Poisoning with copper salts is rare. The most important are the sulphate, subacetate, and arsenite.
Sulphate of Copper (bluestone, blue vitriol) in half-ounce doses is a powerful irritant. Has been given to procure abortion.
Subacetate of Copper (verdegris) occurs in masses, or as a greenish powder. Powerful, astringent, metallic taste. Half-ounce doses have proved fatal.
Symptoms.—Epigastric pain, vomiting of bluish or greenish matter, diarrhœa. Dyspnœa, depression, cold extremities, headache, purple line round the gums. Jaundice is common. A chronic form of poisoning may occur, with symptoms closely resembling those of lead.
Post-Mortem Appearances.—Inflammation of stomach and intestines, which are bluish or green in colour.
Treatment.—Encourage vomiting. Give albumin or very dilute solution of ferrocyanide of potassium.
Method of Extraction from the Stomach.—Boil the contents of the stomach in water, filter, pass hydrogen sulphide, filter, collect precipitate and boil in nitric acid, filter, dilute filtrate with water and apply tests. In the case of the solid organs, dry, incinerate, digest ash in hydrochloric acid, evaporate nearly to dryness, dilute with water, and test.
Tests.—Polished steel put into a solution containing a copper salt receives a coating of metallic copper. Ammonia gives a whitish-blue precipitate, soluble in excess. Ferrocyanide of potassium gives a rich red-brown precipitate. Sulphuretted hydrogen gives a deep brown precipitate.
The salts of zinc requiring notice are the sulphate and chloride.
Sulphate of Zinc has been taken in mistake for Epsom salts. In large doses it causes dryness of throat, thirst, vomiting, purging, and abdominal pain.
Post-Mortem Appearances.—Those of inflammation of digestive tract.
Treatment.—Tea, decoction of oak-bark, carbonate of potassium or sodium as antidote.
Chloride of Zinc.—A solution containing this substance (230 grains to the ounce) constitutes 'Burnett's disinfecting fluid.' It is a corrosive poison.
The symptoms are burning sensation in the mouth, throat, stomach, and abdomen, followed by vomiting, diarrhœa, with tenesmus and distension of the abdomen. The vomited matter contains shreds of mucous membrane with blood. There is profound collapse, cold surface, clammy sweats, weak pulse, with great prostration. The treatment is to wash out the stomach with large and weak solutions of carbonate of sodium. Mucilaginous drinks may be given, and hypodermic injections of morphine are useful to allay the pain.
Method of Extraction from the Stomach.—Dry and incinerate the tissues in a porcelain crucible, digest ash in water, apply tests.
Tests.—Ammonia, a white precipitate soluble in excess, reprecipitated by sulphuretted hydrogen; ferrocyanide of potassium, a white precipitate; sulphuretted hydrogen, a white precipitate in pure and neutral solutions. Nitrate of baryta will show the presence of sulphuric acid, and nitrate of silver of hydrochloric acid.
Silver.—Nitrate of silver is a powerful irritant.
Tests.—Black precipitate with sulphuretted hydrogen; white with hydrochloric acid.
Treatment.—Common salt.
Chronic nitrate of silver poisoning is characterized by argyria. The gums show a blue line, which is darker than that produced by lead, and the skin presents a greyish hue, which is permanent.
Bismuth.—The bismuth salts are not poisonous, but may contain arsenic as an impurity, although this is far less common than it was some years ago.
Chromic Acid, Chromate, Bichromate of Potassium.—These act as corrosives when solid or in concentrated liquid forms. In dilute solutions they act as irritants. Used as dyes; have proved fatal more than once. Those engaged in their manufacture suffer from unhealthy ulcers on the nasal septum and hands. The former may to some extent be prevented by taking snuff. Lead chromate (chrome yellow) is a powerful irritant poison. Two drachms of the bichromate caused death in four hours.
Tests.—Yellow precipitate with salts of lead, deep red with those of silver.
Treatment.—Emetics, magnesia, and diluents. Washing out of the stomach with weak solution of nitrate of silver.
Carbon Dioxide.—Carbon dioxide is a product of combustion and respiration, and is generated in many ways during fermentation. It is a constituent of choke damp due to explosions in coal-mines, and is given off from lime-kilns, brick-kilns, and cement-works. It is often met with in dangerous quantities in wells and in brewers' vats. From 10 to 15 per cent. in the atmosphere would prove fatal, but even 2 per cent. inhaled for long would produce serious symptoms. The proportion usually present in air is 0.04 per cent.
Symptoms.—Inhalation of the pure gas causes spasm of the glottis, insensibility, and death from asphyxia, at once; diluted, causes sense of weight in forehead and back of head, giddiness, vomiting, somnolence, loss of muscular power. Insensibility, stertorous breathing, lividity of face and body, and death from asphyxia. Convulsions occasionally.
Post-Mortem Appearances.—Face swollen and livid, or calm and pale; lividity is most marked in eyelids, lips, ears, etc.; limbs usually flaccid, abdomen distended; right side of heart, lungs, and large veins, gorged with dark-coloured blood. Brain and membranes congested.
Treatment.—Pure air, cold affusion, stimulants, artificial respiration, galvanism, inhalation of oxygen, venesection, transfusion.
Carbonic Oxide.—This is one of the most poisonous of gases. It is evolved in the process of burning charcoal and coke in stoves or furnaces. Water-gas, obtained by passing steam over heated coke, contains 40 per cent. of the substance, the remainder being chiefly hydrogen. It forms the chief part of the deadly 'choke damp' after an explosion in a mine. Two per cent. in the atmosphere is immediately fatal.
