into the human body. The encysted worm is found embedded in the
fibres of all the striped muscles of the trunk and limbs, and even
in the heart, where it appears in the form of white ovoid bodies or
capsules, the capsules being sometimes calcareous. The worm passes the
greater part of its existence in the chrysalis state in the muscular
system of one animal, and only reaches its mature condition in the
stomach of another. Virchow and Zenker assert that the trichina not
only frequently presents itself in the human organism, but that this
organism is most favourable for its full development. Once in the
stomach, the period of incubation is about three to eight days, and
then propagation rapidly begins and continues, so that Dr. Kellen
estimates that in about seven days after the ingestion of half a pound
of meat the stomach and intestines may contain thirty millions of the
worms. The worms when introduced into the stomach leave their capsules,
become free, produce young, and these leave the stomach through its
coats for the muscles, where they become encysted. The trichina is most
frequently found in pork, seldom in sheep, horses, or oxen--the last
being the most free.
_Symptoms._--Intestinal irritation, loss of appetite, sickness,
malaise, general weakness of the limbs, and diarrhœa. The eyelids swell
as well as the joints, the skin is bathed in cold, clammy sweat, and a
low form of fever sets in. Death may be due to peritonitis, paralysis
of the muscles--the result of their destruction--or to irritative
fever. During the perforation of the coats of the stomach and bowels by
the worms, the mucous membrane becomes inflamed, pus is formed on the
surface, and the stools become bloody.
TOXICOHÆMIC, SNAKE POISONS, ETC.
Under this head may be classed all those effects produced by the sting
or bite of various insects and reptiles, and also by the bite of the
mad dog and wolf.
No medico-legal question is likely to be raised on this subject, at
least in this country, where, with the exception of the common viper or
adder, all our reptiles are harmless enough.
CHAPTER VII
THE VEGETABLE ALKALOIDS
Vegetable alkaloids may be classified in three groups: (1) derivatives
of pyridine, _e.g._ atropine, conine; (2) derivatives of quinoline,
_e.g._ cinchonine, narcotine; (3) substituted amines and amides. The
majority of the vegetable alkaloids belong to the first two groups.
They are for the most part solid, crystalline, and colourless; a few,
such as conine, nicotine, and pilocarpin, are liquid. They combine with
acids to form salts, and the salts are more soluble in water than the
free alkaloid. Alkaloids possess certain properties in common, amongst
which is that of being precipitated from their solutions by certain
reagents, which are called alkaloidal grouping reagents. Some are
precipitated by all the group reagents, others only by a few.
Alkaloidal Group Reagents
1. _Iodine dissolved in solution of Potassium Iodide_--_Wagner‘s
reagent_.--Gives a reddish-brown precipitate with most alkaloids.
2. _Phosphomolybdic Acid_--_Sonnenschein‘s reagent_.--Made by
dissolving phosphomolybdate of soda in water containing one-tenth its
volume of strong nitric acid. It gives a yellow precipitate with most
of the alkaloids; it also precipitates ammonium salts and ammonia
derivatives, also salts of lead, silver, and mercury unless there be
sufficient acid to keep them in solution.
3. _Potassio-mercuric Iodide_--_Mayer‘s reagent_.--Made by adding a
solution of potassium iodide to one of mercuric chloride until the red
precipitate first formed be just dissolved. This solution precipitates
most of the alkaloids. The solution to be tested must contain acetic
acid.
4. _Phosphotungstic Acid_--_Scheibler‘s reagent_.--This acts in a
manner very similar to phosphomolybdic acid.
Methods for detecting Vegetable Alkaloids
There are several methods recommended for the isolation and detection
of the vegetable alkaloids, and their separation from the contents of
the stomach or from the membranes and tissues of the body. The process,
however, most generally pursued is that of Stas, which may be briefly
described as follows:
(_a_) The substance to be examined is mixed with twice its weight of
absolute alcohol, to which from ten to thirty grains of tartaric or
oxalic acid--preferably the former--have been added, and the mixture
subjected to gentle heat in a flask, 70° to 75° C., or 158° to 167° F.
(_b_) If the membranes or organs have to be examined, they are finely
divided, treated with absolute alcohol, squeezed, and again treated
with fresh alcohol as in (_a_).
In either case, the mixture, when quite cold, is filtered, and the
alcoholic solution is concentrated by evaporation, either _in vacuo_ or
in a current of air not exceeding 95° F. or 35° C.
The liquid residue is now passed through a moistened filter, which
separates the fat and other insoluble matters. The filtrate is
evaporated to dryness over sulphuric acid or _in vacuo_, and the acid
residue of this evaporation dissolved in the smallest possible quantity
of distilled water. The acid liquid is then _gradually_ neutralised
with the bicarbonate of potash or soda until effervescence ceases, and
afterwards shaken in a flask with four or five times its bulk of pure
ether, and allowed to settle. When the ether has become quite clear, a
small portion of it is decanted into a small glass capsule, and allowed
to spontaneously evaporate in a dry place. If during evaporation
streaks of liquid appear on the side of the capsule, running together
at the bottom, a liquid volatile alkaloid is probably present. If none
of these manifestations occur, the alkaloid is in all probability solid
and non-volatile.
----------------------------------------+-----------------------------------
_The Alkaloid is Volatile_. | _The Alkaloid is Non-Volatile_.
----------------------------------------+-----------------------------------
To the original mixture in a flask | To the original mixture in a
add a moderate quantity of a strong | flask add strong caustic potash or
solution of caustic potash or soda, | soda solution, and agitate with
mixed with ether; agitate, and allow | successive portions of pure ether
the mixture to settle. Pour off | allowing it to completely settle
the ethereal solution, and re-shake | each time. The ethereal solutions,
residue with a fresh quantity of | being mixed, are evaporated, leaving
ether; decant, and mix both solutions. | the alkaloid in an impure state.
The ethereal solution is | To purify it, the solid residue left
now shaken with a mixture of four | on evaporation is treated with a
parts of water and one of sulphuric | small quantity of dilute sulphuric
acid, which withdraws the alkaloid | acid, which dissolves the alkaloid,
from its solution, leaving any fatty | leaving any fatty impurities behind.
matter dissolved in the ether. The | The acid liquid is evaporated
acid solution is now mixed with | to three-quarters of its bulk over
strong potash or soda solution in | strong sulphuric acid, and then a
excess,[20] agitated with ether, the | saturated solution of carbonate of
ether poured off, and then evaporated | potash or soda added. The absolute
at as low a temperature as | alcohol will then dissolve out the
possible,[21] leaving the pure alkaloid| pure alkaloid, giving it, on
with all its characteristic chemical | in the crystalline form, and in
and physical properties. | evaporation, a state to show its
| characteristic reactions.
----------------------------------------+-----------------------------------
[20] The sulphates of alkaloids are insoluble in ether; hence they must
be decomposed by an alkali.
[21] The temperature should be low, or the greater part of the conine
will be evaporated with the ether.
If morphine has to be sought for, the liquid should be shaken with
ether immediately after being neutralised with carbonate of sodium,
and the ether poured off as quickly as possible; for if the alkaloid
have time to separate in the crystalline form, scarcely any of it is
dissolved by the ether (Otto).
The method of Stas is based upon the fact that the salts of the
alkaloids, as a class, are soluble in water and alcohol, but are
insoluble in ether; and that these salts when in solution are readily
decomposed by the mineral alkalies with the elimination of the
alkaloids, which, in their free and uncombined state, are more or less
readily soluble in ether.
Otto‘s Method.--Otto‘s modification of Stas‘s process is simpler, and
at the same time equally accurate. Instead of numerous treatments and
evaporations which have to be gone through in the original process,
Otto converts the alkaloid into a salt, such as the sulphate, by the
addition of acid, and after solution in a small quantity of water,
agitates with successive quantities of ether, which remove all foreign
fatty matters, leaving the solution of the alkaloid comparatively
pure, and from which the alkaloid may be obtained in a state of great
purity, by first rendering the solution alkaline and then using ether
to dissolve the alkaloid.
R. Wagner‘s Method.--The presence of alkaloids in organic
liquids--strychnia in beer, for example--may, according to R. Wagner
(_Zeitschr. Anal. Chem._, vol. iv. p. 387), be detected by mixing the
liquid, diluted with two vols. water (½ to 1 litre), with about 5 c.c.
of a solution of iodine in potassium iodide (12.7 grains iodine to the
litre) and a few drops of sulphuric acid. The precipitate separated
from the supernatant liquid is dissolved in a dilute solution of sodium
hyposulphite, and again precipitated by means of the iodine solution.
If this new precipitate be now dissolved in aqueous sulphurous acid,
the solution will leave, on evaporation, the pure sulphate of the base.
Dragendorff‘s Method.--This is intended for the purpose of separating
alkaloids from each other when more than one are in aqueous solution,
by using different solvents in sequence. Some solvents take up
certain alkaloids to the exclusion of others. The process consists of
extracting the aqueous acid solution of the alkaloids successively
with petroleum spirit, benzene, chloroform, and amyl-alcohol, then
alkalising it and repeating with the same solvents.
1. From the _acid_ solution _benzene_ removes caffeine, colchicine,
santonin, digitalin, cantharidin. _Chloroform_ removes papaverine,
colchicine, narceine, picrotoxin.
2. From the _alkaline_ solution _petroleum ether_ removes strychnine,
brucine, aconitine, veratrine, conine, nicotine, lobeline, emetine,
and aniline. _Benzene_ removes atropine, hyoscyamine, physostigmine,
codeine, narcotine, and further quantities of strychnine, brucine,
aconitine, veratrine, and emetine. _Chloroform_ removes morphine,
narceine, papaverine, strychnine, and brucine. _Amyl-alcohol_ removes
morphine, solanine, and narceine.
The Stas process cannot be recommended for the detection of opium in
organic liquids, for two reasons. Firstly, that it altogether fails
to indicate the presence of meconic acid; and, secondly, because
morphine is almost insoluble in ether. Dragendorff recommends the
use of _benzole_ for separating the alkaloids, but in this substance
morphia is nearly insoluble. It is, however, applicable to strychnine,
aconitine, conine, and atropine; but for the two last, on account of
their volatility, ether is preferable.
Rodger‘s and Girdwood‘s Method.--Extraction with dilute hydrochloric
acid and the use of chloroform instead of ether. Chloroform is a much
better solvent of most alkaloids than ether. Particularly useful for
the isolation of strychnine and for most alkaloids, but there is a
little danger of hydrolysis of the alkaloid in the use of a mineral
acid, _e.g._ hyoscine.
Stevenson‘s Modification of the Otto-Stas Process.--The material to be
examined, if solid, is finely divided, and digested for twenty-four
hours with twice its weight of rectified spirit at 35° C.; if fluid,
with twice its volume. The clear liquid is decanted and the residue
again digested with fresh spirit; this is again decanted, and mixed
with the first alcoholic solution. The residue is now digested with
spirit faintly acidified with acetic acid; this is decanted, and the
residue digested with two or three lots of unacidified alcohol. The
alcoholic extracts obtained before acidification are mixed together and
rapidly raised to 70° C. for a moment or two. They are quickly cooled
and filtered, and the filter washed with spirit. The acidified extract
and those after it are mixed and treated in the same way. The extracts
are then separately evaporated at a temperature not above 35° C. to the
consistency of a syrup, the excess of acid being neutralised with soda;
these are extracted with absolute alcohol, and the extracts evaporated
to a syrup as before. The syrupy extracts are now diluted with a small
quantity of water, filtered, the filters washed with water, and the
filtrates mixed. The liquid will contain the whole of the alkaloids,
and will be free from albuminoids, which have been coagulated while
the extracts were at 70° C. The liquid containing the alkaloids is
extracted several times with washed ether, which removes fatty acids or
oils, but does not remove alkaloidal salts. The ether should be washed
with water to which a few drops of sulphuric acid has been added, and
the water kept: this has to be done because some alkaloidal salts are
slightly soluble in ether. The acid liquid and the acidified aqueous
washings of the ether are mixed together, rendered alkaline with sodium
carbonate, and exhausted firstly with a mixture of one volume of
chloroform to three of ether, and lastly three or four times with ether
alone.
The alkalisation with sodium carbonate liberates the alkaloids from
their salts, and these are soluble in the chloroform-ether and ether.
These ethereal extracts are then washed with water acidified with
sulphuric acid, and water alone, and the washings mixed. The water
acidulated with sulphuric acid converts them into sulphates, which are
insoluble in the ether and chloroform, and are removed by the acidified
water, while impurities are left behind. The mixed aqueous and acid
extracts are again washed with ether, the ether removed, and the
liquid re-alkalised with sodium carbonate and then re-extracted with
chloroform-ether and ether.
The ethereal solutions are removed and are washed with water slightly
alkalised with sodium carbonate. The ethereal solution is filtered
through a dry filter, the filtrate evaporated to dryness first at 35°
C. then at 100° C., and cooled over sulphuric acid. The residue is
weighed and represents the weight of the alkaloids. A test quantity
should be evaporated to see if there be any oily odorous residue,
_i.e._ a volatile alkaloid, nicotine or conine. If so, the chloroform
and ether extracts should be mixed with a little pure ether and strong
hydrochloric acid; the alkaloids are thus changed into non-volatile
hydrochlorides, which are left behind after evaporation of the
chloroform and ether. Any alkaloid found should be converted into the
hydrochloride, dissolved, and tested by special tests. Morphine cannot
be extracted except in very minute amounts by this method. To obtain
it, the first alkaline solution from which the other alkaloids have
been removed should be extracted with acetic ether and ether, in which
morphine is soluble.
[Illustration: Fig. 36.--Photo-micrograph of crystals of hydrochloride
of morphine, × 50.
(R. J. M. Buchanan.)]
Taylor‘s method for the extraction of morphine may be briefly described
as follows:
The liquid--porter, &c.--to be examined is acidified with acetic acid;
or, if a solid organ is to be tested, it must be cut into thin slices
and placed in distilled water acidified in a similar way. In either
case the liquid is digested for one or two hours at a gentle heat,
and filtered. Acetate of lead is now added to the filtrate until no
further precipitation occurs; the liquid is then boiled and filtered.
