It may be inferred that poison has been taken from consideration of the following factors: Symptoms and post-mortem appearances, experiments on animals, chemical analysis, and the conduct of suspected persons.
Whilst recognizing the fact that toxic agents cannot be accurately classified, the following grouping may for descriptive purposes be admitted with the view of saving needless repetition:
1. Corrosives.—Characterized by their destructive action on tissues with which they come in contact. The principal inorganic corrosives are the mineral acids, the caustic alkalies, and their carbonates; the organic are carbolic acid, strong solutions of oxalic acid, and acetic acid.
Symptoms.—Burning pain in mouth, throat, and gullet, strong acid, metallic or alkaline taste; retching and vomiting, the discharged matters containing shreds of mucus, blood, and the lining membrane of the passages. Inside of mouth corroded. There are also dysphagia, thirst, dyspnœa, small and frequent pulse, anxious expression, shock. Death may result from shock, destruction of the parts—e.g., perforation of stomach or duodenum, suffocation; or some weeks subsequently death may be due to cicatricial contraction of the gullet, stomach, or pylorus.
Post-Mortem Appearances.—Those of corrosion, with corrugation from strong contraction of muscular fibres, and followed by inflammation and its consequences. The mouth, gullet, and stomach, and in some cases the intestines, may be white, yellow, or brown, shrivelled and corroded. The corrosions may be small, or may extend over a very large surface. Sometimes considerable portions of the lining membrane of the gullet or stomach may be discharged by vomiting or by stool. Beyond the corroded parts the textures are acutely inflamed. The stomach is filled with a yellow, brown, or black gelatinous liquid or black blood, and may in rare cases be perforated.
2. Irritants.—These are substances which inflame parts to which they are applied. The class includes mineral, animal, and vegetable substances, and contains a larger number of poisons than all the other classes together. Irritants may be divided into two groups: (1) Those which destroy life by the irritation they set up in the parts to which they are applied; (2) those which add to local irritation peculiar or specific remote effects. The first group includes the principal vegetable irritants, some alkaline salts, some metallic poisons, etc.; and the second comprises the metallic irritants, the metalloids (phosphorus and iodine), and one animal substance, cantharides.
Symptoms.—Burning pain and constriction in throat and gullet, pain and tenderness of stomach and bowels, intense thirst, nausea, vomiting, purging and tenesmus, with bloody stools, dysuria, cold skin, and feeble and irregular pulse. The vomit consists at first of the food, then it becomes bile-stained, and later dark coffee-grounds in appearance, due to extravasation of blood from the over-distended vessels in the gastric mucous membrane. Death may occur from shock, convulsions, collapse, exhaustion, or from starvation on account of chronic inflammation of the gastro-intestinal mucous membrane.
Post-Mortem Appearances.—Those of inflammation and its consequences. Coats of stomach, fauces, gullet, and duodenum, may be thickened, black, ulcerated, gangrenous, or sloughing. Vessels filled with dark blood ramify over the surface. Acute inflammation is often found in the small intestines, with ulceration and softening of mucous membrane. The rectum is frequently the seat of marked ulceration.
3. Poisons Acting on the Brain.—Three classes: The opium group, producing sleep; the belladonna group, producing delirium and illusions; and the alcohol group, causing exhilaration, followed by delirium or sleep.
Symptoms.—Of the opium group, giddiness, headache, dimness of sight, contraction of the pupils, noises in the ears, drowsiness and confusion, passing into insensibility. Of the belladonna group, delirium, illusions of sight, dilated pupils, dry mouth, thirst, redness of skin, coma. Of the alcohol group, excitement of circulation and of cerebral functions, want of power of co-ordination and of muscular movement, double vision, mania, followed by profound sleep and coma. In the chronic form, delirium tremens.
Post-Mortem Appearances.—In the opium group, fulness of the sinuses and veins of the brain, with effusion of serum into the ventricles and beneath the membranes. In the belladonna group, nil. In the alcohol group, signs of inflammation, congestion of brain and membranes, fluidity of blood, long-continued rigor mortis.
4. Poisons Acting on the Spinal Cord.—Strychnine, brucine, thebaïne. The leading symptom is tetanic spasm.
5. Poisons Affecting the Heart.—These kill by sudden shock, syncope, or collapse. They comprise prussic acid, dilute solution of oxalic acid and oxalates, aconite, digitalis, strophanthus, convallaria, and tobacco.
6. Poisons Acting on the Lungs.—These have for their type carbonic acid gas and coal gas. The fumes of ammonia are intensely irritating, and may give rise to laryngitis, bronchitis, and even pneumonia. Nitric acid fumes sometimes produce no serious symptoms for an hour or more, but there may then be coughing, difficulty of breathing, and tightness in the lower part of the throat, followed by capillary bronchitis (see p. 120).
If called to a case supposed or suspected to be one of poisoning, the medical man has two duties to perform: To save the patient's life, and to place himself in a position to give evidence if called on to do so. If life is extinct, his duty is a simple one. He should make inquiries as to symptoms, and time at which food or medicine was last taken. He should take possession of any food, medicine, vomited matter, urine, or fæces, in the room, and should seal them up in clean vessels for examination. He should notice the position and temperature of the body, the condition of rigor mortis, marks of violence, appearance of lips and mouth. He should not make a post-mortem examination without an order in writing from the coroner. In making a post-mortem examination, the alimentary canal should be removed and preserved for further investigation. A double ligature should be passed round the œsophagus, and also round the duodenum a few inches below the pylorus. The gut and the gullet being cut across between these ligatures, the stomach may be removed entire without spilling its contents. The intestines may be removed in a similar way, and the whole or a portion of the liver should be preserved. These should all be put in separate jars without any preservative fluid, tied up, sealed, labelled, and initialled. All observations should be at once committed to writing, or they will not be admitted by the court for the purpose of refreshing the memory whilst giving evidence. If the medical practitioner is in doubt on any point, he should obtain technical assistance from someone who has paid attention to the subject.
In a case of attempted suicide by poisoning, is it the duty of the doctor to inform the police? He would be unwise to do so. He had much better stick to his own business, and not act as an amateur detective.
The modes of treatment may be ranged under three heads: (1) To eliminate the poison; (2) to antagonize its action; (3) to avert the tendency to death.
