OF POISONING WITH ALCOHOL, ETHER, AND EMPYREUMATIC OILS.
The last group of the narcotico-acrids comprehends _alcohol_, _ether_,
and the _oleaginous products of combustion_.
_Of Poisoning with Alcohol._
_Of its Action on Animals, and Symptoms in Man._—Alcohol has been
generally believed, since the experiments of Sir B. Brodie,[2511] to act
on the brain through the medium of the nerves, and to do so without
entering the blood. This may be doubted. At least in some experiments
performed several years ago by Dr. C. Coindet and myself it appeared not
to act so swiftly, but that absorption might easily have taken place
before its operation began. At all events, through whatever channel it
may operate, there is no doubt that it enters the blood; for in man the
breath has a strong smell of spirit for a considerable time after it is
swallowed; and it has been found in the tissues and secretions after
death from large doses. Professor Orfila found that alcohol is a violent
poison when injected into the cellular tissue; and that it produces
through that channel the same effects as when taken into the
stomach.[2512] In the course of our experiments Dr. C. Coindet and I
found that it acted with great rapidity when injected into the cavity of
the chest.
Authors who have treated of the action of alcohol and spirituous liquors
on man, have distinguished three degrees in its immediate effects.
1. When the dose is small, much excitement and little subsequent
depression are produced.
2. When the effect is sufficiently great to receive the designation of
poisoning, the symptoms are more violent excitement, flushed face,
giddiness, confusion of thought, delirium, and various mental
affections, varying with individual character, and too familiar to
require description here. These symptoms are soon followed by dozing and
gradually increasing somnolency, which may at length become so deep as
not to be always easily broken. After the state of somnolency has
continued several hours, it ceases gradually, but is followed by
giddiness, weakness stupidity, headache, sickness, and vomiting.
This degree of injury from alcohol may prove fatal, either in itself, by
the coma becoming deeper and deeper,—or from the previous excited state
of the circulation causing diseases of the brain in a predisposed
habit,—or more frequently from the occurrence of some trifling accident,
which in his torpid state the individual cannot avoid or remedy, such as
exposure to cold, falling with the face in mud or water, suffocation
from vomited matters getting into the windpipe, and the like.
Of simple poisoning by the gradual increase of coma the following
judicial case in which I was consulted is a characteristic example. Two
brothers drank in half an hour three bottles of porter, with which three
half-mutchkins (24 ounces) of whisky had been secretly mixed by a
companion, whose object was to fill them drunk by way of joke. In the
course of drinking both became confused. In fifteen minutes after
finishing the last bottle one of them fell down insensible, and had no
recollection of what happened for twelve hours; but he recovered. The
other staggered a considerable distance for an hour, and then became
quite insensible and unable to stand. In four hours more consciousness
and sensibility were quite extinct, the breathing stertorous and
irregular, the pulse 80 and feeble, the pupils dilated and not
contractile, and deglutition impossible. In this state he remained
without any material change till his death, which took place in fifteen
hours after he finished his debauch. A surgeon saw him when he had been
five hours ill, but did little for his relief, as the case appeared
hopeless.
There is a singular variety in the principal symptoms of this form of
poisoning, even when completely formed. From a careful tabular analysis
of no fewer than twenty-six cases, chiefly of the present denomination,
collected by Dr. Ogston of Aberdeen from the experience of the
police-office there, it appears that when the stage of stupor is fully
formed, the person is sometimes capable of being roused, sometimes
immovably comatose for a long time,—that the pulse is sometimes
imperceptible or very feeble, sometimes distinct or even full, generally
slow or natural, seldom frequent, very seldom firm,—that the pupils are
occasionally contracted, much more generally dilated, and in a few
instances alternating between one state and the other,—that the
countenance is commonly pale, sometimes turgid and flushed,—and that the
breathing is for the most part slow, and also soft, yet not unfrequently
laborious, but very rarely stertorous. Convulsions are rare, having been
observed twice only, and on both occasions in young people of the age of
twelve or fourteen.[2513] Dr. Ogston has tried to group these several
symptoms together in classified cases; but the general conclusions at
which he arrives are subject to important exceptions. Neither do any of
the special symptoms seem to bear a marked relation to the ultimate
event. It is peculiarly worthy of remark, that very many cases got well
where the pupils were much dilated, the coma profound, and the pulse
imperceptible.