Symptoms.—When in large amount, insensibility comes on at once; when in very small amounts, headache, giddiness, noises in the ears, nausea, and vomiting, with prostration, insensibility, and coma. There may be convulsions. Even in cases which recover, permanent impairment of the brain may result.
Post-Mortem Appearances.—The blood is bright red in colour, due to the interaction of carbonic oxide with hæmoglobin. A rosy hue of the skin-surface and viscera is often noticed. Bright red patches of colour are found over the surface of the body. The spectrum of the blood is characteristic.
Treatment.—Ammonia to the nostrils, inhalation of oxygen, cold douche in moderation, artificial respiration, transfusion of blood.
Coal Gas.—Coal gas contains light carburetted hydrogen or marsh gas, olefiant gas, ammonia, sulphuretted hydrogen, carbonic acid, carbonic oxide, free hydrogen, and nitrogen. Coal gas has an offensive odour, burns with a yellowish-white flame, yielding water and carbonic acid. Cases of poisoning often due to escape of gas into the room.
Symptoms.—Headache and giddiness, foaming at mouth, vomiting, convulsions, tetanic spasms, stertorous breathing, dilated pupil. The breath smells of gas; there is profound stupor; the patient, if alive, exhales gas from the lungs when removed into a fresh room or into the air. Smell of gas in the room and in patient's breath.
Post-Mortem Appearances.—Pallor of skin and internal tissues; florid colour of neck, back, and muscles, if much CO present in the coal gas; fluid florid blood; infiltration of lungs.
Treatment.—Fresh air, artificial respiration, cold affusion, diffusible stimulants; inhalation of oxygen freely.
Sulphuretted Hydrogen is characterized by its odour, like that of rotten eggs. It is extremely poisonous.
Symptoms.—Giddiness, pain and oppression in stomach, nausea, loss of power; delirium, tetanus, and convulsions.
Post-Mortem Appearances.—Fluid and black blood (sulph-hæmoglobin), smell of H2S on opening the body; loss of contractility of muscles, rapid putrefaction.
Treatment.—Fresh air, stimulants, inhalation of chlorine.
Tests.—Acetate of lead throws down a brown or black precipitate according to the quantity of the gas.
Sewer Gas.—Cesspool emanations usually consist of a mixture of sulphuretted hydrogen, sulphide of ammonium, and nitrogen; but sometimes it is only deoxidized air with an excess of carbonic acid gas.
Symptoms.—If poison concentrated, death may ensue at once; if gas diluted, or exposure only short, insensibility, lividity, hurried respiration, weak pulse, dilated pupils, elevation of temperature to 104°, tonic convulsions not unlike those of tetanus.
Treatment.—Fresh air, oxygen, with artificial respiration. Stimulants, hypodermic of strychnine, and alternate hot and cold douche.
Irritant Gases are—(1) Nitrous acid gas; (2) sulphurous acid gas; (3) hydrochloric acid gas; (4) chlorine; (5) bromine; (6) ammonia. They have the common property of causing irritation and inflammation of the eyes, throat, and air-passages, and may cause spasm of the glottis, bronchitis, and pneumonia.
Sulphurous Acid Gas.—One of the products of combustion of common coal.
Hydrochloric Acid Gas.—Irrespirable when concentrated, and very irritating when diluted. Very destructive to vegetable life.
Chlorine.—Used in bleaching, and as a disinfectant. Greenish-yellow colour, suffocating odour. In poisoning, inhalation of sulphuretted hydrogen gives relief.
The chief vegetable purgatives are aloes, colocynth, gamboge, jalap, scammony, seeds of castor-oil plant, croton-oil, elaterium, the hellebores, and colchicum. All these have, either alone or combined, proved fatal. The active principle in aloes is aloin; of jalap, jalapin; of white hellebore, veratria; and of colchicum, colchicin. Morrison's pills contain aloes and colocynth; aloes is also the chief ingredient in Holloway's pills.
Symptoms.—Vomiting, purging, tenesmus, etc., followed by cold sweats, collapse, or convulsions.
Post-Mortem Appearances.—Inflammation of alimentary canal; ulceration, softening, and submucous effusion of dark blood.
Treatment.—Diluents, opium, stimulants, abdominal fomentations, etc.
Certain of these irritant poisons exert a marked influence on the central nervous system, as the following:
Laburnum (Cytisis Laburnum).—All parts of the plant are poisonous; the seeds, which are contained in pods, are often eaten by children. Contains the alkaloid cytisine, which is also contained in arnica. It has a bitter taste, and is powerfully toxic. Symptoms are purging, vomiting, restlessness, followed by drowsiness, insensibility, and convulsive twitchings. Death due to respiratory paralysis. Most of the cases are in children. Treatment consists of stomach-pump or emetics, stimulants freely, artificial respiration, warmth and friction to the surface of the body.
Yew (Taxus baccata) contains the alkaloid taxine. The symptoms are convulsions, insensibility, coma, dilated pupils, pallor, laboured breathing, collapse. Death may occur suddenly. Treatment as above. Post-mortem appearances not characteristic, but fragments of leaves or berries may be found in the stomach and intestines.
Arum (Arum Maculatum).—This plant, commonly known as 'lords and ladies,' is common in the woods, and the berries may be eaten by children. It gives rise to symptoms of irritant poisoning, vomiting, purging, dilated pupils, convulsions, followed by insensibility, coma, and death.
Many plants have an intensely irritating action on the skin, and when absorbed act as active poisons.
