=, as well as the above, may all act as poisons
to certain persons, and even small medicinal doses may cause serious and
even fatal consequences.
_Symptoms_ (more or less common to all).--Nausea, vomiting, hurried
respiration, marked cyanosis, syncope. Persistent sneezing and
widespread urticaria may be present; collapse.
=Aniline= is an oily liquid, heavier than, and not soluble in, water. It
is colourless or reddish-brown; it has a peculiar tar-like odour; it is
soluble in alcohol, and forms a soluble sulphate with sulphuric acid. A
solution of bleaching-powder gives with solution of the sulphate a
purple colour changing to red-brown.
_Symptoms._--Nausea, vomiting, giddiness, intoxication, drowsiness,
gasping for breath, feeble pulse, and marked cyanosis. In its
_industrial use_ it may act as a poison either by inhalation of the
fumes or by absorption through the skin. The symptoms then are mainly
those of peripheral neuritis with blindness.
_Fatal Dose._--About 6 drachms.
_Treatment._--Wash out stomach; stimulants, artificial respiration,
inhalation of oxygen, transfusion.
=Nitro-benzol= (Artificial Oil of Bitter Almonds).--It is used in
perfumery, but is very poisonous when swallowed, or inhaled, or absorbed
through skin. It is used in the manufacture of aniline dyes, and may act
as an industrial poison. The symptoms closely resemble those of aniline
poisoning, but there is perhaps greater mental confusion.
_Fatal Dose._--Eight to ten drops have caused death.
_Treatment._--Emetics, stimulants, transfusion of saline or blood,
pituitrin, strychnine, or digitalin hypodermically.
=Nitroglycerine= gives rise to intense and persistent headache ('powder
headache'). Throbbing and pulsation of all the arteries in the body;
flushing of the face and collapse may follow.
=Dinitrobenzene= causes symptoms resembling nitro-benzol poisoning, and
when acting as a chronic poison gives rise to weakness, jaundice,
peripheral neuritis.
XXXVIII.--SULPHONAL, TRIONAL, TETRONAL, VERONAL, PARALDEHYDE
These are dangerous drugs. The ordinary _symptoms_ of the group are
noises in the ears, headache, vertigo, inability to stand or to walk
properly, insensibility, and cyanosis.
The most interesting point is the condition of the urine. In cases of
poisoning it is dark or reddish-brown in colour, due to the presence of
_hæmatoporphyrin_. It contains albumin and casts, but no red corpuscles.
In cases of hæmatoporphyrinuria the prognosis is bad, and it is said
that these cases invariably end fatally.
_Treatment._--In an ordinary case emetics, strong coffee, hypodermic
injections of strychnine, saline injections, and transfusion.
Cases of chronic poisoning from the 'als' are not uncommon, and are
increasing in frequency. Hypnogen is apparently identical with veronal.
All the above-named aniline derivatives are included in Part I. of the
scheduled poisons.
XXXIX.--CONIUM AND CALABAR BEAN
=Conium Maculatum= (Spotted Hemlock).--All parts of the plant are
poisonous, often mistaken for parsley. Contains the poisonous principle
_coniine_, a volatile liquid alkaloid with a mousy smell; insoluble in
water; soluble in alcohol, ether, and chloroform. It also contains
methyl coniine.
_Symptoms._--Dryness of throat, headache, dilated pupil, dysphagia, loss
of muscular power, passing into complete paralysis. Delirium, coma, and
convulsions, occasionally.
_Post-Mortem Appearances._--Congested brain and lungs; redness of the
mucous membrane of the stomach. The stomach and intestines should be
examined for fragments of the leaves and fruit, recognized by their
microscopical appearances.
_Treatment._--Emetics, tannic acid or gallic acid. Diffusible
stimulants.
_Method of Extraction from the Stomach._--Use Stas-Otto process.
_Tests._--The mousy odour. Deepened colour and dense white fumes with
nitric acid. Pale red, deepening, with hydrochloric acid.