1. The first indication is met by the administration of emetics, to produce vomiting, or by the application of the stomach-tube. The best emetic is that which is at hand. If there is a choice, give apomorphine hypodermically. The dose for an adult is 10 minims. It may be given in the form of the injection of the Pharmacopœia, or preferably as a tablet dissolved in water. Apomorphine is not allied in physiological action to morphine, and may be given in cases of narcotic poisoning. Sulphate of zinc, salt-and-water, ipecacuanha, and mustard, are all useful as emetics. Tickling the fauces with a feather may excite vomiting.
In using the elastic stomach-tube, some fluid should be introduced into the stomach before attempting to empty it, or a portion of the mucous membrane may be sucked into the aperture. The tube should be examined to see that it is not broken or cracked, as accidents have happened from neglecting this precaution. The bowels and kidneys must also be stimulated to activity, to help in the elimination of the poison.
2. The second indication is met by the administration of the appropriate antidote. Antidotes are usually given hypodermically, or, if by mouth, in the form of tablets. In the absence of a hypodermic syringe, the remedy may be given by the rectum. In the selection of the appropriate antidote, a knowledge of pharmacology is required, especially of the physiological antagonism of drugs. Antidotes may act (1) chemically, by forming harmless compounds, as lime in oxalic acid poisoning; (2) physiologically, the drug which is administered neutralizing more or less completely the poison which has been absorbed; (3) physically, as charcoal. Every doctor should provide himself with an antidote case. The various antidotes will be mentioned under their respective poisons.
3. To avert the tendency to death, we must endeavour to palliate the symptoms and neutralize the effects of the poison. Pain must be relieved by the use of morphine; inflamed mucous membrane soothed by such demulcents as oils, milk, starch; stimulants to overcome collapse; saline infusions in shock, etc. In the case of narcotics and depressing agents, stimulants, electricity, and cold affusions, may be found useful. We should endeavour to promote the elimination of the poison from the body by stimulating the secretions.
Notice the smell, colour, and general appearance, of the matter submitted for examination. The odour may show the presence of prussic acid, alcohol, opium, or phosphorus. The colour may indicate salts of copper, cantharides, etc. Seeds of plants may be found.
This examination having been made, the contents of the alimentary canal, and any other substances to be examined, must be submitted to chemical processes.
Simple filtration will sometimes suffice to separate the required substance; in other cases dialysis will be necessary, in order that crystalloid substances may be separated from colloid bodies.
In the case of volatile substances distillation will be required. The poisons thus sought for are alcohol, phosphorus, iodine, chloral, ether, hydrocyanic acid, carbolic acid, nitro-benzol, chloroform, and anilin. The organic matters are placed in a flask, diluted with distilled water if necessary, and acidulated with tartaric acid. The flask is heated in a water-bath, and the vapours condensed by a Liebig's condenser. In the case of phosphorus the condenser should be of glass, and the process of distillation conducted in the dark, so that the luminosity of the phosphorus may be noted.
For the separation of an alkaloid, the following is the process of Stas-Otto. This process is based upon the principle that the salts of the alkaloids are soluble in alcohol and water, and insoluble in ether. The pure alkaloids, with the exception of morphine in its crystalline form, are soluble in ether. Make a solution of the contents of the stomach or solid organs minced very fine by digesting them with acidulated alcohol or water and filtering. The filtrate is shaken with ether to remove fat, etc., the ether separated, the watery solution neutralized with soda, and then shaken with ether, which removes the alkaloid in a more or less impure condition. The knowledge of these facts will help to explain the following details, which may be modified to suit individual cases: (1) Treat the organic matter, after distillation for the volatile substances just mentioned, with twice its weight of absolute alcohol, free from fusel oil, to which from 10 to 30 grains of tartaric or oxalic acid have been added, and subject to a gentle heat. (2) Cool the mixture and filter; wash the residue with strong alcohol, and mix the filtrates. The residue may be set aside for the detection of the metallic poisons, if suspected. Expel the alcohol by careful evaporation. On the evaporation of the alcohol the resinous and fatty matters separate. Filter through a filter moistened with water. Evaporate the filtrate to a syrup, and extract with successive portions of absolute alcohol. Filter through a filter moistened with alcohol. Evaporate filtrate to dryness, and dissolve residue in water, the solution being made distinctly acid. Now shake watery solution with ether. (3) Ether from the acid solution dissolves out colchicin, digitalin, cantharidin, and picrotoxin, and traces of veratrine and atropine. Separate the ethereal solution and evaporate. Hot water will now dissolve out picrotoxin, colchicin, and digitalin, but not cantharidin. (4) The remaining acid watery liquid, holding the other alkaloids in solution or suspension, is made strongly alkaline with soda, mixed with four or five times its bulk of ether, chloroform, or benzole, briskly shaken, and left to rest. The ether floats on the surface, holding the alkaloids, except morphine, in solution. (5) A part of this ethereal solution is poured into a watch-glass and allowed to evaporate. If the alkaloid is volatile, oily streaks appear on the glass; if not volatile, crystalline traces will be visible. If a volatile alkaloid, add a few pieces of calcium chloride to ethereal solution to absorb the water; draw off the ethereal solution with a pipette, allow it to evaporate, and test the residue for the alkaloids, conine and nicotine.
If a fixed alkaloid, treat the acid solution with soda or potash and ether, evaporate ethereal solution after separation, when the solid alkaloid will be left in an impure state. To purify it, add a small quantity of dilute sulphuric acid, and, after evaporating to three-quarters of its bulk, add a saturated solution of carbonate of potash or soda. Absolute alcohol will then dissolve out the alkaloid, and leave it on evaporation in a crystalline form.
General Reactions for Alkaloids.—(1) Wagner's reagent (iodine dissolved in a solution of potassium iodide) yields a reddish-brown precipitate; (2) Mayer's reagent (potassio-mercuric iodide) gives a yellowish-white precipitate; (3) phospho-molybdic acid gives a yellow precipitate; (4) platinic chloride, a brown precipitate; (5) tannic acid, etc.
In order to isolate an inorganic substance from organic matter, Fresenius's method is adopted. Boil the finely divided substance with about one-eighth its bulk of pure hydrochloric acid; add from time to time potassic chlorate until the solids are reduced to a straw-yellow fluid. Treat this with excess of bisulphate of sodium, then saturate with sulphuretted hydrogen until metals are thrown down as sulphides. These may be collected and tested. From the acid solution, hydrogen sulphide precipitates copper, lead, and mercury, dark; arsenic, antimony, and tin, yellowish. If no precipitate, add ammonia and ammonium sulphide, iron, black, zinc, white, chromium, green, manganese, pink. The residue of the material after digestion with hydrochloric acid and potassium chlorate may have to be examined for silver, lead, and barium.