The meconic acid remains on the filter as meconate of lead, while
the filtrate contains the morphine as acetate. The liquid is freed
from excess of lead by passing through it a current of sulphuretted
hydrogen, filtered to remove the precipitated sulphide of lead, and
the resulting liquid evaporated to an extract on a water bath, and
treated with alcohol. The alcoholic solution on evaporation gives
acetate of morphine, which may then be tested.
[Illustration: Fig. 37.--Photo-micrograph of meconic acid crystallised
from aqueous solution, × 50. (R. J. M. Buchanan.)]
[Illustration: Fig. 38.--Photo-micrograph of meconic acid crystallised
from an alcoholic solution, × 50. (R. J. M. Buchanan.)]
The meconate of lead which remains on the filter is decomposed by
treating it with dilute sulphuric acid, and gently boiling the mixture.
The filtered liquid should be neutralised before the tests for the
presence of meconic acid are applied.
The reactions of both morphine and meconic acid are best seen from the
following Table:--
Morphine--Solid
--------------------------------+---------------------------------
Treated with strong nitric acid.| Dissolves with effervescence and
| the production of ruddy fumes,
| forming a rich orange-coloured
| solution not changed by the
| addition of stannous chloride.
|
Mixed with a little iodic acid | A blue colour, due to the
and starch paste. | liberation of iodine.
|
Dissolved in cold strong | Bright-green colour.
sulphuric acid, and a drop of|
strong solution of bichromate|
of potash added. |
|
Rubbed with sulphomolybdic acid| A violet colour changing to
(Frohde‘s reagent). | green, and then sapphire-blue.
--------------------------------+---------------------------------
Morphine and Meconic Acid in Solution
---------------------+------------------------+----------------------
| Morphine. | Meconic Acid.
---------------------+------------------------+----------------------
Tested with litmus | Slightly alkaline. | Very distinctly acid.
paper. | |
| |
A little perchloride| An inky-blue colour, | Deep red colour, not
of iron, rendered | destroyed and changed| easily destroyed by
of nearly neutral | to orange-red by | a solution of
as possible. | nitric acid. | corrosive sublimate
| | or dilute mineral
| | acids.
---------------------+------------------------+----------------------
The characteristic tests for morphine are its reactions with nitric
acid, iodic acid and starch, and perchloride of iron. The reaction with
the perchloride of iron is also characteristic of meconic acid. This
last-mentioned test is a very conclusive one for meconic acid, when
certain precautions are taken; for the property of striking a deep red
with a persalt of iron is shared equally by sulphocyanides and alkaline
acetates. The colour produced by sulphocyanic acid _is instantly
bleached_ on the addition of _corrosive sublimate_. The question thus
lies between acetic and meconic acid. To distinguish the one from
the other, the solution to be tested should be boiled for a short
time after the addition of a few drops of sulphuric acid. Any acetate
present is decomposed and the acetic acid is expelled by the boiling;
so that if, after allowing the solution to cool, it still gives the
red colour with perchloride of iron, the reaction may be taken as
conclusive of meconic acid. By these means morphine and meconic acid
may be detected in porter and other liquids.
Table showing the Characters and Tests of the
Following Poisons
------------------------------+-------------------------------
Morphine. | Strychnine.
------------------------------+-------------------------------
1. Crystallises in colourless| 1. Crystallises in white
transparent prisms, belonging| four-sided prisms, terminated
to the trimetric | by four-sided pyramids.
system. |
|
2. Sulphuric acid and | 2. Treated with cold sulphuric
bichromate of potash give | acid, no reaction; on
a bright-green coloration. | the addition of a crystal of
| potassium bichromate, an
| intense purple colour is
| produced, becoming crimson
| and then light red.
|
3. Strong colourless nitric | 3. Strong nitric acid usually
acid, added freely to a cold | produces a yellow or
solution, produces a deep | yellow-brown colour.
orange-red coloration, not |
changed by stannous chloride.|
------------------------------+-----------------------------------
Brucine. | Narcotine.
------------------------------+---------------------------------
1. Crystallises in oblique | 1. Crystallises in right
rhomboidal prisms, sometimes | rhombic prisms, or in needles
agglomerated mushroom-like | grouped in bundles.
heads. |
|
2. Sulphuric acid gives a | 2. Sulphuric acid a bright
rich rose-pink tint; on the | sulphur-yellow colour, potassium
addition of potassium | bichromate added a
bichromate, none of the | green colour as with morphine,
reactions of strychnine | but slower in production.
are observed. |
|
3. Strong nitric acid | 3. Strong nitric acid forms
produces a blood-red | a colourless fluid, becoming
colour, changed after | yellow on heating.
warming and diluting with |
distilled water to purple |
by stannous chloride; |
ammonium sulphide gives |
a similar but less marked |
reaction. Excess of |
stannous chloride |
discharges the blood-red |
colour in the cold. |
------------------------------+---------------------------------
CHAPTER VIII
NARCOTIC POISONS
Somniferous
OPIUM
Opium is the inspissated juice of the _Papaver somniferum_, the garden
or opium poppy. The plant is a native of Egypt and Syria, cultivated in
England.
Opium is sometimes taken in its crude state as a poison, but more
frequently one of its preparations is thus employed--notably the
tincture, better known as laudanum.
The poisonous properties of this drug reside in an alkaloid,
_morphine_--in combination with an acid, _meconic acid_. The several
varieties of opium vary considerably in the quantity of morphine which
they contain, the amount varying from 2 to 9 per cent.
Opium, or its alkaloid, morphine, forms an important ingredient in
_Dalby‘s Carminative_, _Winslow‘s Soothing Syrup_, _Godfrey‘s Cordial_,
_Chlorodyne_, _Nepenthe_, &c.
Of all forms of poisoning, that by opium and its preparations is the
most frequent; and it is stated that three-fourths of all the deaths
from opium occur among children _under five years of age_.
_Symptoms._--The rapidity with which the symptoms of poisoning by opium
make their appearance will depend upon the form in which the poison
is taken--solution, of course, increasing the activity of the drug.
In most cases, an interval of from half an hour to an hour elapses
after the poison has been swallowed before any evil effects become
apparent. Christison, however, mentions a case in which stupor did not
show itself for eighteen hours. During the first stage of poisoning
by opium, the patient may become slightly excited; this state is,
however, soon followed by giddiness and drowsiness. The eyes are kept
open with difficulty. Stupor and insensibility now supervene, from
which he may, in most cases, be temporarily aroused by a loud noise or
a smart blow. As the case progresses, coma and stertorous breathing
occur, and it becomes almost impossible to rouse him at all. The pulse,
at first small, quick, and irregular, becomes slow and full as the
coma increases. The breathing, hurried in the early stages, is now
slow and stertorous. The pupils are contracted in the early stages,
and may be in the later stages dilated; the former condition is most
frequently present, together with insensibility to light. The pupils
may be contracted in cases of _hæmorrhage into the pons Varolii_, and
this disease has been mistaken for opium poisoning. In uræmic coma,
coming on in the course of Bright‘s disease, the pupils may also be
contracted; the nature of the case will be explained by the history
and presence of dropsy. All the secretions, except that of the skin,
are suspended, and the bowels are usually obstinately confined. The
breath may be impregnated with the odour of opium. Certain anomalies
in the symptoms may occur; thus, there may be vomiting and purging,
convulsions (the last most frequent in children), delirium, tetanic
spasms, one pupil dilated and the other contracted, paralysis, and
anæsthesia. It must be borne in mind that remissions sometimes occur in
the symptoms, the patient dying after an attempt at recovery.
A question of some importance may arise as to the amount of volition
and power of locomotion which may exist for some time after a poisonous
dose has been taken. Death may be due to causes other than the effect
of poison. It must, at least, be admitted as possible, that a person,
after swallowing a quantity of opium sufficient to cause death, may yet
be able to walk and move about for one or two hours.
_Opium-eating._--If opium be taken for some time in small doses, the
system becomes tolerant of it, so that a dose which would be poisonous
to most people only produces a slight and pleasurable excitement. De
Quincey was in the habit of taking daily nine ounces of laudanum.
The habitual opium-eater generally suffers from disorders of the
digestive organs, dyspepsia and its train of unpleasant symptoms; the
body becomes thin, the countenance attenuated, the eyes sunken and
glassy, the gait halting, and the body bent. The craving for the drug,
which becomes greater and greater, is only temporarily satisfied by
larger and larger doses. The opium-eater seldom attains a great age,
usually dying before forty. This is perhaps a somewhat exaggerated
picture of the ill effects of opium-eating. Christison, after quoting
the results of his observations in twenty-five cases of confirmed
opium-eaters, concludes as follows: “These facts tend on the whole
rather to show that the practice of eating opium is not so injurious,
and an opium-eater‘s life is not uninsurable, as is commonly thought,
and that an insured person, who did not make known his habit, could
scarcely be considered guilty of concealment to the effect of voiding
his insurance. But I am far from thinking (as several represent who
have quoted this work) that what has now been stated can with justice
be held to establish such important inferences; for there is an obvious
reason why, in an inquiry of this kind, those instances chiefly should
come under notice where the constitution has escaped injury--cases
fatal in early life being more apt to be lost sight of, or more likely
to be concealed.”
_Effects of External Application._--The application of opium to the
surface of the body is not usually attended with dangerous symptoms;
but, in a few cases, due probably to some idiosyncrasy, alarming
effects, or even death, have resulted from the external application of
the drug. Orfila has tried to show that opium is readily absorbed by
the coats of the rectum, and that it acts more rapidly than when taken
into the stomach. This statement does not appear to be correct, for the
dose administered by enema is usually twice that given by the mouth.
_Post-mortem Appearances._--As might be expected, the appearances found
after death are not very characteristic. The vessels of the brain
are congested, and serous effusions in the ventricles or between the
membranes are not uncommon. Engorgement of the lungs is most frequently
present in those cases in which convulsions have occurred. The stomach
is in most cases found quite healthy. The bladder may be full of urine,
due probably to the person being unable to empty it from loss of
consciousness.
_Fatal Period._--From three-quarters of an hour and upwards.
_Fatal Dose._--Four grains is about the smallest fatal dose of opium
in an adult; but cases of recovery, where an ounce or more of laudanum
has been taken, are not very rare. Children are very susceptible to
opium. The smallest dose of morphine that has proved fatal to an infant
is one-twelfth of a grain of the hydrochloride. Half a grain of the
acetate has proved fatal to an adult, one grain of morphine or its
salts has proved fatal on several occasions. With prompt treatment
recovery has taken place after much larger doses, even as much as
seventy-five grains.
_Chemical Analysis and Tests._--These have been described on p. 339 _et
seq._
_Treatment._--The stomach pump should be used without delay, and the
stomach thoroughly washed out. The washing water should contain about
ten to fifteen grains of permanganate of potash to the pint, and the
washing repeated at short intervals, as the permanganate destroys the
morphine. If the stomach tube be not at hand, the patient should be
made to drink the permanganate solution if possible. This treatment
should be carried out even when morphine has been administered
hypodermically, as it is excreted by the stomach. Emetics should also
be given if the patient can swallow; if unable to do so, a hypodermic
of ⅒ grain of apomorphine may be given. The administration of strong
coffee or tea, the application of ammonia to the nostrils, flagellation
of the soles of the feet, and keeping the patient constantly walking
about (a procedure of doubtful value) are among the measures usually
adopted by way of treatment. Galvanism and artificial inflation of
the lungs have done good service even in the most hopeless cases. The
student is referred to some important cases recorded by Dr. Burgess
and others in the _Medical Press and Circular_, vol. i. p. 369, for
the year 1892. Dr. Burgess strongly recommends prolonged artificial
respiration, the interrupted current, and the administration of
stimulants, externally, internally, and hypodermically. Dr. Finny is of
opinion that, while opium may be useful in cases of atropine poisoning,
atropine is of little use in opium poisoning; in this opinion Dr.
Burgess concurred. The state of the respiration is a better test than
the condition of the pupil when atropine is used as an antidote. If
the administration of atropine does not quicken the respiration it
should be discontinued, and other methods tried. Vinegar should not
be given, as it dissolves the morphine and renders it more easy of
absorption. Death is rare in those cases in which proper remedies have
been resorted to before the stage of stupor has commenced.
=Synopsis of the Effects of Opium upon the System=
1. _The Mental Faculties._--The first effect noticed when opium is
taken in small doses is a primary exaltation of the mental faculties;
the imagination is rendered brilliant, and the passions exalted; after
a time drowsiness supervenes, followed by deep sleep. A dose of thirty
drops of the tincture caused in one experimenter an exhilaration of the
mental faculties, and an aptitude for study; the subsequent drowsiness
being removed by a dose of a hundred drops or more, when the greatest
mental excitement was the result.
2. _The Respiration._--The frequency of the respiration is diminished,
and the oxidation of the blood impaired.
3. _The Pulse._--The first effect on the circulatory system is that of
a stimulant, and then sedative. By the administration of repeated small
doses, the force of the circulation may be maintained for some time.
4. _The Eyes and Countenance._--The pupils, when the patient is
powerfully under the influence of opium, are contracted even to a
point. Dilatation, has, however, been noticed in some cases, especially
when death approaches. In apoplexy of the pons Varolii, the pupils are
contracted. The countenance is placid, pale, and ghastly; the eyes
heavy, and the lips livid.
5. _The Cutaneous System._--The skin, although cold, is not
infrequently bathed in profuse perspiration.
6. _The Alimentary Canal._--Sometimes there is vomiting and even
purging; but, as a rule, the secretions along the whole alimentary
canal are diminished, and constipation is the result. According to Dr.
Walter Smith, of Dublin, morphine is mainly excreted into the stomach
and bowels, and so cast out in the fæces. Very little goes out in the
urine.