There are several other umbelliferous plants which are poisonous. The
water hemlock (_Cicuta virosa_) produces symptoms not unlike those of
hemlock; it has been mistaken for parsnip and celery. It contains an
active principle, _cicutoxin_, which in some respects is allied to
strychnine and picrotoxin. The fool's parsley, or lesser hemlock
(_Æthusa cynapium_), is another member of this group, although doubt has
been expressed as to whether it is really poisonous. The water dropwort
(_Oenanthe crocata_) is undoubtedly poisonous, especially to cattle. In
man it produces abdominal pain with diarrhoea and vomiting; dilated
pupils, slow pulse, and cyanosis; delirium, insensibility, and
convulsions. The post-mortem appearances are not characteristic, but the
stomach and intestines should be examined for portions of the plant.
=Calabar Bean or Physostigma.=--The bean of _Physostigma venenosum_
contains the alkaloid physostigmine or eserine, with the antagonistic
alkaloid calabarine.
_Symptoms._--Vomiting, giddiness, irregular cardiac action, contraction
of the pupils, paralysis of lower extremities, and death from asphyxia.
_Treatment._--Emetics; hypodermic injection of 1/50 grain sulphate of
atropine, repeated if necessary.
_Method of Extraction from the Stomach._--Use Stas-Otto process.
_Test._--The contraction of the pupil which it causes.
XL.--TOBACCO AND LOBELIA
=Tobacco.=--_Nicotiana tabacum_ owes its poisonous properties to its
alkaloid nicotine, a volatile, oily, amber-coloured liquid, with an
acrid taste and ethereal odour; soluble in water, alcohol, ether, and
chloroform. The drug has an intense depressant action on the heart and
respiratory centre.
_Symptoms._--Giddiness, fainting, nausea, and vomiting, with syncope,
muscular tremors, stupor, stertorous breathing, and insensible pupil.
Death has occurred after seventeen or eighteen pipes at a sitting.
_Post-Mortem Appearances._--Not uniform or characteristic. General
relaxed condition of muscles; engorgement of cerebral and pulmonary
vessels. Congestion of gastric mucous membrane.
_Treatment._--Emetics, stimulants, hypodermic injection of 1/25 grain of
strychnine. Warmth to the surface by hot bottles, hot blankets.
_Method of Extraction from the Stomach._--Digest the contents of the
stomach in cold distilled water and _very dilute_ sulphuric acid;
strain, filter, and press residue. Evaporate the filtrate to half its
bulk, digest with alcohol, and evaporate alcohol off in a water-bath.
Dissolve residue (sulphate of nicotine) in water, and make solution
alkaline with potash; then shake with ether in a test-tube. Remove ether
and allow it slowly to evaporate. Test resulting alkaloid.
_Tests._--No change of colour with the mineral acids. White deposit with
corrosive sublimate. Sulphuric acid and bichromate of potassium give a
green colour, oxide of chromium. Precipitate with bichloride of platinum
and with carbazotic acid.
=Lobelia Inflata= (Indian Tobacco).--Much used in America by the
Coffenite practitioners, and a valuable remedy for asthma.
_Symptoms._--Nausea, vomiting, giddiness, cold sweats, prostration.
Headache, giddiness, tremors, insensibility, and convulsions.
XLI.--HYDROCYANIC ACID
=Prussic Acid= is the most active of poisons. The diluted hydrocyanic
acid of the Pharmacopoeia contains 2 per cent. of hydrocyanic acid,
Scheele's 4 per cent. It is a colourless liquid, feebly acid, with
odour of bitter almonds.
=Cyanide of Potassium= is largely used in photography and in
electro-plating, and is also poisonous. It often contains undecomposed
carbonate of potassium, which may act as a corrosive poison and cause
erosion of the mucous membranes of the lips, mouth, and stomach.
=Oil of Bitter Almonds=, used as a flavouring agent, may contain (when
improperly prepared) from 5 to 15 per cent. of the anhydrous acid.
_Symptoms._--The symptoms usually come on in a few seconds, and are of
the shortest possible duration. There is a sudden gasp for breath,
possibly a loud cry, and the patient drops down dead. If the fatal
termination is prolonged for a few minutes, the symptoms are intense
giddiness, pallor of the skin, dilatation of the pupils, laboured and
irregular breathing, small and frequent pulse, followed by
insensibility. There may be convulsions or tetanic spasms, with
evacuation of urine and fæces. Death results from paralysis of the
central nervous system, but artificial respiration is useless, as the
drug promptly arrests the heart's action. It also kills the protoplasm
of the red blood-corpuscles, rendering them useless as oxygen-carriers.