For the detection of minute quantities, the microscope must be used, and Guy's and Helwig's method of sublimation will be found advantageous. Crystalline poisons may be recognized by their characteristic forms.
These are sulphuric, nitric, and hydrochloric acids.
Symptoms of Poisoning by the Mineral Acids.—Acid taste in the mouth, with violent burning pain extending into the œsophagus and stomach, and commencing immediately on the poison being swallowed; eructations, constant retching, and vomiting of brown, black, or yellow matter containing blood, coagulated mucus, epithelium, or portions of the lining membrane of the gullet and stomach. The vomited matters are strongly acid in reaction, and stain articles of clothing on which they may fall. There is intense thirst and constipation, with scanty or suppressed urine, tenesmus, and small and frequent pulse; the lips, tongue, and inside of the mouth, are shrivelled and corroded. Exhaustion succeeds, and the patient dies either collapsed, convulsed, or suffocated, the intellect remaining clear to the last. After recovering from the acute form of poisoning, the patient may ultimately die from starvation, due to stricture of the œsophagus, stomach, etc.
Post-Mortem Appearances Common to the Mineral Acids.—Stains and corrosions about the mouth, chin, and fingers, or wherever the acid has come in contact. The inside of the mouth, fauces, and œsophagus, is white and corroded, yellow or dark brown, and shrivelled. Epiglottis contracted or swollen. Stomach filled with brown, yellow, or black glutinous liquid; its lining membrane is charred or inflamed, and the vessels are injected. Pylorus contracted. Perforation, when it takes place, is on the posterior aspect; the apertures are circular, and surrounded by inflammation and black extravasation. The blood in the large vessels may be coagulated.
Avoid mistaking gastric or duodenal ulcer, with or without perforation, for the effects of a corrosive poison.
Treatment.—Calcined magnesia or the carbonate or bicarbonate of sodium, mixed with milk or some mucilaginous liquid, are the best antidotes. In the absence of these, chalk, whiting, milk, oil, soap-suds, etc., will be found of service. The stomach-pump should not be used. If the breathing is impeded, tracheotomy may be necessary. Injuries of external parts by the acid must be treated as burns.
Sulphuric Acid, or oil of vitriol, may be concentrated or diluted. It is frequently thrown over the person to disfigure the features or destroy the clothes. Parts of the body touched by it are stained, first white, and then dark brown or black. The presence of corrosion of the mouth is as important as the chemical tests. Black woollen cloths are turned to a dirty brown, the edges of the spots becoming red in a few days, due to the dilution of the acid from the absorption of moisture; the stains remain damp for long, owing to the hygroscopic property of the acid.
Method of Extraction from the Stomach.—The contents of the stomach or vomited matter should, if necessary, be diluted with pure distilled water and filtered. The stomach should be cut up into small pieces and boiled for some time in water. The solution, filtered and concentrated, is now ready for testing. Blood, milk, etc., may be separated by dialysis, and the fluid so obtained tested. A sulphate may be present. Take a portion of the liquid, evaporate to dryness, and incinerate; a sulphate, if present, will be obtained, and may be tested.
Caution.—Sulphuric acid may not be found even after large doses, due to treatment, vomiting, or survival for several days. In all cases every organ should be examined. Vomited matters and contents of stomach should not be mixed, but each separately examined. This rule holds good for all poisons. On cloth the stain may be cut out, boiled in water, the solution filtered, and tested with blue litmus and other tests.
Post-Mortem Appearances.—Where the acid has come in contact with the mucous membranes there are dark brown or black patches. The stomach is greatly contracted, the summits of the mucous membrane ridges being charred and the furrows greatly inflamed; the contents are black or brown.
Tests.—Concentrated acid chars organic matter; evolves heat when added to water, and sulphurous fumes when boiled with chips of wood, copper cuttings, or mercury. Dilute acid chars paper when the paper is heated; gives a white precipitate with nitrate or chloride of barium, and is entirely volatilized by heat. Dilute solutions give a white precipitate with barium nitrate, insoluble in hydrochloric acid even on boiling.
Fatal Dose.—In an adult, 1 drachm.
Fatal Period.—Shortest, three-quarters of an hour; average period from onset of primary effects, eighteen to twenty-four hours.
Nitric Acid, or aqua fortis, is less frequently used as a poison than sulphuric acid. The fumes from nitric acid have caused death from pneumonia in ten or twelve hours.
Method of Extraction from the Stomach.—The same as for sulphuric acid. In beer, etc., the mixture may be neutralized with carbonate of potassium, dialyzed, the fluid concentrated and allowed to crystallize, when crystals of nitrate of potassium may be recognized.
Post-Mortem Appearance.—The mucous membranes are rendered yellow or greenish if bile be present; they are also thickened and hardened.
Tests.—Concentrated acid gives off irritating orange-coloured fumes of nitric acid gas. When poured on copper, it gives off red fumes and leaves a green solution of nitrate of copper. It gives a red colour with brucine, turns the green sulphate of iron black, and with hydrochloric acid dissolves gold. A delicate test for the acid, free or in combination, is to dissolve in the suspected fluid some crystals of ferrous sulphate, and then to gently pour down the test-tube some strong sulphuric acid. Where the two liquids meet, if nitric acid be present, a reddish-brown ring will be formed. It turns the skin bright yellow, and does the same with woollen clothes, from the formation of picric acid.
Fatal Dose.—Two drachms.
Fatal Period.—Shortest, one hour and three-quarters in an adult; in infants in a few minutes, from suffocation.
Hydrochloric Acid, muriatic acid, or spirit of salt, is not uncommonly used for suicidal purposes, being fifth in the list.
Method of Extraction from the Stomach.—The same as for sulphuric acid. As hydrochloric acid is a constituent of the gastric juice, the signs of the acid must be looked for.
Post-Mortem Appearances.—The mucous membranes are dry, white, and shrivelled, and often eroded.
