Bloxam suggested an admirable and delicate process for the detection of
small quantities of arsenic. The method is, like that of Marsh, founded
on the property possessed by nascent hydrogen of forming a gaseous
compound with arsenic; but, instead of the hydrogen being generated by
the action of dilute sulphuric acid on zinc, Bloxam generates the gas
by an electric current.
The wires from the extremities of a battery terminate in small plates
of platinum foil, which are plunged into the liquid to be tested, the
apparatus being so arranged that the hydrogen gas evolved from the
negative pole is collected. The issuing gas is tested in a similar
manner to that obtained in Marsh‘s process.
This method of Bloxam‘s is exceedingly delicate, and possesses one
great advantage, that no zinc being used, there is no danger of
contamination by the use of impure metal; while, as nothing foreign is
introduced during the process of testing, the liquid under examination
is left pure for the application of other tests if necessary.
[Illustration: Fig. 31.--Dowzard‘s apparatus for Gutzeit‘s test for
arsenic. A and B indicate glass cells or traps which contain solutions
of lead acetate and copper chloride for the purpose of fixing H₂S and
PH₃ which otherwise would react upon the mercuric chloride spot on the
filter-cap. The cells are fitted into one another, as shown in the
figure.]
_Gutzeit‘s Test._--This test is more sensitive to the presence of
minute quantities of arsenic than that of either Reinsch or Marsh. The
apparatus devised by Dowzard should be used (_Journ. Chem. Soc._, vols.
lxxix. and lxxx. 463, p. 715), which consists of an Erlenmeyer‘s flask
fitted with superimposed cells, containing solutions which will wash or
neutralise those gases which would interfere with the accuracy of the
result. The following is Dowzard‘s description of the method of using
the apparatus:
“A weighed or measured portion of the sample is mixed with 5 c.c. of
pure HCl (if the sample is alkaline it must be neutralised first), four
drops of a 15 per cent. solution of cuprous chloride in hydrochloric
acid are then added, and the mixture made up to 30 c.c. with water; if
it is not convenient to work with such a small bulk as 30 c.c. this
quantity may be doubled or trebled, but the same proportion of acid
should be used. A rod of pure zinc, 3 cm. long and 5 mm. in diameter,
is first placed in the flask, the above mixture is then introduced and
the first cell placed in position; lead acetate solution 5 per cent. is
now poured into the cell until it is about half full. The second and
third cells are filled in a similar manner; a small tuft of cotton wool
is introduced into the neck of the top cell, and its mouth capped with
mercuric chloride paper, which may be held in position by an elastic
band or a glass collar made from a piece of glass tubing. After forty
minutes or more the cap is removed and examined in full daylight. A
minute trace of arsenic is indicated by a lemon-yellow spot, which
varies in tint according to the amount present; and a heavy trace by an
orange-brown spot. The mercuric chloride paper is prepared as follows:
one drop of a 5 per cent. solution of mercuric chloride is allowed to
fall on the centre of a piece (4 cm. square) of thin Swedish filtering
paper, such as Muncktell‘s No. 1 F.; the paper is dried before using.”
The lead acetate in the cells absorbs any H₂S gas given off, and if
additional cells contain a 15 per cent. solution of cuprous chloride
in hydrochloric acid, PH₃ is also prevented from passing and causing a
stain. By this method arsenic can be detected in the presence of 2500
times its weight of antimony. The presence of selenium and tellurium
compounds does not interfere with the usefulness of this method.
_Fleitmann‘s Test._--Detects arsenic in the presence of antimony,
but does not detect arsenic as arsenic acid. When zinc or aluminium
is heated with excess of potassium or sodium hydroxide in a mixture
containing arsenious anhydride, arseniuretted hydrogen is evolved. The
gas may be led into 4 per cent. nitrate of silver solution, or a test
tube the top of which is covered with filter paper wet with nitrate of
silver. The gas reduces the silver salt, and a black precipitate is
produced in the solution, or a black spot on the paper.
_Fatal Dose._--Two grains in solution have been known to cause death.
Recoveries have, however, occurred after an ounce or more of the poison
has been taken. Much will depend upon the fulness or emptiness of the
stomach at the time the poison is taken, and also upon the vehicle in
which the poison is administered. Vomiting and purging are more urgent
when the dose is large, probably assisting to get rid of the arsenic
before its fatal action is produced.
_Fatal Period._--From twenty minutes to two or three weeks, and even
later from the secondary effects of the poison. Any thick medium, cocoa
or soup, will of course delay the action of the poison.
_Treatment._--Vomiting should be promoted, and diluent drinks largely
given. The stomach pump, if it can be procured without much delay,
should also be employed to empty the stomach. Emetics of sulphate of
zinc should be given without delay--followed by the administration of
milk, lime-water, and albumen. Symptoms as they occur must be treated
on general principles.
The hydrated sesquioxide of iron, the hydrated oxide of magnesia,
and animal charcoal have been proposed and used as antidotes. The
sesquioxide of iron can be prepared ready to hand by saturating
the tincture _ferri perchloridi_ with ammonia or washing soda. It
should be given freely. Drachm doses of dialysed iron in water may
be administered. Reputed antidotes are useless when the poison is in
the solid state. The diarrhœa, tenesmus, collapse, pain, and nervous
symptoms should be treated on general principles.
=Other Poisonous Compounds of Arsenic=
=Arsenical Vapour.=--The vapour from the flues of the copper and
arsenic smelting-works in Cornwall, escaping into the air, may cause
death to cattle, and the destruction of vegetation. The workmen in
these works not infrequently suffer from eruptions on the skin, and
from great constitutional derangement; but, on the whole, taking into
consideration the dangerous nature of their employment, the men appear
to enjoy average health. Actions for damage and nuisance have resulted
from the escape of this vapour from the factories.
=Arsenite of Potash.=--A solution of arsenite of potash, mixed with
the tincture of red lavender (the solution contains four grains of
arsenious acid in one ounce)--better known as Fowler‘s Solution, or
as Fowler‘s Mineral Solution or Tasteless Ague Drop. It is probably
a solution of arsenious acid in carbonate of potash, and not a true
arsenite of potash. This preparation has been much used as a domestic
remedy for ague in the Fens of Cambridgeshire. Death from its use is
rare; but it is, nevertheless, too dangerous a medicine to be used
recklessly. Idiosyncrasy has much to do with the action of the drug,
some persons taking even large doses with impunity, whilst, in others,
the smallest medicinal dose has produced alarming symptoms. It is
stated that the Styrian arsenic-eating peasant is capable of taking
without injury five grains of arsenious acid for a dose; and in one
case of suspected murder in Styria, the prisoner was acquitted as the
deceased was known to be an arsenic-eater.
_Donovan‘s Solution._--A solution of hydriodate of arsenic and mercury.
Now officinal, and much used by many practitioners.
_Sheep Dip._--The mixture used for washing sheep, composed of
tar-water, soft soap, and arsenic, has caused death in twenty-four
hours. The men engaged in dipping the sheep may suffer both locally and
constitutionally from the effects of the arsenic in the solution.
_Treatment._--As before described.
_Analysis._--See p. 280 _et seq._
=Arsenite of Copper.=--Scheele‘s green, and the aceto-arsenite of
copper, Schweinfurt-green, are met with in commerce and the arts
as green pigments. Among workmen they are familiarly known as
emerald-green, Brunswick-green, or Vienna-green. In France, the term
_vert Anglais_ or English green has been given to them. Scheele‘s
green contains about 55 per cent. of pure arsenious acid; the other,
Schweinfurt-green, about 58 per cent.
These colours are employed for various purposes, among which the
following may be mentioned:
1. Artificial flowers and other articles of dress.
2. Confectionery, pastry ornaments, and toys.
3. As green paint for the insides of houses.
4. In the green colour for wall-papers.
5. In the green-coloured paper lining boxes, &c.
6. Green-coloured tapers used for artificial lighting.
The employment of emerald-green in the colouring of wall-papers is
so extensive, that in the year 1860 an English paper-stainer stated
that he used two tons of arsenic weekly. In 1862 the amount of this
colour manufactured during the year was from 500 to 700 tons. Numerous
cases of chronic arsenical poisoning have resulted from the presence
of arsenic in the form of Scheele‘s green and Schweinfurt-green in
wall-papers and other articles. As the colour is only loosely applied
to the surface by means of a weak solution of size, it is easily
brushed off, and may so impregnate the air of a room as to produce
injurious effects on those who inhabit the apartment. By fermentation
of the starch paste used for fastening the paper to the walls,
nascent hydrogen is liberated, and, combining with the arsenic to
form arseniuretted hydrogen, passes into the air of the room and is
inhaled. This gas is extremely poisonous, and small quantities suffice
to produce serious results. Certain moulds are endowed with the power
of living in materials containing arsenic, and of decomposing arsenious
acid or its salts into the gaseous form known as _diethylarsine_; there
are altogether ten such moulds, and the most active is the _Penicillium
brevicaule_.
In the case of ladies‘ dresses, the following method is adopted:
The colouring material is made by thoroughly stirring
together a mixture containing, in definite proportions, the
green pigment, cold water, starch, and gum arabic, or some
similar substance which shall give the colour consistence
and adhesiveness. Not infrequently in this process the hand
and forearm are freely used in the liquid to expedite the
work. Of this mixture, properly prepared, the workman takes
a quantity in his fingers and roughly spreads it over the
muslin or fine calico. The fabric is then beaten and kneaded
between the hands until it is uniformly coloured. The longer
this process is continued, the more perfect is the result.
The cloth is now fastened to a frame for drying. In all this
process of colouring, the hands, forearms, and frequently
also the face of the operative must become soiled with the
green colour. It will be also observed that the colour is
but loosely applied, _no mordant being used_, as in
calico printing, to fix the pigment in the texture of the
cloth.
_Symptoms._--All the effects produced by arsenic may result from the
use of articles coloured with these pigments. Chronic inflammation of
the stomach and bowels, and irritation of the eyes, accompanied in
some cases with extreme nervous debility and prostration, are by no
means uncommon in those employed in the manufacture of this “cheerful,”
but poisonous colour. The skin of the hands, arms, and scalp is often
attacked by a vesicular eruption or an erythema. When it is borne in
mind that, according to the analysis of Hoffman, a single twig of
twelve artificial leaves may contain as much as ten grains of pure
arsenic, it is not to be wondered at that the most serious results have
occurred from the reckless use of these colours. In Prussia and France
the use of the arsenical colours is prohibited.
_Analysis._--Scheele‘s green is insoluble in water, but is soluble in
ammonia, the solution having a blue colour, from the separation of the
arsenious acid from the oxide of copper. If a few drops of the blue
ammoniacal solution be poured on some crystals of nitrate of silver,
the yellow arsenite of silver is formed. The blue ammoniacal solution,
if acidified with HCl and boiled with pure copper foil, deposits
arsenic on the copper, which, if cut into strips and placed in a small
reduction tube and heated, sublimes and is deposited in octahedral
crystals on the cold portion of the tube. The tests before described
are applicable for the detection of this substance.
=Orpiment=
Orpiment, or yellow arsenic, one of the sulphurets of arsenic, has
been used occasionally as a poison. It is also largely employed in the
arts for paper-staining and for colouring toys. In cases of arsenical
poisoning, it is this compound that is commonly found adhering to the
stomach and intestines. It is formed by the sulphuretted hydrogen, the
result of decomposition, acting on the white arsenic swallowed.
=Realgar=
Realgar, or red arsenic, is another of the sulphurets of arsenic, and,
like orpiment, is largely used in the arts as a colour. It is also
employed, like orpiment, as a depilatory, fatal results having followed
its use for this purpose. The colour of this substance prohibits its
frequent use as a poison.
Both of these compounds owe their poisonous properties to the amount of
free arsenious acid which they contain, and which may be as much as 30
per cent.
_Symptoms._--The symptoms produced by these substances are similar to
those caused by arsenic. The fatal dose will depend on the amount of
free arsenious acid which they may each contain.
_Treatment._--Emetics and demulcent drinks.
=Metallic Arsenic, &c.=
Metallic arsenic, fly powder, arsenic acid, largely used in the
manufacture of magenta, aniline red, or fuchsine, and the arseniates
of potash and soda, are all poisonous. The _papier moure_ of the shops
consists of blotting-paper steeped in a solution of arseniate of
potash. Macquer‘s neutral arsenical salt is the binarsenate of potash.
_Symptoms._--The symptoms are those of arsenical poisoning.
_Treatment._--When metallic arsenic has been taken, vomiting must be
promoted by the use of proper emetics. Tartar emetic should never be
used. In the treatment for poisoning with arsenic acid, or of the
arseniates of potash and soda, the hydrated oxide of iron, or of the
acetate of iron, should be used, as the arseniates are precipitated by
the iron.
=Arsenic Acid=
No case of poisoning by this substance has been recorded, for, although
poisonous, it is better known in the laboratory than in the shops.
It differs from arsenious acid in being only partially volatilised
by heat, in its solubility in water, and in being precipitated of a
brick-red colour by nitrate of silver. With sulphuretted hydrogen a
yellow precipitate is slowly formed, insoluble in hydrochloric acid.
=Arseniuretted Hydrogen=
This gas has proved fatal in several cases. It is generated in the
process known as Marsh‘s process for arsenic, and is so poisonous that
a very small quantity, not sufficient to be detected by its odour, has
caused death. In most cases death has been the result of accident.
_Symptoms._--Giddiness, fainting, constant vomiting, pain in stomach,
and suppression of urine, with rapid destruction of the red blood
corpuscles, associated with hæmorrhages from all the mucous membranes
and jaundice, are among the most prominent symptoms.
The _post-mortem_ appearances are inflammation of the stomach, with
softening of its coats. The liver and kidneys are also more or less
affected, and have been found of a deep indigo colour.
_Analysis._--This has been described when speaking of Marsh‘s process
for arsenic.
=Cacodylic Acid=
Cacodylic acid and the cacodylates are poisonous. The acid dissolves
easily in water and alcohol, and it unites with many metals and
organic substances to form salts. Although it is held by some to be
non-poisonous, Murrell asserts that the administration of cacodylate of
sodium produces symptoms “far more severe than those which follow the
exhibition of arsenic in its ordinary forms” (_B. M. J._, 1900, vol.
ii. p. 1823; 1901, vol. i. p. 120).