Rhus toxicodendron is the poison oak or poison ivy. Poisoning by this plant is rare in England, though not uncommon in the United States. Mere contact with the leaves or branches will in many people set up an acute dermatitis, with much œdema and hyperæmia of the skin. The inflammation spreads rapidly, and there is formation of blebs with much itching. There is often great constitutional disturbance, nausea, vomiting, diarrhœa, and pains in the abdomen. The effects may last a week, and the skin may desquamate.
Primula obconica is another plant which, when handled, gives rise to an acute dermatitis of an erysipelatous character. The face swells, and large blisters form on the cheeks and chin.
Opium.—The inspissated juice of the unripe capsules of the Papaver somniferum. As a poison it is generally taken in the form of the tincture (laudanum), which contains 1 grain opium in 15 minims. Opium is found in almost all so-called 'soothing syrups' for children, and in Godfrey's cordial, Dalby's carminative, and Collis Browne's chlorodyne. Laudanum contains 1 per cent. morphine, and it, along with all other preparations (e.g., paregoric) which contain 1 or more per cent. morphine, are included in Part I. of the Schedule of Poisons, and come under the Dangerous Drugs Regulations.
The most important active principles of opium are the alkaloids morphine and codeine.
Symptoms usually commence in from twenty to thirty minutes: Giddiness, drowsiness and stupor, followed by insensibility. Patient seems asleep; may be roused by loud noise, but quickly relapses. Breathing slow and stertorous, pulse weak, countenance livid. As coma increases, pulse becomes slower and fuller. The pupils are contracted, even to a pin's point; they are insensible to the action of light. In deep, natural sleep the eyes are turned upwards and the pupils contracted. Bowels confined, skin cold and livid or bathed in sweat. Temperature subnormal. Nausea and vomiting are sometimes present. Remissions are not infrequent, the patient appearing about to recover and then relapsing. Hæmorrhage into the pons may give rise to contracted pupils. Young children and infants are specially susceptible to the poison.
Diagnosis is not always easy, and one has to differentiate poisoning from cerebral apoplexy. In the latter one can seldom rouse the patient, the pupils are often unequal, and hemiplegia is present. In compression of the brain, fracture of the skull may be present, subconjunctival hæmorrhages may be seen, the pupils are unequal and dilated, and the paralysis increases. In uræmic or diabetic coma the urine must be examined.
The habitual use of opium is not uncommon, and opium-eaters are able to take enormous quantities of the drug. The opium-eater may be known by his attenuated body, withered yellow countenance, stooping posture, and glassy, sunken eyes.
Post-Mortem Appearances.—Not characteristic. Turgescence of cerebral vessels. There may be effusion under arachnoid, into ventricles, at base of the brain, and around the cord. Rarely extravasation of blood. Stomach and intestines usually healthy. Lungs gorged, skin livid.
Fatal Period.—Usually nine to twelve hours; but in many cases, if life is prolonged for eight hours, recovery takes place.
Fatal Dose.—Four grains of opium is the smallest fatal dose in an adult, or one drachm of laudanum; children are proportionately much more susceptible to the action of opium than adults.
Treatment.—Stomach-tube, emetics, strong coffee or tea, ammonia to nostrils. Give 10 grains of permanganate of potassium in a pint of water acidulated with sulphuric acid, and repeat the dose every half hour. Belladonna by mouth, or atropine hypodermically. Patient must be kept roused by dashing cold water over him, flagellating with a wet towel, walking about, etc. In conditions of collapse, however, this treatment must not be continued, but everything should be done to preserve the strength. Treatment must be continued as long as life remains.
Method of Extraction from the Stomach.—Opium itself cannot be directly detected, but we test for morphine and meconic acid. These may be separated from organic mixtures thus: Boil the organic matter with distilled water, spirit, and acetic acid; filter, and to the fluid passed through add acetate of lead till precipitate ceases. Filter. Acetate of morphine passes through, and meconate of lead remains. The solution of acetate of morphine may be freed from excess of lead by hydrogen sulphide and filtered, excess of hydrogen sulphide driven off by heat, and tests applied. Put the meconate of lead with water into a beaker and pass hydrogen sulphide; sulphide of lead is formed, and meconic acid set free. Filter. Concentrate the solution of meconic acid, allow a portion to crystallize, and apply tests.
Tests.—Morphine and its acetate give an orange-red colour with nitric acid, becoming brighter on standing; decompose iodic acid, setting free iodine; with perchloride of iron, gives a rich indigo-blue; with bichromate of potassium, a green turning to brown. When the alkaloid is heated in a watchglass with a drop of strong sulphuric acid until the acid begins to fume, and is then allowed to get quite cold, a drop of nitric acid produces a brilliant red colour. The iodic acid test is very delicate, but requires great care, and may be used in the presence of organic matter.
Meconic acid gives a blood-red colour with perchloride of iron, not discharged by corrosive sublimate or chloride of gold. The similar colour produced by sulpho-cyanide of potassium and perchloride of iron is discharged by chloride of gold and corrosive sublimate.
Morphine Habit.—Individuals who have acquired this habit take the drug usually by hypodermic injection. The victim suffers from nausea and vomiting, and becomes so mentally debilitated that asylum treatment is required.
Belladonna.—The root, leaves, and berries, of the Atropa belladonna are poisonous from the presence of alkaloid atropine.
Symptoms.—Dryness of mouth and throat, intense thirst, dysphagia and dysphonia, quick pulse, noisy delirium and stupor. Strangury and hæmaturia, and redness of the skin, especially of the face, like that of scarlatina, have been noticed. Dilatation of the pupil occurs, whether the poison be taken internally or applied locally to the eye.
Post-Mortem Appearances.—Congestion of cerebral vessels, dilated pupils, red patches in alimentary canal.