_Post-Mortem Appearances._--Skin livid, pale, or violet, with bright red
patches on the dependent parts. The gastro-intestinal mucous membrane is
bright red in colour, owing to the presence of cyanmethæmoglobin. Hands
clenched, nails blue, jaws fixed, froth about mouth. Eyes prominent and
glistening, odour of acid from body, venous system gorged.
_Treatment._--Empty the stomach by the tube at once, and wash it out
with a solution of sodium thiosulphate. Strong ammonia to the nostrils.
Stimulants freely--brandy, chloric ether, ammonia, sal volatile _ad
libitum_. If patient cannot swallow, inject hypodermically either brandy
or ether. Hypodermic injection of 1/50 grain atropine. Douche to the
face, alternately hot and cold. Death commonly occurs so rapidly that
there is no time for treatment.
_Fatal Dose (Smallest)._--Half a drachm of the B.P. acid, equal to 0.6
grain of the anhydrous. _Recovery_ from 1/2 ounce of the B.P. acid.
These records are fallacious, for in specimens the percentage of
anhydrous acid varies enormously. Practically, 1 grain of the anhydrous
acid is fatal.
_Fatal Period._--From two to five minutes after a large dose, but may be
less.
_Method of Extraction from the Stomach._--Having previously carefully
fitted a watchglass to a wide-mouthed bottle, nearly fill the bottle
with the contents of the stomach, blood, secretions, etc. Place a few
drops of a solution of nitrate of silver on the concave surface of the
watchglass, and cover the mouth of the bottle with it. The vapour of
hydrocyanic acid, if present, will form a white precipitate which may be
tested. Other watchglasses, treated with sulphide of ammonium or
sulphate of iron and liquor potassæ, will give the reactions of the acid
with appropriate tests. This method removes all objections as to foreign
admixture. If the acid is not at first detected, gentle warming of the
bottle in a water-bath will assist the evolution of the vapour. The
vapour may be obtained by distillation, but this process is open to
objections to which the other is not. In some cases it becomes changed
in the body into formic acid, which should therefore be sought for.
_Tests._--With nitrate of silver a white precipitate, insoluble in cold,
but soluble in boiling, nitric acid. The precipitate heated, evolves
cyanogen, having an odour of peach-blossoms, and burning, when lighted,
with a pink flame. Liquor potassæ and sulphate of iron give a
brownish-green precipitate, which turns to Prussian blue with
hydrochloric acid. Liquor potassæ and sulphate of copper give a
greenish-white precipitate, becoming white with hydrochloric acid.
Sulphide of ammonium gives sulpho-cyanide of ammonium. This develops a
blood-red colour with perchloride of iron, bleached by corrosive
sublimate.
XLII.--ACONITE
=Aconite= (_Aconitum Napellus_, monkshood).--Root and leaves. Poisonous
property depends upon an alkaloid, aconitine. Aconite is one of the
constituents of St. Jacob's Oil.
_Symptoms._--Numbness and tingling in mouth, throat, and stomach,
giddiness, loss of sensation, deafness, dimness of sight, paralysis,
first of the lower and then of the upper extremities, vomiting, and
shallow respiration. Pupils dilated. Pulse small, irregular, finally
imperceptible. The mind remains unaffected. Death often sudden.
_Post-Mortem Appearances._--Venous congestion, engorgement of brain and
membranes.
_Treatment._--Emetics, stimulants freely. Best antidote is sulphate of
atropine, 1/50 grain hypodermically, and also strychnine. Digitalis also
useful. Warmth to whole body. Patient to make no exertion.
_Fatal Dose._--Of root or tincture, 1 drachm.
_Fatal Period._--Average, less than four hours.
_Method of Extraction from the Stomach, etc._--Extraction from contents
of stomach by Stas-Otto process. It may be found in the urine; gives
usual alkaloidal reactions, but no distinctive chemical test known.
_Tests._--Chiefly physiological; tingling and numbness when applied to
tongue or inner surface of cheek. Effects on mice, etc. A cadaveric
alkaloid or ptomaine has been found in the body, possessing many of the
actions of aconitine. The presence of this substance was suggested in
the Lamson trial.
