OF THE NARCOTIC RANUNCULACEÆ.
The greater part of the poisons belonging to the Natural Family
_Ranunculaceæ_ are acrid only in their action, and have been already
taken notice of among the irritants. Two only are yet known to possess
narcotic properties, namely, _monkshood_, and _black hellebore_. The
latter is a true narcotico-acrid. The former has till lately been always
considered so; but its acrid properties seem doubtful or feeble, while
its action on the nervous system is most intense.
_Of Poisoning with Monkshood._
Monkshood, the _Aconitum napellus_ of botanists, is an active poison,
and has commonly been considered a true narcotico-acrid. But its effects
have been hitherto much misunderstood. It has been used for criminal
purposes in Ireland; and in 1841, a woman, M’Conkey, who was executed
there for poisoning her husband, was proved to have administered this
substance [see p. 61]. The root of another species, the _A. ferox_, is
well known to be in common use as a poison, under the name of Bikh, in
Bengal, and Nabee, in the Madras Presidency.
The toxicological history of the genus, and of this species in
particular, has been rendered complex and obscure, by the extreme
difficulty of distinguishing accurately the several species from one
another. The whole genus, now a numerous one, is generally conceived to
be eminently poisonous. But from some observations of my own, as well as
an elaborate inquiry, not yet made public, by Dr. Alexander
Fleming,[2247] a recent graduate of this university, I am inclined to
think that this is a mistake, that the poisonous species are not
numerous, and that many aconites are inert, at least in this climate.
The _A. napellus_, a doubtful native of Britain, and the most common
species in our gardens, shoots up annually a leafy stem from a black,
tapering, spindle-shaped root. The stem, which is from two to five feet
high, ends in a long dense spike of fine blue flowers; and when the
seeds ripen in autumn, it dies down, and the root also shrivels and
perishes. But in the spring, while the stem is rising, one or more
tubers form near the crown of the root; each tuber quickly assumes the
spindle-shaped form of its parent, but has a light brown, instead of a
brownish-black tegument; and when the plant is in flower, the new tuber,
destined for the root of next year’s plant, is as large as the parent
one, firmer, more amylaceous, and not so apt to shrivel in drying. This
mode of propagation has led some to describe the root erroneously as
sometimes palmated. Dr. Fleming considers the young, full-grown tuber to
be the most active part of the plant; but the root of the existing
plant, the leaves, and also the seeds, are highly energetic; and every
part is more or less so.
Every part of the _A. napellus_, but especially the root, affects
remarkably the organs of taste, producing a very singular sense of heat,
numbness, and tingling of those parts of the mouth to which it is
applied. Dr. Fleming has ascertained, that this peculiar taste, or
rather sensation, is a property belonging to the narcotic principle of
monkshood, and that in all probability it is a measure of the activity
of the plant as a poison. It is most intense in the root, next in the
seeds, and next in the leaves before the flowers blow. Geiger first
ascertained, and I have since observed, that the sensation thus
occasioned by the leaves diminishes in intensity as the flowers expand,
and almost disappears when the seeds ripen. Contrary to what has been
often stated, it is not diminished by drying the leaves, even with the
heat of the vapour-bath. Nor is it materially lessened by time, if the
dried leaves be preserved with care; for I have found it intense after
six years. Geiger observed some years ago, that several species or
varieties do not possess it. I have ascertained that _A. napellus_,
_sinense_, _tauricum_, _uncinatum_, and _ferox_, possess it intensely,
_A. schleicheri_ and _nasutum_ feebly, _A. neomontanum_ very feebly; all
of which are therefore probably poisonous, in proportion to the
intensity of their taste. _A. ferox_, well known as a deadly poison in
the East, and undoubtedly the most virulent of all the species, produces
by far the most intense and persistent effect on the mouth of all the
species I have had an opportunity of examining. Those which do not
produce it at all, at least in this climate, are _A. paniculatum_,
_lasiostomum_, _vulparia_, _variegatum_, _nitidum_, _pyrenaïcum_, and
_ochroleucum_. It would be premature to say that all these species are
inert; but I suspect they are: and, at all events, I have ascertained
that the leaves of _A. paniculatum_, although the officinal species
recognised in the London Pharmacopœia, are quite inactive in this
climate; and Dr. Fleming has found the root inert in medicinal doses of
considerable magnitude.