Treatment.—Wash out the stomach freely; a hypodermic injection of apomorphine as an emetic, followed by hypodermic injections of pilocarpine or morphine. Tea, coffee, or tannin, to precipitate the alkaloid.
Tests.—Atropine may be recognized by its action on the pupil. The chloro-iodide of potassium and mercury precipitates it from very dilute solutions.
Hyoscyamus (Henbane).—Hyoscyamus niger.
Stramonium (Thorn-Apple).—Datura stramonium.
Symptoms.—Identical with those of belladonna and hyoscyamus, the post-mortem appearances and treatment being also the same.
Cannabis Indica (Indian Hemp).—When smoked, produces intoxication and mania. Hashish, used in the East as a narcotic, may cause persons to run 'amok' and commit murder.
Cocaine.—Any dose above 1/2 grain applied to a mucous membrane or injected hypodermically may give rise to alarming symptoms. These are intense pallor, faintness, giddiness, dilatation of pupils, paroxysmal dyspnœa, rapid, intermittent, and weak pulse, nausea and vomiting, intense prostration verging on collapse, and convulsions. The patient may recover if allowed to remain in a recumbent position, but stimulants by mouth—e.g., ammonia—and the hypodermic injection of brandy or ether may be necessary, with the inhalation of nitrite of amyl.
For care in the prescribing of cocaine see under the 'Dangerous Drugs Act, 1920' (p. 82).
The Cocaine Habit consists in the self-administration of the drug hypodermically. It induces excitement, which is followed by prostration. In time melancholia or mania develops, with great irritation of the skin ('cocaine bugs').
The liniment, oil, and spirit have been poisonous in large dose.
Symptoms.—Odour of breath, languor, giddiness, faintness, dimness of vision, difficulty of breathing, delirium, convulsions, with hot skin, flushed face, and dilated pupils.
Fatal Dose.—Thirty grains.
Cocculus Indicus.—The fruit of Anamirta cocculus. Contains a poisonous active principle, picrotoxin; used to adulterate beer, and by poachers to stupefy fish.
Symptoms.—Convulsions, followed by stupor and complete loss of voluntary power.
Tetrachlorethane ('Cellon').—Acetylene tetrachloride; vapour has caused poisoning in aeroplane ('dope') and cinema film works.
Symptoms.—Gastric symptoms and marked jaundice. This may be followed in days or weeks by stupor, coma, death.
Post-Mortem.—Fatty degeneration of internal organs, chiefly liver.
Trinitrotoluene (T.N.T.).—An explosive solid which stains the skin an orange colour; may be absorbed through skin or be inhaled.
Symptoms.—Shortness of breath, headache, drowsiness. Later, skin irritation, gastritis, jaundice, blood degeneration.
Treatment.—Remove from work, rest in bed, diuretics, purgatives, alkalies.
Alcohol, ether, and chloroform, induce general anæsthesia, often preceded by delirious excitement, and followed by nausea and vomiting. When they cause death, it is by inducing a state like apoplexy or by paralyzing the heart.
Alcohol.—Absolute alcohol is ethyl hydroxide (C2H5OH) with not more than 1 per cent. by weight of water. Rectified spirit (spiritus rectificatus) contains 90 per cent. of alcohol. Methylated spirit consists of rectified spirit with 10 per cent. of wood spirit. Proof spirit contains a little over 49 per cent. of absolute alcohol; brandy or whisky, 53 per cent.; port wine, 20 to 25 per cent.; ales and stout, 4 to 6 per cent.
Symptoms.—Acute poisoning; confusion, giddiness, staggering gait, headache, passing into stupor, with subnormal temperature, and coma. Vomiting may occur and recovery ensue, otherwise collapse sets in. Pupils usually dilated.
Dipsomaniacs suffer from indigestion, vomiting and purging, jaundice, albuminuria, diabetes, cirrhosis of liver, degeneration of kidneys, congestion of brain, peripheral neuritis, alcoholic insanity, and various forms of paralysis. In the acute form delirium tremens is the most common manifestation.
Post-Mortem Appearances.—Deep red colour of lining membranes of stomach. Sometimes congestion of cerebral vessels and meninges. Lungs congested, blood fluid. Rigor mortis persistent.
Fatal Dose.—Death from 1/2 pint of gin and from two bottles of port, but recovery from larger quantities.
Fatal Period.—Average about twenty-four hours.
Treatment.—Stomach-tube, cold affusion, electricity, injection of a pint of hot coffee into the rectum. Give chloride of ammonium in 30 grain doses to prevent delirium; strychnine or digitalin hypodermically.
Method of Extraction from the Stomach.—Neutralize the contents of the stomach, if acid, with sodium carbonate; place them in a retort and carefully distil. Collect the distillate, mix with chloride of calcium or anhydrous sulphate of copper, and again distil. Agitate distillate with dry potassium carbonate, and draw off some of the supernatant fluid for testing.
Tests.—Odour. Dissolves camphor. With dilute sulphuric acid and bichromate of potassium turns green, and evolves aldehyde. Product of combustion makes lime-water white and turbid.
Methyl Alcohol: Wood Naphtha.—Used to produce intoxication by painters, furniture-polishers, etc.
Symptoms are those of alcoholic poisoning, but vomiting and delirium are more persistent. Total or partial blindness may follow as a sequel of optic atrophy. A fatal result not infrequently follows.