The Indian aconite, _Aconitum ferox_, the Bish poison, is much more
active than the European variety. It contains a large proportion of
pseudaconitine, and is frequently employed in India, not only for the
destruction of wild beasts, but for criminal purposes.
=Aconitine= varies much in activity according to its mode of preparation
and the source from which it is derived. The most active kind is
probably made from _A. ferox_.
XLIII.--DIGITALIS
All parts of the plant _Digitalis purpurea_ (purple foxglove) are
poisonous. Contains the glucoside digitalin and other active principles.
_Symptoms._--Nausea, vomiting, purging, and abdominal pains. Vomited
matter grass-green in colour. Headache, giddiness, and loss of sight;
pupils dilated, insensitive; pulse weak, remarkably slow and irregular;
cold sweat. Salivation occasionally, or syncope and stupor. Death
sometimes quite suddenly.
_Post-Mortem Appearances._--Congested condition of brain and membranes;
inflammation of gastric mucous membrane.
_Treatment._--Emetics freely; infusions containing tannin, as coffee,
tea, oak-bark, galls, etc. Stimulants. Hypodermic injection of 1/120
grain of aconitine.
_Method of Extraction from the Stomach, etc._--Use Stas-Otto process.
_Tests for Digitalin._--A white substance, sparingly soluble in water,
not changed by nitric acid; turns yellow, changing to green, with
hydrochloric acid. The minutest trace of digitalin moistened with
sulphuric and treated with bromine vapour gives a rose colour, turning
to mauve. This is very delicate, but in experienced hands the
physiological test is more reliable. The chemist who has had no
practical experience in pharmacological methods would be wiser to keep
to his chemical tests.
XLIV.--NUX VOMICA, STRYCHNINE, AND BRUCINE
=Nux Vomica= consists of the seeds of the _Strychnos nux vomica_. From
these strychnine and brucine are obtained. The symptoms, post-mortem
appearances, and treatment, of poisoning by nux vomica are the same as
for strychnine.
=Strychnine= is a powerful poison, and forms the active ingredient of
many 'vermin-killers.' It occurs as a white powder or as colourless
crystals, with a persistent bitter taste; very slightly soluble in
water; more or less soluble in benzol, ether, and alcohol.
_Symptoms._--Sense of suffocation, twitchings of muscles, followed by
tetanic convulsions and opisthotonos, each lasting half to two minutes.
Mental faculties unaffected, face congested and anxious; eyes staring,
lips livid; much thirst. The period of accession of the symptoms varies
with the mode of administration of the poison. Symptoms, as a rule, come
on soon after food has been taken. Patient may die within a few hours
from asphyxia or from exhaustion.
In _Tetanus_ there is usually history of a wound; the symptoms come on
slowly; lockjaw is an early symptom, and only later complete
convulsions; the intervals between the fits are never entirely free from
rigidity. Death is delayed for some days.
_Post-Mortem Appearances._--Heart empty, blood fluid, rigor mortis
persistent. Hands usually clenched; feet arched and inverted. Congestion
of brain, spinal cord, and lungs.
_Treatment._--Emetics or stomach-pump if the patient is deeply
anæsthetized. Tannic acid and permanganate of potassium. Bromide of
potassium 1/2 ounce with chloral 30 grains, repeated if necessary.
_Fatal Dose (Smallest)._--Quarter of a grain.
_Fatal Period (Shortest)._--Ten minutes; usually two to four hours.
_Method of Extraction from the Stomach._--The alkaloid may be separated
by the process of Stas-Otto.
_Tests._--Strychnine has a characteristic, very bitter taste; it imparts
this taste to even very dilute solutions; it is unaffected by sulphuric
acid, but gives a purple-blue colour, changing to crimson and light red,
when the edge of this solution is touched with dioxide of manganese,
potassium bichromate, ferricyanide of potassium, or permanganate of
potassium. This test is so delicate as to show the 1/25000 of a grain of
the alkaloid. A very minute quantity (1/5000 grain) in solution placed
on the skin of a frog after drying causes tetanic convulsions.
=Brucine.=--This alkaloid, found associated with strychnine, possesses
the same properties, though in a less powerful degree. Nitric acid gives
a blood-red colour, changed to purple with protochloride of tin.