The properties of monkshood have been traced by Geiger and Hesse to a
peculiar alkaloid, named aconitina: which is white, pulverulent,
fusible, not volatile, soluble in ether and alcohol, sparingly so in
water, and capable of forming crystallizable salts with acids. It
produces most intensely the peculiar impression caused by the plant on
the mouth, tongue, and lips; and it is a poison of tremendous activity,
probably indeed the most subtle of all known poisons. Although not a
volatile principle, it has been supposed peculiarly liable to
decomposition by heat, at least in its natural state of combination in
the plant or its pharmaceutic preparations. This opinion is founded on
the uncertainty of the medicinal action of the common extract of the
shops, and on the results of experiments on animals by Orfila.[2248] In
one experiment he found that half an ounce of the extract of the
Parisian shops had no effect at all on a dog, while a quarter of an
ounce killed another within two hours. Careless preparation may account
for such differences; but at the same time an error in choosing the
species of plant is an equally probable explanation. The properties of
monkshood appear to me to resist a heat of 212°, either in drying the
plant or in preparing an extract from it.
The medico-legal chemistry of monkshood has not been studied. If any of
the suspected matter be obtained in a pure state, its best character is
its remarkable taste; to which I have found nothing exactly similar in
the numerous trials I have made with other narcotic and acrid plants. A
complex substance, such as the contents of the stomach, or vomited
matter, should be evaporated over the vapour-bath to the consistence of
thin syrup, and agitated with absolute alcohol. The filtered alcoholic
solution being then evaporated, the extract may be subjected to the
sense of taste.
_Action._—The action of monkshood is a subject of great interest, but
has hitherto been much misunderstood. Sir B. Brodie, who was the first
to examine it in recent times, found that the leading phenomena in
animals, were staggering, excessive weakness, slow laborious
respiration, and slight convulsive twitches before death.[2249] Had
these observations been followed up by his successors with a
discriminating eye, toxicologists would not have been so much misled as
they have been. Orfila, who was the next to examine the subject
experimentally, failed to appreciate the phenomena with exactness.[2250]
He thinks monkshood acts peculiarly upon the brain, causing delirium,
and that it is a local irritant, capable of developing more or less
intense inflammation. A single experiment made in 1836 convinced me that
the former statement is incorrect, and led me to consider that the
symptoms depend in a great measure on gradually-increasing paralysis of
the muscles, which terminates in immobility of the chest and diaphragm,
and consequent asphyxia. Dr. Pereira, in some experiments with an
alcoholic extract, published in 1842, took notice of two remarkable
phenomena,—an extraordinary diminution of common sensation, evidenced by
the animal being insensible to pinching and pricking,—and the total
absence of stupor, as shown by the animal following its owner, and
recognizing him when called.[2251] Similar observations have been made
in poisoning with monkshood in man. The ablest investigation yet
undertaken into the actions of this substance is contained in the
unpublished Inaugural Dissertation of Dr. Fleming.
He found that the most remarkable symptoms are weakness and staggering,
gradually increasing paralysis of the voluntary muscles, slowly
increasing insensibility of the surface, more or less blindness, great
languor of the pulse, and convulsive twitches before death. He farther
observed that the pupil becomes much contracted; that the irritability
of the voluntary muscles is impaired; that the veins are congested after
death, the blood unaltered, and the heart capable of contracting for
some time after respiration has ceased. Lastly, he maintains that this
poison has not, as is generally thought, any irritant properties, that
neither the plant, nor its extract, nor its alkaloid occasions
vascularity in any membrane to which it is applied, even, for example,
in the lips or tongue while burning and tingling from its topical
action; that this peculiar effect is therefore merely a nervous
phenomenon; and that he never could observe either the diffuse cellular
inflammation described by Orfila to arise from the application of
monkshood to a wound, or the inflammatory redness of the alimentary
canal noticed by others as one of its effects when swallowed.
Orfila ascertained that monkshood exerts its action through the medium
of the blood; for its effects are greater when it is introduced into a
wound, than when it is swallowed, and they are still greater when it is
injected directly into a vein. It is a poison of very great activity. I
have found that thirty grains of an alcoholic extract, the produce of
three-quarters of an ounce of fresh leaves, will kill a rabbit in two
hours and a quarter, if introduced between the skin and muscles of the
back. Five drachms of the root in one of Orfila’s experiments with the
dog, occasioned death in twenty-one minutes, when swallowed.
The alkaloid, aconitina, seems to produce in animals precisely the same
effects as the plant or its extract. Orfila and Dr. Pereira agree in
this; and my own observation, limited to a single experiment, is to the
same effect. It is probably the most subtile of all known poisons. Dr.
Pereira mentions that the fiftieth part of a grain has endangered life
when used medicinally.[2252] In my experiment the tenth of a grain,
introduced in the form of hydrochlorate into the cellular tissue of a
rabbit, killed it in twelve minutes.