7. _The Average Commencement of Symptoms._--Much depends upon the
size and form of the dose. In most cases the first appearance of the
symptoms is seldom delayed beyond an hour after the poison is taken.
8. _The Average Period of Death._--Seven to twelve hours.
Table showing some of the Symptoms and Effects of
Opium and Belladonna
---------------------------------+-----------------------------------
Opium. | Belladonna.
---------------------------------+-----------------------------------
1. Slight excitement, coma, | 1. Active, busy delirium preceding
lethargy, and no return of the | the coma, followed by delirium,
excitement should the patient | if recovery takes place.
recover. |
|
2. Coma is of shorter duration | 2. Coma is of longer duration
than in poisoning by belladonna.| than in poisoning by opium.
|
3. Pupils contracted. | 3. Pupils dilated.
|
4. Local application to the eye | 4. Dropped into the eye, the
does not affect the pupil. | pupils are dilated.
|
5. Bowels as a rule confined. | 5. Bowels not affected.
|
6. Acts powerfully on children. | 6. Well borne by children.
---------------------------------+-----------------------------------
Table showing the Points of Distinction between
Apoplexy and Narcotic Poisoning
------------------------------------+--------------------------------
Apoplexy. | Narcotic Poisoning.
------------------------------------+--------------------------------
1. Apoplexy _may_ be preceded by | 1. No premonitory symptoms,
premonitory symptoms, as giddiness,| except by fortuitous
headache, noises in the ears, | combination.
and partial paralysis. |
|
2. Apoplexy chiefly attacks the | 2. More frequently in the
old, and is very rare in young | young, especially of the
people. | female sex.
|
3. Most frequently among fat | 3. In fat or thin people.
people. |
|
4. Symptoms may come on during | 4. An interval of from ten to
the meal or _immediately_ after. | thirty minutes always occurs,
| even in the case of opium, the
| commonest of narcotic poisons.
|
5. The symptoms commence abruptly, | 5. The symptoms advance
sometimes with deep stupor. | gradually.
|
6. Patient is with difficulty, if | 6. Patient may be roused from
ever, temporarily aroused. | the deepest lethargy if shaken
Convulsions common. Face bloated. | or spoken to in a loud voice.
Pupils _dilated_, or irregular. | Convulsions rare in opium
| poisoning. Face seldom bloated.
| Pupils _contracted_.
|
7. Life may be prolonged for a | 7. Life is seldom prolonged
day or more. Apoplexy _may_, | beyond six or eight hours.
however, kill in an hour. | Shortest time in which opium
| has caused death, _three_
| hours.
|
8. No response when the forehead | 8. Patient may be roused by
is smartly tapped with the | tapping the forehead, &c.
finger-nails, or when water is |
injected into the ear. |
------------------------------------+--------------------------------
Table showing the Condition of the Pupils in--
-----------------------+---------------------------------------------
Ordinary sleep |The eyes turned upwards; pupils contracted.
|
Chloroform narcosis |When the _liquid_ is taken, coma; pupils
|dilated; eyes suffused or glistening, and
|turned upwards. When the _vapour_ is
|inhaled, pupils first contracted; when
|coma supervenes, dilated.
|
Apoplexy |Pupils dilated; insensible to light.
|Sometimes unequal. Apoplexy of pons
|Varolii, pupils contracted.
|
Alcoholic coma |The pupils dilated or variable, and not
|affected by a bright light placed before
|them.
|
Poisoning by opium |Contracted in some cases to a pin‘s head;
|as death approaches, the pupils dilate.
|
Carbolic acid |Contracted and insensible to light.
|
Calabar bean |Powerful contraction of the pupils.
|
Hyoscyamus or atropine |Dilatation of the pupils.
|
Strychnine |In some cases the pupils, during the
|paroxysms, are dilated, and contracted
|during the intermissions.
|
Aconite |Sometimes contracted; but in 17 out of 20
|cases recorded by Dr. Tucker, dilatation
|was present.
-----------------------+---------------------------------------------
CHAPTER IX
DELIRIANT POISONS
Under this head will be noticed those poisons whose action on the
animal economy is characterised by _delirium_, illusion of the
senses, and marked _dilatation_ of the pupil. In some cases there is
considerable irritation of the digestive organs, accompanied with a
difficulty in passing water, sometimes ending in complete suppression
of urine. The mydriatic alkaloids atropine, hyoscine, hyoscyamine,
daturine, duboisine, scopolamine, are practically identical in chemical
composition and action, and produce similar symptoms.
The following are among the most important poisons of this group:--
1. Belladonna.
2. Hyoscyamus.
3. Stramonium.
4. Solanum Dulcamara.
5. Solanum Nigrum.
6. Solanum Tuberosum.
Those of less importance are _Œnanthe crocata_ or Dropwort, Camphor,
Salicylic Acid, and Yew--the last already described among the Vegetable
Irritants.
BELLADONNA
_Symptoms._--Taken internally or applied externally, belladonna,
_Atropa Belladonna_ (_N. O. Solanacea_), or its alkaloid atropine,
causes dryness of the mouth and throat, with intense thirst. Nausea and
vomiting are present in most cases, accompanied with giddiness, double
or indistinct vision, active delirium, convulsions, ending in stupor
and coma. In the majority of cases an erythematous rash appears on the
skin, with elevation of temperature resembling scarlet fever. A very
marked characteristic of poisoning by solanaceous plants is _dilatation
of the pupil_, the iris in some cases being reduced to a mere line
round the pupil. The symptoms in some cases which have been recorded
are almost identical with those of delirium tremens. In other instances
there has been little or no delirium, the patient at once passing
into fatal lethargy. Alarming symptoms have followed from drinking a
decoction of belladonna leaves, which were mistaken and supplied for
those of the ash. Accidental poisoning has also frequently occurred
among children from their eating the ripe berries of the belladonna
plant. Slight symptoms of poisoning are sometimes met with from the
use of belladonna plasters to remove the milk from the breasts of
women delivered of still-born children, or in cases where the child has
died soon after birth. In these cases the patients complain of intense
dryness of the mouth, dimness of vision, and itching of the skin. The
removal of the plasters will at once arrest the unpleasant symptoms.
In the _Gazette des Hôpitaux_, July 1859, a case is recorded of
poisoning by the outward application of belladonna in the form of the
following liniment: Camphorated oil of henbane, ten ounces; extract of
belladonna, four scruples. The patient was seriously ill for some days,
but ultimately recovered.
Poisoning has also resulted from the use of a solution of atropine
(four grains to one ounce) dropped into the eye in the treatment of
iritis. (See _British Medical Journal_, 1876, vol. i.)
_Post-mortem Appearances._--Congestion of the vessels of the brain,
sometimes with fluid blood, at other times with thick black blood.
The stomach may or may not be congested; but in cases where the ripe
berries have been taken, the mucous lining may be seen deeply dyed by
the juice of the berries. The pupils are usually found dilated.
_Fatal Dose._--One teaspoonful of belladonna liniment and one drachm
of tincture have proved fatal. Recovery has taken place after half an
ounce of liniment and extract. Children are less affected than adults.
Of atropine half a grain has proved fatal. Recovery has taken place
after five grains of the sulphate.
_Fatal Period._--Twelve hours to several days.
_Chemical Analysis._--From organic mixtures the alkaloid may be
obtained by Stas‘s process, and treated according to Vitali with a
little fuming nitric acid, and then dried in a water bath: when cold,
it must be moistened with a drop of potassæ dissolved in absolute
alcohol. A violet colour changing to red is produced, the violet being
characteristic, as strychnia when treated as above gives a red colour.
The physiological action on the pupil must also be noted. When the
berries are taken, the mucous membrane of the stomach may be found
dyed of a purple colour, turned green by alkalies and red by acids.
Fragments of the berries may also be found in the stomach.
To a small quantity of solid atropine add a drop or two of strong
sulphuric acid, then a crystal of sodium nitrite; a yellow colour is
produced, which alcoholic solution of potash changes to reddish-violet
and then pale rose.
Free atropine gives a red colour with phenolpthalein; the colour is
discharged with alcohol, but reappears on evaporating it.
_Gerrard‘s Test._--Mercuric chloride dissolved in alcohol gives a red
colour.
_Blyth‘s Test._--To the solid alkaloid add strong solution of baryta,
evaporate, to dryness, and heat the residue, when the smell of hawthorn
blossom is given off.
_Wormley‘s Test._--An alcoholic solution of bromine gives a crystalline
yellow precipitate.
_Treatment._--Wash out the stomach and give hypodermic injections
of one-third of a grain of pilocarpine, which is the best antidote.
Emetics and purgatives, castor-oil and animal charcoal may be
administered. The symptoms as they present themselves must be treated
on general principles.
_N.B._--Belladonna has been stated to act in
antagonism to opium, and its administration
recommended in poisoning by that drug.
HYOSCYAMUS
Hyoscyamus, _Hyoscyamus niger_, or henbane (_N.O. Solanaceæ_),
alkaloids hyoscine, hyoscyamine, taken in large doses, produces
symptoms not unlike those due to belladonna. There is the same
affection of sight--double vision; the same dilatation of the pupils,
delirium, confusion of thought, insensibility, and coma. Hyoscine has
a hypnotic effect in comparison to the deliriant action of belladonna.
But its action varies very much on different people. A form of mania,
with wild hallucinations, has sometimes been observed to follow the
administration of this drug.
The peculiar property of henbane is marked by its tendency to produce
a general paralysis of the nervous system. The root has been eaten by
mistake for parsnips, when all the foregoing symptoms were present. The
seeds are more poisonous than the roots, the leaves being the least
poisonous part of the plant.
_Post-mortem Appearances._--The morbid appearances are not unlike those
which result from poisoning with belladonna.
_Fatal Dose._--Nothing certain can be stated as to the amount required
to cause death. Alarming symptoms are said to have followed the
administration of ten minims of the tincture, repeated every six hours.
Twenty of the _seeds_ have caused active delirium. Idiosyncrasy may
have something to do with this result. Half a drachm of the tincture
is often given to an adult, and repeated every four hours, without any
unpleasant result.
_Treatment._--As for belladonna, emetics and purgatives, to expel the
poison from the system.
STRAMONIUM
The Thorn Apple, _Datura Stramonium_ (_N.O. Solanaceæ_), possesses
powerful poisonous properties. These are marked by the production of
giddiness, impairment of vision, and syncope. Furious delirium is not
infrequent; and in one case where this state was present there was
loss of speech. The face is usually flushed, the eyes glistening and
restless, and the pupils dilated; in short, the countenance is that
of one intoxicated. Taken together, the symptoms are not unlike those
produced by belladonna.
Poisoning by stramonium seeds is a favourite mode of procedure among
the Hindoos; but as the poison is most frequently given to facilitate
robbery, death seldom results from its use. In India, the seeds are
mixed with the boiled rice so commonly eaten there, and as they closely
resemble the seeds of the common capsicum, the dangerous nature of
the mixture is not readily detected. The seeds of the datura can be
distinguished by the taste, which is slightly bitter, whereas that of
the capsicum is hot and pungent. The outward application of the leaves
may give rise to all the appearances of poisoning.
The active principle of stramonium is the alkaloid _Daturine_, which
crystallises in colourless quadrangular prisms, with a bitter acrid
taste. It resembles atropine and hyoscyamine in chemical properties.
_Post-mortem Appearances._--Congestion of the vessels of the brain and
its membranes, with some slight gastric irritation.
_Treatment._--As for belladonna, emetics and purgatives, to get rid of
the portions of the plant swallowed.
Some other solanaceous plants--_Solanum Dulcamara_, Bittersweet or
Woody Nightshade, _Solanum nigrum_, or Garden Nightshade, and the
_Solanum tuberosum_, or Potato--possess poisonous properties. They,
like the other members of the order to which they belong, give rise to
symptoms characterised by giddiness, dimness of sight, trembling of the
limbs, and delirium. The water in which the potato has been boiled is
sometimes used by the vulgar as an application to favus of the scalp.
The active principle of these plants resides in an alkaloid,
_Solanine_, which is not a very powerful poison. A rabbit has been
killed in a few hours by two grains of the sulphate of solanine.
ŒNANTHE CROCATA
Hemlock-Dropwort, or Dead-tongue, is a poisonous indigenous,
umbelliferous plant.
Accidental poisoning by this plant has occurred, the root having been
mistaken for parsnip. The symptoms in one of the cases which have been
recorded were those of _delirium tremens_; in another, which terminated
fatally, vomiting of blood was followed by convulsions. First
contraction and then dilatation of the pupil, spasmodic respiration,
and an almost imperceptible pulse were the effects noticed. Death may
take place in a few hours.
_Post-mortem Appearances._--Congestion of the vessels of the brain, and
gastric irritation. The face has sometimes a bloated expression, and
blood may escape from the ears and mouth.
_Treatment._--Purgatives and emetics, to evacuate the bowel and
stomach, and thus get rid of the poison.
CAMPHOR
Camphor is a concrete vegetable oil obtained from _Camphora
officinarum_ (_N.O. Lauraceæ_). Its employment for the purpose of
homicide is rare, but several cases of accidental poisoning from the
use of the homœopathic solution have been recorded (_British Medical
Journal_, 1873, vol. ii. p. 617).
The symptoms are--languor, giddiness, delirium, foaming at the mouth,
vomiting of blood-tinged fluid, convulsions, gastric irritation, and
great abdominal pain. In one case--that of a young lady aged twenty,
who took twenty-five drops of “Epps‘ Concentrated Solution of Camphor”
for a sore throat--all the above-mentioned symptoms were present; she
was also unconscious for several hours, and partially paralysed for
several days--perfect recovery from the nervous symptoms not taking
place for more than six months.
The homœopathic solution (Rubini‘s) is stronger than that of the
British Pharmacopœia in the proportion of 7.2 to 1. For its detection
in organic fluids, it may be removed by chloroform; and from fixed
oils, by distillation. Water precipitates it from its alcoholic
solution.