XLV.--CANTHARIDES
=Cantharides.=--Spanish fly, or blistering beetle, is the basis of most
of the blistering preparations. It is sometimes taken as an
abortifacient or given as an aphrodisiac, but whether it has any such
action is open to question. It acts as an irritant to the kidneys and
bladder, and sometimes produces haæmaturia and a good deal of temporary
discomfort.
_Symptoms._--Burning sensation in the throat and stomach, with
salivation, pain and difficulty in swallowing. Vomiting of mucus mixed
with blood. Tenesmus, diarrhoea, the motions containing blood and mucus.
Dysuria, with passage of small amounts of albuminous and bloody urine.
Peritonitis, high temperature, quick pulse, headache, loss of
sensibility, and convulsions.
_Post-Mortem._--Gastro-intestinal mucous membrane inflamed, with
gangrenous patches. Genito-urinary tract inflamed. Acute nephritis.
_Treatment._--An emetic of apomorphine; demulcent drinks, such as
barley-water, white of egg and water, linseed-tea and gruel (but not
oils), with a hypodermic injection of morphine to allay pain.
_Tests._--The vomited matter often contains shining particles of the
powder. The urine will probably be albuminous.
XLVI.--ABORTIFACIENTS
Emmenagogues are remedies which have the property of exciting the
catamenial flow; ecbolics, or abortives, are drugs which excite
contraction of the uterus, and are supposed to have the power of
expelling its contents. The vegetable substances commonly reputed to be
abortives are ergot, savin, aloes (Hierapicra), digitalis, colocynth,
pennyroyal, and nutmeg; but _there is no evidence to show that any drug
possesses this property_. Lead in some parts of the country is a popular
abortifacient. A medicine may be an emmenagogue without being an
ecbolic. Permanganate of potassium and binoxide of manganese are
valuable remedies for amenorrhoea, but will not produce abortion. The
vegetable substances frequently used as abortives are savin and ergot.
=Savin= (_Juniperus Sabina_).--Leaves and tops of the plant yield an
acrid oil having poisonous properties, and which has even produced
death.
_Symptoms._--Those of irritant poisons. Purging not always present, but
tenesmus and strangury.
_Post-Mortem Appearances._--Acute inflammation of alimentary canal.
Green powder found. This, washed and dried and then rubbed, gives odour
of savin.
_Test._--A watery solution of savin strikes deep green with perchloride
of iron, and if an infusion of the twigs has been taken the twigs may be
detected with the microscope. The twigs obtained from the stomach, dried
and rubbed between the finger and thumb, will give the odour of savin.
=Ergot= (_Secale Cornutum_).--A parasitic fungus attacking wheat,
barley, oats, and rye, which is reputed to have the power of causing
contraction of unstriped muscular fibre, especially that of the uterus.
_Symptoms._--Lassitude, headache, nausea, diarrhoea, anuria,
convulsions, coma. Small quantities frequently repeated have in the past
produced gangrene of the extremities, or anæsthesia of fingers and toes.
_Tests._--Lake-red colour with liquor potassæ; this liquid filtered
gives a precipitate of same colour with nitric acid.
XLVII.--POISONOUS FUNGI AND TOXIC FOODS
=Fungi.=--Of the poisonous mushrooms, the _Amanita phalloides_ and the
fly agaric, or _Agaricus muscarius_, are the most potent. The active
principle of the former is _phallin_, and of the latter _muscarine_. The
_Amanita phalloides_ is distinguished from the common mushroom
(_Agaricus campestris_) by having permanent white gills and a hollow
stem. The _Agaricus muscarius_ is bright red with yellow spots. Phallin
is a toxalbumin which destroys the red blood-corpuscles, causing the
serum to become red in colour and the urine blood-stained. Fibrin is
liberated, and thromboses occur, especially in the liver. The symptoms
may be mistaken for phosphorus-poisoning or acute yellow atrophy of the
liver. Muscarine affects the nervous system chiefly.
_Edible fungi_ have an agreeable taste and smell, and are firm in
substance. _Poisonous fungi_ have an offensive smell and bitter taste,
are often of a bright colour, and soon become pulpy.