_Symptoms in Man._—A perplexing discrepance exists in the accounts that
have been published of the effects of monkshood on man; which seems to
have arisen, less from any actual contrariety in the phenomena, than
from loose observation, or a misunderstanding of the facts; for most of
the recent statements of competent observers are consistent with one
another.
Dr. Fleming says that in medicinal doses it occasions warmth in the
stomach, nausea, numbness and tingling in the lips and cheeks, extending
more or less over the rest of the body, diminution in the force and
frequency of the pulse, which sometimes sinks to 40 in the minute, great
muscular weakness, confusion of sight or absolute blindness; and if the
dose be unduly large, there is a sense of impending death, sometimes
slight delirium, and a want of power to execute what the will directs,
but without any loss of consciousness. The warmth which is excited is
unattended with any elevation of temperature, vascularity of the skin,
or acceleration of the pulse. No true hypnotic effect is produced; but
by inducing serenity, or deadening pain, it may predispose to sleep. The
highest degree of these effects is not unattended with danger.
When it is administered in doses adequate to occasion death, it seems in
general to operate by inducing extreme depression of the circulation.
Dr. Fleming recognizes two other modes of death in animals,—first, by an
overwhelming depression of the nervous system, proving fatal in a few
seconds, without arresting the action of the heart,—and secondly, by
asphyxia, or arrestment of the respiration, the result of paralysis
gradually pervading the whole muscular system, respiratory, as well as
voluntary. But these effects, he thinks, cannot be recognized in the
cases which have been published of poisoning in man, because the dose
required to produce either of them is very large. The least variable
symptoms in the human subject are, first, numbness, burning, and
tingling in the mouth, throat, and stomach,—then sickness, vomiting, and
pain in the epigastrium,—next, general numbness, prickling, and impaired
sensibility of the skin, impaired or annihilated vision, deafness, and
vertigo,—also frothing at the mouth, constriction at the throat, false
sensations of weight or enlargement in various parts of the body,—great
muscular feebleness and tremor, loss of voice, and laborious
breathing,—distressing sense of sinking and impending death,—a small,
feeble, irregular, gradually-vanishing pulse,—cold, clammy sweat and
pale bloodless features,—together with perfect possession of the mental
faculties, and no tendency to stupor or drowsiness,—finally, sudden
death at last, as from hemorrhage, and generally in a period varying
from an hour and a half to eight hours. The symptoms may begin in a few
minutes, as in a case observed by Dr. Fleming, which was occasioned by
the tincture of the root; or they may be postponed for three-quarters of
an hour, as in an instance recorded by Dr. Pereira,[2253] which arose
from the root being used by mistake for horse-radish. Two or three
drachms of the root are sufficient to kill a man; and Dr. Fleming
mentions one instance where two grains of the alcoholic extract
occasioned alarming effects, and another where four grains proved fatal.
I may observe, however, that I have given six grains of a carefully
prepared alcoholic extract (the same of which thirty grains killed a
rabbit in little more than two hours), to a female suffering from
rheumatism, without being able to observe any effect whatsoever.
If all the reports of cases now on record are to be trusted, the
following anomalies have occurred. Some persons are said to have
presented convulsions. Slight spasmodic twitches of the muscles are not
uncommon, and probably depend, as Dr. Fleming suggests, on venous
congestion, the result of incomplete asphyxia. Stupor and even
apoplectic insensibility are also sometimes represented to have been
observed. If really ever present, they must depend on the same cause;
but there is reason to apprehend, that extreme nervous depression and
faintness have been mistaken for stupor and coma. Delirium of the
frantic kind, mentioned by some of the older authors, is justly
considered by Dr. Fleming to be of doubtful occurrence, as it has never
been observed in recent times. Irritation in the alimentary canal is
distinctly mentioned as indicated by prominent symptoms, even in some
cases observed but a few years ago, and apparently with care. Dr.
Fleming properly objects to nausea, vomiting, or pain in the epigastrium
as evidence of irritation in the stomach; for these symptoms may all
depend on the same local nervous impression which is produced on the
organs of taste. And he denies that purging is ever produced in any
genuine case of poisoning with monkshood. The following, however, seem
unequivocal examples of irritation in the alimentary canal. M.