In the present form of poisoning with alcoholic fluids, it usually
happens that if the stage of stupor be completely overcome, recovery
speedily ensues, without any particular symptom except headache,
giddiness, sickness, and the customary consequences of a debauch. Hut on
some occasions the comatose stage is succeeded by one which indicates
much cerebral excitement,—by flushed face, injected eyes, restlessness,
a febrile state of the pulse, and delirium, even of the violent kind. In
other cases this affection puts on very much the characters of a slight
attack of typhoid fever.
In the second variety of the second degree of intoxication, an
apoplectic disposition is called into action by the excited state of the
circulating system; and death ensues from apoplexy or some other disease
of the brain, rather than from simple poisoning. Thus in some instances,
as will be more fully mentioned under the head of the morbid
appearances, extravasation of blood is found within the head after
death, preceded by the usual phenomena of ordinary intoxication. Since
this is a rare effect of intoxication, it must be considered as the
result of poisoning with spirits, exciting sanguineous apoplexy in a
predisposed constitution. In other cases the stupor of intoxication,
after putting on all the characters of apoplexy for two days and
upwards, terminates fatally without extravasation. Here the poison
operates by developing a constitutional tendency to congestive apoplexy.
Again, this mode of action is still more clearly shown in some cases,
where an interval of returning health occurs between the immediate
narcotic effects of the poison and the ultimate apoplectic coma which is
the occasion of death. Such a course of events, which, however, is of
rare occurrence, is well exemplified in the following cases. A man drank
32 ounces of rum one afternoon, and was comatose most of the ensuing
night. Next morning, though very drowsy, he was sensible when roused;
and in the evening he was considered convalescent. But two days
afterwards he became delirious; in two days more he died comatose; and
congestion was the only appearance found in the brain.[2514] Another
instance, most remarkable in its circumstances, is the following, which
has been related by Dr. Golding Bird. A workman in a distillery, after
drinking eight ounces of rectified spirit by mistake for water, suddenly
fell down senseless and motionless, and remained so for eleven hours. He
then began to recover, and came round so far that he returned to his
work next morning. After this he continued to pass dark, pitch-like
evacuations. In three weeks he became drowsy, mistook one thing for
another, answered questions sluggishly, and had a frequent pulse, and
dilated sluggish pupils; in which state he continued three weeks later
when the account was published.[2515] The following case, related by Dr.
Chowne, also seems to belong to the same category, although it presents
anomalies. A boy, eight years of age, soon after swallowing about eight
ounces of gin, said he felt like a drunk man, and suddenly became
motionless and insensible. In no long time he vomited a fluid of the
odour of gin; and in seven hours from the commencement a fluid was
withdrawn from the stomach, possessing no longer any such odour. He was
now motionless, insensible, pale, and cold; the pupils were contracted,
the pulse feeble and hurried, the breathing stertorous and slow; and he
made ineffectual efforts to vomit. Stimulants of all kind had little
effect on him for a day and a half, when the breathing became more
natural, and his look quite intelligent. Yet he could not answer
questions, exhibited no sign of volition, and had a pulse so frequent as
160. In twenty-four hours more the breathing became laborious and
rattling, and the lips livid; and death took place near the close of the
third day. The only appearances of any note in the dead body were
general injection of the arachnoid membrane of the brain, and effusion
of frothy mucus into the bronchial ramifications.[2516] Similar to these
is the following extraordinary case which has been communicated to me by
Dr. Traill. A boy seven years of age, who was persuaded by two
miscreants to take nearly five ounces of undiluted whisky, suffered for
two days from the ordinary symptoms of excessive intoxication, which
were then immediately followed by epileptic convulsions. These continued
to recur with more or less violence, but always frequently, for two
months down to the date of the judicial investigation to which the case
gave rise. All these forms of the effects of drinking ardent spirits can
scarcely be considered as simple poisoning, but as the result of
poisoning developing a tendency to diseases of the head.
The third variety of poisoning with spirits in the second degree proves
fatal, not in itself, but by some trivial accident happening, from which
the individual cannot escape on account of his powerless insensibility.
Thus, it is no uncommon thing for persons in a state of deep
intoxication to fall down in an exposed place, where they perish from
cold, or to tumble with the face in a puddle, and so be suffocated, or
to be choked by inhaling the contents of the stomach imperfectly
vomited, or by lying in such a posture that their neck-cloth produces
strangulation. These statements are so familiar, that it is unnecessary
to illustrate them by special facts. The reader’s attention was called
to such accidents in the previous editions of this work. Two well-marked
cases of the kind have been since published by Mr. Skae.[2517]
In cases of simple poisoning in the second degree the progress of the
symptoms is on the whole remarkably uniform, gradual and uninterrupted.
But there are likewise some anomalies which it may be well to notice.