Tests.—The concentrated acid yields dense white fumes with ammonia. When warmed with black oxide of manganese and strong sulphuric acid it gives off chlorine, recognized by its smell and bleaching properties. Diluted it gives with nitrate of silver, a white precipitate, which is insoluble in nitric acid and in caustic potash, but is soluble in ammonia, and when dried and heated melts, and forms a horny mass. Stains on clothing are reddish-brown in colour.
Fatal Dose.—Half an ounce.
Fatal Period.—Shortest, two hours; average, twenty-four hours. Death may occur after an interval of some weeks from destruction of the gastric glands and inability to digest food.
Oxalic Acid is used by suicides, though not often by murderers. The crystals closely resemble those of Epsom salts or sulphate of zinc; oxalic acid has been taken in mistake for the former. It is in common use for cleansing brass, in laundry work, for dyeing purposes, and especially for bleaching straw hats.
Symptoms.—If a concentrated solution be taken, it acts as a corrosive, causing a burning acid, intensely sour taste, which comes on immediately, great pain and tenderness and burning at pit of stomach, pain and tightness in throat. Vomiting of mucus, bloody or dark coffee-ground matters, purging and tenesmus, followed by collapse, feeble pulse, cyanosis and pallor of the skin; also swelling of tongue, with dysphagia. In some cases cramps and numbness in limbs, pain in head and back, delirium and convulsions. May be tetanus or coma. If taken freely diluted, the nervous symptoms predominate, and may resemble narcotic poisoning. Sometimes almost instant death.
Post-Mortem Appearances.—Mucous membrane of mouth, throat, and gullet, white and softened, as if they had been boiled; there are often black or brown streaks in it. Stomach contains dark, grumous matter, and is soft, pale, and brittle. Intestines slightly inflamed, stomach sometimes quite healthy.
Treatment.—Warm water, then chalk, carbonate of magnesium, or lime-water, freely. Not alkalies, as the oxalates of the alkalies are soluble and poisonous. Castor-oil. Emetics, but not stomach-pump.
Fatal Dose.—One drachm is the smallest, but half an ounce is usually fatal.
Method of Extraction from the Stomach.—Mince up the coats of the stomach and boil them in water, or boil the contents of the stomach and subject them to dialysis. Concentrate the distilled water outside the tube containing the vomited matters, etc., and apply tests.
Tests.—White precipitate with nitrate of silver, soluble in nitric acid and ammonia. When the precipitate is dried and heated on platinum-foil, it disperses as white vapour with slight detonation. Sulphate of lime in excess gives a white precipitate, soluble in nitric or hydrochloric acid, but insoluble in oxalic, tartaric, acetic, or any vegetable acid.
Oxalate or Binoxalate of Potash (salts of sorrel or salts of lemon) is almost as poisonous as the acid itself.
Carbolic Acid, Phenic Acid, or Phenol, is largely employed as a disinfectant, and is often supplied in ordinary beer-bottles without labels.
Symptoms.—An intense burning pain extending from the mouth to the stomach and intestines. Indications of collapse soon supervene. The skin is cold and clammy, and the lips, eyelids, and ears, are livid. This is followed by insensibility, coma, stertorous breathing, abolition of reflex movements, hurried and shallowed respiration, and death. The pupils are usually contracted, and the urine, if not suppressed, is dark in colour, or even black. Patients often improve for a time, and then die suddenly from collapse. When the poison has been absorbed through the skin or mucous membranes, a mild form of delirium, with great weakness and lividity, are the first signs.
Post-Mortem.—If strong acid has been swallowed, the lips and mucous membranes are hardened, whitened, and corrugated. In the stomach the tops of the folds are whitened and eroded, while the furrows are intensely inflamed.
Treatment.—Soluble sulphates which form harmless sulpho-carbolates in the blood should be administered at once. An ounce of Epsom salts or of Glauber's salts dissolved in a pint of water will answer the purpose admirably. After this an emetic of sulphate of zinc may be given. White of egg and water or olive-oil may prove useful. Warmth should be applied to the body.
Fatal Dose.—One drachm, but recovery has taken place after much larger quantities, if well diluted or taken after a meal.
Tests are not necessary, as the smell of carbolic acid is characteristic.
Local action of carbolic acid produces anæsthesia and necrosis. Accidents sometimes happen from too strong lotions applied as surgical dressings.
Lysol is a compound of cresol and linseed-oil soap, and is much less toxic than carbolic acid.
Caustic Potash occurs in cylindrical sticks, is soapy to the touch, has an acrid taste, is deliquescent, fusible by heat, soluble in water. Liquor Potassæ is a strong solution of caustic potash, and has a similar reaction. Carbonate of Potassium, also known as potash, pearlash, salt of tartar, is a white crystalline powder, alkaline and caustic in taste, and very deliquescent. The bicarbonate is in colourless prisms, which have a saline, feebly alkaline taste, and are not deliquescent.
Symptoms.—Acrid soapy taste in mouth, burning in throat and gullet, acute pain at pit of stomach, vomiting of bloody or brown mucus, colicky pains, bloody stools, surface cold, pulse weak. These preparations are not volatile, so that there is not much fear of lung trouble. In chronic cases death occurs from stricture of the œsophagus causing starvation.
Post-Mortem Appearances.—Soapy feeling, softening, inflammation, and corrosion of mucous membrane of mouth, pharynx, œsophagus, stomach, and intestines. Inflammation may have extended to larynx.
Method of Extraction from the Stomach.—If the contents of the stomach have a strong alkaline action, dilute with water, filter, and apply tests.
Tests.—The carbonates effervesce with an acid. The salts give a yellow precipitate with platinum chloride, and a white precipitate with tartaric acid. They are not dissipated by heat, and give a violet colour to the deoxidizing flame of the blowpipe. Stains on dark clothing are red or brown.
Treatment.—Vinegar and water, lemon-juice and water, acidulated stimulant drinks, oil, linseed-tea, opium to relieve pain, stimulants in collapse. Do not use the stomach-tube. The glottis may be inflamed, and if there is danger of asphyxia, tracheotomy may have to be performed.
Carbonate of Sodium occurs as soda and best soda, the former in dirty crystalline masses, the latter of a purer white colour. It is also found as 'washing soda.'
Symptoms, Post-Mortem Appearances, Treatment, and Extraction from the Stomach.—As for potash.