Professor Fraser of Edinburgh, on the other hand, from clinical
observation and chemical tests, affirms that cacodylic acid and the
cacodylates are extremely stable bodies, and the arsenic in them is
with such great difficulty set free that it passes through the body in
combination as an inert substance (_B. M. J._, 1902, vol. i. p. 713).
=Arsenical Contamination of Food Stuffs=
Arsenic is found associated with many other substances in nature,
particularly copper and pyrites. Arsenic is commonly present in
commercial sulphuric acid manufactured from pyrites containing the
metal, and when such acid is used with common salt for the production
of hydrochloric acid, the latter also becomes contaminated. It may be
safely stated that commercial sulphuric acid, hydrochloric acid, copper
and zinc, free from arsenic, do not exist in the market. Hence in the
detection of arsenic by the toxicologist the absolute purity of these
reagents, which he uses, must be established.
In the manufacture of glucose, arseniferous sulphuric acid has been
the means of contaminating it. Ritter and Blyth pointed out the
danger, by this means, of conveying arsenic into beer, confectionery,
syrup, and other food stuffs. Glucose made with such acid, and used
in the manufacture of beer, was the cause, in the year 1900, of a
widespread and serious epidemic of arsenical poisoning in Manchester
and Liverpool, in which several thousand persons suffered. Arsenic may
also contaminate grain during malting by the use of anthracite coal or
sulphur bar in the kilns.
Recapitulation of the Leading Facts with regard to
Poisoning with Arsenic
--------------------------+------------------------------------------
ACUTE POISONING.--SYMPTOMS, ETC.
--------------------------+------------------------------------------
Action on alimentary | Intense irritation of the stomach, upper
canal | part of small intestine, and lower part
| of the large. The inflamed condition of
| the stomach occurs even if arsenic be
| absorbed by the skin. Not present in
| all cases.
|
Circulation | The heart weakened, with a consequent
| reduction in force and frequency of
| pulse.
|
The brain and nervous | In some cases the action upon the brain
system. | is that of a narcotic, and the
| paralysis sometimes seen appears to be
| due to a direct action of the drug on
| the cord.
|
The urinary organs | Arrest of the action of the kidneys is
| not uncommon. Stranguary.
|
Fatal dose | Two grains.
|
Average period of the | From half an hour to an hour after the
commencement | poison is taken.
of the symptoms. |
|
Average period before | Ten to twenty-four hours.
death. |
--------------------------+------------------------------------------
CHRONIC POISONING.--SYMPTOMS, ETC.
--------------------------+------------------------------------------
The eyes, nose, and mouth| Irritation and redness of the eyes and
| nostrils. Dryness of the mouth and
| throat.
|
The stomach and bowels | Loss of appetite, colicky pains, cramps,
| irritability of bowels, mucous
| discharges.
|
Nervous system | Depression and irritability of spirits,
| sleeplessness, giddiness, convulsions,
| vertigo, paralysis, etc.
|
Cutaneous surface | Brown pigment deposit in the skin of the
| face. “Eczema arsenicale,” etc.
|
Means of diagnosis in | Examine the urine unostentatiously.
suspected cases. | Remove patient from present abode.
| Examine wall-paper, etc., for arsenic.
|
The probable | Signs of irritation, slight or absent,
_post-mortem_ | in stomach and bowels.
if death is due |
to this poison. |
|
Organs most important to | Liver, stomach, kidney.
secure for analysis. |
|
Circumstances under | Green wall-papers, coloured toys and
which it may occur | sweets, green tarlatan dresses, etc.
independently of |
criminal administration.|
--------------------------+------------------------------------------
ANTIMONY
Antimony, the Stibium of the ancients, is obtained from the native
sulphide. Metallic antimony is of a bluish-white colour, crystalline
and brittle. It melts at about 840° F., and is slowly volatilised at a
white heat.
Two compounds of antimony--tartar emetic and chloride of antimony--are
alone of any toxicological interest.
[Illustration: Fig. 32.--Photo-micrograph of crystals of tartarated
antimony, × 50.
(R. J. M. Buchanan.)]
=Tartar Emetic=
=Antimonium Tartaratum. Tartarated Antimony=
Tartar emetic occurs as a white powder; sometimes, however, with a
yellowish tint. It is soluble in about three parts of boiling water and
fifteen of cold, and insoluble in alcohol.
The _vinum antimoniale_ of the Pharmacopœia contains two grains of the
salt in an ounce of wine.
Before 1856 poisoning by antimony was of rare occurrence, but since
that year several cases of chronic poisoning have occurred, giving to
this substance considerable importance.
Symptoms of Antimonial Poisoning
_Acute._--Tartar emetic is an irritant poison, but possesses slight
corrosive properties. When taken in large doses, two or three drachms,
it gives rise to a metallic taste in the mouth, which is not easily
removed. In most cases, violent vomiting follows immediately after the
poison is swallowed, the vomiting continuing even after the stomach
is emptied of its contents. In a few cases, however, even when a
large dose has been taken, vomiting may be absent. Burning pain is
felt at the pit of the stomach, accompanied with cramps in the belly
and purging. There is considerable difficulty in swallowing, and the
patient complains of tightness and constriction in the throat. The
mouth and throat in some cases are excoriated, or covered with whitish
aphthous-looking spots, which ultimately become brown or black. In some
cases the thirst is intense; in others, absent or nearly so. Cramps
in the lower extremities, almost amounting in some cases to tetanic
spasms, followed by extreme depression, are generally the precursor of
a fatal termination. The urine may be suppressed, as is the case in
arsenical poisoning; in some cases it has even been increased. On this
point, however, the statements of observers differ. Trousseau says that
the urine is suppressed; Huseman that it is _never_ suppressed. The
skin is in some cases covered by a pustular eruption, not unlike that
of smallpox. Dobie has recorded a case of poisoning by tartar emetic in
which a comatose condition was present. In antimonial poisoning, even
in the most desperate cases, there is always greater hope of recovery
than in arsenical poisoning.
[Illustration: Fig. 33.--Photo-micrograph of crystals of tartarated
antimony, × 50.
(R. J. M. Buchanan.)]
_Chronic._--The symptoms which mark the chronic form of poisoning
differ chiefly in being less intense and less rapid than in the acute.
Chronic poisoning by small repeated doses is that form of poisoning
which appears most in vogue of late years--as certain diseases,
enteritis, etc., can be simulated by the administration of repeated
small doses. The unfortunate victim complains of constant nausea and
retching, with great depression. Food is objected to, as it only
increases the vomiting. The matters vomited are at first merely mucus,
but after a time they become mixed with bile. Each time the poison is
repeated, the symptoms become aggravated. Emaciation gradually sets in,
and the person dies from complete exhaustion, or from the effects of
a larger dose than usual. Chronic poisoning has given rise to several
errors in diagnosis, and the histories of recorded cases should put
medical men on their guard. In all doubtful cases examine the urine.
_Post-mortem Appearances._--The mucous membrane of the throat, gullet,
and stomach is inflamed, and in some places softened and corroded.
Aphthous-looking spots are not infrequently found on the mucous
membrane of the stomach, and these may also be observed on the throat
and on the small intestines. The liver has been found in some cases of
chronic poisoning, where the fatal termination has been for some time
retarded, enlarged, and its structure so soft as to be easily broken
down. Fatty degeneration of the internal organs has been found after
protracted fatal administration of the drug. It is stated that in
Brunswick the fatty livers of the geese are produced by the judicious
administration of antimony. The appearances above detailed may be more
or less absent or present, according to the time that may have elapsed
from the swallowing of the poison to the time at which death has
occurred.
At the _post-mortem_ examination on the body of Mr. Bravo, poisoned
with tartar emetic in 1876, the mucous surfaces of the stomach and
duodenum were found pale and yellowish. Ulcers were present in the
cæcum, and the rest of the large intestine blood-stained, but not
ulcerated. Stevenson records the _post-mortem_ appearances of the
bodies of three women poisoned by tartar emetic (_B. M. J._, 1903,
vol. i. p. 873). They are of peculiar interest in reference to the
preservative action of antimony upon the bodies of those poisoned by
it. In the case of M. E. Marsh, upon whose body the examination was
made eight days after death, there was no odour of putrefaction, the
bowels were in a condition of acute catarrh and streaky congestion
without ulceration.
The body of Bessie Taylor had been buried for twenty-one months;
ordinary putrefactive changes were absent, and with the exception of
the integuments, it was in a remarkably good state of preservation.
The alimentary canal showed acute non-ulcerative gastro-enteritis, the
stomach and duodenum were of a cinnabar-red colour, the jejunum also
in patches. The ileum was covered with orange-red mucus in its lower
portion, and there was an orange-coloured patch twelve inches above
the ileo-cæcal valve. The patch on analysis was proved to contain
antimonious sulphide. Similar orange patches were present in the colon
and upper portion of the rectum. There were no ulcerations, but the
mucous membrane of the intestines was of a dull cinnabar-red colour.
The body of Mary J. Spink was exhumed five years after burial, and
presented a life-like aspect; there was no putrefactive odour, and
no larvæ present. The stomach and intestines were of a cinnabar-red
colour; there were no ulcerations; the intestines contained
orange-coloured mucus.
Elimination of Antimony from the System
Antimony, taken in a large dose, or in small doses frequently repeated,
appears to be rapidly absorbed, and then eliminated from the system by
the kidneys. Dating from the time at which the poison was swallowed, it
will be found in the organs of the body in the following order:--
1. Stomach and bowels, but slightly in the liver.
2. Absent from the stomach, but present in the liver,
spleen, and kidneys--traces in the blood.
3. Present in the fat and bones, with traces in the liver,
fæces, and urine.
4. The period required for its complete elimination from the
vital organs varies from fifteen to thirty days.
In other words, the presence of antimony in the stomach and intestines
points to the recent administration of the poison; and its absence
from those organs, and presence in the others above mentioned, to a
more remote period of administration. It has been suggested that in
some cases the poison may be eliminated by the mucous membrane of the
stomach. This assumption has been proved to be correct, for it has been
shown that antimony may be found in the stomach after the inhalation of
antimoniuretted hydrogen.
_Fatal Dose._--It is impossible to state with certainty the exact
amount of antimony--tartar emetic--which may prove fatal, as recoveries
have taken place even after an ounce had been taken. Large doses are
uncertain in their effects, as the severe vomiting which they produce
generally helps to get rid of the poison. In small doses, death may
result from the depressing action which it exerts over the heart.
_Fatal Period._--From a few hours to several weeks, and even months.
_Treatment._--Promote vomiting by the administration of warm water,
or warm greasy water, or the stomach may be washed out with a syphon
tube, unless the chloride of antimony is the poison, and then give
tannic acid in drachm doses in warm water, or any vegetable infusion
containing tannin--viz., tea, oak bark, or cinchona bark. Demulcent
drinks may be administered, and warmth applied. Opium may be given to
relieve pain, and stimulants for the depression.
The Detection of Antimony
Prepare the solutions of the liver and other solid organs, and also the
contents of the stomach, as described under the detection of arsenic,
using tartaric acid instead of hydrochloric acid. Through a portion
of one of the solutions, obtained by filtration or dialysis, pass a
current of sulphuretted hydrogen, which will produce, if antimony be
present, an orange-coloured precipitate of the sulphide of antimony.
The precipitated sulphide is dissolved by hot hydrochloric acid with
the evolution of sulphuretted hydrogen; and if the resulting solution
be poured into water, a white precipitate is formed of oxychloride of
antimony, soluble in tartaric acid. Chloride of bismuth is precipitated
when poured into water, but the precipitate is turned black by sulphide
of ammonium, the antimonial orange-red; the precipitate of bismuth is
not soluble in tartaric acid, the antimonial is soluble.
Marsh‘s and Reinsch‘s processes may also be used for the detection of
antimony. The former is, however, open to the objection that antimony,
when present in any quantity, rapidly precipitates on the zinc in the
form of a flocculent black deposit, while the issuing gas is found to
contain only traces of the metal.
Reinsch‘s process is, however, very delicate, and its application is in
every respect similar to that in use for the detection of arsenic. The
acid liquid should, however, be boiled down to a small bulk with the
copper, before a conclusion is drawn as to the entire absence of the
metal.
Table giving the Characteristic Reactions of Antimonial
and Arsenical Deposits on Copper.
--------------------+----------------------------+----------------
| Antimony. | Arsenic.
--------------------+----------------------------+----------------
The colour of the | Lustrous, with a violet | Dark steel-grey
deposit on copper| hue. | colour, and
by Reinsch‘s | | lustrous.
process is-- | |
| |
The coated copper | No effect, or only a | Well-marked
heated in the end| trifling white sublimate,| sublimate of
of a small tube. | non-crystalline, | octahedral
| non-volatile. If the | crystals; is
| sublimate be dissolved | readily
| in solution of tartaric | volatile.
| acid and sulphuretted |
| hydrogen passed |
| through the solution, |
| the orange antimonious |
| sulphide is thrown |
| down. |
--------------------+----------------------------+----------------
It may be noted that mercury likewise yields a deposit on copper with
Reinsch‘s process; but the coating is in this case either of a grey
colour or white, and silvery on the application of friction. When
the coated copper is heated in a glass tube, there is a sublimate of
metallic mercury readily aggregating into globules on being rubbed with
a glass rod. If the deposit is trifling in quantity, a magnifying-glass
should be used to identify the metallic globules. This test at once
distinguishes a deposit on copper due to mercury from that produced
under similar conditions by arsenic or antimony.
_Quantitative Analysis._--Take a measured quantity of the suspected
liquid and precipitate thoroughly with sulphuretted hydrogen. Wash,
dry, and weigh precipitate. One hundred parts equal 202.78 parts of
crystallised tartar emetic.
Recapitulation of the Leading Facts with regard to
Poisoning with Antimony.
---------------------------------------------------------------------
ACUTE POISONING.--SYMPTOMS, ETC.