Thus, occasionally after the phenomena of ordinary intoxication have
gone on gradually increasing without having attained a very great
height, sudden lethargy supervenes at once, and may prove fatal with
singular rapidity. My colleague, Dr. Alison, has communicated to me the
particulars of a case of the kind where death took place from simple
intoxication, twenty minutes after the state of lethargy began. The
individual reached his home in a state of reeling drunkenness, but able
to speak and give an indistinct account of himself. He then became
lethargic, and died in the course of twenty minutes. On examining the
body, Dr. Alison could not discover any morbid appearance, except some
watery effusion on the surface of the brain and in the ventricles; but
the contents of the stomach had a strong smell of spirits. Instances of
such excessive rapidity, however, are rare, unless from the third form
of poisoning.—An anomaly of a different kind, of which a remarkable
example was brought judicially under my notice, is sudden supervention
of deep insurmountable stupor, without the usual precursory symptoms,
yet not till after a considerable interval subsequently to drinking. In
May, 1830, a lad of sixteen, in consequence of a bet with a
spirit-dealer, swallowed sixteen ounces of whisky in the course of ten
minutes, and, pursuant to the terms of the wager, walked up and down the
room for half an hour. He then went into the open air, apparently not at
all the worse for his feat; but in a very few minutes, while in the act
of putting his hand into his pocket to take out some money, he became so
suddenly senseless as to forget to withdraw his hand, and so insensible
that his companions could not rouse him. A surgeon, who was immediately
procured, contented himself with giving several clysters and a dose of
tartar-emetic, which did not operate; and the young man died in the
course of sixteen hours. The cause of the retardation of the symptoms
was partly perhaps that he had taken supper only an hour before drinking
the spirits, but chiefly, I presume, because the stupor was kept off for
a time by the stimulus of determination to win his bet.—Several cases
somewhat similar have been described by Dr. Ogston. In these sudden
insensibility came on while the individuals had been drinking freely for
some time, without showing any marked sign of approaching
intoxication.[2518] The cause of the postponement and sudden invasion of
the stupor does not exactly appear; but a familiar cause of its abrupt
invasion in ordinary cases of drunkenness is sudden exposure to cold.
It is impossible to fix the extremes of duration of the present form of
poisoning in fatal cases. For, on the one hand, one or other of the
accidents mentioned above may bring the case to a speedy close; and, on
the other hand, the supervention of apoplexy may protract it to several
days. The ordinary duration in fatal cases seems to be from twelve to
eighteen hours.
3. The third degree of poisoning is not so often witnessed, because, in
order to produce it, a greater quantity of spirits must be swallowed
pure and at once, than is usually taken by those among whom poisoning in
the second degree chiefly occurs. When swallowed in large quantity, as
by persons who have taken foolish wagers on their prowess in drinking,
there is seldom much preliminary excitement; coma approaches in a few
minutes and soon becomes profound, as in apoplexy. The face is then
sometimes livid, more generally ghastly pale; the breathing stertorous,
and of a spirituous odour; the pupils sometimes much contracted, more
commonly dilated and insensible; and if relief is not speedily procured,
death takes place,—generally in a few hours, and sometimes immediately.
According to Mr. Bedingfield, who witnessed many cases of poisoning with
rum at Liverpool, which always follow the arrival of the West India
vessels, the patient will recover if the iris remains contractile; but
if it is dilated and motionless on the approach of a light, recovery is
very improbable.[2519]
A case is briefly alluded to by Orfila of a soldier, who drank eight
pints of brandy for a wager, and died instantly.[2520] A case of the
same kind is quoted by Professor Marx.[2521] Another, which happened in
the person of a London cabman, is noticed in a French Journal. The man,
for a bribe of five shillings, drank at a draught a whole bottle of gin;
and in a few minutes he dropped down dead.[2522] Similar accidents occur
not infrequently in this country; but I have not met with any fully
described by authors. A case of the less rapid variety of the present
form occurred at the Infirmary here in 1820. A man stole a bottle of
whiskey; and, being in danger of detection, took what he thought the
surest way of concealing it, by drinking it all. He died in four hours
with symptoms of pure coma.
Convulsions are not common in such cases. I have seen a remarkable
example, however, in which the coma was accompanied with constant
alternating _opisthotonos_ and _emprosthotonos_. The subject was a boy
who had been induced to drink raw whisky by an acquaintance, and had
been two hours insensible before I saw him. The stomach-pump, which was
immediately applied, brought away a large quantity of fluid with a
strong spirituous odour; and he recovered his senses in fifteen minutes,
but remained very drowsy for the rest of the day.