Tests.—Alkaline reaction, effervesces and evolves carbonic acid when treated with an acid; crystallizes, gives yellow tinge to blowpipe flame. No precipitate with tartaric acid, nor with bichloride of platinum.
Ammonia may be taken as liquor ammoniæ (harts-horn), as carbonate of ammonium, as 'Cleansel,' or as 'Scrubb's Cloudy Ammonia.'
Symptoms.—Being volatile, it attacks the air-passages, nose, eyes and lungs, being immediately affected; profuse salivation; lips and tongue swollen, red, and glazed. The urgent symptoms are those of suffocation.
Inhalation of the fumes of strong ammonia may lead to death from capillary bronchitis or broncho-pneumonia. Death may result from inflammation of the larynx and lungs. When swallowed in solution, the symptoms are similar to those of soda and potash.
Post-Mortem Appearances.—Similar to other corrosives.
Method of Extraction from the Stomach.—The contents of the stomach, etc., must be first distilled, the gas being conveyed into water free from ammonia.
Tests.—Nessler's reagent is the most delicate, a reddish-brown colour or precipitate being produced, but ammonia may be recognized by its pungent odour, dense fumes given off with hydrochloric acid, and strong alkaline reaction.
Treatment.—Vinegar and water. Other treatment according to symptoms.
Fatal Dose.—One drachm of strong solution.
Fatal Period (Shortest).—Four minutes.
Nitrate of Potassium (Nitre, Saltpetre)—Bitartrate of Potassium (Cream of Tartar)—Alum (Double Sulphate of Alumina and Potassium)—Chlorides of Lime, Sodium, and Potassium.—All these are irritant drugs, and give the usual symptoms.
Chlorate of Potassium produces irritation of stomach and bowels; hæmaturia; melæna; cyanosis, weakness, delirium, and coma.
Post-Mortem.—Blood is chocolate-brown in colour, and so are all the internal organs; gastro-enteritis; nephritis.
Tests.—Spectroscope shows blood contains methæmoglobin; the drug discharges the colour of indigo in acid solution with SO2.
Treatment.—Transfusion of blood or saline fluid; stimulants.
Sulphuret of Potassium (liver of sulphur) occurs in mass or powder of a dirty green colour; has a strong smell of sulphuretted hydrogen.
Symptoms.—Of acute irritant poisoning, with stupor or convulsions. Excreta smell of sulphuretted hydrogen.
Post-Mortem Appearances.—Stomach and duodenum reddened, with deposits of sulphur. Lungs congested.
Treatment.—Chloride of sodium or lime in dilute solution, and ordinary treatment for irritant poisoning.
Fatal Period (Shortest).—Fifteen minutes.
Chloride of Barium occurs crystallized in irregular plates, like magnesium sulphate, soluble in water and bitter in taste. Carbonate of Barium is found in shops as a fine powder, tasteless and colourless, insoluble in water, but effervescing with dilute acids, and readily decomposed by the free acids of the stomach. Nitrate of Barium occurs in octahedral crystals, soluble in water.
Method of Extraction from the Stomach.—Dialysis as for other soluble poisons.
Tests.—Precipitated from its solutions by potassium carbonate or sulphuric acid. Burnt on platinum-foil, it gives a green colour to the flame.
Symptoms.—Besides those of irritants generally, violent cramps and convulsions, headache, debility, dimness of sight, double vision, noises in the ears, and beating at the heart. The salts of barium are also cardiac poisons.
Post-Mortem Appearances.—As of irritants generally. Stomach may be perforated.
Treatment.—Wash out stomach with a solution of sodium or magnesium sulphate, or of alum, and give stimulants by the mouth and hypodermically.
Iodine occurs in scales of a dark bluish-black colour. It strikes blue with solution of starch, and stains the skin and intestines yellowish-brown. Liquid preparations, as the liniment or tincture, may be taken accidentally or suicidally.
Symptoms.—Acrid taste, tightness of throat, epigastric pain, and then symptoms of irritant poisons generally. Chronic poisoning (iodism) is characterized by coryza, salivation, and lachrymation, frontal headache, loss of appetite, marked mental depression, acne of the face and chest, and a petechial eruption on the limbs.
Post-Mortem Appearances.—Those of irritant poisoning with corrosion, and staining of a dark brown or yellow colour.
Treatment.—Stomach-pump and emetics, carbonate of sodium, amylaceous fluids, gruel, arrowroot, starch, etc.
Analysis of Organic Mixture containing Iodine.—Add bisulphide of carbon, and shake. The iodine may be obtained on evaporation as a sublimate. It will be recognized by the blue colour which it gives with starch.
Iodide of Potassium.—Colourless, generally opaque, cubic crystals, soluble in less than their weight of cold water.
Symptoms.—Not an active poison, but even small doses sometimes produce the effects of a common cold, including those symptoms already mentioned as occurring with iodine.
Analysis.—Iodide of potassium in solution gives a bright yellow precipitate with lead salts; a bright scarlet with corrosive sublimate; and a blue colour with sulphuric or nitric acid and starch.
Phosphorus is usually found in small, waxy-looking cylinders, which are kept in water to prevent oxidation. It may also occur as the amorphous non-poisonous variety, a red opaque infusible substance, insoluble in carbon disulphide. Ordinary phosphorus is soluble in oil, alcohol, ether, chloroform, and carbon disulphide; insoluble in water. It is much used in rat poisons, made into a paste with flour, sugar, fat, and Prussian blue. Yellow phosphorus is not allowed to be used in the manufacture of lucifer matches, and the importation of such is prohibited. In 'safety' matches the amorphous phosphorus is on the box.
Symptoms.—At first those of an irritant poison, but days may elapse before any characteristic symptoms appear, and these may be mistaken for those of acute yellow atrophy of the liver. The earliest signs are a garlicky taste in the mouth and pain in the throat and stomach. Vomited matter luminous in the dark, bile-stained or bloody, with garlic-like odour. Great prostration, diarrhœa, with bloody stools. Harsh, dry, yellow skin, purpuric spots with ecchymoses under the skin and mucous membranes, retention or suppression of urine, delirium, convulsions, coma, and death. Usually there are remissions for two to three days, then jaundice comes on, with enlargement of the liver; hæmorrhages from the mucous surfaces and under the skin; later, coma and convulsions. In chronic cases there is fatty degeneration of most of the organs and tissues of the body. The inhalation of the fumes of phosphorus, as in making vermin-killers, etc., gives rise to 'phossy-jaw.'