-------------------------+-------------------------------------------
Action on alimentary | Intense irritation of the stomach and
canal. | bowels, constant vomiting, and
| frequently purging. Eliminated by the
| stomach when absorbed by the skin, or as
| antimoniuretted hydrogen by the lungs.
| Presence, in some cases absence, of
| signs of inflammation in intestinal
| canal.
|
Circulation | The cardiac contractions are lessened in
| frequency and force, the heart being
| finally arrested in diastole.
|
Brain and nervous | Sometimes delirium, paralysis of sensation
system. | and motion, and diminution of reflex
| action.
|
Urinary organs | Secretion of the kidneys, as a rule, not
| arrested; sometimes increased.
|
Fatal dose | Two grains.
|
Average period of | A very short time after the poison is
commencement of | taken. Almost immediately.
symptoms. |
|
Average period before | Various. Ten to twenty hours.
death. |
-------------------------+-------------------------------------------
CHRONIC POISONING.--SYMPTOMS, ETC.
-------------------------+-------------------------------------------
Mouth | Aphthous spots on mouth, metallic taste.
|
The stomach and bowels | Constant irritation, nausea, sinking at
| the stomach, symptoms of enteritis or
| cholera, purging, tenesmus, etc.
|
Nervous system | Malaise, low spirits, giddiness, delirium.
|
Cutaneous surface | Pustular eruption like smallpox, sweating,
| decrease in temperature.
|
Means of diagnosis in | Same as for arsenic.
suspected cases. |
|
The probable post-mortem| Much the same as in arsenic poisoning.
if death is due to |
this poison. |
|
Organs most important to| Liver, stomach, and kidneys.
secure for analysis. |
-------------------------+-------------------------------------------
MERCURY
Metallic mercury possesses no toxicological interest, as it appears to
be almost inert, even in very large doses. If applied to the skin in a
finely-divided state, as in mercurial ointment, or internally, as blue
pill, its toxic effects may be produced. The vapour given off from the
metal is highly poisonous, producing salivation, emaciation, and death.
A singular accident of poisoning by mercurial vapour occurred on board
H.M.S. _Triumph_ in 1810, owing to the bursting of bladders containing
large quantities of the metal; in three weeks 200 men were affected
with salivation, etc., nearly all the cattle on board died, as well as
the mice, a dog, and a canary-bird.
[Illustration: Fig. 34.--Photo-micrograph of crystals of corrosive
sublimate, × 50. (R. J. M. Buchanan.)]
Corrosive Sublimate
This is the most important of the preparations of mercury. It occurs
either in crystalline masses of prismatic crystals or as a white
powder. It is now known among chemists as the perchloride, though it
is frequently spoken of as the bichloride, chloride, and oxymuriate of
mercury. It has a powerful metallic and styptic taste, and is soluble
in about sixteen parts of cold water and three of boiling water.
Alcohol and ether readily dissolve it, the _latter having the power of
abstracting it from its solution in water_. This property of ether is
of importance as a means of separating corrosive sublimate from its
solution in other liquids. It is important to remember that corrosive
sublimate is soluble in alcohol (R. _v._ Walsh). The liquor hydrargyri
perchloridi of the Pharmacopœia contains half a grain of the salt to a
fluid ounce of water. Half a grain of the muriate of ammonia is added
to increase the solubility of the mercurial salt. Applied externally
to the unbroken skin, corrosive sublimate has caused death in several
cases, the symptoms being almost identical with those which follow the
entrance of the poison into the stomach. Toxic symptoms have followed
intra-uterine or vaginal injections of solution of perchloride of
mercury, also when it has been used to wash out abscess cavities.
Acute poisoning, in some cases fatal, has resulted from the external
application of corrosive sublimate to ulcers and tumours.
Symptoms of Poisoning by Corrosive Sublimate
_Acute._--The symptoms come on almost immediately the poison is
swallowed. A strong metallic coppery taste in the mouth is experienced,
and a choking sensation in the throat. Pain of a burning character
is felt, extending from the mouth to the stomach, followed by nausea
and vomiting of stringent mucus, more or less tinged with blood, and
violent purging, the evacuations being also mixed with blood and mucus.
The pulse is feeble, quick, and irregular; the countenance flushed
or pale, and the tongue white and shrivelled. This appearance of the
tongue is not present in all cases. Broncho pneumonia may occur. The
skin is cold and clammy, and the functions of the kidneys are altered
and albuminuria present, there being in many cases complete suppression
of urine. As is the case with other irritant poisons, the symptoms and
effects produced admit of considerable variation. Thus, there may be
no pain in the stomach, and no purging. Salivation is present in some
cases, but chiefly in those in whom the fatal termination is somewhat
prolonged. This sign is not infrequently absent. Poisoning with
corrosive sublimate differs from arsenical poisoning in the following
particulars:--Corrosive sublimate has a distinct metallic taste,
arsenic is almost tasteless; the symptoms in the former supervene
immediately the poison is swallowed, in the latter there is a short
delay. The discharges in corrosive sublimate are more frequently bloody
than in arsenic poisoning.
_Chronic._--The symptoms present in this form of poisoning are
modified by the size of the dose, and the interval allowed to elapse
between each dose. Nausea, followed by occasional vomiting, and pains
in the stomach, are complained of by the patient. There is general
constitutional disturbance, with anæmia and cachexia, and consequent
mental depression. Salivation, as might be expected, is a more
prominent symptom than in acute poisoning; but the salivation may be
intermittent--that is, it may cease and then reappear, even after the
lapse of months, without an additional dose of mercury having been
given in the interval. Salivation may also come on in the course of
certain diseases, attacking the salivary glands, and it may also be
produced by other causes--pregnancy, etc. The glands of the mouth
become swollen and painful, the gums tender, and the teeth loosened
fall out of the mouth. Periostitis of the jaw may occur. The breath
has a peculiar, offensive smell, the bowels are irritable, and
diarrhœa is not infrequently present. It must be borne in mind that
in certain diseases--granular disease of the kidney--the smallest
dose of any mercurial preparation may produce profuse ptyalism. And
the toxicologist must be careful not to mistake the affection known
as _cancrum oris_, or “the canker,” most common in delicate, ill-fed
children and adults, for the effects of mercury. The nervous system
is more or less affected, neuralgic pains and mercurial tremors
being present in many cases. The tremors commence in the tongue and
face and spread to the arms and legs--they are similar to those of
paralysis agitans; at first they are invoked by exertion, finally they
become continuous; they cease during sleep. Paralysis may also occur,
especially in those exposed to the vapour of mercury. Habit appears to
exert some influence on the action of corrosive sublimate, if we may
accept the story of the old man of Constantinople, who for thirty years
took large doses till his daily allowance was a drachm, and then died
at the respectable age of one hundred years.
_Post-mortem Appearances._--The morbid appearances are chiefly
confined, as is the case with arsenic, to the stomach and bowels;
but the corrosive action of the mercurial sublimate is more marked.
Inflammation more or less intense is always present in the stomach, the
mucous membrane of which may be found of a slate-grey colour, corroded,
and so soft as to scarcely admit of the removal of the organ without
tearing it. The cæcum and rectum are also sometimes found inflamed,
and the mucous membrane softened. Perforation of the stomach is very
rare, only one case having been recorded in which this was present. The
mouth, throat, and gullet may also present signs of the action of the
poison similar to those just described as seen in the stomach. Patches
of pneumonia are present in the lungs of some cases, and the kidneys
show coagulative and desquamative nephritis.
_Fatal Dose._--The smallest dose was _two grains_ in the case of a
child, but the exact amount to cause death in an adult has not been
accurately determined. Recovery has taken place after one hundred
grains has been taken.
_Fatal Period._--From half an hour to five days. No exact time can
be stated. In one case death took place on the twelfth day after
swallowing seventy grains of the perchloride.
_Treatment._--Vomiting, if present, must be encouraged; if absent, it
must be produced by emetics--zinc sulphate or cupric sulphate, followed
by copious draughts of warm water. The hypodermic injection of ¹/₂₀ to
⅒ grain of apomorphine may also be used to produce vomiting. Albumen,
the white of egg, or vegetable gluten produced from flour by washing it
in a muslin bag, should be given. The albuminate of mercury so formed
should be quickly removed by an emetic or lavage by means of a soft
tube and funnel in mild cases, as it is soluble in excess of albumen,
and may be digested or absorbed. The rapid removal of the poison from
the stomach, however, is the end to which all our exertions must tend.
The forcible use of the stomach pump should not be employed if it
can possibly be avoided, as it may greatly injure the softened mucous
membrane of the gullet and stomach. Opium may be given to relieve pain,
and opium enemata to relieve purging and tenesmus.
=Calomel=
Calomel, or the subchloride of mercury, is not used as a poison.
In large doses it may act as an irritant poison, and death has not
infrequently occurred even from comparatively small doses. Profuse
salivation and gangrene of the mouth have resulted from its use,
and cases are recorded of death resulting from these. In many
cases idiosyncrasy appears to modify, more or less, the action of
this preparation of mercury. The poisonous effect of calomel has
been attributed to--(1) Adulteration with corrosive sublimate. (2)
Conversion of the calomel into corrosive sublimate by the action of the
hydrochloric acid of the gastric juice.
_N.B._--The free acid of the gastric juice is probably in too small a
quantity to materially alter the composition of the calomel.
=Ammonio-Chloride of Mercury=
White precipitate may, if taken in large doses, produce alarming
effects, but it cannot be regarded as an active poison. Pavy‘s
experiments on rabbits indicate that it is a more powerful poison than
was formerly thought to be the case. Its action is that of an irritant,
accompanied with, in some cases, severe salivation.
=Red Precipitate=
Red oxide of mercury possesses poisonous properties, but it is
seldom employed as a poison. The symptoms most frequently present
are vomiting, coldness of the surface of the body, stupor, pain in
the abdomen, and cramps of the muscles of the lower extremities. The
vomited matters are generally mixed with some of the red oxide.
=Cinnabar. Vermilion=
A compound of sulphur and mercury in the form of a dark red crystalline
mass is known as cinnabar; and to the same substance reduced to a fine
powder the name vermilion has been given. It is used as a red pigment.
It can scarcely be considered as a poison, Orfila asserting that it
is not poisonous. The vapour of this substance appears, however, to
be capable of producing severe symptoms, and in one case, profuse
salivation resulted from the application of the vapour to the body.
=Cyanide of Mercury=
This substance, though an active poison little inferior to corrosive
sublimate, is seldom used as such, probably from its being better known
to chemists than to the general public. It differs from corrosive
sublimate in having no local corrosive action. It has been supposed,
but proof is wanting, that its injurious effects are due to its
decomposition by the acids of the stomach and the formation of prussic
acid. Death has occurred in nine days from a dose of ten grains. It
acts as an irritant. The sulphocyanide of mercury is used in the
manufacture of the toy known as Pharaoh‘s serpents.
=Turbith Mineral=
A powerful irritant poison, but seldom used. A drachm has caused death
in a boy sixteen years of age. Coldness of the surface, burning pain in
the stomach and bowels, with other symptoms of irritant poisoning, were
present. After death, the mucous membranes of the throat, stomach, and
bowels were found considerably inflamed.
=Nitrates of Mercury=
These substances--the nitrate and sub-nitrate--are used in the arts for
various purposes. They act as powerful irritant poisons, with symptoms
and _post-mortem_ appearances not unlike those before described when
speaking of corrosive sublimate and other irritants.
_Chemical Analysis_:
Table showing the Reaction of Mercuric and
Mercurous Salts with Reagents
-------------------------------+------------------------------------
Mercuric Salts
-------------------------------+------------------------------------
1. With solution of iodide of | 1. Bright scarlet precipitate,
potassium. | soluble in excess.
|
2. With potash solution. | 2. Bright yellow precipitate.
|
3. With hydrosulphuret of | 3. First a yellowish and then a
ammonia. | black precipitate is produced.
|
4. Heated in a reduction tube.| 4. It melts, boils, is volatilised,
| and forms a white crystalline
| sublimate.
|
5. With ether. | 5. It is freely soluble in ether;
| and the ethereal solution, when
| allowed to evaporate
| spontaneously, deposits the salt
| in white prismatic crystals.
|
6. Heated with carbonate of | 6. Globules of metallic mercury
soda in a reduction tube. | are produced.
-------------------------------+------------------------------------
Mercurous Salts
-------------------------------+------------------------------------
1. Hydrochloric acid. | 1. A white precipitate of calomel,
| blackened on addition of ammonia.
|
2. Potassium iodide solution. | 2. Green precipitate.
|
3. Caustic potash or soda | 3. Black precipitate of mercurous
solution. | oxide.
-------------------------------+------------------------------------
=Detection of Mercury in the Tissues and in the Contents of the
Stomach.=
Mercury is particularly liable to be absorbed by the tissues; it also
readily combines with various organic substances, gelatine, albumin, &c.
[Illustration: Fig. 35.--Photo-micrograph of globules of mercury
obtained by Reinsch‘s process, × 50. (R. J. M. Buchanan.)]
_A._--If the contents of the stomach are under examination, they should
be diluted with distilled water, filtered, and the residue pressed and
reserved for further examination.
The liquid thus obtained may be concentrated, and, while still warm,
slightly acidified with hydrochloric acid. A slip of zinc foil, with
a piece of gold foil twisted round it, is then introduced. If mercury
be present, the gold will, sooner or later, lose its yellow colour,
and its surface become white and silvery, while the zinc is wholly or
partially dissolved. The gold being removed, separated from the zinc,
washed first with water and then with ether, is divided into two equal
parts. One half may be heated in a reduction tube, when it will yield a
sublimate of metallic mercury, identified by the spherical form of the
globules under a magnifying-glass, and their metallic reflection and
complete opacity. The other half of the gold may be treated with nitric
acid and heated, which will dissolve off the mercury. The resulting
solution, after expelling the excess of acid by evaporation, will give
a scarlet precipitate with iodide of potassium soluble in excess; and,
with protochloride of tin, a black precipitate of metallic mercury.