Pallas[2254] mentions, that three out of five persons, who took a
spirituous infusion of the root by mistake for lovage [_Ligusticum
levisticum_], died in two hours with burning in the throat, vomiting,
colic, swelling of the belly and purging. A similar set of cases is
described by M. Degland.[2255] Four persons took the tincture of the
root by mistake for tincture of lovage; and three of them were seized
with burning pain from the throat to the stomach, a sense of enlargement
of the tongue and face, colic, tenderness of the belly, vomiting, and
purging. One of these, who ultimately recovered, had frantic delirium
for some time after the other symptoms went off. The two others died,
one in two hours, the other half an hour later. Dr. Pereira[2256] and
Dr. Fleming doubt the authenticity of these cases; and it may be, that
such unusual symptoms may have arisen either from some other root
mistaken by the narrators for monkshood, or from irritant substances
given along with or after it. At the same time I may mention, that in
the first trials I made with monkshood as a medicine, using a carefully
prepared extract of the root, I was deterred from proceeding by two
patients being attacked with severe vomiting, griping, and diarrhœa.
It may be well to conclude these general statements by the particulars
of a few well authenticated cases. Dr. Pereira describes two that were
occasioned by the root having been dug up in February by mistake for
horse-radish.[2257] The parties, a gentleman and his wife, ate, the
former about a root and a half, the latter not much more than half a
root. Both of them in three-quarters of an hour had burning, and
numbness in the lips, mouth, and throat, extending to the stomach and
followed by vomiting. The husband had subsequently violent and frequent
vomiting, partly owing to an emetic. His extremities became cold, the
lips blue, the eyes glaring, and the head covered with cold sweat. There
was no spasm or convulsion, but some tremor. He had no delirium, or
stupor, or loss of consciousness, but complained of violent headache.
The respiration was not affected; and although he felt very weak, he was
able to walk with a little assistance only a few minutes before death;
which took place, as if from fainting, about four hours after the poison
was swallowed.—His wife, in addition to the early symptoms already
mentioned, had such weakness and stiffness of the limbs that she was
unable to stand; and she could utter only unintelligible sounds; but she
had no spasms or convulsions. She experienced a strange sensation of
numbness in the hands, arms, and legs, diminution of sensibility over
the whole integuments, especially of the face and throat, where the
sense of touch was almost extinguished. She had also some dimness of
vision, giddiness, and at times an approach to loss of consciousness,
but no delirium, sleepiness, or deafness. She recovered, under the use
of emetics, laxatives, and stimulants. In neither of these cases was
there any diarrhœa.—A patient of Mr. Sherwen,[2258] five minutes after
taking a tincture of the root, suffered from the same incipient symptoms
as above, but without actual vomiting. The face seemed to her to swell,
and the throat to contract; she became nearly blind, and excessively
feeble, but did not lose her consciousness. The eyes were fixed and
protruded, and the pupils contracted, the jaws stiff, the face livid,
the whole body cold, the pulse imperceptible, the heart’s action feeble
and fluttering, and the breathing short and laborious. An emetic was
followed first by violent convulsions, and then by vomiting; after which
she slowly recovered. At all times she was so sensible as to be able to
tell how the accident happened.—Dr. Ballardini of Brescia met with
twelve simultaneous cases of poisoning with the juice of the leaves,
used by mistake for scurvy-grass [_Cochlearia officinalis_]. Each person
had three ounces of juice. Three of them died in two hours; but the rest
were saved. The chief symptoms were extreme weakness and anxiety,
paleness and distortion of the features, dilatation of the pupils,
dulness of the eyes, giddiness, headache, chiefly occipital, some
distension and pain of the belly, vomiting of a green matter, and in
some diarrhœa. The whole body was cold, the nails livid, the limbs
cramped, the pulse small and scarcely perceptible. In the fatal cases
there were convulsions.[2259]—MM. Pereyra and Perrin mention, that,
while using the alcoholic extract in the Hospital of St. André at
Bordeaux, the sample of the drug happened to be changed when the dose
had been raised so high as ten grains; and that the patients who were
taking it were then all seized with burning in the mouth and throat,
vomiting, pungent pains in the extremities, cold sweating, anxiety,
extreme general prostration, great slowness and irregularity of the
pulse, convulsions, and congestion in the venous system. One patient
died; the others recovered under no other treatment than stimulant
friction along the spine.[2260] An infant at Suippe, in the French
Department of the Marne, ate a few leaves and flowers of monkshood,
while walking in a garden. Soon afterwards he began to stagger as if
tipsy, and to complain of pain in the belly. In two hours an emetic was
given; but a few minutes afterwards, the eyes became convulsed, the jaws
locked, the trunk bent rigidly backward, and the limbs convulsed; and
death ensued in five minutes more.[2261]
_Morbid Appearances._—In Ballardini’s fatal cases the pia mater and
arachnoid were much injected; there was much serosity under the
arachnoid and in the base of the cranium; the lungs were considerably
gorged with blood; the heart and great vessels contained but a little
black fluid blood: the villous coat of the stomach was spotted with red
points; and the small intestines presented inwardly red patches and much
mucus. In the Bordeaux case there was venous congestion in the head and
chest, the lungs particularly being much gorged with blood. The right
side of the heart was full of blood, of gelatinous consistence. In
Pallas’s cases the gullet, stomach, small intestines and rectum were
very red, the lungs dense, dark, and gorged, and the cerebral vessels
turgid.