_Symptoms._--These may be of the narcotic or irritant types. Usually,
however, there is violent colic, with thirst, vomiting, and diarrhoea,
mental excitement, followed by delirium, convulsions, coma, slow pulse,
stertorous breathing, cyanosis, cold extremities, and dilated pupils.
_Post-Mortem._--In phallin-poisoning the blood remains fluid; numerous
hæmorrhages are present, with fatty degeneration of the internal organs.
_Treatment._--Use the stomach-tube to give a solution of permanganate of
potash, emetics, followed by a hypodermic injection of 1/50 grain of
atropine. Transfusion of saline fluid. A dose of castor-oil would be
useful.
=Foods.=--The kinds of food which most frequently produce symptoms of
poisoning are pork, veal, beef, meat-pies, potted and tinned meats,
sausages, and brawn. Sausage-poisoning is common in Germany. It is not
necessary that the food should be 'high' to give rise to poisoning. It
may arise from the use of the flesh of an animal suffering from some
disease, from inoculation with micro-organisms, or from the presence of
toxalbumoses or ptomaines. Many diseases, such as diarrhoea, enteric
fever, and cholera, and perhaps tuberculosis, may be caused by eating
infected food. Trichiniasis may also be mentioned. Tinned fish often
gives rise to symptoms of poisoning, and shell-fish are not uncommonly
contaminated with pathogenic micro-organisms. Mussel-poisoning was
formerly supposed to be due to the copper in them derived from ships'
bottoms, but it is more probably the result of the formation of a toxine
during life, and not after decomposition has set in. Milk, too, may give
rise to gastro-intestinal irritation from the occurrence in it of
chemical changes. There have been epidemics of poisoning from eating
cheese containing _tyrotoxicon_. Ergotism from eating bread made with
ergotized wheat is now rare, but _pellagra_ from the consumption of
mouldy maize, and _lathyrism_, due to the admixture with flour of the
seeds of certain kinds of vetch, are still common in Southern Europe.
_Symptoms._--The symptoms which result from the ingestion of poisonous
meat are often very severe. In some cases their appearance is delayed
from twenty-four to forty-eight hours. They may resemble those of an
infectious disease or those of acute enteritis. Usually there are
headache, anorexia, rigors, intestinal disturbance, pains in the back
and limbs, and delirium. Sometimes the symptoms resemble
atropine-poisoning, a condition due to ptomatropine.
_Treatment._--Emetics, purgatives, stimulants, with hypodermic
injections of strychnine and atropine along with stimulants.
XLVIII.--PTOMAINES OR CADAVERIC ALKALOIDS
Every medical man, before presenting himself to give evidence in a case
of suspected poisoning, should make himself thoroughly acquainted with
recent researches on the subject. Ptomaines are, for the most part,
alkaloids generated during the process of putrefaction, and they closely
resemble many of the vegetable alkaloids--veratrine, morphine, and
codeine, for example--not only in chemical characters, but in
physiological properties. They are probably allied to neurine, an
alkaloid obtained from the brain and also from the bile. Some of them
are analogous in action to muscarine, the active principle of the fly
fungus. Some are proteids, albumins, and globulins. Ptomaines may be
produced abundantly in animal substances which, after exposure under
insanitary conditions, have been excluded from the air. Ptomaines or
toxalbumins are sometimes found in potted meats and sausages, and are
due to organisms--the _Bacillus botulinus_, the _B. enteritidis_ of
Gärtner, the _B. proteus vulgaris_, or the _B. ærtrycke_ (which is
perhaps the most common of all). The symptoms produced by the latter are
usually vomiting, abdominal pain, pains in the limbs and cramps,
diarrhoea, vertigo, coldness, faintness, and collapse. The symptoms of
_botulism_ are dryness of skin and mucous membranes, dilatation of
pupils, paralysis of muscles, diplopia, etc. Articles of food most often
associated with poisoning are pork, ham, bacon, veal, baked meat-pie,
milk, cheese, mussels, tinned meats.
In a case of suspected poisoning, counsel for the defence, if he knows
his work, will probably cross-examine the medical expert on this
subject, and endeavour to elicit an admission that the reactions which
have been attributed to a poison may possibly be accounted for on the
theory of the formation of a ptomaine. There is practically no
counter-move to this form of attack.