_B._--For the detection of mercury in the insoluble form, the residue
from _A_ is dried; or, if the tissues are under examination, they
should be finely divided, and freed from superfluous moisture. In
either case, the substance is boiled in moderately strong nitric or
hydrochloric acid (about one part of acid to four of water). After
digestion for some time, the liquid is filtered, concentrated, and
tested as in _A_. When there is reason to infer the presence of
corrosive sublimate in considerable quantity in an organic liquid,
advantage may be taken of the solubility of the salt in ether, and
the power possessed by this liquid of abstracting it from its aqueous
solutions. The liquid is agitated with an equal volume of ether, the
ethereal solution poured off and allowed to spontaneously evaporate,
when the corrosive sublimate will be left in white silky prisms,
yielding all the characteristic reactions of the salt. In obscure cases
of salivation, the saliva should be examined as follows: Take about
two drachms of the saliva, acidulate with pure hydrochloric acid, and
immerse in the mixture a very small piece of copper gauze attached
to a platinum wire, and set aside in a warm place for some hours. If
mercury be present, the copper will be covered with a white coating;
this should be washed and heated in a reduction tube, when globules of
mercury will be formed, and examined with a lens.
_C._--Mercury in solution may be detected by Reinsch‘s process. On
boiling with pure copper foil after acidifying the solution with
hydrochloric acid, the mercury is deposited on the copper in the
metallic state, as a whitish silvery film, which can be polished
to a silvery mirror surface. On washing the film in water, ether,
and absolute alcohol and allowing it to dry, then subliming it in a
reduction tube by the aid of heat, the mercury deposits on the cool
part of the tube in the form of minute globules, which may be easily
recognised through the microscope. If a small crystal of iodine be now
placed in the tube and gently warmed so as to volatilise it, but not
the mercury, and the tube be left to stand for a short time, the iodine
combines with the mercury to form the scarlet iodide, the colour of
which renders it easy of recognition.
According to Bonnewyn, the presence of an extremely small quantity of
corrosive sublimate (¹/₅₀₀₀₀) in calomel may be detected by immersing
a clean knife blade, moistened with alcohol or ether, in the suspected
calomel. A black spot is formed on the steel very difficult of removal.
No spot is formed when the calomel is pure.
LEAD
Metallic lead is not poisonous; but it appears probable that when it
is acted upon by the acids of the intestinal secretions, it may become
so changed as to produce unpleasant symptoms. Any salt of lead is
poisonous when in a condition to be absorbed into the system.
Sugar of lead and white lead are alone important, and will therefore be
briefly considered.
=Sugar of Lead=
Acetate of Lead. Subacetate. Goulard‘s Extract
_General Character._--The acetate of lead, better known as sugar
of lead, is not unlike loaf-sugar in its general appearance. It is
usually met with in the form of solid crystalline masses of a white or
brownish-white colour. To the taste it is sweet, a metallic astringent
taste being left in the mouth. Acetate of lead is soluble in water and
in alcohol. The subacetate is a more active poison than the neutral
acetate. Sugar of lead is popularly considered as an active poison, but
this does not appear to be the case. Sir R. Christison gave eighteen
grains daily in divided doses for eight or ten days with no other
unpleasant symptoms than slight colicky pains in the abdomen. Lead is
probably eliminated from the system by the urine, and also by the milk;
but there is reason to believe that when once deposited in the body,
some considerable time is required for its complete elimination. Dr.
Wilson is of opinion that in chronic lead poisoning the lead is more
largely deposited in the spleen than in any other organ of the body.
This organ should therefore always be carefully examined in suspected
cases of poisoning by this metal.
_Goulard‘s Extract_ is a solution of the subacetate of lead. It may be
of a reddish colour, from the employment of common vinegar in the place
of pure acetic acid in the manufacture.
_Goulard‘s Lotion_ is the extract diluted with water.
=White Lead=
White lead, carbonate of lead, ceruse, or kremser white, is used as a
pigment. It is generally in the form of white, heavy chalky masses,
insoluble in water, and, when taken in large doses, poisonous. It is
this substance which, in the majority of cases, causes chronic lead
poisoning, or _painter‘s colic_.
The _chloride_ and _nitrate_, the oxides, _litharge_ and _red
lead_, are all poisonous; but the _sulphate_, due probably to its
insolubility, appears to be inert.
Lead poisoning may result from--
1. Constant contact with lead and its salts in manufactories.
2. Its use in the arts and as a pigment. The injurious effects of
this substance are strikingly seen among painters, the makers of
glazed cards, and the workmen engaged in preparing Brussels lace--this
material being whitened by beating white lead into it. All thus
employed are liable to suffer more or less from chronic poisoning.
3. Its application to the surface of the body in the form of ointment,
plasters, cosmetics, and hair-dyes.
4. Drinking water impregnated with lead, from being stored in leaden
cisterns or conveyed in leaden pipes.
“The action of water upon lead is much modified by the presence of
saline substances. It is increased by chlorides and nitrates, and
diminished by carbonates, sulphates, and phosphates, and especially
by carbonate of lime, which, held in solution by excess of carbonic
acid, is a frequent ingredient of spring and river water. But water
highly charged with carbonic acid may become dangerously impregnated
with lead, in the absence of any protecting salt, in consequence of
its solvent power over carbonate of lead. In general, water which is
not discoloured by sulphuretted hydrogen may be considered as free
from lead; but there are few waters which have passed through leaden
pipes, or have been retained in leaden cisterns, in which a minute
analysis will not detect a trace of the metal; and were it not for the
great convenience of lead, iron pipes and slate cisterns would, from a
sanitary point of view, be in all cases preferable.
“Another case of contamination by lead may arise from electric action,
as where iron, copper, or tin is in contact with or soldered into lead;
and in these cases, owing to the action of alkaline bases as well as
of acids upon the lead, danger may occur when it is thrown into an
electro-negative as well as into an electro-positive state.
“Cisterns are sometimes corroded and their bottoms are perforated by
pieces of mortar having dropped into them, the lime of which has caused
the oxidation of the metal and a solution of the oxide.”
5. Lead may also find its way into the system by means of the food.
Farinaceous foods, chocolate, and tea may become contaminated if lead
wrappers be used; and confectionery from the use of lead chromate as a
colouring agent. The use of leaden vessels in the manufacture of cider
is attended with danger, and also the keeping of pickles in glazed
earthenware jars. The celebrated “Devonshire Colic” was the result
of cider-making in leaden vats. Beer may be contaminated with lead
if allowed to stand in leaden pipes overnight. Rum has been known to
have been dangerously impregnated with lead, leaden worms having been
used attached to the stills. Many tobacconists are in the habit of
using lead foil to wrap up their tobacco and snuff; this practice has
resulted in several cases of chronic lead poisoning. Soda and Seltzer
waters may contain lead when kept in syphons with leaden caps or valves.
6. Acute and subacute cases of poisoning occur from the taking of lead
in the form of diachylon pills to procure abortion.
=Symptoms of Poisoning by Lead=
_Acute._--A metallic taste in the mouth, accompanied with dryness in
the throat and intense thirst, is experienced by the patient soon after
the poison is swallowed. In some cases, however, _two or more hours_
may elapse before the effects of the poison begin to show themselves.
Vomiting may or may not be present. Twisting colicky pains are felt
in the abdomen, relieved in some cases by pressure. The paroxysms
of pain may be separated by intervals of ease. The bowels are, as a
rule, obstinately confined, and the fæces are of a dark colour, from
the formation of the sulphuret of lead. The skin is cold, the pulse
quick and weak, and there is considerable prostration of strength. In
some cases the patient suffers from cramps of the calves of the legs,
and sometimes, in protracted cases, paralysis of one or more of the
extremities may supervene. The effect on the nervous system, headache,
temporary blindness, is marked by giddiness, and stupor, in some
cases delirium even resembling acute mania, terminating in coma, or
convulsions and death. Albuminuria may occur.
_Chronic._--This form of poisoning generally occurs among painters,
manufacturers of white lead, pewterers, and others. The early symptoms
are those of ordinary colic, only more severe. The patient generally
complains, in the first instance, of feeling unwell, and of general
debility. He then suffers from pain of a twisting, grinding nature,
felt in the region of the navel, the abdomen being retracted and hard.
The bowels are obstinately confined. The appetite becomes capricious,
and may be entirely lost. The mouth is parched, the breath fœtid, the
countenance sallow, the skin dry, and general emaciation sets in. A
nasty sweetish metallic taste in the mouth is present in most cases.
Not infrequently the subjects of lead poisoning experience a peculiar
form of paralysis of the upper extremities, well known as “dropped
hand.” It appears that this condition is the result of paralysis of
the extensor muscles of the wrist, the long supinator escaping. In
other cases the muscles of the shoulder girdle or pelvic girdle and
legs may be affected. Acute general paralysis has occurred in workers
with lead, and may prove fatal. Optic neuritis and optic atrophy occur
in some cases. Persistent headache may be present in others. The
muscles undergo a form of fatty degeneration. The lead appears to act
primarily on the muscles, then on the nerves, and lastly on the nerve
centres. The absorption of lead causes marked anæmia with degeneration
of the red corpuscles, which show marked punctate basophilia. One
other symptom of importance has yet to be noticed. The gums, at their
margins where they join the teeth, present a _well-marked blue line,
absent where a tooth has been removed_. This is not present in all
cases, but it should be looked for. Chronic lead absorption produces
cardiovascular changes with arterio-sclerosis, valvular degeneration,
cardiac hypertrophy, and chronic renal changes with albuminuria.
Closely associated with these conditions are saturnine arthritis
and gout. The effects upon the vessels may predispose to cerebral
hæmorrhage or lead encephalopathy. Cicconardi suggests as a method of
diagnosis in lead poisoning, where the cause of the colic is uncertain,
to paint the skin with a 6 per cent. solution of sodium sulphite. If
lead be the cause the painted part will become darkened in colour.
_N.B._--The symptoms produced by white lead--carbonate
of lead--are those of _colica pictonum_, or _painter‘s colic_,
described under the head of Chronic Lead Poisoning.
_Post-mortem Appearances._--In acute poisoning the mucous membrane of
the stomach and intestines is inflamed, and is in some cases covered by
layers of white or whitish-yellow mucus, more or less impregnated with
the salt of lead swallowed. Corrosion of the mucous membrane may occur
if the dose be large, and this condition is more frequently present
when the neutral salt is taken.
In chronic poisoning there are no constant _post-mortem_ appearances.
The muscles of the paralysed extremity are usually found flaccid, of a
cream colour, and the subject of fatty degeneration.
_Fatal Dose._--Sugar of lead is not an active poison, recovery having
taken place after one ounce had been swallowed.
_Fatal Period._--Uncertain.
_Treatment._--The stomach should be emptied by means of the pump or
syphon tube, followed by the free administration of the sulphates of
soda and magnesia. The carbonates should not be given, the carbonate
of lead being poisonous. Vomiting should be promoted, and a powerful
cathartic administered. Albumen and milk should also be given, as these
precipitate the oxide. In the chronic form of poisoning, the iodide
of potash and aperients, notably the sulphate of magnesia, should be
administered. Dixon Mann does not consider that iodide of potash is
of any value as an eliminator of lead, as the latter forms a stable
compound with the tissues. Sulphur baths are also useful in removing
the lead from the system. Lately the galvanic bath has been tried
with great success. By way of _prophylaxis_, it has been recommended
that all those engaged in lead manufactories, or who are obliged to
handle this metal frequently, should partake largely of lemonade made
with sulphuric acid, should not take their meals in the factories, or
without well washing the hands.
_Chemical Analysis_.--When the solid acetate is heated on platinum
foil, it melts, then solidifies, becomes dark in colour, and gives off
fumes of acetic acid.
The following are the liquid tests for lead in solution:
1. Dilute sulphuric acid gives a white precipitate of the sulphate,
which is insoluble in nitric, but soluble in hydrochloric acid, in
excess of caustic potash solution, and in ammonium acetate solution.
2. Solution of potassium iodide gives a yellow precipitate, soluble in
boiling water and caustic potash solution.
3. Sulphuretted hydrogen, or ammonium sulphide, gives a black
precipitate.
4. Potassium bichromate a yellow precipitate.
=Detection of Lead in Organic Mixtures=
The contents of the stomach or vomited matters must be diluted
with water and filtered. The residue left on the filter, washed
with distilled water, should be set aside for further examination;
the filtrate and washings acidified with nitric acid. A current of
sulphuretted hydrogen passed through the solution will then throw down
the whole of the lead, should any of that metal be present, in the
form of a brownish-black sulphide, which may be collected on a small
filter and dried. The sulphide, boiled with dilute nitric acid, is
partly converted into insoluble sulphate, and in part dissolved as
nitrate. The carefully neutralised solution may be either tested at
once or carefully concentrated. In either case, the production of a
bright yellow precipitate, with a solution of bichromate of potash, and
a similar one with a solution of iodide of potassium, may be taken as
conclusive of the presence of lead. The portion of lead deposited as
sulphate will be found to be soluble in a solution of pure potash, the
resulting liquid giving a brown-black precipitate on the addition of
sulphide of ammonium.
The insoluble residue left on the filter should be incinerated in a
porcelain crucible, either with or without nitric acid, care being
taken not to raise the temperature more than is necessary to produce
the desired effect: the carbonised mass boiled with dilute nitric
acid evaporated to dryness, extracted with distilled water, and
then filtered, the filtrate tested as before mentioned. It is often
useful, as a preliminary test for the presence of lead in a soluble
form, to dip a piece of bibulous paper into the clear liquid obtained
by submitting the contents of the stomach or vomited matters to
filtration, and then exposing the paper to the action of a current of
sulphuretted hydrogen. If lead be present, blackening of the paper will
take place.
To detect the lead in the urine and fæces, Dixon Mann advised the urine
to be evaporated to the consistency of gruel, and the fæces to be mixed
with distilled water to a similar consistence; the organic matters are
then to be destroyed with hydrochloric acid and chlorate of potash
with the aid of heat, and the solution filtered. The filtrate is then
placed in a cell with a parchment bottom, and this into another cell
containing distilled water acidulated with sulphuric acid. Two pieces
of platinum foil are now placed in the inner and outer cells, separated
by the parchment; that in the inner cell is connected with the cathode,
that in the outer with the anode of four Grove cells, and the current
closed for several hours. The lead, if present, is deposited on the
platinum connected with the cathode.
The magnesium method (Marsden & Abram) is useful. A strip of pure
magnesium is placed in the urine, to which has previously been added
ammonium oxalate, about 1 gramme to 150 c.c. Lead, if present, is
deposited on the magnesium in about half an hour, but it may take some
hours. The strip is washed in distilled water and dried--warmed with a
crystal of iodine the yellow iodide will form; or the deposit may be
dissolved in HNO₃ and tested in the usual way.