_Post-mortem Appearances._--Those produced by irritants.
_Treatment._--Purgation and emetics, to empty the bowel and stomach.
SALICYLIC ACID
This substance, prepared by acting on a mixture of carbolic acid and
sodium with carbonic acid at a moderate heat, is used largely for
acute rheumatism. In some cases premonitory symptoms of poisoning have
demanded a cessation in the administration of the drug. The most usual
of these are noises in the ears, difficulty of hearing, amblyopia,
delirium, and profuse perspiration. There may be hæmorrhages from the
mucous membranes, and into the retina. When the drug is discontinued
the symptoms pass off. The symptoms are held by some observers to be
due to the artificial and not the natural acid.
CHAPTER X
INEBRIANT POISONS
The poisons grouped under this head are characterised by causing
delirium, followed by narcotism. Recovery is not infrequently slow, the
system suffering more or less severely from the effects of the poison.
In the case of alcohol, loss of appetite, accompanied with considerable
gastric irritation, are among the after-effects of the poison.
The chief of this group are--Alcohol, Cocculus Indicus, Poisonous
Fungi, Nitro-Benzene.
Others of less importance will be briefly considered.
ALCOHOL
It will be necessary to consider poisoning by this substance under two
forms--acute and chronic. So many anomalies present themselves that it
is difficult to give a clear outline of the symptoms.
_Acute._--In most cases the symptoms come on within a few minutes
after the poison is swallowed. Giddiness, confusion of ideas, and a
difficulty in walking straight are among the first effects produced,
these being followed by stupor and coma. Nausea and vomiting are the
early signs of recovery. In some cases there may be _no_ premonitory
symptoms, sudden and complete stupor supervening some time after a
large dose of alcohol has been taken.
The patient not infrequently recovers from the first symptoms. A
relapse takes place; he becomes insensible, and dies convulsed. The
countenance wears a vacant expression, the face flushed and bloated,
the lips livid, and the pupils dilated and insensible to light. The
pupils may be contracted, but dilate on irritating the skin by a
pin-prick or pinch. The sensibility of the pupil to the action of
light should be regarded as a favourable symptom. The rapidity with
which alcohol acts is not so great as to prevent the individual from
walking some distance and performing certain acts of volition. The
rapidity with which the symptoms show themselves will depend upon the
previous habits of the individual, and the strength and quantity of the
alcohol taken. Alcohol, when diluted, induces a preliminary stage of
excitement, followed by stupor; but when concentrated, stupor may come
on almost immediately after the spirit is swallowed.
The vapour of alcohol may act as a poison, giving rise to the symptoms
above mentioned.
Congestion of the lungs or brain, or both together, is in most cases
the cause of death in acute poisoning by alcohol.
_Chronic._--The habitual dram-drinker suffers from many diseases. The
appetite becomes impaired; there is considerable irritation of the
stomach and bowels, marked by vomiting and purging. Then follows a long
list of organic diseases. The structure of the liver becomes changed;
it may increase in size, become lighter in colour and cirrhotic,
being then known as “hobnailed” or _dram-drinker‘s liver_. Jaundice
and dropsy may be present as the result of this altered condition of
the gland. The kidneys also suffer from granular degeneration. Then
follow a long series of nervous complaints: congestion of the brain,
paralysis, _delirium tremens_, and insanity. Sudden death by coma not
infrequently ends the career of the drunkard.
_Delirium tremens_ is one of the most common results of the habit of
drinking; and this affection, it is stated, may be induced by the
sudden discontinuance of alcohol in those who are habitually given to
its use.
_Post-mortem Appearances._--The stomach may present the usual signs of
inflammation, due to the irritant action of alcohol. The colour of the
mucous membrane of the stomach may be bright red, dark red, brown, or
quite pale. The brain and its membranes are sometimes congested, and
the intracranial vessels gorged with blood. The odour of alcohol may
be present in the contents of the stomach; and alcohol may, in some
cases, be detected in the lungs, brain, and other organs of the body.
The lungs are not infrequently found congested, and the right cavities
of the heart full of dark-coloured blood. Casper examined a case in
which the cavities of the heart were empty. The blood is remarkably
fluid, and of a dark colour. “Lymphatic exudation between the cerebral
meninges, so that the pia mater upon the cerebral hemispheres is seen
here and there whitish as if varnished, is not a result of death from
drinking, but is the result of the chronic irritation of the brain by
habitual drunkenness, and is therefore a very common appearance in the
bodies of all drunkards, from whatever cause they have died.” One other
condition occurring in those dying from the effects of alcohol, is the
remarkably long continued presence of the _rigor mortis_, and perfect
freedom from putrefaction, even up to the ninth day, in an atmosphere
by no means unfavourable to early decomposition. A condition of the
skin known as _cutis anserina_, or “goose skin,” was present in some of
the cases examined by Casper.
_Absorption and Elimination._--From experiments on animals, it has been
shown that alcohol is rapidly absorbed, and then eliminated from the
system, and that all traces of alcohol may disappear in a few hours,
and yet death be the result of its action. Alcohol is supposed to be
decomposed in the body, but the exact changes it undergoes do not
appear to be very clearly made out.
_Fatal Period._--Death has occurred in a few minutes after a large
dose of alcohol had been swallowed. The average fatal period is about
twenty-four hours. Death may also be an indirect result of the action
of alcohol on the system.
_Fatal Dose._--Uncertain. The age and habits of the individual must be
considered. Between three and four ounces proved fatal to a boy seven
years of age.
Table showing the Points of Distinction between Concussion
of the Brain, Alcoholic Poisoning, and
Poisoning by Opium.
-----------------------+---------------------+---------------------
Concussion of the Brain.|Alcoholic Poisoning. | Poisoning by Opium.
-----------------------+---------------------+---------------------
1. Marks of violence | 1. The absence of | 1. Same as under
on the head. |marks of violence, |alcohol.
|unless the person has|
|fallen on the ground.|
|The history of the |
|case will help in |
|forming an opinion. |
| |
2. Stupor comes on | 2. Excitement | 2. The symptoms
suddenly. |previous to the |slow in appearing;
|stupor, which comes |drowsiness, stupor,
|on suddenly. |lethargy. Muscles
| |relaxed, and loco-
| |motion impossible.
| |The patient may be
| |roused by a sharp
| |question.
| |
3. Face pale and | 3. Face flushed; | 3. The face pale,
cold; the pupils |and pupils generally |pupils contracted.
sluggish and insensible|dilated. |
to light, sometimes | |
dilated | |
| |
4. Remissions are | 4. Partial recovery| 4. Remissions are,
rare, the patient |may take place, |as a rule, rare in
recovering slowly, |followed by death |this form of
and with some |after the lapse |poisoning.
confusion of ideas. |of some hours. |
| |
5. Absence of the | 5. Presence of the| 5. Odour of opium
odour of alcohol in |odour of alcohol in |in the breath.
breath; if present, |the breath. |
it is probably due | |
to the treatment of | |
bystanders. | |
| |
-----------------------+---------------------+---------------------
_Chemical Analysis._--Tests for Alcohol:
1. Characteristic smell.
2. It dissolves camphor.
3. Treated with dilute sulphuric acid and a strong solution
of bichromate of potash, the green oxide of chromium
is set free, and the vapour of _aldehyde_ may be
detected by the smell.
4. Burnt under the mouth of a test tube, moistened with
solution of baryta or lime-water, a deposit is formed in
the tube of carbonate of baryta or lime.
5. If a few drops of a solution of iodine in iodide of
potassium be added to alcohol, and then sufficient
caustic potash be added to decolourise it, a crystalline
precipitate of iodoform with its characteristic odour
will be formed.
6. If copper turnings be added to a solution containing
alcohol, then some strong nitric and sulphuric acid, and
the mixture warmed, the odour of sweet spirit of nitre
will be given off.
7. On warming with sodium or lead acetate and sulphuric acid
the odour of acetic ether is evolved.
_Alcohol in the Contents of the Stomach or in the Tissues._--The
contents of the stomach, or the tissues bruised and macerated in
distilled water, should be carefully distilled in a water bath. It
will be necessary to neutralise the liquid prior to distillation.
The distillate should be mixed with chloride of calcium or anhydrous
sulphate of copper, and re-distilled. The liquid thus obtained is
shaken with dry carbonate of potash, and allowed to settle. The alcohol
rises to the top of the mixture, whence it may be removed by the aid of
a pipette, and tested as before mentioned.
_Treatment._--Immediate use of the stomach pump and emetics; to empty
the stomach a hypodermic injection of apomorphine may be given.
Affusion of cold water to the head, or the injection of cold water
into the ears, may be tried. The administration of ammonia, and the
employment of galvanism, have been of service in some cases.
COCAINE
Cocaine is an alkaloid obtained from the _Erythroxylon Coca_. It
produces a paralysing effect upon the endings of sensory nerves, and is
used as a local anæsthetic. When absorbed into the blood it paralyses
the vagus and causes increased rapidity of the pulse. Applied to the
eye it causes dilatation of the pupil. It first has a stimulating
action on the centres of the brain and spinal cord, finally paralysing
them. It produces death by paralysis of respiration, according to
Mosso, by causing tetanus of the respiratory muscles.
_Symptoms._--The symptoms produced are pallor, cyanosis, faintness, and
cold sweats, pain in the precordial region, rapid pulse, intermittent
heart beat, laboured respiration. The pupils are dilated. Speech
becomes incoherent, there may be trismus of the jaws, the ideas are
confused, and there may be delirium. Tetanic spasms of muscles may
occur, and convulsions, also loss of consciousness.
Chronic poisoning, following the cocaine habit, produces a long
series of symptoms which are manifestations of mental and physical
degeneration, which in extreme cases may pass on to insanity, with
hallucinations and delusions.
_Fatal Dose._--Half a grain injected into the gum of an adult has
caused alarming symptoms, and two-thirds of a grain has caused death.
Recovery has taken place after forty-three grains were taken by the
mouth.
_Fatal Period._--Death has occurred in twenty minutes after three and a
half grains by hypodermic injection.
_Chemical Analysis._--The alkaloid may be separated from the stomach
contents or viscera by the usual procedure for extraction of alkaloids.
1. On the addition of strong nitric acid and evaporating to dryness,
the residue when treated with alcoholic solution of potash gives off an
odour like peppermint or meadow-sweet.
2. _Goeldner‘s Test._--Strong sulphuric acid and resorcin when mixed
with cocaine gives a blue colour, changing to rose-pink on addition of
caustic potash. Goeldner considers this a reaction peculiar to cocaine.
3. _Metzer‘s Test._--If a few drops of a 5 per cent. solution of
chromic acid in water be added to a solution of cocaine hydrochloride,
each drop gives a yellow precipitate which redissolves. The addition of
strong hydrochloric acid produces a yellow precipitate of chromate of
cocaine. Metzer considers this reaction peculiar to cocaine.
4. When applied to the tongue or lips a feeling of numbness is
produced; it is rendered more effectual if a solution of sodium
bicarbonate be first applied to the mucous membrane.
_Treatment._--Wash out the stomach and encourage vomiting. Stimulants
and ammonia should be given freely, and if convulsions occur chloroform
should be inhaled. Tannic acid or gallic acid in thirty-grain doses
have been recommended, also iodine one grain with potassium iodide ten
grains, in a wine-glassful of water between the stomach-washing or
emesis. Oxygen inhalations and artificial respiration may be resorted
to in failure of the respiration.
COCCULUS INDICUS
The fruit of Cocculus Indicus, _Anamirta paniculata_ (_N.O.
Menispermaceæ_), is poisonous, and is frequently used by poachers to
capture fish. The berries are ground to powder, mixed with bread,
and then thrown into the water. When taken by the fish, they become
stupefied, float to the surface, and are then taken.
The poisonous properties are due to a crystalline alkaloid,
_Picrotoxin_. Fraudulent publicans have used this drug for the
adulteration of beer. The strength of the beer is first reduced by the
addition of salt and water, and then the cocculus indicus is added,
to give to it an intoxicating property. The effect produced on the
unfortunate customers is a strong desire to sleep, with more or less
wakefulness. Loss of voluntary power is present, but consciousness
is not lost, the sufferer lying in a state bordering on nightmare.
Cocculus is not used in medicine or the arts, and yet a large quantity
is imported, and mysteriously disappears in this country.
_Symptoms._--The symptoms which have been noticed in poisoning by this
substance are--nausea, vomiting, severe abdominal pains, stupor, and
intoxication. Two deaths at least have been reported as resulting from
it. In the case of R. _v._ Cluderay, “the defendant administered to a
child two cocculus indicus berries, entire in the pod, with intent to
murder the child.” The kernel is a poison; the pod is not, and will
not dissolve in the stomach; and they were therefore harmless. This
was held to be administering poison with intent to murder, within the
section of the Statute.
_Picrotoxin_, the alkaloid, is in fine white crystals, intensely bitter
to the taste, soluble in boiling water, slightly so in cold. Alcohol
and ether readily dissolve it. Strong nitric acid dissolves it,
without change of colour; and sulphuric acid produces an orange-yellow
colour, changed to pale yellow by dilution. In organic liquids it
might be mistaken for sugar, or _vice versa_, as it precipitates the
oxide of copper when boiled with the sulphate of copper and potash. In
examining beer supposed to be adulterated with picrotoxin, the beer
should be acidulated with hydrochloric acid, and then shaken up with
ether. On spontaneous evaporation of the ether, the picrotoxin is left
in crystals.
_Treatment._--Stomach pump, emetics, apomorphine subcutaneously; then
chloral and the bromide of potassium. Chloroform may be inhaled.
Paraldehyde is said to be a specific antidote.
LOLIUM TEMULENTUM
The seeds of _Lolium temulentum_, or common darnel, are poisonous.
Cases of poisoning have occurred from these seeds being accidentally
ground with wheat or rye, and then made into bread.