Post-Mortem Appearances.—Softening of the stomach, hæmorrhagic spots on all organs and under the skin, fatty degeneration of liver, kidneys, and heart, blood-stained urine, phosphorescent contents of alimentary canal.
Treatment.—Early use of stomach-pump and emetics, followed by the administration of permanganate of potassium or peroxide of hydrogen to oxidize the phosphorus. Oil should not be given. Sulphate and carbonate of magnesium, mucilaginous drinks. Sulphate of copper is a valuable antidote, both as an emetic and as forming an insoluble compound with phosphorus.
Fatal Dose.—One grain and a half.
Fatal Period.—Four hours; more commonly two to four days.
Detection of Phosphorus in Organic Mixtures.—Mitscherlich's method is the best. Introduce the suspected material into a retort. Acidulate with sulphuric acid to fix any ammonia present. Distil in the dark, through a glass tube kept cool by a stream of water. As the vapour passes over and condenses, a flash of light is perceived, which is the test.
Arsenic is the most important of all the metallic poisons. It is much used in medicine and the arts. It occurs as metallic arsenic, which is of a steel-grey colour, brittle, and gives off a garlic-like odour when heated; as arsenious acid; in the form of two sulphides—the red sulphide, or realgar, and the yellow sulphide, or orpiment; and as arsenite of copper, or Scheele's green. It also exists as an impurity in the ores of several metals—iron, copper, silver, tin, zinc, nickel, and cobalt. Sulphuric acid is frequently impregnated with arsenic from the iron pyrites used in preparing the acid. It is a constituent of many rat pastes, vermin or weed killers, complexion powders, sheep dips, etc.
Arsenious Acid (White Arsenic, Trioxide of Arsenic).—Colourless, odourless, and almost tasteless. It occurs in commerce as a white powder or in a solid cake, which is at first translucent, but afterwards becomes opaque. Slightly soluble in cold water; 1 ounce of water dissolves about 1/2 grain of arsenic. Fowler's solution is the best-known medicinal preparation of arsenic, and contains 1 grain of arsenious anhydride in 110 minims.
Symptoms.—Commence in from half to one hour. Faintness, nausea, incessant vomiting, epigastric pain, headache, diarrhœa, tightness and heat of throat and fauces, thirst, catching in the breath, restlessness, debility, cramp in the legs, and convulsive twitchings. The skin becomes cold and clammy. In some cases the symptoms are those of collapse, with but little pain, vomiting, or diarrhœa. In others the patient falls into a deep sleep, while in the fourth class the symptoms resemble closely those of English cholera. The vomited matters are often blue from indigo, or black from soot, or greenish from bile, mixed with the poison. Should the patient survive some days, no trace of arsenic may be found in the body, as the poison is rapidly eliminated by the kidneys. In all suspected cases the urine should be examined.
The symptoms of chronic poisoning by arsenic are loss of appetite, silvery tongue, thirst, nausea, colicky pains, diarrhœa, headache, languor, sleeplessness, cutaneous eruptions, soreness of the edges of the eyelids, emaciation, falling out of the hair, cough, hæmoptysis, anæmia, great tenderness on pressure over muscles of legs and arms, due to peripheral neuritis, and convulsions.
Pigmentation is common; the face becomes dusky red, the rest of the body a dark brown shade. This darkening is most marked in situations normally pigmented and in parts exposed to pressure of the clothes, such as the neck, axilla, and inner aspect of the arms, the extensor aspects being less marked than the flexor. The pigmentation resembles the bronzing of Addison's disease, but there are no patches on the mucous membranes, and the normal rosy tint of the lips is not altered. The skin over the feet may show marked hyperkeratosis.
The nervous system is notably affected. The sensory symptoms appear first: numbness and tingling of the hands and feet, pain in the soles of the feet on walking, pain on moving the joints, and erythromelalgia. Then come the motor symptoms, with drop-wrist and drop-foot. The patient suffers severely from neuritis, and there may be early loss of patellar reflex. The nervous symptoms come on later than the cutaneous manifestations.
Post-Mortem Appearances.—Signs of acute inflammation of stomach, duodenum, small intestines, colon, and rectum. Stomach may contain dark grumous fluid, and its mucous coat presents the appearance of crimson velvet. Ulceration is rare, and cases of perforation still less common, the patient dying before it occurs. If life has been preserved for some days, there is extensive fatty degeneration of the organs. There may be entire absence of post-mortem signs. Putrefaction of the body is retarded by arsenic.
Treatment.—The stomach-pump, emetics, then milk, milk and eggs, oil and lime-water. Inflammatory symptoms, collapse, coma, etc., must be treated on ordinary principles. As an antidote, the best when the poison is in solution is the hydrated sesquioxide of iron, formed by precipitating tinctura ferri perchloridi with excess of ammonia, or carbonate of soda. This is filtered off through muslin and given in tablespoonful doses. It forms ferric arsenate, which is sparingly soluble. Colloidal iron hydroxide may be used instead. Dialyzed iron in large quantities is efficacious.
Fatal Dose (Smallest).—Two grains. Exceptionally, recovery from very large doses if rejected by vomiting.
Fatal Period (Shortest).—Twenty minutes. Exceptionally, death as late as the sixteenth day. The effects of arsenic are modified by tolerance, some persons being able to take considerable quantities. The peasants of Styria are in the habit of eating it.
Method of Extraction from the Stomach.—The coats of the stomach should be examined with a lens for any white particles. These, if present, may be collected, mixed with a little charcoal in a test-tube, and heated. If arsenic is present, a metallic ring will be formed in the cooler parts of the tube. If this ring be also heated, octahedral crystals of arsenic will be deposited farther up the tube, and are easily recognized by the microscope. The contents of the stomach, or the solid organs minced up, should be boiled with pure hydrochloric acid and water, then filtered. The filtrate can then be subjected to Marsh's or Reinsch's process.
Tests.—In solution, arsenic may be detected by the liquid tests. (1) Ammonio-nitrate of silver gives a yellow precipitate (arsenite of silver). (2) Ammonio-sulphate of copper gives a green precipitate (Scheele's green). (3) Sulphuretted hydrogen water gives a yellow precipitate.