Goadby recommends inoculating the urine with bacillus coli, which
during its growth produces H₂S; this precipitates any lead as sulphide.
After filtering, the filtrate is dissolved in a small quantity of 10
per cent. nitric acid and tested by the usual methods.
Recapitulation of the Leading Facts with regard to
Poisoning by Lead
--------------------+-------------------------------------------
ACUTE POISONING.--SYMPTOMS, ETC.
--------------------+-------------------------------------------
Action on alimentary| Sweet metallic taste in mouth. Vomiting,
canal. | constipation, burning twisting pain in
| the belly. Inflammation of canal.
|
|
|
Circulation. | The pulse lowered, and tendency to death
| from syncope. Anæmia.
|
Nervous system. | Neuralgic pain, convulsions, cramps,
| paralysis, &c.
--------------------+-------------------------------------------
CHRONIC POISONING.--SYMPTOMS, ETC.
--------------------+-------------------------------------------
Mouth and alimentary| Sweet metallic taste; blue line at margins
canal. | of gums; breath fœtid. Colic,
| constipation.
|
Nervous and muscular| Headache, delirium, stupor, amaurosis,
symptoms. | paralysis of the extensor muscles of the
| wrist, anæsthesia of the affected part.
| Fatty degeneration of the muscles.
|
Circumstances under | Certain trades, as painters, plumbers,
which it may occur. | type-founders, &c. Action of drinking
| water on lead. Hair-dyes, food in leaden
| utensils, &c.
|
Prophylaxis | Grinding lead colours in oil or water.
| Cleanliness in factories. Slate cisterns
| for water. Dilute sulphuric acid
| lemonade.
|
Medical treatment | Epsom salts, iodide of potassium, galvanic
| baths, &c.
--------------------+-------------------------------------------
COPPER
Metallic copper, like metallic lead, is not poisonous, but its oxides
are; it should, therefore, not be swallowed, as it is rapidly acted on
by the intestinal secretions and poisonous compounds formed. An alloy
of copper is used for ornamenting ginger-bread, &c. All the salts of
copper are poisonous. The most important are, however, the _sulphate_,
_blue-stone_, or _blue vitriol_, and the _subacetate_ or _verdigris_.
Copper is eliminated to a slight extent by the urine. It has been
found in the stomach, liver, and intestines eight months after its
administration had been discontinued. It has also been detected more
readily in the bronchial secretion than in the urine.
=Symptoms of Poisoning by Copper=
_Acute._--The primary action of the sulphate of copper in from five- to
fifteen-grain doses is that of a quick emetic; in larger doses, a
powerful irritant; but when absorbed, it appears to act chiefly on the
brain and nervous system. Its irritant action is marked by nausea,
vomiting, griping pain in the belly, which is greatly distended,
and increased flow of saliva. The vomited matters are of a bluish
or greenish colour, and the discharges from the bowels greenish and
containing blood. The vomited matters become blue on the addition of
ammonia. The above-mentioned symptoms usually follow immediately after
the poison is swallowed, and rapidly increase in severity. After a
time, the remote effects supervene, marked by headache, giddiness,
laboured breathing, quick irregular pulse, coma or convulsions,
paralysis, and death.
In poisoning by this substance, the convulsions are most violent, and
wild incoherent delirium not infrequent.
The subacetate of copper or verdigris produces symptoms not unlike
those just described. Jaundice and suppression of urine may result when
either this or the sulphate is taken.
_Chronic._--Constant and troublesome irritation of the stomach and
bowels; vomiting and purging, attended with considerable straining
at stool; loss of appetite, loss of power, and general emaciation
set in. The patient is subject to frequent trembling of the limbs,
which may end in paralysis. The mouth is unpleasant, and a coppery,
metallic taste is experienced. Cramps or colicky pains in the belly are
not infrequently present. Jaundice is sometimes present. The vomited
matters are greenish; but the practitioner must not be led away, and
thus mistake the colour of the vomited matters which occur in some
morbid states of the bile, for the result of poisoning by a salt of
copper. A form of chronic poisoning affecting workers in this metal
has been described by some French pathologists as “copper-colic.” A
cachectic condition of the system, accompanied with one or more of the
symptoms already detailed, marks this form of poisoning. _A purple_
line along the margins of the gums is present in some cases.
Copper poisoning may result from--
1. Its introduction into the system by using, for culinary purposes,
copper vessels not properly tinned. An interesting account of poisoning
from this source may be found in the second volume of the _Medical
Observations and Inquiries by a Society of Physicians in London_,
published 1764. The cases there recorded occurred on board ship, with
most alarming symptoms.
2. By constant application of the metal to the surface of the body,
necessitated by certain processes in its manufacture and in its
application for industrial purposes. M. Michel Levy, however, says
in his work, _Traité d‘Hygiène, Publique et Privée_, that workmen
in copper may pass green-coloured urine and yet be as robust and as
long-lived as other workmen.
3. The use of certain preparations of this metal as pigment.
4. The use of German silver--an alloy of copper, zinc, and nickel--may
be rendered dangerous by the action of acid food upon the compound.
5. The use of a salt of copper to give a green fresh colour to certain
tinned vegetables and fruits, peas, &c., now introduced into this
country from France.
_Post-mortem Appearances._--The mucous membrane of the stomach is
inflamed, the inflammation extending sometimes into the gullet. The
intestines may be found perforated. The lining membrane of the whole
alimentary canal presents a deep green colour, distinguished from that
the result of a morbid condition of the bile by being turned blue on
the addition of ammonia.
_Fatal Dose._--Nothing certain is known as to the exact quantity that
may prove fatal, as the evidence of the poisonous action of copper is
somewhat contradictory. It appears to be more dangerous in small doses
than in large ones. Half an ounce of verdigris or subacetate has proved
fatal to an adult.
_Fatal Period._--The shortest time on record is four hours.
_Treatment._--Induce vomiting, and assist the emetic action of the
copper salts by the free use of warm water, milk, or any demulcent
drink. The stomach tube may be used if vomiting does not occur. As an
antidote, large quantities of albumen and iron filings have been given,
of which the former appears to be most efficacious.
_Chemical Analysis._--The following are the liquid tests for copper in
solution:--
1. Ammonia gives a bluish-white precipitate soluble in excess, forming
a blue solution.
2. Sulphuretted hydrogen and ammonium sulphide give a
chocolate-coloured precipitate.
3. Ferrocyanide of potassium gives a port-wine colour, or reddish-brown
precipitate.
4. If a bright steel needle be introduced into an acid solution of
copper, the metal is deposited on the needle.
5. If a piece of zinc bound with platinum wire be placed in a solution
of a copper salt, the metal is deposited on the platinum; it is turned
violet on exposure to the vapour from sulphuric acid mixed with
potassium bromide.
=Detection of Copper in Organic Liquids=
_A._--The finely-divided tissue, or the contents of the stomach,
diluted with water, are thrown on a filter, and the insoluble portion
set aside for further treatment. (See _B._)
The filtrate and washings may now be concentrated, acidified with
sulphuric acid, and a polished needle inserted in the liquid; and
should no immediate deposition of metallic copper occur, it may be
allowed to remain for several hours. The colour of the metallic deposit
is highly characteristic of copper. As a corroborative proof, the
concentrated liquid may be placed in a platinum capsule with some
fragments of zinc, when the copper will be deposited on the platinum
capsule at the parts in contact with the zinc; the liquid poured off,
and the excess of zinc adhering to the platinum removed by dilute
hydrochloric acid. The copper may now be dissolved off the platinum by
nitric acid, the excess of acid driven off by heat, and the solution
subjected to the wet tests given above.
_B._--The insoluble portion from _A_ is incinerated in a porcelain
crucible. The ash thus obtained is digested in hydrochloric acid
with the aid of heat, and evaporated nearly to dryness. The residue,
dissolved in distilled water, may be tested as under ‘_A_.’
ZINC
The sulphate and the chloride of zinc are alone important. Poisoning by
the chloride of zinc has been described (p. 265).
=Sulphate of Zinc=
White vitriol or white copperas.
_Symptoms._--The sulphate of zinc acts as a pure irritant. Violent
vomiting, accompanied with pain in the abdomen, and purging, are the
symptoms which first make their appearance. These may be followed by
symptoms which betoken collapse, viz. coldness of the limbs, paleness
of the face, irregular pulse, and fainting.
_Post-mortem Appearances._--Presence of inflammatory action.
_Fatal Dose._--Uncertain.
_Fatal Period._--Death has occurred in four hours.
_Chemical Analysis._--Distinguished from oxalic acid by remaining fixed
when heated on platinum foil.
In Solution:
1. _Ammonia_ gives a white precipitate soluble in excess.
2. _Ferrocyanide of Potassium_, a white precipitate.
3. _Sulphuretted Hydrogen or Ammonium Sulphide_, a milky-white
precipitate in a neutral pure solution.
4. _Nitrate of Baryta_, a white precipitate showing the presence of
sulphuric acid.
5. _Caustic potash_ or _soda_, a white precipitate soluble in excess.
In Organic Mixtures pass sulphuretted hydrogen, collect the sulphuret,
and decompose it with boiling hydrochloric acid, then test for zinc.
_Treatment._--Tea, coffee, milk, warm water, albumen, and in some cases
enemata of gruel and other emollients.
IRON
The preparations of iron which are of importance are the sulphate and
the muriate.
Sulphate of Iron
_Copperas_ or _Green Vitriol_--has been administered as a poison, but
more frequently to procure abortion. An ounce has been taken with no
other serious effect than the production of violent pain, purging,
and vomiting. Constant application of this substance to the body
has produced vomiting, pains in the belly and limbs. These symptoms
disappear on treatment.
_Chemical Analysis._--(1) Hydrosulphuret of ammonia gives a black
precipitate. (2) Ferrocyanide of potassium added to it, in solution,
gives rise to a greenish-blue precipitate, becoming dark blue on
exposure. (3) Chloride of barium will point to the nature of the acid
present.
=Muriate of Iron=
Better known as the _Tincture of Sesquichloride of Iron_, or the
_Tinctura Ferri Perchloridi_.--The tincture acts as a corrosive and
irritant poison, death having followed in five weeks after an ounce and
a half had been swallowed. It is sometimes used as an abortifacient.
Recovery has, however, taken place after three ounces had been
swallowed. The symptoms present in most cases observed were those of a
corrosive and irritant.
_Chemical Analysis._--(1) The addition of nitrate of silver, causing
a white precipitate insoluble in nitric acid, points to the presence
of chlorine. (2) The peroxide of iron, indicated by the formation of
Prussian blue on adding a solution of the ferrocyanide of potassium.
BISMUTH
The preparations of this metal act as irritant poisons, death having
occurred from a dose of two drachms of the sub-nitrate. Dr. Trail
(_Outlines of Medical Jurisprudence_, p. 116) mentions the ease of a
patient of his who took _six drachms_ in three days in divided doses.
The symptoms were vomiting, extreme pain in the abdomen and throat,
a weak, feeble pulse, and much anxiety about the præcordia. Recovery
took place. A case of severe vomiting during pregnancy, ending fatally,
was mistaken for arsenic poisoning. The error arose from mistaking a
greyish powder on the walls of the stomach for arsenic. It turned out
on further inquiry that it was bismuth, given medicinally to prevent
the vomiting. Bismuth carbonate mixed with gruel or bread and milk
is given in large quantities for the purposes of radiography of the
alimentary canal without any untoward effects.
POTASSIUM
=Nitrate of Potash=
This substance is well known as nitre, saltpetre, and sal prunella. In
large doses it acts as an irritant, and cases are recorded in which it
has been used to poison children. In one case, the presence of crystals
of the salt in some of the dried vomited matter on the child‘s shoe,
led to an explanation of the cause of death.
_Symptoms._--Those of a pure irritant, to which death must be referred,
and not to any constitutional action of the drug. The nervous symptoms,
which are sometimes very marked, are, as is well known, common to the
action of many pure irritants. In some cases there is suppression of
urine.
_Post-mortem Appearances._--Those produced by irritants generally.
_Chemical Analysis._--Separate the poison by dialysis, evaporate, and
test the crystals as directed under nitric acid.
_Fatal Dose._--About an ounce.
_Fatal Period._--Two hours.
_Treatment._--The same as for other irritants; demulcent drinks.
Promote vomiting.
=Sulphate of Potash=
_Sal Polychrist_, _Sal de Duobus_, or sulphate of potash, acts as an
irritant poison, being largely used in France as an abortive. The
symptoms and the _post-mortem_ appearances are much the same as those
produced by the nitrate. A like treatment may also be adopted. In the
detection of this substance, the nitrate of baryta will point to the
acid present, and bichloride of platinum to the presence of potash.
=Chlorate of Potash=
This salt acts as a poison when taken in large doses, producing
symptoms which might be mistaken for poisoning with arseniuretted
hydrogen, or for such diseases as hæmoglobinuric fever.
_Symptoms._--These comprise pain in the stomach and bowels with
vomiting, collapse and stupor, cyanosis, jaundice; diminution of the
urine, which contains hæmoglobin, casts, and albumen. It is a question
whether the jaundice is hæmatogenous or hepatogenous. Chlorate of
potash destroys the red corpuscles, the hæmoglobin is dissolved out and
is set free in the liquor sanguinis.
_Fatal Dose._--45-50 grains proved fatal to a child three years old.
For an adult 390 grains to an ounce and a half.
_Fatal Period._--From five hours to several days.
_Treatment._--The stomach should be washed out through the syphon tube.
Venæsection may be useful, with subsequent transfusion of fresh blood.
The nephritis and other symptoms must be treated generally.
_Post-mortem Appearances._--The mucous membrane of the stomach may be
inflamed and submucous hæmorrhages may be found. The blood is chocolate
in colour and gives the spectrum of methæmoglobin. The spleen is
enlarged and chocolate-coloured, and the kidneys acutely inflamed.
_Chemical Analysis._--Chlorate of potash may be separated from organic
material by dialysis.
1. If to a solution of the salt a few drops of indigo sulphate be
added, and then a few drops of strong sulphuric acid, the indigo-blue
is bleached.