_Symptoms._--Gastric irritation, nausea, and vomiting followed by
giddiness, deafness, loss of vision, and, in some cases, delirium. Not
infrequently the symptoms resemble those produced by ergot. No death
has been recorded as resulting from the use of these seeds. Three
ounces of paste made from darnel flour, given to a dog, did not cause
death.
POISONOUS FUNGI
Accidental poisoning by mushrooms is by no means rare. The _Agaricus
campestris_, and a few others, are edible; but it is a fact worthy
of notice that the poisonous properties of mushrooms are modified
by climate and the seasons of the year at which they are collected.
Idiosyncrasy may have something to do with the injurious effects
produced on some persons by the fungi.
The _Agaricus campestris_, or common mushroom of this country, is
sometimes poisonous; and in some countries--Italy and Hungary--it is
usually avoided. In Russia and in France certain fungi are eaten which
are regarded as poisonous by us.
Bentley gives, in his _Botany_, the following table, by which edible
and poisonous mushrooms may be known:
-----------------------------------+---------------------------------
Edible. | Poisonous.
-----------------------------------+---------------------------------
1. Grow solitary in dry airy | 1. Grow in clusters in woods
places. | and dark damp places.
|
2. Generally white or brownish. | 2. Usually with bright colours.
|
3. Have a compact, brittle | 3. The flesh tough, soft, and
flesh. | watery.
|
4. Do not change colour by the | 4. Acquire a brown, green, or
action of the air when cut. | blue tint when cut and
| exposed to the air.
|
5. Juice watery. | 5. Juice often milky.
|
6. Odour agreeable. | 6. Odour commonly powerful and
| disagreeable.
|
7. Taste not bitter, acrid, | 7. Have an acrid, astringent,
salt, or astringent. | acid, salt, or bitter taste.
-----------------------------------+---------------------------------
_Symptoms._--Two sets of symptoms may follow the use of mushrooms as
food--those of irritant and those of narcotic poisoning. In the latter
class, giddiness, double vision, and even delirium, have been present.
Nausea, vomiting, purging, and convulsions characterise those of the
former class. In some cases the individual has presented all the
appearances of intoxication.
_Post-mortem Appearances._--These will depend to a great extent upon
the character of the symptoms prior to death. If signs of irritation
have been present, inflammation of the stomach and bowels will most
probably be found; but if, on the other hand, narcotic symptoms were
predominant, congestion of the vessels of the brain will most likely be
present. Arsenic and other poisons have been mixed with mushrooms with
intent to kill; the probability of this occurring should be borne in
mind, and a rigid examination of the contents of the stomach made in
all doubtful cases.
_Treatment._--Castor-oil and emetics, atropine hypodermically.
NITROBENZENE, OR ESSENCE OF MIRBANE
This substance, prepared by acting on benzene by nitric acid, is
largely used for flavouring sweets, &c. Nitrobenzene is a heavy,
yellow, oily substance with a strong odour of bitter-almond oil, from
which, however, it differs by undergoing no change of colour when
agitated with strong sulphuric acid. The natural oil acquires a fine
crimson colour when treated with strong sulphuric acid.
_Symptoms._--These may not make their appearance for three or four
hours after the poison is swallowed or inhaled. The vapour is more
powerful than the liquid. In some cases which have been described,
the patient has complained of feeling drunk, with pain in the head,
giddiness, faintness, distorted vision, drowsiness, ending in coma and
death. The face is flushed, the jaws sometimes spasmodically closed,
and the lips livid. Vomiting then supervenes, the vomited matters
having the odour of bitter almonds. Symptoms not unlike those produced
by prussic acid or the essential oil of bitter almonds have been
noticed in one or two cases; but, as a rule, the insensibility is not
immediate, as in prussic acid poisoning, and in this fact lies the
distinction between the two substances. Rapidly fatal cases might be
mistaken for apoplexy, but the odour betrays the cause of death.
_Post-mortem Appearances._--Nothing very characteristic is found after
death due to this poison. The blood is sometimes black and fluid and
gives the spectrum of acid hæmatin, the lungs congested, and the liver
of a purple colour. The blood, contents of the stomach, and even the
tissues, may smell strongly of this substance.
_Chemical Analysis._--Nitrobenzene may be separated by distilling the
organic mixture with sulphuric acid, when the distillate will contain
the poison if present. It is converted into aniline by heating it
with acetic acid and iron filings. (See test for aniline, _infra._)
On account of its odour, the only substance with which it can be
confounded is the essential oil of bitter almonds, which owes its
poisonous properties to the prussic acid it contains.
The following Table may assist in its Detection.
-----------------------+---------------------+-----------------------
| Nitrobenzene. | Oil of Bitter Almonds.
-----------------------+---------------------+-----------------------
Strong sulphuric acid.| No change of colour.| A rich crimson colour.
| |
Proto-sulphate and the| No blue colour. | Prussian blue.
persulphate of iron,| |
liquor potassæ, and | |
hydrochloric acid. | |
| |
Solution of sulphate | Insoluble. | Soluble.
of soda. | |
-----------------------+---------------------+-----------------------
_Treatment._--Stomach pump, emetics, stimulants, cold douche,
artificial respiration.
DINITROBENZENE
This substance is a solid of a yellow colour, and is used in the
manufacture of _roburite_, _bellite_, and _sicherite_, explosives used
in coal mines for blasting. Poisoning by it occurs amongst the workmen
who come in contact with it in factories where it is used, by inhaling
either the vapour or fine particles, and by handling it may become
absorbed through the skin.
_Symptoms._--In acute cases these are similar to poisoning by
nitrobenzene. In chronic poisoning there is a marked and peculiar
pallor of the face, with a livid blue colour of the ears, lips,
fingers, and toes. Nausea and vomiting occur, with weakness,
giddiness, and staggering. Amblyopia is a common symptom, with
concentric contraction of the visual field and central scotoma. The
blood resembles that of pernicious anæmia, and the urine is brown or
blackish, due to some pigments of the aromatic series.
_Post-mortem Appearances._--The blood has been found
chocolate-coloured, and ecchymoses have been noted in mucous membranes.
_Treatment._--As for nitrobenzene.
ANILINE
Aniline is a colourless oily liquid gradually changing to brown on
exposure to air. The various aniline dyes are obtained by oxidation
of aniline. Aniline is produced by reduction of nitrobenzene. It is
slightly soluble in water, freely so in alcohol or ether. It can be
absorbed through the unbroken skin as well as by the lungs and mucous
membranes. It is used in the manufacture of marking inks. It has very
toxic properties.
_Symptoms._--The symptoms come on rapidly--nausea and vomiting,
with giddiness and drowsiness; the lips, face, ears, fingers, toes,
conjunctivæ, and mucous membranes become cyanotic. The respirations
are slow and laboured. The pulse may be full and slow, or small and
irregular. The body surface is cold, the pupils react sluggishly
to light. The blood is chocolate-coloured, and is said to give the
spectrum of methæmoglobin. The blue colour is held to be due to pigment
changes, and not to true cyanosis. Convulsions and coma may come on in
fatal cases.
Buchanan met with a case of aniline poisoning in a man who by mistake
swallowed about half an ounce of marking ink. Vomiting came on early,
with giddiness and staggering gait. The body became changed in colour
very rapidly--the colour being between a slate and leaden hue. The
eyeballs were of the same colour but of a lighter shade, the mouth
and tongue exhibited the colour most markedly. The temperature was
subnormal, the pulse quick and feeble, and the breathing occasionally
interrupted with sighing respirations. The blood failed to give the
spectrum of methæmoglobin. The symptoms passed off within twenty-four
hours. During the illness, the man passed several green-coloured
motions. The vomit was of a purplish-black colour--from the marking
ink--and on analysis gave the reactions of aniline. Some of the ink was
procured, and on being analysed was found to consist of hydrochloride
of aniline and chloride of copper. The treatment consisted of stomach
lavage and inhalations of oxygen, which gave the patient much relief.
Cases have been recorded of aniline poisoning in infants from
absorption of the material from linen napkins, which were stamped
with marking ink. Buchanan has seen lividity arise from the dry
hydrochloride of aniline having been carried in a paper parcel in the
waistcoat pocket for two or three days.
_Post-mortem Appearances._--None characteristic.
_Fatal dose._--Six drachms have proved fatal, probably less might do so.
_Chemical Analysis._--Aniline may be separated from organic matter by
alkalising and distilling the mixture.
1. If chloride of lime (bleaching powder) be added slowly to an aqueous
solution of aniline, a deep purple colour is produced, which changes to
brownish-red.
2. If strong sulphuric acid be added to aniline in a porcelain capsule
it forms a dirty-white mass; on adding water and then potassium
bichromate a bronze-green colour is produced, which changes rapidly to
blue and then black.
3. If aniline be dissolved in excess of aqueous solution of phenol, and
bleaching powder dropped into the mixture, a yellow streak changing to
blue follows each drop.
4. Heated with corrosive sublimate a rich crimson colour is produced.
5. If aniline be mixed with a little chloroform and alcoholic solution
of potash and heated, the peculiar odour of phenyl-isocyanide is given
off.
_Treatment._--As for nitrobenzene.
Fusel-oil, Amylic Alcohol, Potato-Spirit.--Fusel-oil, also known as
amylic alcohol, is known by its unpleasant odour and burning taste; it
acts like alcohol as an inebriant, giving rise to headache, giddiness,
&c.
Nitro-glycerine.--In liquid or vapour, violent headache and throbbing
in the temples are produced by this substance, which is used in the
treatment of angina pectoris.
ACETANILIDE (ANTIFEBRIN), PHENAZONUM (ANTIPYRIN), AND PHENACETIN
These substances are used extensively as antipyretics. They have been
known to cause poisoning when administered in large doses.
_Symptoms._--The symptoms are principally those of depression,
impairment of sight, vertigo, sleepiness, and unconsciousness;
collapse, cyanosis, and loss of body temperature; the pulse and
respiration are lowered. Antipyrin causes tumultuous action of the
heart, and there may be erythematous or herpetic eruptions on the skin.
Aniline derivatives, like sulphonal and other synthetic drugs, tend
to destroy the red corpuscles of the blood, and decompose hæmaglobin,
producing hæmatoporphyrin which appears in the urine.
_Chemical Analysis._--Antifebrin may be extracted from an acid solution
by chloroform; for antipyrin the solution should be alkaline.
_Antifebrin_ gives the phenyl-isocyanide reaction on warming with
alcoholic solution of potash and chloroform. Bichromate of potassium
dissolved in strong sulphuric acid gives a red colour, changing to
brown and dirty green; sodium nitrite and strong hydrochloric acid give
a yellow colour, changing to green and blue; on evaporation the residue
is orange, and turns red on addition of ammonia.
_Antipyrin._--Heated with strong nitric acid and the liquid
allowed to cool, a purple colour is produced; if water be added a
violet precipitate is thrown down, and the filtered liquid will be
purplish-red. Ferric chloride gives a blood-red colour, destroyed by
a mineral acid. An aqueous solution of potassium nitrite and strong
sulphuric acid gives a green colour.
_Phenacetin_ is coloured yellow by nitric acid, the colour persisting
when heated. It dissolves in sulphuric acid without change of colour.
Boiled with hydrochloric acid, then diluted with water and chromic acid
solution added, gives a deep red solution.
CHAPTER XI
SEDATIVE POISONS
Cardiac
DIGITALIS
The common foxglove, _Digitalis purpurea_, (_N.O. Scrophulariaceæ_),
grows wild in the hedges in the South of England. All parts of the
plant are poisonous, from the presence of a glucoside _digitalin_, and
in addition it also contains the glucosides digitoxin, digitonin, and
digitalein; according to Kopp, digitoxin is six to ten times more toxic
than digitalin.
_Symptoms._--Nausea, salivation, vomiting, purging, and severe
abdominal pains are first noticed. The patient then complains of pain
in the head, giddiness, and a gradual loss of sight. The eyes protrude,
the pupils are dilated and insensible to light, and the sclerotics,
according to Tardieu, are of a characteristic blue colour; the pulse
weak, slow (forty in the minute) and jerky, sometimes intermittent. The
surface of the body is cold, and bathed in perspiration. An aggravation
in the symptoms takes place whenever the patient attempts to leave the
recumbent position; hence, in all cases of poisoning, and in those
where the therapeutical action of the drug is sought, the patient
should be warned of the danger of leaving the recumbent posture. A
marked depression in the action of the heart is a characteristic
effect of this poison. The effect on the heart may be divided into
three stages: (1) diminution in the frequency of the pulse, and rise
of arterial pressure; (2) both of these become abnormally low; (3)
frequency of pulse abnormally high, arterial pressure abnormally low.
Convulsions have sometimes been noticed, and syncope and stupor are not
uncommon.
_Post-mortem Appearances._--Congestion of the brain and its membranes,
and some inflammatory redness of the mucous membrane of the stomach.
The blood is fluid.
_Fatal Dose._--Uncertain. Large doses of the infusion and tincture have
been given without any untoward results. Thirty-eight grains of the
powdered leaves, and nine drachms of the tincture, have proved fatal.
One-quarter to half a grain of digitalin might prove fatal to an adult.
_Fatal Period._--From three-quarters of an hour to twenty-four hours.
_Chemical Analysis._--If the leaves in an infusion be taken, these must
be sought for and examined. The glucoside may be extracted by first
removing the impurities by means of petroleum ether, then acidifying
with acetic acid and extracting with chloroform.
The following are the tests for _digitalin_:
1. An almost amorphous, white, or fawn-coloured inodorous
substance.
2. Almost insoluble in water.
3. Decomposes nitric acid, with the evolution of nitrous
acid fumes. An orange-yellow-coloured solution is formed,
which, in a few days, assumes a golden-yellow tint.
4. Sulphuric acid dissolves it, changing it to a
reddish-brown colour, changed to violet by bromine vapour.
5. Hydrochloric acid with it at first forms a yellow
solution, which, when heated, changes to a bright green
colour.
The physiological test may be employed by injecting a solution of a
carefully prepared extract of the contents of the stomach or vomited
matters under the skin of a frog, dog, or rabbit.