Few trustworthy observations have been made on the effects of the other
species of aconite. Dr. Pereira found the A. ferox of the East Indies to
be a much more deadly poison to animals than common monkshood; but its
effects were otherwise identical.[2262] Three grains of the root put
into the throat of a rabbit, killed it in nineteen minutes; one grain of
the alcoholic extract, introduced into the peritonæum, proved equally
deadly. Nine grains will kill a cat in four hours.[2263]——Of the other
aconites the A. cammarum, and A. lycoctonum are said to have proved
fatal frequently in Germany; but no accurate facts on the subject are on
record.—It was stated above that the A. paniculatum, supposed by De
Candolle to have been the true aconite of Baron Störck, is inert in this
country. I introduced the alcoholic extract of three ounces of the fresh
leaves collected near the end of June, into the cellular tissue between
the skin and muscles of a young rabbit, having previously converted the
extract into an emulsion with mucilage and water. This was four times
the dose of A. napellus, which I had found sufficient to kill a strong
adult rabbit in two hours and a quarter; but no effect whatever was
produced.—Mr. Ramsay of Broughty Ferry has described a case of fatal
poisoning with a handful of aconite leaves which were mistaken for
parsley, and which he supposes to have been those of A. neomontanum. The
subject, a boy of fourteen, was attacked with a sense of burning in the
mouth, throat, and stomach, afterwards with vomiting and convulsions,
and died considerably within five hours.[2264] The very feeble taste of
this species—which besides is little cultivated in Scotland,—inclines me
to doubt whether it was the species that produced such violent effects.
_Of Poisoning with Black Hellebore._
Black hellebore, or Christmas-rose, the _Helleborus niger_ of botanists,
is a true narcotico-acrid poison. It is a doubtful native of this
country. It produces a large white ranunculus-like flower about
midwinter. The root, the only part used in medicine, or to be found in
the shops, consists of a short root-stock and numerous, long, black
undivided rootlets. The fresh root in January is not acrid to the taste.
Its active principle appears from the researches of MM. Feneulle and
Capron, to be an oily matter containing an acid.[2265]
Its action has not yet been examined with particular care. Two or three
drachms of the root killed a dog in eighteen hours, when swallowed; two
drachms killed another in two hours, when applied to a wound; and six
grains in a wound caused death in twenty-three hours. In all cases the
leading symptoms are efforts to vomit, giddiness, palsy of the
hind-legs, and insensibility.[2266] Ten grains of the extract introduced
into the windpipe killed a rabbit in six minutes.[2267] Orfila found
redness of the rectum, when the animals survived a few hours. But none
of these experiments show the powerful irritant action exerted by the
root upon man.
The Bulletins of the Medical Society of Emulation mention two cases of
poisoning with hellebore, which arose from the ignorance of a quack
doctor. Both persons, after taking a decoction of the root, were seized
in forty-five minutes with vomiting, then with delirium, and afterwards
with violent convulsions. One died in two hours and a half, the other in
less than two hours.[2268] Morgagni has related a case which proved
fatal in about sixteen hours, the leading symptoms of which were pain in
the stomach, and vomiting. The dose in this instance was only half a
drachm of the extract.[2269] In a case not fatal, related by Dr.
Fahrenhorst, the symptoms were those of irritant poisoning generally,
that is, burning pain in the stomach and throat, violent vomiting, to
the extent of sixty times in the first two hours, cramps of the limbs,
and cold sweating. The most material symptoms were at this time quickly
subdued by sinapisms to the belly and anodyne demulcents given
internally; and in four days the patient was well. The dose here was a
table-spoonful of the root in fine powder.[2270] In small doses of ten
or twenty grains, it is well known to be a powerful purgative to man. I
have known severe griping produced by merely tasting the fresh root in
January.
The morbid appearances in Morgagni’s case were the signs of inflammation
in the digestive canal, particularly in the great intestines. In the
case described in the French Bulletins, there was gorging of the lungs,
and the stomach had a brownish-black colour as if gangrenous.
The other species of hellebore have not been carefully examined; but it
is probable that they all possess similar properties. The _H. hyemalis_
and _viridis_ are said by Buchner to be weaker than the _H. niger_; and
the _H. fœtidus_ is the most poisonous of all.[2271]