Such are the forms of poisoning with spirits usually admitted by
authors. But it also appears to act sometimes as an irritant. After its
ordinary narcotic action passes off, another set of symptoms
occasionally appear, which indicate inflammation of the alimentary
canal. Cases of this kind are exceedingly rare; yet they have been met
with, as the following extract shows. “A young man at Paris had been
drinking brandy immoderately for several successive days, when at length
he was attacked with shivering, nausea, feverishness, pain in the
stomach, vomiting of everything he swallowed except cold water, thirst,
and at last hiccup, delirium, jaundice, and convulsions; and death took
place on the ninth day. On examining the body the stomach was found
gangrenous over the whole villous coat; the colon too was much inflamed;
and all the small intestines were red.”[2523]
A case of great complexity, but probably of the same nature, has been
related by Opitz in Pyl’s Memoirs. The subject was a woman liable to
epilepsy, and addicted to excessive drinking. After one of her
drinking-bouts she was seized with vomiting and severe pain of the
bowels, afterwards with delirium, then with convulsions, and she died in
twenty-four hours after the first attack. The stomach and intestines
were greatly inflamed, a table-spoonful of blood was effused into the
ventricles of the brain, and the left lung was purulent.[2524]
Besides the immediately fatal effects of spirituous liquors now
described, there is still another variety of poisoning more common than
any yet mentioned, and constituting a peculiar disease. People who fall
into the unhappy vice of habitual intoxication, after remaining in a
state of drunkenness for several days together, are often attacked with
a singular maniacal affection, which is accompanied with tremors,
particularly of the hands, and after enduring for several days, ends at
last in coma. When the delirium is not so violent, the disease by proper
treatment may be cured. But frequently, after the delirium and tremor
have continued mildly for some time, they increase, and the delirium
becomes furious, or coma rapidly supervenes; in either of which cases
the disorder commonly proves fatal in two or three days more. This
disease, which is now familiar to the physician, is called _delirium
tremens_. It is supposed by some to depend on inflammation of the
membranes of the brain, followed by effusion.
Other diseases, besides _delirium tremens_, are also slowly induced by
the habitual and excessive use of spirituous liquors; but in general
the habit of intoxication acts in inducing these diseases only as a
predisposing cause. A particular variety of tuberculated liver
probably arises from the habitual use of spirits without the
co-operation of other causes. That variety of disease of the kidney,
which was first brought under the notice of the profession by Dr.
Bright,[2525] is also obviously often connected with the habit of
drinking spirits. The following have been enumerated among the
diseases where the same habit acts powerfully as a predisposing
cause—indurated pancreas,—indurated mesenteric glands,—scirrhous
pylorus,—catarrh of the bladder,—inflammation, suppuration and
induration of the kidneys,—incontinence of urine,—aneurism of the
heart and great vessels,—apoplexy of the lungs,—varicose
veins,—mania,—epilepsy,—tendency to gangrene of wounds,—spontaneous
combustion.[2526]
_Of the Morbid Appearances._—Some doubts exist as to the morbid
appearances in the bodies of those poisoned by spirituous liquors.
In animals killed by alcohol, Orfila says he found the villous coat of
the stomach constantly of a cherry-red odour. I have several times
remarked the same appearance. When the stomach was empty before the
alcohol was introduced, I have always found the prominent part of its
rugæ of a deep cherry-red tint, the margin of the patches being more
florid, and evidently consisting of a minute network of vessels.
In man these signs of irritation have not been always observed. In the
patient who died in the Infirmary here, the stomach was quite natural to
appearance. Dr. Ogston notices injection of the small intestines and
thickening of the mucous membrane of the stomach and intestines as
common appearances in the cases he has examined; but he seems to
consider these the effects not of the last fatal dose, but of the habit
of frequent excessive drinking.[2527]
The blood in the heart and great vessels is commonly fluid and very
dark, and the lungs are sometimes more or less gorged with the same
fluid.
The state of the brain differs much according to the mode of death.
Sometimes great congestion and even actual extravasation of blood are
found in the heads of persons who have died of excessive continuous
drinking,—the excitement of such a debauch being apt, as already
mentioned, to induce apoplexy in a predisposed habit. Accordingly
extravasation was found by Professor Bernt of Vienna in no less than
four cases of the kind, two of which happened in the persons of young
men not above twenty-two years of age;[2528] and Dr. Cooke quotes
another in his work on nervous diseases.[2529] I have myself met with
another remarkable instance. A female out-pensioner of Trinity Hospital
here, who was much addicted to drinking, and for fourteen days after the
New-year of 1830 had been very little in her sober senses, soon after
arriving at home one evening much intoxicated, fell down comatose, and
died in ten or twelve hours. An enormous extravasation of clotted blood
was found in the ventricles, producing extensive laceration of the right
middle and anterior lobes of the brain.—In such cases it is natural to
suppose that a predisposition to apoplexy must concur with the
intoxication; otherwise it is not easy to see why death from
extravasation is not more frequently produced by excessive drinking.