The following table gives the points of distinction between concussion of brain, alcoholic poisoning, and opium poisoning:
| Concussion of Brain. | Alcohol. | Opium. |
| 1. Marks of violence on head | 1. No marks of violence, unless person has fallen. History will be of use. | 1. As alcohol. |
| 2. Stupor, sudden. | 2. Excitement precedes sudden stupor. | 2. Symptoms slow. Drowsiness, stupor, lethargy. |
| 3. Face pale, cold; pupils sluggish, sometimes dilated. | 3. Face flushed; pupils generally dilated. | 3. Face pale; pupils contracted. |
| 4. Remission rare. Patient recovers slowly. | 4. Partial recovery may occur, followed by death. | 4. Remission rare. |
| 5. No odour of alcohol in breath. | 5. Odour of alcohol in breath. | 5. Odour of opium in breath. |
Ether is a volatile liquid prepared from ethylic alcohol by interaction with sulphuric acid. It contains 92 per cent. of ethyl oxide (C2H5)O. It was formerly called 'sulphuric ether.' It is a colourless, inflammable liquid, having a strong and characteristic odour, specific gravity 0.735. Purified ether from which the ethylic alcohol has been removed by washing with distilled water, and most of the water by subsequent distillation in the presence of calcium chloride and lime. It is this preparation which is used for the production of general anæsthesia. It has a specific gravity of 0.722 to 0.720, and its vapour is very inflammable.
Symptoms.—When taken as a liquid, same as alcohol. When inhaled as vapour, causes slow, prolonged, and stertorous breathing; face becomes pale, lips bluish, surface of body cold. Pulse first quickens, then slows. Pupils dilated, eyes glassy and fixed, muscles become flabby and relaxed, profound anæsthesia. Then pulse sinks and coma ensues, sensation being entirely suspended. Nausea and vomiting not uncommon.
Post-Mortem Appearances.—Brain and lungs congested. Cavities of heart full of dark, liquid blood. Vessels at upper part of spinal cord congested.
Treatment.—Exposure to pure air, cold affusion, artificial respiration, galvanism.
Method of Extraction from the Contents of the Stomach.—Same as for alcohol. During distillation pass some of the vapour into concentrated solution of bichromate of potash, nitric and sulphuric acids, and note reaction as for alcohol.
Tests.—Vapour burns with smoky flame, depositing carbon. Sparingly soluble in water. With bichromate of potash and sulphuric acid same as alcohol.
Chloroform.—A colourless liquid, specific gravity 1.490 to 1.495, very volatile, giving off dense vapour. Sweet taste and pleasant odour.
Symptoms.—When swallowed, characteristic smell in breath, anxious countenance, burning pain in the throat, stomach, and region of the abdomen, staggering gait, coldness of the extremities, vomiting, insensibility, deepening into coma, with stertorous breathing, dilated pupils, and imperceptible pulse. When inhaled, much the same as ether, but produces insensibility and muscular relaxation more rapidly. It would be impossible to instantly render a person insensible by holding a pocket-handkerchief saturated with chloroform over the face. Statements such as this, which are often made in cases of robbery from the person and in cases of rape, are incredible.
Delayed Chloroform-Poisoning.—Death may take place in from four to seven days after chloroform has been administered, especially in the case of children. The internal organs are found to be fattily degenerated, and death is thought to be due to acetonuria.
Post-Mortem Appearances.—Cerebral and pulmonary congestion. Heart empty, or right side distended with dark blood.
Treatment.—Stomach-tube and free lavage; cold affusion; drawing forward tongue; artificial respiration; galvanism and suspension with head downward. Inhalation of nitrite of amyl; strychnine hypodermically.
Fatal Dose.—When swallowed, from 1 to 2 ounces.
Method of Extraction from the Stomach.—By distillation at 120° F. The vapour, as it passes along a glass tube, may be decomposed by heat into chlorine, hydrochloric acid, and carbon—the first shown by setting free iodine in iodide of starch, the second by reddening blue litmus-paper, and the last by its deposit.
Tests.—Taste, colour, weight; burns with a green flame; dissolves camphor, guttapercha, and caoutchouc.
Iodoform.—Poisoning may result from its use in surgery. It produces delirium, sleepiness, and coma. It may lead to mental weakness or optic neuritis.
It was formerly largely used as a hypnotic, and many fatal consequences ensued. It is prepared from alcohol and chlorine.
Symptoms.—Deep sleep, loss of muscular power, diminished or abolished reflex action and sensibility, followed by loss of consciousness and marked fall of temperature. Pulse may become quick, and face flushed or livid and bloated. Prolonged use of this drug may produce a peculiar eruption on the skin. Supposed to act in the blood by being decomposed into chloroform and sodium formate. Its effects are due chiefly to depression of the central nervous system, the medulla being the last part of the nervous system to be attacked.
Method of Extraction from the Stomach.—By distillation in strongly alkaline solutions, when it may be obtained as chloroform and tested as such.
Treatment.—Stomach-tube or emetic. Hypodermic injections of strychnine. Keep patient warm, and inject a pint of hot strong coffee into the rectum. Nitrite of amyl and artificial respiration.
Tests.—Heated with caustic potash, it yields chloroform and potassium formate. The chloroform is readily recognized by its odour, and, if the solution be concentrated, by separating as a heavy layer at the bottom of the test-tube.
Cases of poisoning by petroleum and paraffin are common, and occur chiefly in children.
Petroleum is a natural product, and is a mixture of the higher saturated hydrocarbons. The crude petroleum is purified by distillation, and is then free from colour, but retains its peculiar penetrating odour. Different varieties are sold under the names of cymogene, gasolene, naphtha, petrol, and benzoline. Benzoline is highly inflammable, and is often called mineral naphtha, petroleum naphtha, and petroleum spirit. Benzoline is not the same as benzene or benzol, which is one of the products of the dry distillation of coal.