Marsh's Process.—Put pure distilled water into a Marsh's apparatus with metallic zinc and sulphuric acid. Hydrogen is set free, and should be tested by lighting the issuing gas and depressing over it a piece of white porcelain. If no mark appears, the reagents are pure, and the suspected liquid may now be added. The hydrogen decomposes arsenious acid, and forms arseniuretted hydrogen. The gas carried off by a fine tube is again ignited. A piece of glass or porcelain held to the flame will have, if arsenic be present, a deposit on it having the following characters: In the centre a deposit of metallic arsenic, round this a mixture of metallic arsenic and arsenious acid, and outside this another ring of arsenious acid in octahedral crystals. The deposit is dissolved by a solution of chloride of lime, turned yellow by sulphide of ammonium after evaporation; on the addition of strong nitric acid, evaporated and neutralized with ammonia and nitrate of silver added, a brick-red colour is produced—arseniate of silver.
Reinsch's Process.—Boil distilled water with one-sixth or one-eighth of hydrochloric acid, and introduce a slip of bright copper. If, after a quarter of an hour's boiling, there is no stain on the copper, add the suspected liquid. If arsenic be present, it will form an iron-grey deposit. If this foil be dried, cut up, put in a reduction-tube, and heated, crystals of arsenious trioxide will be deposited on the cold part of the tube.
These tests are difficult to apply, but as arsenic is a ubiquitous poison, and as there are many sources of fallacy, it would be well, when possible, to obtain the services of an expert.
Biological Test.—Put the substance to be tested into a flask with some small pieces of bread, sterilize for half an hour at 120° C. When cold, inoculate with a culture of Penicillium brevicaule, and keep at a temperature of 37° C. If arsenic is present, a garlic-like odour is noticed in twenty four hours, due to arseniuretted hydrogen or an organic combination of arsenic. This test is delicate, and will detect 1/1000 of a milligramme, but it is not quantitative.
Other Preparations of Arsenic.—These are arsenite of potash (Fowler's solution), cacodylate of sodium, and arsenite of copper (Scheele's green), the last frequently used for colouring dresses and wall-papers. Persons using these preparations may suffer from catarrhal symptoms, rashes on the neck, ears, and face, thirst, nausea, pain in stomach, vomiting, headache, perhaps peripheral neuritis and loss of patellar reflex. The cacodylates, although formerly employed in the treatment of phthisis, should be used with the utmost caution. The arsenites give the reactions of arsenious acid.
Arsenic is eliminated not only by the kidneys and bowels, but by the skin, and in women by the menses. It may be detected in the sweat, the saliva, the bronchial secretion, and, during lactation, in the milk.
The sale of arsenic and its preparations to the public is properly hedged round with restrictions of all kinds. It is included in Part I. of the Poisons and Pharmacy Act (8 Edward VII., c. 55). No arsenic may be sold to a person under age, nor may it be sold unless mixed with soot or indigo in the proportion of 1 ounce of soot or 1/2 ounce of indigo at the least to every pound of arsenic.
Arseniuretted Hydrogen (arsine, AsH3) is an extremely poisonous gas, and is evolved in various chemical and manufacturing processes. When damp, Ferro-silicon evolves AsH3 and PH3, both very lethal gases. Ferrochrome is used in making steel, and it also evolves PH3, and in such extreme dilution as 0.02 per cent. may cause death.
Tartar Emetic (tartarized antimony, potassio-tartrate of antimony) occurs as a white powder, or in yellowish-white efflorescent crystals. Vinum antimoniale contains 2 grains to a fluid ounce of the wine.
Symptoms.—Metallic taste, rapidly followed by nausea, incessant vomiting, burning heat and pain in stomach, purging. Dysphagia, sense of constriction in throat, intense thirst, cramps, faintness, profound depression; in fatal cases, giddiness and tetanic spasms. In chronic poisoning, nausea, vomiting and purging, weak pulse, loss of appetite, debility, cold sweats, great prostration, progressive emaciation. The symptoms in chronic poisoning may simulate gastritis or enteritis. Externally applied, it produces an eruption not unlike that of smallpox.
Post-Mortem Appearances.—Inflammation, softening, and an aphthous condition of the throat, gullet, and stomach, the last reddened in patches. In chronic poisoning, inflammation also of cæcum and colon. Brain and lungs may be congested. Decomposition is hindered for long.
Treatment.—Promote vomiting by warm greasy water, or the stomach-tube may be used. Cinchona bark or any preparation containing tannin, as tea, decoction of oak bark, etc. Morphine to allay pain.
Fatal Dose.—In an adult 2 grains (same as arsenic).
Fatal Period.—Death follows in eight to twelve hours, from exhaustion.
Method of Extraction from the Stomach.—The contents of the stomach or its coats should be finely cut up and boiled in water, acidulated with tartaric acid and subjected to dialysis, or strained and filtered. Pass hydrogen sulphide through the filtered or dialyzed fluid until a precipitate ceases to fall; collect the sulphide thus formed, wash and dry it. Boil the orange-coloured sulphide in a little hydrochloric acid. If the solution be now added to a large bulk of water, the white oxychloride is precipitated, which is soluble in tartaric acid and precipitated orange yellow with hydrogen sulphide. The chloride of bismuth is also precipitated white, but the precipitate is not soluble in tartaric acid, and the precipitate with hydrogen sulphide is black.
Tests.—Soluble in water, but not in alcohol.
Heated in substance, it crepitates and chars; and if heat be increased, the metal is deposited. Treated with sulphuretted hydrogen, a characteristic orange-red sulphide is formed.
A drop of the solution evaporated leaves crystals, either tetrahedric, or cubes with edges bevelled off. Sulphuretted hydrogen passed through gives the orange-red precipitate above named. Dilute nitric acid gives a white precipitate, soluble in excess, and also in tartaric acid. Marsh's and Reinsch's processes are applicable for the detection of antimony, but Reinsch's is the better. Reinsch's process gives a violet deposit instead of the black, lustrous one of arsenic.
Chloride of Antimony (Butter of Antimony).—A light yellow or dark red corrosive liquid.
Symptoms.—Violet corrosion and irritation of the alimentary canal, with the addition of narcotic symptoms. After death the mucous membrane of the entire canal is charred, softened, and abraded.
Treatment.—As for tartar emetic; magnesia in milk.