Extravasation is not apt to occur in the cases of rapid death brought on
by a very large quantity swallowed at once. The circulation, indeed, is
during life in a state quite the reverse of excitement; and accordingly
the brain and its membranes are found quite healthy. They were
particularly so in the man who died in the hospital here. It is right to
mention, however, that one of Bernt’s cases, although the symptoms and
other particulars are not mentioned, possibly belongs to the present
variety, as the man swallowed for a wager a quart of brandy at a
draught.[2530] According to Dr. Ogston, who has given the best account
of the appearances within the head in the ordinary cases of this kind,
there is usually serous effusion under the arachnoid membrane,
occasionally minute injection of vessels, commonly more or less general
gorging of the larger veins, and especially effusion of serosity to the
amount of two or even four ounces in the ventricles.[2531]
When delirium tremens proves fatal, effusion is commonly found among the
membranes of the brain; and occasionally to a great extent. In one
instance, which proved fatal in two or three days, I have seen minute
vascularity of the membranes, with effusion of fibrin, and without
effusion of serosity; but such cases are rare. There is also, according
to Andral, very extensive softening of the mucous coat of the
stomach.[2532] In an instance mentioned in Rust’s Journal, besides
effusion into the cerebral membranes, there was found an enormous
accumulation of fat in all the cavities, a conversion of the muscular
substance into fat, and a nauseous sweet smell from the whole
body.[2533]
In all cases of rapid poisoning with spirituous liquors some of the
poison will be found in the stomach. For when the case is one of pure
narcotic poisoning, unaided by the effects of blows, exposure to cold,
or the like, and the person dies in a few hours, the poison cannot be
all absorbed before death.—Although the spirituous liquors used in
Britain have all very powerful odours, the inspector in a case of
importance ought not to confine himself to this test alone. He must
subject the suspected matter to distillation; and then remove the water
from what distils over by repeated agitation with dry carbonate of
potass, till he procures the alcohol of the spirit in such a state of
purity as to be inflammable.
Alcohol may also be in some circumstances detected in the tissues and
secretions of the body. A spirituous odour has been remarked not
infrequently in various parts, and especially in the brain. Dr. Cooke
mentions a case in which the fluid in the ventricles of the brain had
the smell and taste of gin, the liquor which had been taken;[2534] Dr.
Ogston adverts to an instance, in which after death by drowning during
intoxication, he found in the ventricles nearly four ounces of fluid,
having a strong odour of whisky;[2535] in the case which occurred in the
hospital here the odour of whisky was said to have been perceived in the
pericardium; and in a man who died of long-continued intoxication from
immoderate drinking Dr. Wolffe found that the surface, and still more
the ventricles, of the brain had a strong smell of brandy, although the
contents of the stomach had not.[2536]
The presumption afforded by such facts as these, in favour of the
absorption of alcohol and the possibility of detecting it throughout the
animal system, has been turned to certainty by the late experimental
researches of Dr. Percy; who found that in animals poisoned with
alcoholic fluids, as well as in the case of a man who died during the
night after drinking a bottle of rum, alcohol could be detected,
generally in the urine, and also in the brain, by cautious distillation,
and removing the water from the distilled fluid by means of dry
carbonate of potass.[2537] Dr. Percy gave me an opportunity of verifying
his results with the brain of the man; and I had no difficulty in
obtaining from a few ounces of brain a sufficiency of spirit to exhibit
its combustion on asbestus repeatedly.
It is hardly necessary to add, that when the individual has survived the
taking of the poison a considerable length of time, an odour of spirits
will not be perceived either in the stomach or elsewhere. In the
out-pensioner of Trinity Hospital, for example, who survived about
twelve hours, no spirituous odour could any where be perceived. In such
cases the poison disappears during life by absorption.—A question may
even be entertained, whether the odour may not sometimes be
imperceptible at the inspection of the body, although the poison was
really present immediately after death. It is probable that, as in the
instance of hydrocyanic acid, the alcohol, on account of its volatility
or fluidity, will evaporate or percolate away in a few days. In this
manner only can be explained the occasional absence of the odour in
persons who have been killed in the early stage of drunkenness. I could
not perceive any odour of whisky in the stomach of the woman Campbell,
who was murdered by the notorious resurrectionist Burke, although she
had drunk spirits to intoxication half an hour before her death. The
body was not examined till thirty-eight hours after.[2538] It must be
observed, however, that alcohol may exist in the contents of the stomach
and be detected by chemical analysis, although it is not indicated by
its odour. I have twice had occasion to observe this, where the bodies
were disinterred some time after death.