From its very general use as a fuel in motor-cars many accidents have happened from inhaling the vapour of petrol. It gives rise to coldness, shallow respiration, syncope, and insensibility, but seldom death.
Paraffin, also known as kerosene and mineral oil, is a mixture of saturated hydrocarbons obtained by the distillation of shale.
By the retailer the terms 'petroleum' and 'paraffin' oil are used indifferently, and each is sold for the other without prejudice.
Symptoms.—These substances are not very active poisons, and, as a rule, even children recover. The breath has the odour of paraffin, the face is pale and cyanotic, hot and dry, and there may be vomiting. Death may result from gastro-enteritis or from coma.
Fatal Dose.—In the case of an adult, 1/2 pint should not prove lethal, and patients have recovered after drinking a pint.
Treatment.—Emetics, purgatives, and stimulants.
Many of the synthetical coal-tar products now so largely employed as analgesics are powerful toxic agents.
Phenazone, Antipyrine, or Analgesin, is a complex benzene derivative prepared from aniline, aceto-acetic ether, and methyl iodide. It is in colourless, inodorous, scaly crystals, which have a bitter taste. It is soluble in its own weight of water.
Tests.—Can be extracted from an alkaline solution of chloroform. The residue left on the evaporation of chloroform should be employed for testing. If heated with strong nitric acid and allowed to cool, a purple colour is produced. Ferric chloride gives a blood-red coloration, destroyed by the addition of mineral acids.
Treatment.—Stimulants freely, inhalation of oxygen, patient to be kept in the recumbent position.
Acetanilide, Antifebrin, Phenylacetamide (a constituent of 'Daisy' or 'headache' powders), is obtained by the interaction of acetic acid and aniline. It is in colourless, inodorous, lamellar crystals, which have a slight pungent taste. It is insoluble in water.
Tests.—May be extracted from acid solutions by ether or chloroform. If heated with solution of potassium hydroxide, odour of aniline is given off; if liquid, when it is warmed with a few drops of chloroform, a penetrating and unpleasant odour of isocyanide.
Treatment.—Emetics, stimulants, inhalation of ether, recumbent position.
Phenacetin, Phenacetinum, is produced by the interaction of glacial acetic acid and para-phenetidin. It is in white, tasteless, inodorous, glistening, scaly crystals, insoluble in water. Of all the members of the group, it most rarely produces toxic symptoms.
Treatment.—As for the other members of this group.
Exalgin, Aspirin, etc., as well as the above, may all act as poisons to certain persons, and even small medicinal doses may cause serious and even fatal consequences.
Symptoms (more or less common to all).—Nausea, vomiting, hurried respiration, marked cyanosis, syncope. Persistent sneezing and widespread urticaria may be present; collapse.
Aniline is an oily liquid, heavier than, and not soluble in, water. It is colourless or reddish-brown; it has a peculiar tar-like odour; it is soluble in alcohol, and forms a soluble sulphate with sulphuric acid. A solution of bleaching-powder gives with solution of the sulphate a purple colour changing to red-brown.
Symptoms.—Nausea, vomiting, giddiness, intoxication, drowsiness, gasping for breath, feeble pulse, and marked cyanosis. In its industrial use it may act as a poison either by inhalation of the fumes or by absorption through the skin. The symptoms then are mainly those of peripheral neuritis with blindness.
Fatal Dose.—About 6 drachms.
Treatment.—Wash out stomach; stimulants, artificial respiration, inhalation of oxygen, transfusion.
Nitro-benzol (Artificial Oil of Bitter Almonds).—It is used in perfumery, but is very poisonous when swallowed, or inhaled, or absorbed through skin. It is used in the manufacture of aniline dyes, and may act as an industrial poison. The symptoms closely resemble those of aniline poisoning, but there is perhaps greater mental confusion.
Fatal Dose.—Eight to ten drops have caused death.
Treatment.—Emetics, stimulants, transfusion of saline or blood, pituitrin, strychnine, or digitalin hypodermically.
Nitroglycerine gives rise to intense and persistent headache ('powder headache'). Throbbing and pulsation of all the arteries in the body; flushing of the face and collapse may follow.
Dinitrobenzene causes symptoms resembling nitro-benzol poisoning, and when acting as a chronic poison gives rise to weakness, jaundice, peripheral neuritis.
These are dangerous drugs. The ordinary symptoms of the group are noises in the ears, headache, vertigo, inability to stand or to walk properly, insensibility, and cyanosis.
The most interesting point is the condition of the urine. In cases of poisoning it is dark or reddish-brown in colour, due to the presence of hæmatoporphyrin. It contains albumin and casts, but no red corpuscles. In cases of hæmatoporphyrinuria the prognosis is bad, and it is said that these cases invariably end fatally.
Treatment.—In an ordinary case emetics, strong coffee, hypodermic injections of strychnine, saline injections, and transfusion.
Cases of chronic poisoning from the 'als' are not uncommon, and are increasing in frequency. Hypnogen is apparently identical with veronal.
All the above-named aniline derivatives are included in Part I. of the scheduled poisons.
Conium Maculatum (Spotted Hemlock).—All parts of the plant are poisonous, often mistaken for parsley. Contains the poisonous principle coniine, a volatile liquid alkaloid with a mousy smell; insoluble in water; soluble in alcohol, ether, and chloroform. It also contains methyl coniine.
Symptoms.—Dryness of throat, headache, dilated pupil, dysphagia, loss of muscular power, passing into complete paralysis. Delirium, coma, and convulsions, occasionally.