2. If a small crystal of the chlorate be heated in a test tube with a
drop of strong sulphuric acid, it explodes with detonation.
BARIUM
The chloride, nitrate, and carbonate of barium are all irritant
poisons. But besides their irritant action, the salts of barium also
appear to act on the nervous system and the heart, arresting its action
in systole. The symptoms, post-mortem appearances, and treatment are
the same as for the other irritant poisons. Sulphate of magnesia, or
other soluble sulphate, should be given to form an insoluble sulphate
of baryta. Sulphate of barium is also used like bismuth carbonate for
radiography.
_Chemical Analysis._--Sulphuric acid or alkaline sulphate gives a
white precipitate with solution of chloride of baryta, insoluble in
nitric acid. The salts impart to flame a greenish-yellow colour. The
chlorine is detected by nitrate of silver. Dissolve the carbonate in
hydrochloric acid, and test as above.
CHROMIUM
Two compounds of this metal are largely used in the arts for dyeing
purposes--the neutral chromate and the acid bichromate of potash. The
bichromate of potash is a powerful poison, and death may occur from its
direct action on the nervous system, without the development of any of
the signs of irritation; in other cases, however, well-marked irritant
symptoms have been present. Applied externally, it produces deep
fistulous sores, especially on the mucous membrane of the septum of the
nose, in the workmen who are engaged in its manufacture. These sores
are prevented to some extent by taking snuff. Dyers not infrequently
suffer severely on their arms when using it in the course of their
trade. Death has resulted in _four hours_ after its administration.
_Chemical Analysis._--A solution of the bichromate of potash, added to
a solution of acetate of lead, gives a yellow precipitate; with nitrate
of silver, a red. The salt boiled with hydrochloric or sulphuric acid
and alcohol, gives a green liquid.
_Treatment._--Emetics, magnesia, chalk, demulcent drinks, &c.
CHAPTER V
VEGETABLE AND ANIMAL IRRITANTS
=Mode of Action.=--The general effects produced by the somewhat large
class of vegetable irritants are--
1. Severe abdominal pain, accompanied with vomiting and purging.
2. Absence in most cases of any cerebral or nervous symptoms.
3. The irritant properties appear to reside in an acrid oil or resin.
In colchicum, stavesacre, and some others, the presence of an alkaloid
may account for their active properties.
4. In medicinal doses, the vegetable irritants act as safe purgatives.
5. The _post-mortem_ appearances found in the alimentary canal betoken
inflammation, the result of irritation.
6. Applied externally, they produce inflammation, pustular eruptions,
and sometimes unhealthy callous sores.
SAVIN
The leaves and tops of this plant, _Juniperus Sabina_ (_N.O.
Coniferæ_), yield an acrid volatile oil, to the presence of which the
poisonous properties are due. The oil is colourless or pale yellow,
with a peculiar terebinthinate odour. It is used in medicine both
internally and externally, and is supposed to possess emmenagogue
properties. The dried powder is less active than the fresh tops. Savin
is seldom used as a poison, more frequently to procure abortion. Its
use for this purpose is mentioned in the old ballad of “Marie Hamilton”:
“The King has gane to the Abbey garden,
And pu‘d the savin tree,
To scale the babe from Marie‘s heart;
But the thing it wadna be.”
_Symptoms._--Those of irritant poisoning. Violent pain in the abdomen,
followed by vomiting, and in some cases salivation and strangury.
Purging is not always present. When taken to procure abortion, death
often takes place before the object for which it was taken is attained.
_Post-mortem Appearances._--The stomach, gullet, and intestines are
found congested and inflamed. The stomach may in places be seen
corroded, and a green powder adherent to its coats. The powder washed
and dried, and then rubbed, gives off the odour of savin.
_Chemical Analysis._--When an infusion or decoction of the leaves
has been taken, chemical analysis is of no assistance. The oil may
be separated from the contents of the stomach by subjecting them to
distillation, and then shaking the distillate with ether, when the oil
is dissolved out. On the evaporation of the ether, the oil is left for
examination. When the powder is taken the contents of the stomach are
not unlike green pea-soup. If a small portion of the green liquid be
taken, and diluted with water, the green chlorophyll, being insoluble,
will sink; but if the colour be due to bile, the liquid will remain of
a uniform green colour. If a portion of the green matter be collected,
dried, and then rubbed in a mortar, the characteristic odour of savin
will be given off. The microscope may detect bits of the twigs.
The oil, on the addition of strong sulphuric acid, gives a brown
colour. On diluting the coloured liquid with water, a dense white
precipitate forms.
CROTON OIL
The oil expressed from the seeds of _Croton tiglium_ (_N.O.
Euphorbiaceæ_).
The seeds, when taken, produce violent pains in the stomach and
purging. Pereira has described the case of a man who suffered severely
from inhaling the dust of the seeds. The dose of the oil is from half
a minim to a minim. Dr. Trail mentions the case of a delicate lady
patient who took three drops for a dose without inconvenience. Dr. Adam
records a case (_Edinburgh Medical Journal_, 1856) of a man who, in
mistake, drank three drachms of a liniment containing about fifty drops
of croton oil. After the most alarming symptoms, the patient ultimately
recovered. Two drachms and a half have caused death (_Journal de Clinic
Médicale_, 1839, p. 509). The poisonous properties depend upon the
presence of a fatty acid.
A medical friend informed Husband that in Shetland six drops in as many
colocynth pills have, in cases there, only produced “a comfortable
‘_aisement_’ of the bowels.” This is attributed to the _dura ilia_,
resulting from a constant fish diet.
_Symptoms._--Pain in the abdomen, vomiting, and purging, followed by
exhaustion and collapse. In some cases, when the dose is large, the
pain is hot and burning, and may be felt from the mouth downward.
_Chemical Analysis._--Separate the oil from the contents of the stomach
by means of ether, and then drive off the ether by means of heat. The
oil then warmed with nitric acid becomes of a brown colour, and nitrous
acid vapours are given off.
COLCHICUM
The poisonous properties of _Colchicum autumnale_, Meadow Saffron
(_N.O. Melanthaceæ_) reside in an alkaloid _Colchicine_, chiefly found
in the corms, but also present in other parts of the plant. The seeds
have caused death.
In June 1875 an epidemic of gastric irritation among the inhabitants
of Rione Boego was traced to the use of the milk of goats which had
accidentally eaten the leaves of colchicum.
_Symptoms._--Colchicum, in medicinal doses, increases the activity of
the liver, and bile is freely secreted. The action of the kidneys and
of the skin is also increased. The heart is more or less affected, and
its frequency diminished. In large doses, all the symptoms of irritant
poisoning are present, and in some cases have been likened to those
observed in Asiatic cholera.
_Post-mortem Appearances._--Death may result from its use without
leaving any morbid appearances. In other cases, however, the usual
signs of inflammation were present. Casper describes the colour
and condition of the blood in those poisoned by colchicum as dark
cherry-red, with the consistency of treacle. A marked congestion of the
vena cava may also be present.
_Chemical Analysis._--Colchicine, obtained by Stas process, added to
concentrated nitric acid, becomes of a violet colour, changing to
blue and brown. The violet solution changes to yellow on dilution
with water, then to red on adding caustic soda. Tincture of iodine
precipitates colchicine of a kermes brown colour, platinum bichloride
yellow, and tannic acid white, the precipitate being soluble in
alcohol, acetic acid, and alkaline carbonates. Strong sulphuric acid
gives a yellow colour with colchicine, which changes to green, violet,
and reddish-brown on the addition of nitric acid.
_Fatal Dose._--One ounce of the tincture.
_Treatment._--Stimulants and opium should be given to counteract its
depressing effects. Tannin is said to be an antidote.
ERGOT
Like savin, ergot is more frequently used to procure abortion than as a
poison. When taken in a large dose it causes vomiting, purging, intense
thirst, hurried breathing, and irregularity of the heart‘s action.
Ergot appears to act powerfully on non-striated muscular fibre wherever
it exists in the body; hence the vessels contract powerfully, and the
peristaltic action of the intestinal canal is greatly increased. On the
pregnant uterus its action is uncertain, as it does not appear to have
any marked power in inducing labour, but on the parturient uterus its
effects are most marked. A case is recorded in the _Lancet_ (vol. ii.
1882) in which ergot had been taken for some time to procure abortion,
but this end not being accomplished, the patient took “two hands full”
of the powdered ergot to expedite matters, which caused the following
fatal symptoms: There was some amount of jaundice, and the expression
of the face was anxious. Occasionally fits of stupor occurred, and the
general condition of the patient was maudlin, but there was no smell
of alcohol in the breath; but during the course of the case, which
ended fatally, a distinct etherish smell could be perceived. The pulse
was so quick that it could not be counted, and it had also a peculiar
jerky feeling under the finger. Attempts were made to induce labour
by passing a _bougie-a-boule_, but the patient died collapsed before
delivery could be effected.
Where the drug has been taken for some time in the form of rye-bread
made from the diseased grain, the symptoms in some cases are referable
to the nervous system; in others, the blood appears to undergo
certain changes; and hæmorrhages into the internal organs, as in the
case just mentioned, have been frequently noticed. Gangrene of one
or more of the extremities has also been known to occur. To chronic
poisoning by this drug the term _Ergotism_ has been applied, and may
occur under two forms--the spasmodic and the gangrenous; the former
marked by convulsions, giddiness, delirium, dimness of vision, and
tetanic spasms; the latter, as a rule, by dry gangrene of the nose or
extremities.
_Chemical Analysis._--Ergot has a peculiar, slightly fishy odour, which
is increased by rubbing up the powder with liquor potassæ and heating
the mixture. At the same time it turns a reddish colour. The production
of this odour, and the appearance under the microscope, are the only
tests yet known for this substance in powder. From organic mixture it
may be extracted with hot alcohol acidulated with sulphuric acid. The
solution is red in colour, and shows two bands in the spectrum, one in
the green, and a second, broader and more marked, in the blue.
_Treatment._--Wash out the stomach, and give inhalations of amyl
nitrite.
BLACK HELLEBORE
This plant, _Helleborus niger_--Black Hellebore--(_N.O. Ranunculaceæ_),
known as the Christmas rose, is the melampodium of the old
pharmacopœias. All parts of the plant are poisonous.
_Symptoms._--Purging, vomiting, pain in the bowels, and cold sweats.
Death is generally preceded by convulsions and insensibility.
_Post-mortem Appearances._--Those common to the action of other
irritants.
WHITE HELLEBORE
White Hellebore, _Veratrum album_ (_N.O. Melanthaceæ_), acts very much
in the same manner as the black hellebore, but is more powerful. The
powder causes violent sneezing. The alkaloid _Veratria_ appears to be
the active principle. The symptoms and _post-mortem_ appearances are
analogous to those produced by black hellebore.
GAMBOGE
Gamboge is the gum resin of _Garcinia Morella_. It is an active
ingredient in certain quack “vegetable pills.” One drachm has caused
death by its irritant action. Owing to the imperfect pulverisation of
gamboge in quack pills, they have caused violent irritation of the
bowels, straining at stool, and prolapsus uteri, due to the irritating
action of small pieces of this substance.
JALAP
Jalap, the powder obtained from the tubers of _Exogonium Purga_. The
active properties of the drug reside in a resin. It is a drastic
purgative; twelve grains have killed a dog.
SCAMMONY
Scammony is obtained from the dry root of _Convolvulus Scammonia_. Like
the last mentioned, it is a powerful purgative, and may cause death if
given in large doses to debilitated individuals.
CASTOR-OIL
The oil expressed, with or without the aid of heat, from the seeds of
_Ricinus communis_. A girl, eighteen years of age, died in Liverpool in
1837 from eating a few of the castor-oil seeds.
ARUM MACULATUM
Cuckoo-pint, Wake-robin, or Lords and Ladies, is one of the most acrid
of indigenous vegetables. The active property of the plant appears to
be lost by drying, and by distillation in water. Children have been
poisoned by its leaves.
YEW
The twigs and fruit of _Taxus baccata_ act as irritant poisons,
producing also symptoms which point to cerebro-spinal mischief. A case
is recorded of poisoning by yew leaves, in which only five grains of
the leaves were found in the stomach; yet death took place within an
hour from the time the symptoms commenced (_British Medical Journal_,
1876, vol. ii. p. 392). In the above-mentioned case, vomiting and other
signs of gastric irritation were absent. The chief symptoms present
were--pallor of the face, faintness, an almost imperceptible pulse,
facial convulsions, foaming at the mouth, stertorous breathing, loss
of consciousness, ending in death. The symptoms are due to an alkaloid
toxin. Several children have died after eating the fruit. _Post-mortem_
signs of irritation of the alimentary canal.
LABURNUM
_Cytisus Laburnum_, or common Laburnum, the seeds, bark, and wood of
which are poisonous. They contain a narcotico-acrid, crystallisable
alkaloid--_Cytisine_--producing vomiting, foaming at the mouth,
convulsions, and insensibility. Recovery took place in two cases
mentioned by Trail, from the use of emetics and ammonia.
FOOL‘S PARSLEY
_Æthusa Cynapium_ has been mistaken for parsley. Nausea, vomiting,
giddiness, and severe abdominal pains are among the most common
symptoms of poisoning by this plant.
BRYONY
Two plants are included under this name, _Bryonia dioica_, white
bryony (_N.O. Cucurbitaceæ_), the only indigenous cucurbitaceous
plant, and the _Tamus communis_, black bryony _(N.O. Dioscoreaceæ_).
Both the bryonia dioica and the tamus communis possess active irritant
properties. They are of importance from the fact of their growing wild,
and the possibility of the fruit being eaten by children.
ELATERIUM
Elaterium, the inspissated juice of _Ecballium officinarum_, or
Squirting Cucumber. It is a powerful drastic purgative, one grain
having given rise to alarming symptoms in man.
ANIMAL IRRITANTS
CANTHARIDES
Cantharides--_Cantharis vesicatoria_ (_N.O. Coleoptera_)--is seldom
given as a poison, but is most frequently employed to procure abortion,
or for its supposed aphrodisiac properties.
Cantharides is a pure irritant. Applied externally, it produces
vesication; and if absorbed, strangury.
Cantharidine--the active principle of Cantharides--is insoluble in
water and bisulphide of carbon. It is but slightly soluble in alcohol,
but it is dissolved by chloroform, ether, and some oils. Four parts of
cantharidine have been procured from a thousand parts of the flies.