INDEX
Abdomen, injuries of, 29
Abortifacients, 147
Abortion, criminal, 42
Acetanilide, 136
Acetate of lead, 116
Aconite, 143
Adipocere, 18
Adultery, 62
Age, determination of, 12
Alcohol, 130
Alcoholic insanity, 76
Alkaloids, 93
Alum, 103
Ammonia, 102
Anæsthetics, death from, 19
Aniline, 136
Antifebrin, 136
Antimony, 112
Antipyrine, 135
Aqua fortis, 97
Arsenic, 107
Arsenious acid, 107
Artificial oil of bitter almonds, 137
Arum, 124
Asphyxia, 13
Assaults, 21
Assizes, 7
Atropine, 127
Barberio's test, 58
Barium salts, 104
Belladonna, 127
Bestiality, 59
Bichromate of potassium, 119
Bismuth, 119
Blackmailing, 60
Bladder, injuries of, 30
Blood-stains, 30
Born in wedlock, 52
Botulism, 151
Brain, injuries to, 26
Breslau's life test, 49
Brucine, 146
Bruises, 22
Bullet wounds, 24
Burnett's fluid, 119
Burns, 22
Cadaveric alkaloids, 150
rigidity, 17
Calabar bean, 139
Camphor, 129
Cantharides, 146
Carbolic acid, 100
Carbonic acid gas, 120
oxide, 121
Carnal knowledge, 55
Cellon, 129
Chemical analysis, 91
Chest injuries, 28
Chloral, 134
Chlorate of potassium, 103
Chloride of zinc, 119
Chlorine, 122
Chloroform, 19, 132
Choke-damp, 121
Chromium, 119
Chronic lead-poisoning, 117
Clothing, fibres of, 34
Coal-gas, 121
Cocaine, 128
Cocculus indicus, 129
Cold, death from, 39
Coma, 14
Common witness, 2
Concealment of birth, 45
of pregnancy, 45
Conium, 138
Contused wounds, 24
Cooling, rate of, 16
Copper, 117
Coroners, 4
Coroner's court, 4
Corrosive sublimate, 113
Corrosives, 86
Cretinism, 69
Crimes, 1
Criminal abortion, 42
Criminal Appeal Court, 8
courts, 7
Cross-examination, 3
Crown Court of Assize, 7
Culpable homicide, 21
Cut throat, 28
Dangerous Drugs Bill, 82
Death in the foetus, 50
signs of, 16
Delivery, 41
Dementia, 70
Depositions, 6
Determination of sex, 11
Diachylon pills, 117
Diaphragm, wounds of, 29
Digitalis, 144
Dinitrobenzene, 137
Divorce, 60
"Dope," 129
Drowning, 36
Duration of pregnancy, 50
Dyeing of hair, 11
Dying declarations, 10
Ecchymosis, 22
Electricity, 38
Epilepsy, 65, 75
Ergot, 148
Ether, 132
Evidence, giving of, 2
Examination-in-chief, 3
Experiments on animals, 85
Experts, 2
Eye injuries, 27
Face injuries, 27
Feeble-minded, 69
Fees for medical witness, 5, 7
Feigned diseases, 63
Felony, 1
Ferro-silicon, 111
Finger prints, 11
Florence's test, 58
Foeticide, 42
Foods, poisonous, 150
Found dead, 5
Fruit stains, 33
Fungi, 148
Gaseous poisons, 120
General paralysis, 71
Genital organs, wounds of, 30
Grand jury, 8
Gunshot wounds, 24
Hæmin crystals, 32
Hair, detection of, 33
dyeing of, 11
Hanging, 35
Head injuries, 26
Heart, injuries of, 29
Heat, death from, 39
Hemlock, 138
Henbane, 128
Homicide, 21
Hydrochloric acid, 98
gas, 122
Hydrocyanic acid, 140
Hyoscyamus, 128
Hypostasis, 16
Identification of dead, 12
Identity, personal, 10
Idiocy, 68
Imbecility, 69
Impotence, 54
Incest, 59
Incised wounds, 23
Indecent assault, 57
Indictable offences, 2
Inebriates Act, 78
Infanticide, 44
Inheritance, 54
Injuries, 21
Insanity, 67-76
Intestines, wounds of, 30
Iodide of potassium, 104
Iodine, 104
Irritants, 87
gases, 122
vegetable, 123