From all that has been said, there ought seldom to be much difficulty in
recognizing a case of poisoning with spirituous liquors.
But, before quitting the subject, a form of it must be noticed which may
be extremely difficult to distinguish. It was formerly remarked that the
eatable mushrooms have been sometimes poisoned with substances
possessing effects on the system analogous to those caused by the
deleterious fungi. In the same manner spirituous liquors may be poisoned
with narcotics allied to them in action. Thus, in former parts of this
work, it has been stated that a young man was killed during a debauch in
consequence of his companions having mingled opium with his wine; that
many persons have been poisoned and some killed by fermented liquors
drugged in the same manner; that murder has been accomplished by
poisoning wine with nightshade; and that several fatal accidents have
occurred in consequence of liqueurs having been too strongly impregnated
with hydrocyanic acid, to give them a ratafia flavour. Cases of this
nature may be embarrassing. In general, they may be made out by
attending strictly to the symptoms, the quantity of liquor taken, and
the contents of the stomach. But, it must be admitted, that if a
murderer, who chooses such a method, should season his guest’s drink
judiciously, and ply him well with it, a medical jurist might be puzzled
to determine whether the liquor was to blame in point of quality or
quantity.
_Of the Treatment._—The treatment of poisoning with alcoholic fluids
does not differ essentially from that of poisoning with opium. In the
former, as in the latter, the chief objects must be to remove the poison
from the stomach, and to rouse the patient from his state of stupor; but
in poisoning with alcoholic fluids it is also frequently necessary to
treat a secondary stage of reaction by local and even general
antiphlogistic measures. As to the primary object, the removal of the
poison from the stomach, it appears that in the present form of
poisoning emetics are more seldom effectual than in the case of other
narcotics, and that the stomach-pump should be promptly resorted to. It
is remarkable that the operation of clearing out the stomach is likewise
often a sufficient stimulus to dispel stupor immediately and even
permanently. I have seen almost complete consciousness permanently
restored with the discharge of the alcoholic fluid; and the same remark
has been made by others. Where the senses are not thus restored, one of
the most effectual stimulants, according to the practice of the
police-office of this city, is the injection of water into the ears.
Great advantage has been derived, as in poisoning with opium, from the
cold affusion applied to the head. Dr. Ogston, who has appended to his
paper formerly quoted a very useful summary of the treatment of
poisoning with spirits, has found this a safe and effectual remedy where
the heat of the head was unnaturally great and that of the body not too
low.[2539] Cases have been published where it proved successful although
the pulse was gone at the wrist, the breathing scarcely perceptible, and
the temperature of the whole body greatly reduced.[2540] It is doubtless
a powerful remedy: but where the general temperature of the surface is
much lowered, I conceive it should be restricted to the head and neck,
and conjoined with the application of warmth to the body. Dr. Ogston
objects to the general use of blood-letting in cases of poisoning with
spirits, as being often apt to be followed by sudden sinking. Where
other remedies are judiciously used, it is probably seldom called for;
and the purpose it is intended to serve, namely, the relief of cerebral
congestion and determination, is better fulfilled by the local
employment of cold, and local blood-letting. Ammonia and its acetate
have been found useful as internal stimulants where the stupor is deep.
The treatment of the secondary affections adverted to above does not
require specific mention.
_Of Poisoning with Sulphuric and Nitric Ether._
Sulphuric ether and nitric ether are poisons of the same nature with
alcohol. But the effects produced by them when taken in considerable
doses are not very well known.
Orfila found that half an ounce of sulphuric ether introduced into the
stomach of a dog and secured there by a ligature on the gullet, excited
efforts to vomit, in ten minutes inability to stand, and in six minutes
more, insensibility. In fifteen minutes more the animal revived a
little, but soon became again comatose; and it died in three hours after
the commencement of the experiment. The villous coat of the stomach was
reddish-black, the other coats of a lively red colour.[2541]
The effects of the ethers on man have not been accurately ascertained.