_Symptoms_.--An acrid taste is first experienced in the mouth,
followed by a burning heat in the throat, stomach, and abdomen. There
is constant vomiting of bloody mucus, and the stools also contain
blood. The patient complains of intense thirst, pains in the loins,
and an incessant desire to void urine, which is frequently mixed with
blood. Salivation in some cases is a prominent symptom. Strangury may
result from the external application of cantharides as a blister, &c.
Priapism is often obstinate and painful, and the fatal termination is
generally ushered in by violent convulsions and delirium. In pregnant
women, abortion may take place as a result of the general irritation
and disturbance of the system, there being no proof that the uterus
is particularly affected by the drug. The vomited matters may contain
shining green particles, the presence of which indicates the nature of
the poison taken. The invasion of the symptoms may in some cases be
retarded.
_Post-mortem Appearances_.--Those of powerful irritation. The mucous
membrane of the whole alimentary canal, from the mouth to the rectum,
has been found in a state of acute inflammation. The uterus, kidneys,
and internal organs of generation share also in the general irritation,
ulceration of the bladder having been met with in some cases. Portions
of the wings and elytra are sometimes found adhering to the coats of
the stomach.
_Fatal Dose_.--One ounce of the tincture has caused death in fourteen
days. This is perhaps the smallest fatal dose on record. Six ounces
have been stated to have produced no dangerous symptoms. The
worthlessness of the preparation may account for this result.
_Treatment_.--Vomiting should be promoted and warm mucilaginous drinks
given. If vomiting be absent, emetics should be administered. Oil
should not be given, as it dissolves out the active principle. Opium
may be given with advantage.
_Chemical Analysis_.--The contents of the stomach should be
concentrated and then treated with chloroform, filtered, and the
filtrate allowed to spontaneously evaporate. A portion of the residue
should then be placed on the skin, and the presence or absence of
vesication noticed. Examined under the microscope, portions of
the wing-cases may be detected. No change of colour is produced
in cantharidine by the action of sulphuric or nitric acid, thus
distinguishing this substance from any of the vegetable alkaloids.
PUTREFACTIVE OR BACTERIAL ALKALOIDS
The processes by which complex and highly organised substances are
broken up into their primary elements are largely synthetical. The
putrefactive processes brought about by the action of bacteria result
in the formation of special products, some of which combine with
certain mineral and vegetable acids to form definite chemical salts;
in this respect they correspond with inorganic and organic bases.
These products are called ptomaines, a name suggested by an Italian
toxicologist, Selmi, and it is derived from the Greek word πτῶμα, a
cadaver or corpse.
On account of their basic properties, resembling the vegetable
alkaloids, they are called putrefactive or bacterial alkaloids. They
have been called animal alkaloids, but some ptomaines may be produced
by the action of bacteria upon vegetable proteids; so this term is not
strictly applicable, and should be restricted to those basic bodies
or “_leucomaines_” that result from metabolism of the tissues in the
animal body.
The essential element of their basic nature is nitrogen, and in this
they resemble the vegetable alkaloids. Some contain oxygen, like the
fixed alkaloids, while others do not, like the volatile alkaloids
nicotine and conine. The kind of ptomaine formed depends upon the
nature of the bacterium, the material upon which, and the conditions
under which, it grows; the amount of oxygen present; the temperature
and the period of growth. All ptomaines are not necessarily poisonous.
Albumin is the origin from which all alkaloids, vegetable or animal,
are derived. The following is a list of the principal ptomaines:
_Methylamine_, CH₃NH₂.--Found in herring brine
and decomposing fish--non-poisonous.
_Dimethylamine_, (CH₃)₂NH₂.--From putrefying
gelatine, yeast, fish, and sausage--non-poisonous.
_Trimethylamine_, (CH₃)₃N.--Various decomposing animal
and vegetable tissues, ergot--poisonous in large
quantities.
_Ethylamine_, C₂H₅NH₂.--Beet-sugar,
wheat-flour--non-poisonous.
_Diethylamine_, (C₂H₅)₂NH₂.--Putrid fish and
sausage--non-poisonous.
_Triethylamine_, (C₂H₅)₃N.--Putrid fish and
sausage--non-poisonous.
_Propylamine_, C₃H₇NH₂.--From cultures of bacteria of
fæces--non-poisonous.
_Butylamine_, C₄H₁₁N.--From cod-liver oil. Diaphoretic
and diuretic--in large doses causes vomiting and stupor.
_Iso-amylamine_, (CH₃)₂·CH·CH₂CH₂NH₂.--Decomposing
yeast and cod-liver oil--active poison, causes
convulsions and death.
_Caproylamine_, C₆H₁₅N.--Called septicin by Hager.
_Collodine_, C₈H₁₁N.--The first ptomaine obtained in
a chemically pure condition--from putrid horse flesh,
pancreas, gelatine, and mackerel.
_Hydrocollodine_, C₈H₁₃N.--Putrefying horse flesh and
mackerel--highly poisonous.
_Parvoline_, C₉H₁₃N.--Putrid horse flesh and mackerel.
_Unnamed base_, C₁₀H₁₅N.--From decomposing fibrin and
jelly-fish. Like curare in its action.
_Putrescine_, C₄H₁₂N₁₂.--From human corpses--feebly poisonous.
_Cadaverine_, C₅H₁₆N₂.--From human corpses--causes suppuration.
_Neuridine_, C₅H₁₄N₂.--Common product of putrefaction--quite inert.
_Neurine_, C₅H₁₃NO.--From human corpses, intensely
poisonous--resembles muscarin in its action.
_Choline_, C₅H₁₅NO₂.--From putrefying animal and
vegetable substances--feebly poisonous; by giving up one
molecule of water it changes to neurine--this may be
brought about by bacteria or chemical agencies.
_Muscarine_, C₅H₁₃NO₂.--From putrid fish and horse
flesh. The active principle of poisonous mushroom.
_Gadinine_, C₇H₁₆NO₂.--From putrefying codfish,
haddock, and gelatine, in pure cultures of proteus
vulgaris--poisonous in large quantities.
_A Base_ (_?_), C₇H₁₇NO₂.--From decomposing
horse flesh--its action is like curare: causes loss of
temperature, rigors, convulsions, and general paralysis:
the heart stops in diastole.
_Mydaleine._--Composition not determined--from human
corpses--actively poisonous.
Even after prolonged periods and with access of air, any putrefactive
alkaloids which may form do so in very small quantities, and they are
very unstable. In their chemical reactions they respond to many of the
group-tests used for alkaloids, but they differ in their reaction to
the special tests used for vegetable alkaloids. There is no test that
will differentiate between putrefactive and vegetable alkaloids, as a
class; at the same time no putrefactive alkaloid will give the same
chemical reactions, and have the same physiological properties, as any
one of the vegetable alkaloids.
_Neurine_ was first obtained by Liebreich by boiling protagon with
concentrated baryta. Since then it has been extracted from putrefying
animal tissues. The free base is strongly alkaline, and gives a white
cloud with the vapour of hydrochloric acid. It is intensely poisonous,
resembling muscarine in its action. Very small quantities cause
complete paralysis in frogs. Respiration ceases first, and the heart
beats become more and more feeble, until it stops in diastole. If
atropine be now injected the heart begins to beat again.
As a defence set up in cases of poisoning, when one or other of the
rarer alkaloids has been used, it has been suggested that the poison
discovered in the body of the deceased was due to the processes of
putrefaction of the tissues themselves. In view of this it is important
to know the toxic power of such putrefactive alkaloids as may be found
in the human cadaver.
Two only of these are actively poisonous--_neurine_ and _mydaleine_;
others are toxic in so small a degree that large amounts would be
required to produce lethal effects, far more in proportion to the body
weight than any vegetable alkaloid for which it may be alleged they
have been mistaken.
_Neurine_ does not appear before the fifth or sixth day after death,
_mydaleine_ not until the seventh day, and only in traces; it does not
appear in amount sufficient for quantitative analysis until the end of
the second or third week.
At the period after death when a medico-legal analysis has generally to
be made, _choline_ is the only alkaloid present, and it is but feebly
poisonous.
In rabbits _neurine_ causes marked salivation and increased flow
of secretion from the eyes and nose. The heart beats more quickly
at first, but gradually slows down and stops in diastole. There is
increased peristalsis of the intestines with profuse diarrhœa. There
is narrowing of the pupil both after injection or local installation.
Clonic spasms and violent convulsions occur, and are followed by
paralysis first of the hind then of the fore legs, ending in death. The
symptoms are prevented or relieved by atropine.
If atropine be injected first the poisonous effects of the _neurine_ do
not show themselves.
_Mydaleine_ was discovered by Brieger in putrefying cadaveric organs.
Small doses injected into guinea-pigs cause profuse lachrymation and
coryza.
The pupils dilate and then become motionless. The temperature rises
from 1° to 2° Centigrade. There is somnolence at this stage, with
increased intestinal peristalsis. The pulse and respirations are
quickened; later these with the temperature return to the normal, and
the animal recovers. Large doses cause death with the heart in diastole
and the intestines contracted.
Clonic spasms and stupor precede death.
_The Extraction of putrefactive alkaloids_ from organic matters may be
carried out by the process for alkaloid extraction (_vide_ p. 335 _et
seq._).
Amongst the attempts made to distinguish the putrefactive from
vegetable alkaloids by chemical reactions one method was based on the
rapid reduction of potassium ferricyanide to the ferrocyanide. After
converting the alkaloid to a sulphate, a solution of it is mixed with
a drop of potassium ferricyanide and a drop of ferric chloride added:
the deep blue colour of Prussian blue is produced if reduction to the
ferrocyanide has taken place. However, certain vegetable alkaloids,
viz. morphine, aconitine, eserine, and hyoscyamine act rapidly as
reducing agents upon the ferricyanide. Emetine, igasurine, nicotine,
colchicine act less rapidly. Brieger considers that when the reaction
occurs with putrefactive alkaloids it is due to impurities present in
them. Brouardel and Boutmy have suggested making use of the action
of alkaloids upon photographic silver bromide paper as a means of
distinction. The paper is written upon with a solution of the alkaloid
and kept light free for half an hour; it is then fixed in a solution
of sodium hyposulphite and washed in water. The putrefactive alkaloids
are said to reduce and blacken the silver compound, while the vegetable
alkaloids do not. Neither of these processes is to be relied upon for
medico-legal purposes.
LEUCOMAINES OR ANIMAL ALKALOIDS
_Leucomaines_ or _animal alkaloids_ are basic substances which
originate from the metabolic processes taking place in the animal body.
They closely resemble the vegetable alkaloids, and some are found in
plants as well as animals. It is probable that some of them may have
originated primarily from the putrefactive processes in the intestines
and been absorbed into the system. The following is a list of the
principal leucomaines resulting from the metabolism of the tissues of
the animal body:
_Adenin_, C₅H₅N₅.--From thymus gland, from all tissues
animal or vegetable which are rich in nucleinic
acid--poisonous in large doses.
_Sarkine_ or _hypoxanthine_, C₅H₄N₄O.--From urine and
flesh--causes increased reflex excitability and
convulsive seizures.
_Guanine_, C₅H₅N₅O.--From flesh and guano--it is inert.
_Xanthine_, C₅H₅N₄O₂.--From flesh and urine--acts as a
muscle stimulant.
_Heteroxanthine_, C₆H₆N₄O₃.--From urine.
_Methylxanthine_, C₆H₆N₄O₂.--From urine.
_Paraxanthine_, C₇H₈N₄O₂.--From urine--destroys
spontaneous muscular action, lessens reflex excitability.
_Carnine_, C₇H₈N₄O₃.--From fresh meat.
_Gerotine_, C₅H₁₄N₂.--From liver and kidneys, an isomer
of cadaverine--exerts a paralysing action upon the nerve
centres and cardiac ganglia.
_Spermin_, C₂H₅N.--From semen, testicles, ovaries,
breast, thyroid, pancreas, and spleen, normal bone
marrow. Poehl states that it has a tonic effect on the
nervous system.
_Creatinine_, C₄H₇N₃O.--From urine.
_Crusocreatinine_, C₅H₈N₄O.--From fresh meat.
_Xanthocreatinine_, C₅H₁₀N₄O.--From fresh meat--causes
depression, fatigue, somnolence, defæcation, and
vomiting.
_Betaine_, C₅H₁₁NO₂.--From urine.
_Mytilotoxine_, C₆H₁₅NO₂.--From poisonous mussels.
=The Relation of Leucomaines to Disease=
It will be necessary in considering the relation of leucomaines to
disease to give the term a wider significance than that relative to
the chemistry of these bodies. Autogenous diseases may be looked upon
as having their origin in altered metabolism of the tissue cells,
apart from the introduction of foreign cells or poisons. “It is
certainly true that if we should drink only chemically pure water, take
only that food which is free from all adulteration and infection,
and breathe the purest air free from all organic matter living and
dead, yet our excretions would contain poisons. It is true that the
excretions of all living things, plants, and animals contain substances
which are poisonous to the organisms excreting them” (Vaughan).
Bouchard estimates that the amount of a certain poison formed in
the intestines of a healthy man in twenty-four hours, if absorbed,
would prove fatal. Unless free elimination takes place, elevation of
temperature may follow.
The products of imperfect digestion, if absorbed, may give rise to
serious disturbances. Hildebrandt has shown by his experiments that
subcutaneous injection of pepsin into dogs is followed by elevation
of body temperature, which he calls “ferment fever.” The fever
reaches a maximum within a few hours and may last several days.
Rigors are frequent. The animals suffer from trembling in the limbs,
uncertainty of gait, vomiting, dyspnœa, and coma followed by death. On
_post-mortem_ examination there are found degeneration of the heart,
muscles, liver, and kidneys, abundant hæmorrhages into the intestine,
Peyer‘s patches, the mesenteric glands, and occasionally into the
lungs. The blood is at first lessened in coagulability, afterwards
increased, and thrombi formed which have been found in the lungs and
kidneys.
Excessive formation of these poisonous substances within the body
or insufficient elimination of them produces serious disturbances.