_Treatment._--Purgatives and emetics should be given, followed by
infusions containing tannin, green tea, oak bark, galls, strong coffee,
and other stimulants. The patient should be kept in the recumbent
posture, and on no account allowed to sit up.
TOBACCO
The consumption of tobacco, _Nicotiana Tabacum_ (_N.O. Solanaceæ_),
has greatly increased of late years. In some countries its use was
prohibited by stringent laws. In Russia amputation of the nose was the
punishment. Several Popes have excommunicated those who smoked in St.
Peter‘s at Rome; and in some parts of Switzerland it was ranked on the
tables next to adultery. Amurath IV made smoking tobacco a capital
offence. Be this as it may, the moderate use of tobacco does not appear
to lead to injurious results; and it is found that workmen engaged in
the manufacture of tobacco do not suffer from any diseases other than
those affecting the generality of mankind.
_Nicotine_--the alkaloid--is a colourless or slightly amber-coloured,
oily, volatile liquid. It is to this principle that the poisonous
activity of the drug is due. It differs from the other oily alkaloid,
_conine_, in appearing of a green colour when a drop is placed on the
surface of white enamelled glass--conine having a _pink_ colour. They
both leave a greasy stain on paper. Nicotine has been detected by
Stas‘s process in the tongue, stomach, lungs, and liver. A ptomaine not
unlike nicotine has been discovered.
_Symptoms._--Symptoms of poisoning by tobacco are by no means uniform,
and have been variously described by observers. As a type of the
effects produced, the following may be noticed as occurring to the tyro
after his first or second “pipe”: The pulse is primarily quickened;
then follow nausea and faintness, accompanied with an intense feeling
of sinking. The face is blanched, the pulse slow; perspiration
stands on the forehead, and ultimately he vomits, and then gradually
recovers. Cold air blowing on the face, or sponging the face with
cold water, materially hastens a return to comfort. Sometimes, as
in the case related by Dr. Marshall Hall of a man who smoked two
“pipes,” nausea, vomiting, and syncope occurred, followed by stupor,
stertorous breathing, general spasms, and insensibility of the pupil.
After an interval of a few hours, the above symptoms again returned,
but from which the patient ultimately recovered. Death has resulted
as a sequence to excessive smoking. Gruelin records two cases--one
from seventeen, the other from eighteen, pipes smoked at a sitting.
The symptoms after taking nicotine are more acute, and are a burning
acrid taste in the mouth and throat, nausea, vomiting, unconsciousness,
shock, sighing respirations, delirium, convulsions; the pupils first
contracted then dilated.
The filthy habit of snuff-taking has also been accredited with one
or two deaths. Santeuil, the French poet, died in two days from the
effects of snuff mixed with his wine as a practical joke.
In animals, the symptoms are--nausea, vomiting, purging, convulsions,
stupor, and death. The heart becomes paralysed. One drop of the
empyreumatic oil on the tongue of a cat killed it in two minutes, the
animal dying in convulsions.
_Post-mortem Appearances._--These are by no means uniform or
characteristic. If much vomiting precedes death, the vessels of the
brain may be engorged with blood. Inflammation of the stomach and
intestines is also present in some cases. The odour of nicotine may be
detected in the vomit or the stomach contents.
_Fatal Period._--The symptoms soon make their appearance, and death has
occurred in three-quarters of an hour, or even less--in three minutes
after taking the nicotine, in fifteen minutes after enema of tobacco.
_Fatal Dose._--One to three drops of nicotine would probably kill an
adult in a few minutes; an enema containing half a drachm of the leaves
has proved fatal.
As an enema, tobacco should be used with extreme care.
_Chemical Analysis._--Nicotine obtained by the usual process for
alkaloid extraction, and mixed with water, may have the following tests
applied after solution in dilute hydrochloric acid:
1. Chloride of platinum gives an orange-yellow crystalline
precipitate.
2. Corrosive sublimate, a white crystalline precipitate.
3. Arsenio-nitrate of silver, a yellow precipitate.
4. Caustic potash added to the hydrochloride and warmed
causes a strong odour of tobacco.
5. Solution of iodine in ether added to ethereal solution
of nicotine is followed by the production of long needle
crystals after some hours.
_Treatment._--Promote vomiting, wash out the stomach, cold water
douches, and stimulants. Inject strychnine hypodermically.
LOBELIA
Lobelia, or Indian Tobacco, _Lobelia inflata_ (_N.O. Lobeliaceæ_),
is extensively employed in North America in the treatment of asthma.
The plant is officinal in the British Pharmacopœia. In small doses it
possesses expectorant properties.
_Symptoms._--Nausea, vomiting, giddiness, cold clammy sweats, and
great depression. The pulse becomes irregular, and very feeble. Taken
together, the symptoms are not unlike those produced by tobacco.
_Fatal Period._--One to two days, or more.
_Fatal Dose._--One drachm of the powder.
_Chemical Analysis._--The alkaloid is fluid and may be extracted like
nicotine; with it (1) strong sulphuric acid gives a red colour; (2)
sulphomolybdic acid gives a violet colour.
_Treatment._--The same as recommended under tobacco. Stimulants should
be given, ether hypodermically or alcohol _per rectum_.
VERATRINE
The alkaloid _Veratrine_ is obtained from the dried fruit of _Asagrœa
officinalis_ (_N.O. Melanthaceæ_).
The alkaloid is in the form of a white amorphous powder, bitter and
acrid to the taste. It acts as a powerful errhine, causing violent
sneezing. Insoluble in water, it is readily dissolved by alcohol,
ether, and chloroform. When gently heated on a plate with strong
sulphuric acid, it first turns yellow, then crimson. Veratrine is
entirely dissipated by heat.
Two grains of the alkaloid killed a cat in one minute; a dog being
destroyed in two hours by a dose of three grains. The one-sixteenth of
a grain (?) of veratrine in a pill caused alarming symptoms in an adult
woman, for whom it was ordered by a medical man.
_Symptoms._--Acrid burning sensation in the throat and down the
œsophagus to the stomach, vomiting, great thirst, diarrhœa may occur
with tenesmus. The pulse is feeble and respiration slow. The pupils may
be dilated or contracted. Collapse and twitching of muscles, loss of
consciousness and convulsions, or delirium and stupor may come on.
_Post-mortem Appearances._--Are the same as in poisoning by any of the
vegetable irritants.
_Treatment._--Stomach pump, and emetics. Astringent infusions should
be given, and alcohol and opium administered if the condition of the
patient seems to require them.
_Chemical Analysis._--Extract in the usual way for alkaloids.
1. Strong sulphuric acid produces a yellow colour, changing to red,
produced rapidly if heated.
2. Strong hydrochloric acid and heat produces a red colour.
3. Sulphomolybdic acid produces a reddish colour, changing to dirty
brown, greenish, and finally blue.
These tests should be done with the solid veratrine.
HYDROCYANIC ACID
Hydrocyanic acid is a compound of cyanogen and hydrogen. It was first
obtained by Scheele in 1782, but it was not until 1815 that Gay-Lussac
pointed out its real nature. Anhydrous hydrocyanic acid may be obtained
by passing over cyanide of mercury, gently heated, a stream of dry
sulphuretted hydrogen. It is now made by mixing ferrocyanide of
potassium with dilute sulphuric acid, and applying heat, when the acid
is distilled over and collected in a cooled receiver.
Dilute hydrocyanic acid, the only important form of the acid from a
toxicological point of view, is a colourless, feebly acid liquid,
with a peculiar odour, like that of bitter almonds or peach kernels
(specific gravity, 0.997). The Pharmacopœial acid contains 2 per cent.
of anhydrous acid; that of Scheele 5 per cent. According to Taylor,
however, the percentage of the acid varies from 1.3 to 6.5. Taking
into consideration the smallness of the dose, and the shortness of the
time before death occurs, it is the most deadly of all known poisons.
Prussic acid is not regarded as a cumulative poison--that is, it does
not gradually accumulate in the body and then break out with dangerous
or fatal violence.
_Symptoms._--These will be more or less modified by the quantity of
the dose, and in some cases closely resemble an attack of epilepsy. In
most cases, the symptoms of poisoning are seldom delayed beyond _one_
or _two_ minutes; and if the dose be large, the symptoms of poisoning
may come on while the person is drinking. Giddiness, followed by almost
complete insensibility, mark the accession of the symptoms. The eyes
are fixed, staring, and glassy; the pupils are dilated, and insensible
to light. The muscles of the extremities are relaxed, and the limbs
flaccid. A white or bloody froth surrounds the mouth, and the jaws
are fixed. The surface of the body is cold and clammy to the touch;
the respiration is sometimes long-drawn and spasmodic; and the pulse
so reduced as to be almost imperceptible. The breathing is sometimes
_stertorous_ in character. This is an important fact; for, in ignorance
of the occasional presence of this symptom, it was argued that Walter
Palmer, whose breathing was stertorous, died of apoplexy, and not from
prussic acid as was alleged. When the dose is small (between twenty
and thirty drops of the dilute acid), the patient complains of nausea,
giddiness, and a feeling of constriction round the head. The mind is
confused, the pulse hurried, and the breathing irregular. Salivation
may also be present. Tetanic spasms and involuntary evacuations precede
the fatal termination. When the dose is from ten to twenty drops, the
patient complains of nausea, giddiness, and a feeling of impending
suffocation. These symptoms under treatment may soon pass off, or
leave the patient more or less confused and listless. In most cases,
where the dose is very large, death takes place suddenly, without
convulsions; but the period of death does not appear to be as short in
man as in the lower animals.
_External Application._--Applied to the unbroken skin, prussic acid
does not appear to have caused any alarming symptoms; but it should
be used with the utmost caution where the skin is at all abraded or
ulcerated.
_Post-mortem Appearances._--In making an inspection, care should be
taken; for, if the dose be large, the vapour from the corpse on opening
it has been known to produce giddiness and fainting. Externally, the
skin is pale, livid, or of a violet colour. The hands are clenched,
and the nails blue. The jaws are firmly set, and there is usually some
froth around the mouth. The internal organs are greatly congested, and
the venous system gorged with fluid dark-coloured blood. The stomach
and intestines are sometimes inflamed, but in many cases they present
no material alteration in colour.
The appearances, when only a small dose has been taken, are not unlike
those of asphyxia. The detection of the odour of hydrocyanic acid in
the body is of importance; but this may be absent from the following
causes:
1. Smallness of the quantity of the acid present.
2. Volatilisation from exposure of the corpse to the air.
3. The smallness of the dose, and its absence the result
of absorption and elimination, if death has not rapidly
taken place.
4. The amount of dilution of the poison.
5. Concealed by other odorous substances.
In some cases, the smell may be detected in the stomach seven or
eight days after death. The viscera should, in all cases of suspected
poisoning, be placed in a glass-stoppered jar, and the stopper covered
by bladder and tinfoil. Hydrocyanic acid is so volatile that, unless
the greatest care be taken, all traces of it may vanish; and thus the
guilty person may be allowed to escape.
_Fatal Period._--From a few seconds to as many minutes. Under active
treatment, if a patient survive forty minutes, he will generally
recover.
_Fatal Dose._--Thirty minims of the dilute acid of the Pharmacopœia.
This contains six-tenths of a grain of the anhydrous acid. Recovery
has, however, taken place even after comparatively large doses. The
strength and age of the individual, and also the emptiness or fulness
of the stomach at the time the poison is swallowed, will materially
affect the issue.
Experiments on Animals
Numerous experiments on animals have been made to ascertain the
rapidity with which prussic acid kills. The late Sir R. Christison
found that three drops projected into the eye acted on a cat in twenty
seconds, and killed it in twenty more. The same quantity dropped on
a fresh wound in the loins acted in forty-five, and proved fatal in
one hundred and five seconds. In the cases where death did not occur
so rapidly, there were regular fits of violent tetanus; but in the
very rapid cases, the animals perished, just as the fit was ushered
in, with retraction of the head. In rabbits opisthotonos, in cats
emprosthotonos, were the chief tetanic symptoms.
As a proof that the acid acts equally on the brain and spinal cord, may
be noticed the presence of coma and tetanus in some cases of poisoning
by this substance.
In the experiments on animals certain effects were noticed, which are
as follows:
_Expulsion of the Fæces and Urine._--In some cases only the fæces, in
others the urine alone, was involuntarily expelled; and in some other
cases neither the one nor the other was present.
_The Shriek or Cry._--This cry, though a common, is by no means a
constant symptom.
_Convulsions._--These are sometimes present.
_Acts of Volition._--Only slight acts are possible; in the case of one
of the dogs experimented on by Mr. Nunneley, the animal “went down,
came up, and then went down again the whole flight of a steep, winding
staircase.”
The _Post-mortem Appearances_ were not well marked in the animals
subjected to experiment. In chronic cases, Mr. Nunneley states that
both sides of the heart were distended with black blood. The pure
acid is stated to completely destroy the irritability of the heart
and voluntary muscles, galvanism producing no effect whatever. “In
eight experiments on cats and rabbits with the pure acid, the heart
contracted spontaneously, as well as under stimuli, for some time after
death, except in the instance of the rabbit killed with twenty-five
minims, and one of the cats killed by three drops applied to the
tongue. In the last two the pulsation of the heart ceased with the
short fit of tetanus which preceded death; and in the rabbit, whose
chest was laid open instantly after death, the heart was gorged, and
its irritability utterly extinct.”
=Detection of Hydrocyanic Acid in Cases of Poisoning=
The “_Vapour Tests_” are those most readily applied to organic
mixtures; but in some cases it may be necessary to make a distillation
of the suspected substance, in order to isolate the poison.