The most important salt of mercury, toxicologically, is corrosive sublimate. Other poisonous preparations are red precipitate, white precipitate, mercuric nitrate, the cyanide and potassio-mercuric iodide. Calomel has very little toxic action. Metallic mercury is not poisonous, but its vapour is.
Corrosive Sublimate (perchloride of mercury) is in heavy colourless masses of prismatic crystals, possessing an acrid, metallic taste. It is soluble in sixteen parts of cold and two of boiling water. Soluble in alcohol and ether, the latter also separating it from its solution in water.
Symptoms come on rapidly. Acrid, metallic taste, constriction and burning in throat and stomach, nausea, vomiting of stringy mucus tinged with blood, tenesmus, purging. Feeble, quick, and irregular pulse, dysuria with scanty, albuminous or bloody urine or total suppression. Cramp, twitches and convulsions of limbs, occasionally paralysis. In poisoning from the medicinal use of mercury, there may be salivation, a coppery taste in the mouth, peculiar fœtor of breath, tenderness and swelling of mouth, inflammation, swelling and ulceration of gums (cancrum oris), a blue line on the gums, and the loosening of teeth. Mercury is less quickly eliminated from the body than arsenic. In chronic cases 'mercurialism,' 'hydrargyrism,' 'ptyalism,' or 'salivation,' including most of the symptoms enumerated above. May get eczema mercuriale and periostitis. Profound anæmia often a prominent symptom; neuritis not uncommon. If fumes of mercury inhaled, mercurial tremors develop.
Post-Mortem Appearances.—Corrosion, softening, and sloughing ulceration of stomach and intestines. The mucous membrane of the œsophagus and stomach is often of a bluish-grey colour. The large intestine and rectum are often ulcerated and gangrenous. Inflamed condition of urinary organs, with contraction of the bladder.
Treatment.—Encourage or produce vomiting. Albumin, as white of egg, gluten, or wheat flour, is the best antidote. Demulcent drinks, milk, and ice. Stomach-tube to be used with care, owing to softened state of gullet and stomach.
Fatal Dose.—Three grains in a child.
Fatal Period.—Half an hour the shortest.
Method of Extraction from the Stomach.—A trial test may be made of the contents of the stomach with copper-foil. If mercury is found, the contents of the stomach may be dialyzed, the resulting clear fluid concentrated and shaken with ether, which has the power of taking corrosive sublimate up, and thus separating it from arsenic and other metallic poisons. The ether allowed to evaporate will leave the corrosive sublimate in white silky-looking prisms. Suppose no mercury is found in the dialyzed fluid, owing to the fact that corrosive sublimate enters into insoluble compounds with albumin, fibrin, mucous membrane, gluten, tannic acid, etc., we must dry the insoluble matter, and heat it with nitro-hydrochloric acid until all organic matter is destroyed and excess of nitric acid expelled. The residue dissolved in water, filtered, and tested with copper-foil, etc.
Tests.—The following table gives the action of corrosive sublimate with reagents:
| 1. With iodide of potassium | Bright scarlet colour. |
| 2. With potash solution | Bright yellow colour. |
| 3. With hydrochloric acid and sulphuretted hydrogen | First a yellowish and then a black colour. |
| 4. Heated in a reduction-tube | Melts, boils, is volatilized, and forms a white crystalline sublimate. |
| 5. With ether | Freely soluble; the ethereal solution, when allowed to evaporate spontaneously, deposits the salt in white prismatic crystals. |
| 6. Heated with carbonate of sodium in a reduction-tube | Globules of metallic mercury are produced. |
A very simple process for detecting corrosive sublimate is to put a drop of the suspected solution on a sovereign and touch the gold through the solution with a key, when metallic mercury will be deposited on the gold.
Acetate of Lead (Sugar of Lead).—A glistening white powder or crystalline mass. Soluble in water, with a sweetish taste. It is practically the only lead salt which gives rise to acute symptoms, and only when taken in large doses.
Symptoms.—Metallic taste, dryness in throat, intense thirst, vomiting, colicky pains, cramps, cold sweat, constipation and scanty urine, severe headache, convulsions.
Chronic lead-poisoning is liable to occur in those who handle lead in any form—white-lead workers, paint manufacturers, plumbers, pottery workers, etc.
In chronic lead-poisoning the most prominent symptoms are a blue line on the gums, anæmia, emaciation, pallor, quick pulse, persistent constipation, colic, cramps in limbs, and paralysis of the extensor muscles, causing 'dropped hand.' May get saturnine encephalopathies, of which intense headache, optic neuritis, and epileptiform convulsions, are the most common. Albumin in urine, tendency to gout, and in women to abortion.
Post-Mortem Appearances.—Inflamed mucous membrane of stomach and intestines, with layers of white or whitish-yellow mucus, impregnated with the salt of lead.
Treatment.—Sulphate of sodium or magnesium, or a mixture of dilute sulphuric acid, spirits of chloroform, and peppermint-water. Milk, or milk and eggs. As a prophylactic among workers in lead, a drink containing sulphuric acid flavoured with treacle should be given. Lavatory accommodation should be provided, and scrupulous cleanliness should also be enjoined in the workshops. The dry grinding of lead salts should be prohibited. The ionization method of Sir Thomas Oliver is most useful both as regards cure and also prevention of chronic poisoning by lead.
Fatal Dose and Fatal Period.—Uncertain.
Method of Extraction from the Stomach.—Dry the contents of the stomach or portions of the liver, etc., and incinerate in a porcelain crucible. Treat the ash with nitric acid, dry, and dissolve in water. The solution of nitrate of lead may now have the proper tests applied.
Tests.—Sulphuretted hydrogen gives a black precipitate; liquor potassæ, white precipitate; sulphuric acid, white precipitate, insoluble in nitric acid; iodide of potassium, a bright yellow precipitate. A delicate test for lead in water is to stir the water, concentrated or not, with a glass rod dipped in ammonium sulphide: a brown coloration is produced. One-tenth of a grain of lead in a gallon of water may be detected.
Chronic lead-poisoning is an 'industrial disease,' and, being an occupation risk, its victims are entitled to compensation at the hands of their employers. In case of death, compensation has been awarded even when at the autopsy the patient has been found to have suffered from acute tuberculosis of the lungs. The responsibility of apportioning the monetary value of disablement resulting from the action of the lead rests with a judge or jury, who are guided by the expert medical evidence available.
Diachylon, or lead-plaster, is largely used as an abortifacient.