Post-Mortem Appearances.—Congested brain and lungs; redness of the mucous membrane of the stomach. The stomach and intestines should be examined for fragments of the leaves and fruit, recognized by their microscopical appearances.
Treatment.—Emetics, tannic acid or gallic acid. Diffusible stimulants.
Method of Extraction from the Stomach.—Use Stas-Otto process.
Tests.—The mousy odour. Deepened colour and dense white fumes with nitric acid. Pale red, deepening, with hydrochloric acid.
There are several other umbelliferous plants which are poisonous. The water hemlock (Cicuta virosa) produces symptoms not unlike those of hemlock; it has been mistaken for parsnip and celery. It contains an active principle, cicutoxin, which in some respects is allied to strychnine and picrotoxin. The fool's parsley, or lesser hemlock (Æthusa cynapium), is another member of this group, although doubt has been expressed as to whether it is really poisonous. The water dropwort (Œnanthe crocata) is undoubtedly poisonous, especially to cattle. In man it produces abdominal pain with diarrhœa and vomiting; dilated pupils, slow pulse, and cyanosis; delirium, insensibility, and convulsions. The post-mortem appearances are not characteristic, but the stomach and intestines should be examined for portions of the plant.
Calabar Bean or Physostigma.—The bean of Physostigma venenosum contains the alkaloid physostigmine or eserine, with the antagonistic alkaloid calabarine.
Symptoms.—Vomiting, giddiness, irregular cardiac action, contraction of the pupils, paralysis of lower extremities, and death from asphyxia.
Treatment.—Emetics; hypodermic injection of 1/50 grain sulphate of atropine, repeated if necessary.
Method of Extraction from the Stomach.—Use Stas-Otto process.
Test.—The contraction of the pupil which it causes.
Tobacco.—Nicotiana tabacum owes its poisonous properties to its alkaloid nicotine, a volatile, oily, amber-coloured liquid, with an acrid taste and ethereal odour; soluble in water, alcohol, ether, and chloroform. The drug has an intense depressant action on the heart and respiratory centre.
Symptoms.—Giddiness, fainting, nausea, and vomiting, with syncope, muscular tremors, stupor, stertorous breathing, and insensible pupil. Death has occurred after seventeen or eighteen pipes at a sitting.
Post-Mortem Appearances.—Not uniform or characteristic. General relaxed condition of muscles; engorgement of cerebral and pulmonary vessels. Congestion of gastric mucous membrane.
Treatment.—Emetics, stimulants, hypodermic injection of 1/25 grain of strychnine. Warmth to the surface by hot bottles, hot blankets.
Method of Extraction from the Stomach.—Digest the contents of the stomach in cold distilled water and very dilute sulphuric acid; strain, filter, and press residue. Evaporate the filtrate to half its bulk, digest with alcohol, and evaporate alcohol off in a water-bath. Dissolve residue (sulphate of nicotine) in water, and make solution alkaline with potash; then shake with ether in a test-tube. Remove ether and allow it slowly to evaporate. Test resulting alkaloid.
Tests.—No change of colour with the mineral acids. White deposit with corrosive sublimate. Sulphuric acid and bichromate of potassium give a green colour, oxide of chromium. Precipitate with bichloride of platinum and with carbazotic acid.
Lobelia Inflata (Indian Tobacco).—Much used in America by the Coffenite practitioners, and a valuable remedy for asthma.
Symptoms.—Nausea, vomiting, giddiness, cold sweats, prostration. Headache, giddiness, tremors, insensibility, and convulsions.
Prussic Acid is the most active of poisons. The diluted hydrocyanic acid of the Pharmacopœia contains 2 per cent. of hydrocyanic acid, Scheele's 4 per cent. It is a colourless liquid, feebly acid, with odour of bitter almonds.
Cyanide of Potassium is largely used in photography and in electro-plating, and is also poisonous. It often contains undecomposed carbonate of potassium, which may act as a corrosive poison and cause erosion of the mucous membranes of the lips, mouth, and stomach.
Oil of Bitter Almonds, used as a flavouring agent, may contain (when improperly prepared) from 5 to 15 per cent. of the anhydrous acid.
Symptoms.—The symptoms usually come on in a few seconds, and are of the shortest possible duration. There is a sudden gasp for breath, possibly a loud cry, and the patient drops down dead. If the fatal termination is prolonged for a few minutes, the symptoms are intense giddiness, pallor of the skin, dilatation of the pupils, laboured and irregular breathing, small and frequent pulse, followed by insensibility. There may be convulsions or tetanic spasms, with evacuation of urine and fæces. Death results from paralysis of the central nervous system, but artificial respiration is useless, as the drug promptly arrests the heart's action. It also kills the protoplasm of the red blood-corpuscles, rendering them useless as oxygen-carriers.
Post-Mortem Appearances.—Skin livid, pale, or violet, with bright red patches on the dependent parts. The gastro-intestinal mucous membrane is bright red in colour, owing to the presence of cyanmethæmoglobin. Hands clenched, nails blue, jaws fixed, froth about mouth. Eyes prominent and glistening, odour of acid from body, venous system gorged.
Treatment.—Empty the stomach by the tube at once, and wash it out with a solution of sodium thiosulphate. Strong ammonia to the nostrils. Stimulants freely—brandy, chloric ether, ammonia, sal volatile ad libitum. If patient cannot swallow, inject hypodermically either brandy or ether. Hypodermic injection of 1/50 grain atropine. Douche to the face, alternately hot and cold. Death commonly occurs so rapidly that there is no time for treatment.