The first point to be noticed is, whether any _odour_ of the acid can
be perceived in the substance under examination. In any case, the
contents of the stomach or finely-divided tissues should be mixed with
water, and examined as to the reaction with test paper. If the mixture
be found to be _alkaline_, it must be neutralised by the addition of
tartaric acid; if, on the contrary, it be _acid_, carbonate of soda
must be carefully added to neutralisation. A state of neutrality is
always necessary previous to distillation, for the following reasons:
An _alkaline_ state of the liquid would, on the one hand, prevent, or,
at all events, retard, the evolution of the hydrocyanic acid; whilst,
on the other, the existence of any _free acid_ would decompose any
cyanide which might be present, and thus give rise to an evolution of
hydrocyanic acid not existing as such in the mixture.
The organic mixture is then placed in a flask, and the contents
distilled at as low a temperature as possible by the aid of a water
bath.
Should hydrocyanic acid be present, the distillate will yield all the
characteristic reactions of the dilute acid.
1. Nitrate of silver will give a curdy-white precipitate, insoluble
in cold but soluble in boiling nitric acid. A portion of the
precipitate, on the addition of some liquor potassæ, sulphate of iron,
ferric chloride and hydrochloric acid, forms Prussian blue. In this
test, which may be taken as quite conclusive, the hydrochloric acid
decomposes the cyanide of silver; and on the addition of the sulphate
of iron, Prussian blue is formed.
2. If a portion of the dry precipitate formed by the nitrate of silver
be heated in a test tube, cyanogen gas will be evolved, known by its
characteristic odour of peach blossoms, and by its burning at the mouth
of the tube with a rose-coloured flame.
3. To the solution containing hydrocyanic acid add a few drops of
potassium nitrite, two or three drops of ferric chloride solution and
dilute sulphuric acid until a yellow tint is obtained; heat to boiling,
cool, precipitate excess of iron with ammonia, filter, and add one or
two drops of a very dilute solution of colourless ammonium sulphide.
A very minute quantity of hydrocyanic acid gives a violet-red colour,
changing to blue, green, and finally yellow.
4. If a solution of starch be tinged blue with iodine, the colour will
be discharged by a minute quantity of hydrocyanic acid.
=Vapour Tests.=--There are three tests for the presence of hydrocyanic
acid when present in organic mixtures, which have the advantage of
being applicable without the addition of anything extraneous to the
mixture to be tested. They are all dependent on the volatile nature of
hydrocyanic acid, and may be applied as follows, the suspected mixture
being divided into three portions:
1. _Iron or Prussian Blue Test._--The liquid mixture to be tested is
placed in a small beaker glass, and covered with a glass plate the
centre of which is smeared with a mixture of potash and proto-sulphate
of iron. The whole is now left undisturbed for some time. The glass is
eventually removed, and the mixture of potash and iron treated with
hydrochloric acid, which, should hydrocyanic acid be present, will
cause the development of Prussian blue.
2. _Sulphur Test, or Liebig‘s Test._--A second portion of the original
mixture is placed in a beaker, and a watch-glass containing a few drops
of bisulphide of ammonium is suspended over the liquid, the mouth
of the beaker being closed. A short time is allowed to elapse; the
watch-glass is then removed, and its contents evaporated to dryness
at a low temperature. A blood-red colour is developed on the addition
of a little perchloride of iron to the _dry_ residue. This effect is
due to the absorption of the hydrocyanic acid vapour by the bisulphide
of ammonium--sulphocyanide of ammonium being formed, which, on the
addition of perchloride of iron, gives the blood-red colour of the
sulphocyanide of iron, which is bleached by corrosive sublimate.
3. _Silver Test._--This is the most successful of the vapour tests,
a single apple pip yielding all the reactions. If a watch-glass
containing a few drops of nitrate of silver solution be suspended in
a beaker (as in 2), the silver solution will become white and opaque,
from the formation of cyanide of silver; examined under the microscope
it is seen to consist of small prismatic crystals. The cyanide as
formed, treated with hydrochloric acid, liquor potassæ, and sulphate of
iron, will give Prussian blue.
_The Quantitative Analysis._--Use the precipitate of cyanide of silver,
100 grains being equal to 20.33 of pure anhydrous acid.
=Treatment.=--The treatment of poisoning by prussic acid is now to be
considered. As part of the general treatment, the stomach pump should
be at once employed, and the stomach emptied and then washed out with
water.
_Ammonia._--The use of this substance was first advocated by Mr. John
Murray of London, and is no doubt a valuable remedy if given early.
Care should be taken that the mucous membrane of the air passages and
alimentary canal be not inflamed by using too strong a solution.
_Chlorine._--Recommended by Riauz in 1822. Water impregnated with the
vapour of chlorine may be given internally, and the gas may be breathed
under proper precautions.
_Cold Affusion._--First proposed by Dr. Herbst of Göttingen. Its
success is most to be looked for when it is employed before the
convulsive stage of the poisoning is over. The cold water should be
poured on the head and down the spine.
[Illustration: Fig. 39.--Photo-micrograph of crystals of cyanide of
silver obtained by the vapour test, × 50. (R. J. M. Buchanan.)]
_Bleeding from the Jugular Vein._--In one case treated by Magendie,
bleeding from the jugular vein was attended with success.
_Chemical Antidotes._--The administration of a solution of carbonate
of potash, followed by a solution of the mixed sulphates of iron, has
been suggested. The formation of Prussian blue is the result. The
only objection to this treatment is, that prussic acid is so rapidly
absorbed that death may result from the already absorbed acid before
the antidote can be given.
_Atropine._--This should be given hypodermically.
_Peroxide of hydrogen_ should be given freely by means of the stomach
tube.
_Cobalt_ nitrate 0.5 to 1 per cent. solution has been advocated
hypodermically.
_Sodium thiosulphate_, in 10 per cent. solution, repeated
hypodermically.
Cyanide of Potassium
This substance is used largely by photographers and electro-platers.
It acts as a poison in a similar manner to hydrocyanic acid, and the
symptoms are the same. As a commercial preparation it frequently
contains undecomposed potassium carbonate, and may exert a corrosive
action on the mucous membranes of the mouth and stomach, leading to the
production of blood-stained mucus in the stomach.
_Post-mortem Appearances._--These are the same as those described under
hydrocyanic acid, with the addition of the corrosive effects.
_Fatal Dose._--Five grains have proved fatal in a quarter of an hour;
recovery has taken place after forty grains.
_Chemical Analysis._--Same as for hydrocyanic acid.
_Treatment._--As for hydrocyanic acid.
PREPARATIONS CONTAINING HYDROCYANIC ACID
The following plants contain prussic acid, and are therefore more or
less poisonous in proportion to the quantity of the acid which they
severally contain:
Nat. Ord. Rosaceæ
_Amygdalus Communis._--The Almond and its varieties.
_Prunus Domestica._--The Plum and its varieties.
_Cerasus._--The Cherry and its varieties.
_Pyrus Aria_, or White Bean Tree.--The seeds are poisonous.
Nat. Ord. Euphorbiaceæ
_Jatropha Manihot_, or Bitter Cassava.
Bitter Almonds
The essential oil of bitter almonds is very poisonous. “The oil does
not, like common essential oils, exist ready formed in the almond,
but it is only produced when the almond pulp comes in contact with
water. It cannot be separated by any process whatever from the almond
without the co-operation of water--neither, for example, by pressing
out the fixed oil, nor by the action of ether, nor by the action of
absolute alcohol. After the almond is exhausted by ether, the remaining
pulp gives the essential oil as soon as it is moistened; but if it is
also exhausted by alcohol, the essential oil is entirely lost. The
reason is, that alcohol dissolves out a peculiar crystalline principle
named _Amygdalin_, which, with the co-operation of water, forms the
essential oil by reacting on a variety of the albuminous principle in
the almond, called _Emulsin_, or _Synaptase_.
The essential oil of bitter almonds may contain from 6.0 to 14.33 per
cent. of hydrocyanic acid. Deaths from the incautious use of this oil
for flavouring articles of confectionery are not infrequent. As the
flavour is not in the least injured, it has been suggested to subject
the oil to repeated distillation with caustic potassæ, by which means
the oil is purified from prussic acid.
_Symptoms in Man._--Nausea, vomiting, and diarrhœa, due to gastric
irritation, have occurred when the dose has been small, as is the case
when confectionery owes its flavour to the use of the essential oil.
Idiosyncrasy may have something to do with these effects, for cases
are on record where a single almond has produced a state resembling
intoxication, followed by an eruption not unlike urticaria or
nettle-rash. Taken in large doses, the symptoms produced are identical
with those described under poisoning by prussic acid. The breath is
usually strongly impregnated with the odour of bitter almonds.
_Symptoms in Animals._--Vomiting, trembling, weakness, paralysis,
tetanic convulsions, and coma.
_Post-mortem Appearances._--These are identical with those seen in
poisoning by the pure acid.
_Fatal Dose._--The essential oil is from four to eight times as strong
as the acid of the Pharmacopœia. From twenty to thirty drops have
proved fatal. Death may take place in half an hour or less.
_Treatment._--The same as that recommended under prussic acid.
Cherry-Laurel
The cherry-laurel, _Prunus Laurocerasus_--the leaves of which have
been used for flavouring custards, &c.--contains prussic acid, and is
therefore poisonous.
In the British Pharmacopœia there is an _Aqua Laurocerasi_--laurel
water--prepared from the leaves. It contains 0.1 per cent. of
hydrocyanic acid. It should be used with extreme caution, as the amount
of hydrocyanic acid contained in the leaves is uncertain. Death has
frequently resulted from its use. The most important case, however, is
that of Sir T. Broughton. His mother, who gave him his usual draught
on the morning of his death, observed that it had a strong smell of
bitter almonds. Two minutes after he took it she observed a rattling
or gurgling in his stomach; in ten minutes more he seemed inclined to
doze; and five minutes afterwards she found him quite insensible, with
the eyes fixed upwards, the teeth locked, froth running out of his
mouth, and a great heaving at his stomach, and gurgling in his throat.
He died within half an hour after swallowing the draught. No light was
thrown on the case by the carelessly conducted _post-mortem_; but the
suddenness of his death, the improbability of apoplexy occurring at so
early an age, and the odour of bitter almonds observed by his mother,
pointed out clearly enough the true cause of death.
ACONITE
All parts of this plant, the _Aconitum Napellus_ (_N.O. Ranunculaceæ_),
are poisonous. The poisonous properties depend upon the presence of an
alkaloid--_aconitine_--chiefly found in the root.
Poisoning by the alkaloid came before the public mind in the case of
Dr. Lamson, executed for the murder of his brother-in-law. The symptoms
noticed in that case were very much as detailed below. When any part
of the plant is chewed, a sensation of tingling is experienced in the
mouth, and burning in the throat. Many of the aconites are, however,
inert. The root, having been taken by mistake for horse-radish, has led
to several cases of accidental poisoning.
-------------------------------------+------------------------------
Aconite | Horse-Radish
-------------------------------------+------------------------------
_General Characteristics._-- | _General Characteristics._--
Root conical; dark brown externally,| Root cylindrical, of nearly
and with numerous twisted rootlets; | the same thickness down its
internally, the colour is whitish. | whole length. Externally,
| buff-coloured; internally,
| white.
|
_Taste._--Produces a tingling | _Taste._--Sweet and pungent.
and numbing sensation in the mouth. |
-------------------------------------+------------------------------
_Symptoms in Man._--The patient complains, within a short time after
the poison is taken, of dryness of the throat, accompanied with
tingling and numbness of the mouth and tongue. He then complains of
nausea, vomiting, pain in the epigastrium, and distressing dyspnœa,
of a sensation of formication or tingling, with numbness in his face
and limbs, which appear to him heavy and enlarged. In attempting to
walk he staggers, his limbs losing their power of supporting his
body. He becomes giddy, his pupils dilated, and his sight and hearing
imperfect; but he is seldom unconscious till near death. His pulse
irregular, gradually becomes weaker, and at last almost imperceptible;
his skin cold and clammy; his features pale and bloodless; and his mind
clear: then suddenly he dies, in some cases from shock, in others from
asphyxia; or he may die from syncope, especially after some exertion.
_Symptoms in Animals._--Weakness of the limbs and staggering, the
respiration slow and laboured, loss of sensation, paralysis, dimness of
vision, increasing difficulty in breathing, _convulsions_, and death by
_asphyxia_.
Delirium is present in some cases, and dilatation of the pupil has also
been noticed. In a case recorded in the _British Medical Journal_,
1877, vol. i. p. 258, two ounces of the tincture of aconite were drunk
in mistake for _Succus Limonis_; recovery took place, but not before
alarming symptoms had taken place, and death at one time appeared
imminent.
_Post-mortem Appearances._--General venous congestion. The brain and
its membranes are, in most cases, found congested and the stomach and
intestines inflamed.
_Fatal Period._--The symptoms may come on immediately, or may be
delayed for an hour or two. In the case mentioned in the _British
Medical Journal_ the patient walked about five miles after swallowing
two ounces of the tincture, which he drank at 11 o‘clock, returning
home at 2.30 P.M. An excise officer, who died in about four hours, was
able to walk from the Custom House over London Bridge. Death has taken
place in so short a time as one hour and a quarter.
_Fatal Dose._--About two grains of the extract, and one drachm of the
tincture. Much will depend upon the amount of the alkaloid present. One
drachm of the scraped root is said to have proved fatal. One-fifteenth
of a grain of aconitine has proved fatal.
_Chemical Analysis and Tests._--The alkaloid must be isolated from the
contents of the stomach by the process of Stas. The physiological test
consists in placing a small portion of the extract, or the alkaloid so
obtained, on the tongue or lip, and noting if tingling be produced.
To the pure alkaloid, nitric acid added produces no change of colour.
Officinal phosphoric acid added, and the mixture carefully evaporated,
a violet colour is produced; this reaction is due to impurities in the
aconitine.
_Kundrat‘s Test._--A solution of ammonium vanadate in strong sulphuric
acid produces a coffee colour with aconitine.
_Treatment._--Emetics, stomach lavage, castor-oil, and animal charcoal
should be given. The administration of digitalis in aconite poisoning
has been attended with good results. (See _British Medical Journal_,
11th December 1872.) The drug may be given hypodermically as an
antidote. Stimulants will be required; and friction down the spine,
together with galvanism and artificial respiration, may be tried.