From some observations published in the Journal of Science, sulphuric
ether appears to act energetically even in small doses. In moderate
quantity it produces a strong sense of irritation in the throat, a
feeling of fulness in the head, and other symptoms like those excited by
nitrous-oxide gas. A gentleman, in consequence of inhaling it too long,
was attacked with intermitting lethargy for thirty-six hours, depression
of spirits and lowness of pulse.[2542] When long and habitually used, as
by persons afflicted with asthma, its dose must be gradually increased;
and it appears that considerable quantities may then be taken for a
great length of time without material injury. I have been informed of an
instance of an asthmatic gentleman about sixty years of age who consumed
sixteen ounces every eight or ten days, and had been in the habit of
doing so for many years. Yet, with the exception of his asthma, he
enjoyed tolerable health.
An interesting case has been published which proves that nitric ether in
vapour is a dangerous poison when too freely and too long inhaled. A
druggist’s maid-servant was found one morning dead in bed, and death had
evidently arisen from the air of her apartment having been accidentally
loaded with vapour of nitric ether, from the breaking of a three-gallon
jar of the _spiritus etheris nitrici_. She was found lying on her side,
with her arms folded across the chest, the countenance and posture
composed, and the whole appearance like a person in deep sleep. The
stomach was red internally, and the lungs were gorged.[2543] The editor
of the journal, where this case is related, says he is acquainted with a
similar instance where a young man became completely insensible from
breathing air loaded with sulphuric ether, remained apoplectic for some
hours, and would undoubtedly have perished had he not been discovered
and removed in time.
_Of Poisoning with the Oleaginous products of Combustion._
The physiological effects of these substances have not yet been
extensively investigated. It has been already mentioned, that the
empyreumatic oils of tobacco and other narcotic vegetables are active
poisons; and that the emanations from candle snuffings and imperfectly
consumed tallow probably owe their injurious properties to a peculiar
oil. Many empyreumatic oils are known, and some are used in medicine,
which act powerfully on the animal system as stimulants and
antispasmodics. Among these may be enumerated naphtha, oil of galbanum,
oil of guiaiac, oil of amber, oil of wax, and Dippel’s oil. The last in
particular, which is the rectified empyreumatic oil of hartshorn, but is
prepared also from blood and various animal matters,[2544] has been a
good deal used of late on the continent for medical purposes, and has
even been resorted to as a poison for the purpose of self-destruction.
The only one of these substances whose physiological properties have
been examined with particular care, is the empyreumatic oil procured by
the destructive distillation of lard. When freed of adhering acid by
rectification from quicklime, this oil is limpid and very volatile, has
an insupportable smell, and when diffused in the air, irritates the eyes
and nostrils, and even excites giddiness. Buchner found it to possess
simple narcotic properties. When a mouse was confined under a jar, into
which a little of its vapour was introduced, it suddenly tried to
escape, immediately fell down exhausted, and, although soon afterwards
removed into the open air, expired in about fifteen minutes, without
convulsions. It is much less powerful when introduced into the stomach,
yet is still a dangerous poison through that channel; for five drops
projected into the throat of a chaffinch very nearly proved fatal; and
the only symptoms were excessive exhaustion, slow respiration, and
insensibility.[2545]
Similar effects have been occasionally observed in man. The late
Professor Chaussier has related a case of poisoning in the human subject
from the _oil of Dippel_, or rectified empyreumatic oil of hartshorn. It
is merely mentioned, however, that the individual, on taking a spoonful
by mistake, died immediately; and that no morbid appearance could be
discovered in the dead body.[2546] Another case has been more recently
related, where the poison was the impure oil of commerce, from which the
oil of Dippel is prepared by rectification. The subject was a woman, who
took it intentionally in the dose of an ounce and a half. The symptoms
induced could not be ascertained; but it appeared, that she had been
attacked with vomiting, and, finding the action of the poison either
less speedy, or less supportable than she expected, had thrown herself
into a well and been drowned. The appearances in the body clearly showed
that in this instance the poison had not acted as a pure narcotic. The
whole body exhaled the peculiar fetid odour of the oil. The palate,
tongue, throat, and gullet, were white and shrivelled. The stomach had
outwardly a diffuse rose tint, crossed by gorged black veins, which here
and there had burst and formed patches of extravasation. The contents of
the stomach consisted of remains of food, a good deal of the oil, some
water, and likewise some extravasated blood. Its villous coat was thick,
covered with red points, corrugated into prominent rugæ, but not eroded.