Fatigue fever is an example. A considerable rise of temperature may
follow excessive and prolonged exercise, the appetite is impaired,
and insomnia is present from excitation of the brain and the senses
being rendered more acute. There may be rigors simulating malaria.
This fatigue fever occurs particularly amongst recruits in armies
subjected to prolonged marching. From his observations of this disease
in the Italian army, Mosso states that it is due to the absorption
of poisonous substances into the blood from the tissues, which, if
injected into the circulation of healthy animals, produces symptoms
of exhaustion. The fever of prostration or exhaustion is similar but
less in degree, it is more likely to be produced by prolonged exertion
with insufficient food, it may resemble typhus fever, delirium may
be present, and loss of muscular control over the bowels; death may
result. In non-fatal cases weeks may elapse before recovery takes place.
Rachford has pointed out that an excess of paraxanthine in the blood
is followed by migraine, and it may give rise to epileptic seizures,
gastric neurosis, and asthma; and by injecting paraxanthine into the
blood of mice and rats he has produced symptoms of certain forms of
epilepsy, and others similar to the nervous symptoms of chronic lead
poisoning.
CHAPTER VI
FOOD POISONING (BROMATOTOXISMUS)
Instances have occurred from time to time of serious illness attacking
individuals either separately or collectively shortly after the
ingestion of food. The food may be rendered poisonous in the following
ways:
1. A poisonous substance may have been added to it, intentionally or
accidentally.
2. Grain may become infected with poisonous fungi, _e.g._ ergot.
3. Plants or animals may feed upon materials harmless to them, but
which render them poisonous to man--birds that have fed on mountain
laurel are said to have proved poisonous to man.
4. During periods of physiological activity of certain of their glands,
the flesh of some animals becomes poisonous to man; some fish, for
example, are poisonous during the spawning season.
5. Food may carry infection by contamination with germs, _e.g._ typhoid
bacilli in milk.
6. The animal may suffer from a specific disease, and it may be
transmitted to man, _e.g._ tuberculosis.
7. Foods may be contaminated with bacteria which produce poisons either
before or after the food has been eaten.
8. The food may be infected with parasites or their ova, and which
develop in the individual who partakes of it, _e.g._ trichiniasis.
In cases in which the poison has been added or preformed, the symptoms
of poisoning come on almost immediately or within a short space of
time; there may, however, in the latter, be a delay in the appearance
of the symptoms in instances where the bacterial poison is formed
subsequent to the ingestion of the food. This delay is bordering on the
nature of a true infection. In those cases when the bacteria have been
present in the animal before, or develop in it subsequent to its death,
and which develop in the person who eats it as food, symptoms may not
come on for some time; the condition is a true infection, and there may
be an incubation period over six or seven days.
Meat Poisoning (Kreotoxismus)
Apart from those cases of poisoning following the ingestion of food
to which poison has been added, or from meat affected by parasitic
disease, there have occurred outbreaks of serious illness following
the partaking of meat. Vaughan, in the _Twentieth Century Practice of
Medicine_, vol. xiii. p. 20, holds that “there can scarcely be any
difference of opinion on the following points: (1) With fresh food to
act upon and with normal gastric juice to act, the process of peptic
digestion proceeds without the formation of any harmful substance. (2)
With putrid food, containing poisons to start with, the most active
digestion does not guarantee the destruction of those poisons. (3)
With even the best of food, peptic digestion may proceed so slowly and
imperfectly that during the process poisons may be formed by bacterial
agencies.” During the process of decomposition of meat and other
albuminous foods by bacterial agency, certain poisonous substances are
formed prior to the production of the ptomaines or bacterial alkaloids.
These are known as toxalbumoses and enzymes; they are unstable bodies,
they cannot be obtained in a crystalline form, and their composition
is not fully understood. They give certain reactions with a few group
reagents, but they are recognised only by their effects upon living
animals. As decomposition advances the more stable alkaloids are
formed, but those which are poisonous, like the toxalbumoses, are
readily converted by further processes of putrefaction or by chemical
means into innocuous bodies. Toxins is the general term used in
toxicology for these poisonous substances formed from animal tissues.
It is not necessary that complete putrefaction should have taken place
for meat to prove poisonous. In fact many of the severest cases are
those in which it has not fully putrefied. The most poisonous toxins
are present during the early stages of decomposition, and the changes
are not recognisable by the senses--smell or taste--which would ensure
the rejection of the meat as food.
The poisonous effects are rarely due to the ingestion of bacterial
products alone; those cases in which no bacteriological investigation
of the food has been made cannot be taken into consideration. The
toxalbumoses are destroyed by a few minutes‘ exposure to a temperature
at boiling-point, 212° F. (Durham, _B. M. J._, 1898, vol. ii. p. 797).
In reference to the toxic action of the alkaloids, these have been
noted only from the results following subcutaneous injection; their
effects when taken per orem have not been established by experiment.
In all instances where the necessary bacteriological investigation has
been properly carried out a true infection has been proved to have
taken place.
In cases of meat poisoning the principal bacteria concerned are not the
ordinary putrefactive organisms. The Bacillus enteritidis of Gärtner,
which has been found associated with twelve epidemics, and the Bacillus
botulinus of Ermengem are the most important causative agents.
The Bacillus enteritidis is killed by proper cooking. It is destroyed
in one minute at a temperature of 180° F. At 41° F. it will not grow,
but, in meat kept at 68° F. for seventy-two hours, it flourishes
abundantly. Freezing will not kill it. In meat which has been infected
with the bacilli _post-mortem_ they do not penetrate the meat more
than 1 cm. in ten days. Roasting or boiling will sterilise it. In those
instances in which poisoning has taken place after cooking, the bacilli
have either been present in the meat beforehand, and the temperature
has not been sufficiently high or the cooking sufficiently prolonged,
to ensure their destruction in the deepest portions; or the meat after
cooking has become contaminated, and been insufficiently warmed up
again after keeping it for a day or so. Exposure to sewer gas will not
affect meat and contaminate it with the Bacillus enteritidis. The chief
symptoms due to the Bacillus enteritidis are vomiting and diarrhœa,
herpes labialis, rashes on the skin followed by desquamation in about
fourteen days, jaundice, and great thirst. The onset is sudden, with
nausea, headache, pains in the back and limbs, rigors, fever lasting a
few days, general weakness, and, in cases which recover, convalescence
extending over a period of from three to six weeks.
The symptoms of botulismus, due to the Bacillus botulinus of Ermengem,
and associated with sausage poisoning, are, as a rule, dryness of
the mouth, constriction of the fauces, nausea, vomiting, purgation,
vertigo, dilatation of the pupils, with dimness of vision and diplopia,
and a sense of suffocation. Marked muscular weakness and nervous
prostration are prominent symptoms. In fatal cases there is weakness of
the pulse and cyanosis, with coldness of the surface and perspiration.
The temperature is raised at first and may reach 103° F., but
ultimately falls below normal. Delirium comes on late, followed by coma
and death.
In dangerous cases obstinate constipation may follow after a few hours
of watery stools.
On _post-mortem_ examination of the bodies in fatal cases the following
appearances have been noted: a white, dried, parchment condition of the
mouth, fauces, throat, and gullet; hyperæmia of the mucous membrane of
the stomach and intestines with submucous extravasations of blood. The
abdominal and thoracic viscera have been found engorged with blood,
with enlargement of the spleen; the former are due to failure of the
heart, and cannot be regarded as characteristic of sausage poisoning.
Some stress has been laid on the observation that putrefaction is
unusually delayed, but Müller has shown that no reliance can be placed
upon it; he says that in forty-eight autopsies it has been noted that
in eleven of them putrefaction had developed rapidly.
The symptoms of meat poisoning are grouped by Dixon Mann into two
divisions: (1) those due to a true infection, (2) those due to simple
poisoning.
In (1) the symptoms are those of an infectious disease--they include
headache, anorexia, rigors, constipation followed by diarrhœa, pains in
the back and limbs, photophobia, delirium, skin eruptions, meteorism,
and enlargement of the spleen. The _post-mortem appearances_ greatly
resemble those of enterica--infiltration, ulceration, and sloughing of
Peyer‘s patches; hæmorrhage into the bowels, enlargement of the spleen,
with possibly some pus depots.
In (2) the symptoms are those of acute gastro-enteritis--violent
vomiting, purging, prostration, cramps in the legs, and collapse;
the temperature is generally subnormal, but may be elevated. The
_post-mortem appearances_ are those produced by gastro-enteritis,
with hæmorrhages into the intestinal mucous membrane; the spleen is
frequently enlarged, and Peyer‘s patches may be infiltrated.
Meat poisoning has usually been most frequently associated with the
ingestion of pork, veal, beef, meat pies, potted meat, tinned meat,
sausages, and brawn. The more finely divided the meat, the more
easily and completely it may become infected and poisonous. Cases of
poisoning from the ingestion of canned meats are not uncommon. In some
instances they may be due to metallic poisoning, in the great majority
they are due to putrefactive changes having taken place in the meat.
Ungefug reports a case confirmed by the celebrated chemist Heinrich
Rose, in which sulphate of zinc had been used as a preservative
instead of saltpetre. In some the canning may have been imperfect,
and putrefaction taken place before reaching the consumer; in others
decomposition may have begun after opening the can. The meat may have
been taken from diseased animals, or decomposed prior to canning.
Poisoning by tinned provisions with the metal used for tinning is more
likely to occur with fruits than meat. The malic acid of the juice
probably dissolves the solder and forms a malate of tin. Cherries,
apples, pineapples, and tomatoes are the most likely to do this.
In 1890 Luff investigated four cases of tin poisoning due to the
consumption of tinned cherries. Some of the material left was analysed,
and the juice contained malate of tin in solution equivalent to two
grains of the higher oxide of tin per fluid ounce. It was estimated
that the symptoms were produced by doses of two to four grains of
malate of tin. Two of the patients nearly died from the diarrhœa and
collapse.
Sulphate of copper is used to give a full green colour to peas, olives,
and pickles, or it may contaminate preserved fruits if they be left in
copper vessels. The copper combines with the phyllocyanic acid of the
chlorophyll, and although insoluble in the surrounding liquor, is set
free and absorbed by the process of digestion.
Fish Poisoning (Ichthyotoxismus)
Fish may cause poisoning in two ways: in one the poison is a
physiological product of certain glands of the animal, and is quite
independent of bacteria; the other is due to the poisonous products
of bacterial growth. The fish that are inherently poisonous as a rule
occupy tropical waters: several of them exist in Japanese waters.
Mackerel, carp, barbel, and herrings may become poisonous at times;
some of these, especially mackerel, may rapidly become unfit for food
after they are dead. Caviare and the roe of herrings have caused
poisoning. Shell-fish, especially mussels, also may prove poisonous.
The symptoms of fish and shell-fish poisoning are variable. In some
cases disturbance of the nervous system predominates, with delirium,
convulsions, and paralysis. There may be dryness and constriction
of the throat, dyspnœa, disturbed vision, vertigo, jerky speech or
aphonia, rapid pulse, loss of co-ordination, numbness, formication,
coldness of the limbs, dilated pupils, paralysis, and collapse,
followed by death in a few hours. Other cases exhibit symptoms of
severe gastro-intestinal irritation, with nausea, vomiting, pain,
tenesmus, mucous and bloody stools; in the most dangerous cases the
bowels are constipated. Cases exhibiting the nervous type of symptoms
resemble poisoning by atropine, and an alkaloid--ptomatropine--is
regarded as the cause. It has never been obtained in the pure state,
and nothing is known of its composition. It must not be mistaken, in
toxicological examination, for atropine; its presence can only be
recognised by its action on the pupil.
Many cases of fish poisoning are accompanied by erythema, urticaria,
and severe itching of the skin. In probably all cases there is an
elevation of the body temperature.
Tinned fish has caused poisoning on many occasions. In one case of
tinned salmon poisoning, which proved fatal, parts of the stomach
and intestines were almost gangrenous from the intensity of the
inflammation.
Stevenson (_Brit. Med. Journ._, 1892) records a case of sardine
poisoning which proved fatal, and in which the tissues _post-mortem_
were found to be emphysematous. He extracted an alkaloid from some of
the sardines, and the stomach contents; it was highly toxic and proved
fatal to rats.
It is most probable in poisoning by tinned fish that the contents of
the tins have become contaminated with bacteria before being sealed up.
_Shell-fish_ may become contaminated with bacteria and cause true
infections in people who eat them. Typhoid fever has been carried
in this way by oysters, and probably cockles. The fish may develop
toxins and prove poisonous, and as an example of this mussels produce
a powerful toxin--_mytilotoxine_--while they are alive, which gives
rise to a serious illness termed mytilotoxismus. There are three quite
different classes of symptoms induced by poisonous mussels. In one the
symptoms are principally those of acute gastro-enteritis; in another
skin eruptions are the principal feature; and the third is known as
mytilotoxismus paralyticus, in which there is great disturbance of the
cerebro-spinal nervous system, with paralysis. The two former groups
of symptoms are due to putrefactive processes in the mussels, but the
third or paralytic group is due to the alkaloid _mytilotoxine_, which
is not a product of putrefaction, as it is not found in mussels that
have been allowed to decay.
There is nothing to evidence the idea that mussels absorb metallic
poisons--_e.g._ copper--from the bottoms of vessels.
Poisoning by Milk and Milk Products
The term milk poisoning or galactotoxismus is used here to indicate
the results following the drinking of milk infected with saprophytic
toxicogenic bacteria, and which are mainly responsible for the high
mortality from “summer diarrhœas” of artificially-fed infants. One of
the products of these bacterial infections of milk is the alkaloid
_tyrotoxicon_. It has been isolated by Vaughan from cheese, and has
also been found in ice-cream, frozen custards, and cream puffs.
Vaughan, however, asserts that it is not the one most frequently
present, nor is it the most actively poisonous. There are others which
he considers are poisonous albumins (Vaughan, _Twentieth Cent. Pract.
Med._, vol. xiii.).
The symptoms of poisoning by tyrotoxicon are mainly those of acute
gastro-enteritis, and comprise constriction of the fauces, nausea
and vomiting, sharp griping intestinal pains, headache, thoracic
oppression, chilliness, dizziness, and purging. In severe forms
exhaustion, subnormal temperature, coma, collapse, and death may follow.
TRICHINIASIS