Judicial separation, 62
Jury, coroner's, 4
Kidney, injuries of, 30
Kleptomania, 73
Laborde's method, 37
Laburnum, 123
Lacerated wounds, 24
Lead, 116
Lee-Metford bullet, 24
Legitimacy, 52
Lightning, 38
Live-birth, 44-46
Liver, injuries of, 29
Lobelia, 140
Lucid intervals, 73
Lumbago, 66
Lunacy, 67
certification, 77
Lungs, injuries of, 29
evidences of live-birth from, 47
Magistrate's court, 7
Malingering, 63
Malpractice, 20
Malum regimen, 21
Mania, 71
Manslaughter, 21
Marriage, 60
Marsh's process, 110
Martini-Henry bullet, 25
Maturity of infant, 45
Mauser bullet, 25
Medical evidence, 2
Mentally deficients, 70
Mercury salts, 113
Methyl alcohol, 131
Mineral acids, 94
Misdemeanour, 1
Monkshood, 143
Monomania, 72
Morphine, 127
Murder, 21
Muriatic acid, 98
Naphtha, 135
Nitrate of silver, 119
Nitric acid, 95
Nitro-benzol, 137
Notes, 9
Nux vomica, 145
Oaths Act, 9
Oil of bitter almonds, 141
Opium, 124
Oxalate of potash, 99
Oxalic acid, 98
Paraffin oil, 135
Paranoia, 73
Personal identity, 10
Petroleum, 134
Petty Sessions, 7
Phenacetin, 136
Phenol, 100
Phosphorus, 105
Phossy-jaw, 106
Physostigma, 139
Picrotoxin, 129
Poison, definition of, 80
Poisonous foods, 149
Poisons acting on the brain, 88
classification of, 84
detection of, 91
evidence, 85
scheduled, 81
symptoms and post-mortem appearances, 86
treatment of, 90
Potash, 101
Precipitin test for blood, 33
Pregnancy, 40, 50
insanity of, 73
Presumption of death, 20
survivorship, 21
Primula, 124
Privilege, 8
Procurator Fiscal, 7
Prussic acid, 140
Ptomaines, 150
Puerperal mania, 73
Punctured wounds, 23
Purgatives, 123
Putrefaction, 18
Quarter Sessions, 7
Railway spine, 27
Rape, 55
Reception orders, 77
Rectified spirit, 130
Re-examination, 3
Reinsch's process, 110
Reports, medical, 9
Responsibility, 76
Resuscitation, 36
Rhus, 124
Rigor mortis, 17
Rust stains, 33
Sale of arsenic, 111
Saponification, 18
Satyriasis, 73
Savin, 147
Scars, 11
Schiller's method of resuscitation, 36
Scheduled poisons, 81
Scotch oath, 9
Secrets, professional, 8
Self-inflicted wounds, 24
Seminal stains, 58
Sewer-gas, 122
Sex, determination of, 11
Signs of death, 16
Silver, 118
Skin diseases, 66
Soda, 101
Sodomy, 59
Spanish-fly, 146
Spectroscopic examination of blood, 32
Spinal cord injuries, 27
Spleen, injuries of, 29
Staining, post-mortem, 16
Starvation, 38
Stas-Otto process, 92
Status lymphaticus, 15
Sterility, 54
Stomach, injuries of, 29
Stramonium, 128
Strangulation, 35
Strychnine, 145
Sudden death, 13, 15
Suffocation, 34
Sugar of lead, 116
Sulphonal, 137
Sulphuretted hydrogen, 122
Sulphuric acid, 95
Sulphurous acid gas, 122
Summary offences, 2
Sunstroke, 39
Superfoetation, 53
Syncope, 13
Tartar emetic, 112
Tattoo marks, 10
Teichman's crystals, 32
Tetanus, 145
Tetrachlorethane, 129
Tetronal, 137
Throat injuries, 28
Tobacco, 139
Treason, 1
Trinitrotoluene, 129
Trional, 137
True bill, 8
Undue influence, 74
Unnatural offences, 59
Unsound mind, 67
Veronal, 137
Viability, 51
Vitriol, 95
Voidable marriage, 63
Witnesses, 2
Wounds, 21
Yew, 124
Zinc, 118
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