=Synopsis of the Action of Aconite=
1. _On Nervous System._--Giddiness, numbness, and tingling in the limbs
is a primary effect, followed by gradually increasing paralysis of the
muscles, and insensibility of the surface of the body to pinching and
pricking. Dr. Fleming asserts that it produces a _powerful sedative
effect on the nervous system_. At any rate, it now seems to be proved
that aconite paralyses the sensory nerves, commencing at their
peripheral endings.
2. _On Vascular System._--Extreme depression of the circulation is
produced by doses large enough to cause death. The pulse may become
imperceptible at the wrist. In medicinal doses, aconite lowers the
heart‘s action; in poisonous doses, it causes fatal syncope.
3. _On Digestive System._--Some have denied the irritant action of
aconite on the alimentary canal, but Sir R. Christison states that he
was deterred from the use of aconite “by two patients being attacked
with severe vomiting, griping, and diarrhœa.”
CHAPTER XII
CEREBRAL POISONS
The symptom most characteristic of these poisons is the marked
anæsthesia which they produce when their vapours are inhaled. The
hydrate of chloral, though placed under the above heading, is more
closely allied in its action to opium than to ether or chloroform.
ETHER
Ether, when taken in its liquid form, produces symptoms and
_post-mortem_ appearances not unlike those caused by alcohol.
_Fatal Dose._--No death having been recorded, the fatal dose of this
substance is unknown.
=Ether Vapour.=--The vapour of ether has caused death. Entering the
blood through the lungs, it acts with great rapidity, a state of
lethargy being quickly induced.
The early symptoms are noticed in a modification of respiration, the
breathing becoming slow, prolonged, and stertorous. The face is pale,
the lips bluish, and the surface of the body cold and exsanguine. The
pulse, at first quickened, becomes slower, as the inhalation of the
vapour is continued. The pupils are dilated, and the eyes glassy and
fixed. The voluntary muscles of the body become flabby and relaxed,
the patient still, however, having the power to move the limbs. The
involuntary muscles are not affected; as an instance, the uterus
contracts and expels its contents with ease. If the inhalation of
the vapour be pushed too far, the pulse sinks, and coma ensues, from
which the patient can only with difficulty be aroused; but if in an
early stage the ether be discontinued, the patient quickly regains
consciousness, due to the rapid elimination of the ether by the
lungs. A marked peculiarity in this form of poisoning is the complete
anæsthesia or paralysis of the nerves of sensation.
_Post-mortem Appearances._--These are chiefly found in the brain and
lungs, which in most cases are greatly congested. The cavities of the
heart have been found full of dark-coloured liquid blood. A marked
effect noticed in poisoning by ether is the congestion of the vessels
of the upper portion of the spinal cord. The liver, kidneys, and spleen
are sometimes congested.
_Chemical Analysis._--The contents of the stomach and tissues must be
treated and distilled, as described under alcohol.
_Tests_:
1. The vapour passed into a solution of bichromate of
potash, and sulphuric acid added, gives the reactions of
alcohol.
2. The vapour burns with a smoky flame, depositing carbon on
any cool surface placed above the flame.
3. It is but sparingly soluble in water, on which liquid it
floats.
_Treatment._--When the pulse becomes weak, and the breathing laboured
and stertorous, the inhalation should be discontinued, and cold water
dashed in the face--free ventilation being also allowed. Galvanism and
artificial respiration should also be tried.
CHLOROFORM
The effects produced by chloroform when swallowed are not unlike those
occasioned by alcohol. Four ounces have been taken without causing
death; it is, therefore, not an active poison in this form.
=Chloroform Vapour.=--The symptoms occasioned by chloroform when
inhaled are not unlike those caused by ether, with this exception, that
insensibility and general relaxation of the muscles are more rapidly
produced.
_Symptoms._--The symptoms of poisoning when chloroform is taken by the
mouth are similar to those following inhalation, with irritation of
the mucous membrane of the stomach and intestines. Vomiting generally
occurs, the person becomes unconscious and comatose, the face cyanosed
and the skin moist. The pupils are dilated and insensitive to light.
The breathing is slow and stertorous, the pulse small and feeble.
Death is due to respiratory paralysis first, and paralysis of the
heart in addition, or the latter, according to some observers, may be
the primary cause. On recovery diarrhœa may follow, with occasionally
enlargement of the liver and jaundice.
_Post-mortem Appearances._--Congestion of the vessels of the brain, and
also of the lungs, is generally found. The cavities of the heart are
usually empty; but, in some cases, the right side of the heart is found
distended with dark-coloured fluid blood. Congestion of the spleen,
liver, and kidneys is not of infrequent occurrence.
_Fatal Period and Dose._--In one or two cases where the vapour was
inhaled, death took place in from one to two minutes. Thirty drops thus
taken destroyed life in one minute, and even fifteen drops have proved
speedily fatal. It has thus destroyed life in a smaller dose, and
more rapidly, than any other known poison. When swallowed, one fluid
drachm has proved fatal in a boy, about four fluid drachms in an adult.
Recovery has taken place after four fluid ounces. Three hours is the
shortest fatal period after swallowing chloroform.
_Chemical Analysis._--In searching for the presence of this substance
in the blood or tissues, the examination should be made as speedily as
possible, as chloroform is thought by some observers to have a great
tendency to pass into formic acid, and thus to escape recognition.
1. The substance to be examined should be placed in a flask, to which
is adapted a glass tube bent at right angles. A piece of blue litmus
paper, and another portion of paper moistened with iodide of potassium
and starch paste, are inserted into the end of the glass tube. The
flask and its contents should now be placed in a water bath heated to a
temperature of 161° F. (72° C.), and a portion of the glass tube just
past the bend heated to redness. Any chloroform vapour evolved from
the contents of the flask is decomposed during its passage through
the heated glass tube into free chlorine and hydrochloric acid, the
presence of the former being indicated by the starch paper becoming
blue; while at the same time the reddening of the litmus paper reveals
the presence of the acid. As a further corroboration, the exit tube may
be made to dip into nitrate of silver solution, when a precipitate of
the curdy-white chloride of silver will take place, insoluble in nitric
acid, but dissolving on the addition of ammonia. Every 100 parts of
chloride of silver formed, equals 27.758 of chloroform. By this process
chloroform has been detected four weeks after death in putrid organs.
2. Chloroform may be separated from organic mixtures by distillation.
If aniline and alcoholic solution of potash be added to chloroform and
heated, the peculiar odour of phenyl-isocyanide is given off.
3. A solution of β-naphthol dissolved in caustic potash, when added to
chloroform and heated, gives a blue colour.
4. Chloroform reduces Fehling‘s solution.
_Treatment._--The same as recommended with regard to ether. M. Nelaton
recommends inversion of the body, and ascribes the recovery of one
patient to his suddenly lifting him up and throwing him over his
shoulder with his head hanging down.
CARBON BISULPHIDE
This substance is largely used in certain industries, as it dissolves
oils, fats, caoutchouc, gutta percha, &c. It is very inflammable,
burns with a blue flame, evolving sulphur dioxide. The odour, when
this substance is impure, is very disagreeable. If taken internally,
it produces an intense burning sensation in the throat, headache, and
giddiness. In chronic poisoning from the vapour in manufactories where
it is used, there appear to be two stages--one of excitement, and
one of depression. In the former, there are more or less persistent
headache, irritability of temper, tinnitus aurium, and even mania;
in the latter, anæsthesia of the skin, even affecting the mucous
membranes, patients complaining that their tongues feel as if tied in
a cloth. Paralysis of the limbs has been noted in prolonged cases of
chronic poisoning. The _post-mortem_ appearances do not differ much
from those found after death from the inhalation of chloroform. Carbon
bisulphide may be separated from organic liquids by distillation, and
detected by its odour, and by a black precipitate of sulphide of lead
when heated with nitrate of lead and potash.
CHLORAL HYDRATE
This substance is prepared by acting on alcohol by chlorine. It is used
extensively as a hypnotic, and, owing to its indiscriminate use, many
fatal cases have been recorded. Care should be taken when large doses
are given not to repeat them too quickly, as there appears to be a
tendency to accumulation, and sudden and dangerous action of the drug.
_Symptoms._--Chloral, in moderate doses, acts on the brain as a
powerful hypnotic, the early symptoms being gradual drowsiness,
followed by deep sleep. With a dose of about 30 grains, the patient
can, however, by walking about, ward off sleep. In large doses the
narcosis becomes completely uncontrollable, and the poison then acts
as a depressant to the basal ganglia of the brain, and on the spinal
cord; and, as a result, there is weakness of the heart‘s action, with
ultimate diastolic arrest, slowing of the respiratory movements,
and general muscular weakness, with some anæsthesia. Under these
circumstances the patient has all the appearance of a drunken person,
the face is flushed, and the deep sleep may pass imperceptibly into
death without any marked change. In some cases delirium precedes the
condition of sleep. The pulse in some cases is quickened, and the
face flushed; but, in other cases, the pulse becomes slow and almost
imperceptible, the heart being ultimately arrested in diastole. In
these cases the face is pale, and the breathing performed at long
intervals. The motor paralysis present, when a poisonous dose is
taken, is due to the action of the drug on the spinal cord, and not
on the nerves. During the sleep produced by chloral, the pupils are
contracted, but dilate on the person awakening. In a case described by
Dr. Levinstein, and reported in the _Lancet_, 21st February 1874, the
patient took six drachms with intent to commit suicide. The face was
at first flushed, the veins swollen, and the pulse 160 per minute; he
then became livid, the pupils contracted, and at times the circulation
appeared to be entirely arrested. The temperature varied from 32.9°
C. to 38.7° C. (89.6° F. to 100.4° F.). This case recovered under
treatment by the subcutaneous injections of strychnine (.03 to .04
grain), and the use of faradisation in thirty-two hours after the
poison had been taken. Chronic chloral poisoning, “chloral-drinking,”
has unfortunately become far too common of late years, in which the
mental faculties suffer severely, so that in our asylums, cases of
mania and melancholia are rightly (or wrongly) attributed to the habit.
A peculiar eruption, not unlike that produced by shell-fish, and
followed by desquamation, sometimes occurs when this substance has been
given for some time in medicinal doses.
_Post-mortem Appearances._--These are not unlike those of asphyxia, the
vessels of the brain being engorged, and the ventricles containing an
abnormal quantity of fluid. The mucous membrane of the larynx may be
injected, and in some cases œdematous. The right side of the heart is
engorged and the left empty, together with congestion of the lungs.
Chloral is very little decomposed into chloroform by the blood. W. H.
Roberts has in several cases recovered it as chloral from the blood.
_Fatal Dose._--The fatal dose cannot be accurately stated, but
children, as in the case of belladonna, are said to bear the drug
better than adults. A child a year old died in ten hours from a dose of
three grains. Ten grains proved fatal to an old lady seventy years of
age. Twenty grains has caused death in an adult in half an hour, and in
one case thirty grains. As a rule, any quantity over two drachms may
be considered a dangerous, if not a fatal dose, although recovery has
been stated to have occurred after one ounce. Dr. Richardson considers
120 grains, distributed over twenty-four hours, as a safe dose for an
adult. Death may take place suddenly, or after the lapse of several
hours.
_Fatal Period._--From fifteen minutes, which is the shortest time on
record, to thirty-nine and a half hours, which is the longest period
recorded.
_Chemical Analysis._--Chloral may be extracted from the stomach
contents by digestion with absolute alcohol acidified by sulphuric
acid. The alcoholic extract is filtered and evaporated. The residue is
treated with petroleum ether to remove fatty substances, and finally
shaken with pure ether to remove the chloral. On evaporating the ether
the chloral hydrate is left. From urine it may be extracted by first
acidifying with sulphuric acid and then treating it with petroleum
ether and ether. Chloral hydrate in solution gives the following
reactions:--
1. On agitation with solution of caustic potash, and gently warmed if
necessary, chloroform is evolved, which can be detected by its odour.
From a strong solution the chloroform may separate in the form of
minute globules.
2. If one drop of ammonium sulphide be added to a solution of chloral
hydrate and gently heated, a peculiar opalescent milky reddish-yellow
precipitate forms. This test is extremely delicate, and differentiates
chloral hydrate from chloroform.
3. Alcoholic solution of potash and aniline when added to chloral
hydrate solution, shaken up and warmed, produces the peculiar odour of
phenyl-isocyanide. This is due to the formation of chloroform on the
addition of the caustic potash.
4. If β-naphthol dissolved in caustic potash solution be added to a
solution of chloral hydrate and the mixture warmed, a blue colour is
produced.
5. Chloral hydrate reduces Fehling‘s solution.
To separate chloroform in the stomach contents from chloral hydrate
they should be acidified with tartaric acid and distilled, when
the chloroform which was free in the stomach will pass over to the
receiver. If the residue be now rendered alkaline with caustic potash
and again distilled, any chloroform which then comes over must have
been derived from chloral hydrate in the stomach contents.
_Treatment._--The treatment consists in washing out the stomach, the
administration of emetics, or hypodermic injection of apomorphine,
in the use of galvanism, friction, mustard-plasters to the calves of
the legs, artificial respiration, and the hypodermic injection of a
solution of nitrate of strychnia or injection of atropine. The warmth
of the body must be carefully maintained in all cases by suitable
external applications. Oxygen inhalations are said to be beneficial.
SULPHONAL
Sulphonal is a product of the oxidation of mercaptol, obtained from
acetone and mercaptan; it occurs in tasteless, odourless, colourless
crystals or powder, was introduced into medical practice in 1888, and
has since caused many accidental deaths. The habit of taking it may
be acquired. It has a tendency to accumulative action when taken for
some time without interruption. A serious feature in most of the cases
of poisoning is that usually those taking it have been apparently
benefited by the drug up to the time of the appearance of toxic
symptoms.