The intestines also presented signs of irritation, but in an inferior
degree.[2547] Dr. Kurtze, a German author, mentions that the impure oil
[Oleum Animale Fœtidum] was given with malicious intention in repeated
doses to an infant eighteen days old, whom he attended, and that it
caused crying and vomiting; and he quotes Froriep’s Notizen, for the
case of a woman of thirty, who swallowed nearly two ounces, and, after
repeated attacks of vomiting, threw herself into a well and was
drowned.[2548]
These facts seem to establish sufficiently the propriety of arranging
the empyreumatic oils among the narcotico-acrids.
_Oil of turpentine_ possesses somewhat similar properties; but is much
less active. It was found by Professor Schubarth, that two drachms of
this oil administered to a dog produced immediate staggering, cries,
tetanus, failure of the pulse and breathing, and death in three minutes;
and in the dead body he remarked flaccidity of the heart, gorging of the
lungs, and redness of the stomach.[2549] It is likewise well known to be
a powerful poison for vermin, such as lice, fleas, and worms.—On man its
effects are capricious. It is frequently used along with other laxatives
against obstinate constipation of the bowels, and either in the same
manner or alone as a remedy for intestinal worms. For these purposes it
has been at times administered in very large doses, for example in the
quantity of two, three, or four ounces, without any other effect than
brisk purging. But on the other hand it has sometimes, in much inferior
doses, induced violent hypercatharsis, or acted severely on the urinary
organs, producing strangury and bloody micturition, or affected the
brain, producing a state like intoxication, followed by trance for many
hours.[2550] I am not aware that it has ever proved fatal.
_Oil of tar_, a composite substance obtained by the distillation of
wood-tar, is another pyrogenous fluid of poisonous properties. Messrs.
Slight of Portsmouth have related the case of a seaman, who, after
taking nearly four ounces by mistake for spirits, was attacked with
frequent vomiting of a matter having a strong odour of tar, attended
with excessive pain in the bowels and loins. Nothing was done for his
relief till about seven hours afterwards, when he was freely bled and
purged, with immediate relief; and next morning he was so better as to
be able to resume his work. The urine had a strong tarry odour, and for
some time he suffered from heat in passing it.[2551] A case occurred in
the London Hospital, in which the symptoms were very different. A lad of
eighteen, while intoxicated, took two or three draughts of oil of tar,
although aware of its being poisonous. Not long afterwards he became
insensible, and had laborious, rattling respiration, coldness of the
extremities, suffusion of the conjunctiva, contraction of the pupils,
and an exceedingly feeble pulse. The stomach-pump brought away a liquid
with an overpowering smell of tar. Stimulants, external as well as
internal, venesection, and turpentine clysters were of little avail; the
insensibility continued, with only a short and imperfect interval; and
he died about twenty-four hours after swallowing the poison. The
pulmonary mucous membrane was highly injected, the lungs gorged with
blood and of a tarry odour, the stomach and intestines natural, except
that the whole _valvulæ conniventes_ were yellow,—the brain and its
membranes also natural.[2552] It is mentioned in the paper of Messrs.
Slight that a gentleman at Brighton died in consequence of a druggist
using oil of tar by mistake for something else in making up a
prescription.
_Creasote_ is another pyrogenous substance possessing considerable
activity as a poison. It is now extensively used in small doses as a
medicine for a variety of purposes.
It has been made the subject of physiological experiment by various
inquirers, and especially by Dr. Cormach; who found that doses of
twenty-five or forty drops caused death in a few seconds when injected
into the jugular vein of a dog, by arresting the heart’s action, and
without visibly altering the condition of the blood; that a quantity
somewhat larger caused only sopor and spasmodic twitches of the muscles,
if injected into the carotid artery, and without proving fatal; that
thirty drops introduced into the stomach of a rabbit excited
convulsions, acute cries, and death in one minute, apparently from
arrestment of the action of the heart; and that the same dose given to a
dog brought on salivation, giddiness, tetanic spasm, a feeble,
fluttering, almost imperceptible pulse, and general insensibility, with
dilated immovable pupils; but recovery took place under the employment
of blood-letting.[2553]—The effects of too large a medicinal dose in man
are pain in the stomach and vomiting, and also, according to Dr.
Elliotson, giddiness, headache, and stupor.[2554] Dr. Pereira alludes to
a case, mentioned in the Times newspaper, of death caused in 36 hours by
two drachms taken at once; and in this instance acute pain in the
abdomen was a prominent symptom.[2555] I presume this is the same case
which is mentioned in the Edinburgh Medical and Surgical Journal as
having occurred at Liverpool.[2556]—The results of Dr. Cormack’s
experiments on animals lead to the conclusion, that in poisoning with
creasote, this substance may always be detected in the body, if it has
not been removed by artificial means a considerable time before death.