Fatal Dose (Smallest).—Half a drachm of the B.P. acid, equal to 0.6 grain of the anhydrous. Recovery from 1/2 ounce of the B.P. acid. These records are fallacious, for in specimens the percentage of anhydrous acid varies enormously. Practically, 1 grain of the anhydrous acid is fatal.
Fatal Period.—From two to five minutes after a large dose, but may be less.
Method of Extraction from the Stomach.—Having previously carefully fitted a watchglass to a wide-mouthed bottle, nearly fill the bottle with the contents of the stomach, blood, secretions, etc. Place a few drops of a solution of nitrate of silver on the concave surface of the watchglass, and cover the mouth of the bottle with it. The vapour of hydrocyanic acid, if present, will form a white precipitate which may be tested. Other watchglasses, treated with sulphide of ammonium or sulphate of iron and liquor potassæ, will give the reactions of the acid with appropriate tests. This method removes all objections as to foreign admixture. If the acid is not at first detected, gentle warming of the bottle in a water-bath will assist the evolution of the vapour. The vapour may be obtained by distillation, but this process is open to objections to which the other is not. In some cases it becomes changed in the body into formic acid, which should therefore be sought for.
Tests.—With nitrate of silver a white precipitate, insoluble in cold, but soluble in boiling, nitric acid. The precipitate heated, evolves cyanogen, having an odour of peach-blossoms, and burning, when lighted, with a pink flame. Liquor potassæ and sulphate of iron give a brownish-green precipitate, which turns to Prussian blue with hydrochloric acid. Liquor potassæ and sulphate of copper give a greenish-white precipitate, becoming white with hydrochloric acid. Sulphide of ammonium gives sulpho-cyanide of ammonium. This develops a blood-red colour with perchloride of iron, bleached by corrosive sublimate.
Aconite (Aconitum Napellus, monkshood).—Root and leaves. Poisonous property depends upon an alkaloid, aconitine. Aconite is one of the constituents of St. Jacob's Oil.
Symptoms.—Numbness and tingling in mouth, throat, and stomach, giddiness, loss of sensation, deafness, dimness of sight, paralysis, first of the lower and then of the upper extremities, vomiting, and shallow respiration. Pupils dilated. Pulse small, irregular, finally imperceptible. The mind remains unaffected. Death often sudden.
Post-Mortem Appearances.—Venous congestion, engorgement of brain and membranes.
Treatment.—Emetics, stimulants freely. Best antidote is sulphate of atropine, 1/50 grain hypodermically, and also strychnine. Digitalis also useful. Warmth to whole body. Patient to make no exertion.
Fatal Dose.—Of root or tincture, 1 drachm.
Fatal Period.—Average, less than four hours.
Method of Extraction from the Stomach, etc.—Extraction from contents of stomach by Stas-Otto process. It may be found in the urine; gives usual alkaloidal reactions, but no distinctive chemical test known.
Tests.—Chiefly physiological; tingling and numbness when applied to tongue or inner surface of cheek. Effects on mice, etc. A cadaveric alkaloid or ptomaine has been found in the body, possessing many of the actions of aconitine. The presence of this substance was suggested in the Lamson trial.
The Indian aconite, Aconitum ferox, the Bish poison, is much more active than the European variety. It contains a large proportion of pseudaconitine, and is frequently employed in India, not only for the destruction of wild beasts, but for criminal purposes.
Aconitine varies much in activity according to its mode of preparation and the source from which it is derived. The most active kind is probably made from A. ferox.
All parts of the plant Digitalis purpurea (purple foxglove) are poisonous. Contains the glucoside digitalin and other active principles.
Symptoms.—Nausea, vomiting, purging, and abdominal pains. Vomited matter grass-green in colour. Headache, giddiness, and loss of sight; pupils dilated, insensitive; pulse weak, remarkably slow and irregular; cold sweat. Salivation occasionally, or syncope and stupor. Death sometimes quite suddenly.
Post-Mortem Appearances.—Congested condition of brain and membranes; inflammation of gastric mucous membrane.
Treatment.—Emetics freely; infusions containing tannin, as coffee, tea, oak-bark, galls, etc. Stimulants. Hypodermic injection of 1/120 grain of aconitine.
Method of Extraction from the Stomach, etc.—Use Stas-Otto process.
Tests for Digitalin.—A white substance, sparingly soluble in water, not changed by nitric acid; turns yellow, changing to green, with hydrochloric acid. The minutest trace of digitalin moistened with sulphuric and treated with bromine vapour gives a rose colour, turning to mauve. This is very delicate, but in experienced hands the physiological test is more reliable. The chemist who has had no practical experience in pharmacological methods would be wiser to keep to his chemical tests.
Nux Vomica consists of the seeds of the Strychnos nux vomica. From these strychnine and brucine are obtained. The symptoms, post-mortem appearances, and treatment, of poisoning by nux vomica are the same as for strychnine.
Strychnine is a powerful poison, and forms the active ingredient of many 'vermin-killers.' It occurs as a white powder or as colourless crystals, with a persistent bitter taste; very slightly soluble in water; more or less soluble in benzol, ether, and alcohol.
Symptoms.—Sense of suffocation, twitchings of muscles, followed by tetanic convulsions and opisthotonos, each lasting half to two minutes. Mental faculties unaffected, face congested and anxious; eyes staring, lips livid; much thirst. The period of accession of the symptoms varies with the mode of administration of the poison. Symptoms, as a rule, come on soon after food has been taken. Patient may die within a few hours from asphyxia or from exhaustion.
In Tetanus there is usually history of a wound; the symptoms come on slowly; lockjaw is an early symptom, and only later complete convulsions; the intervals between the fits are never entirely free from rigidity. Death is delayed for some days.
Post-Mortem Appearances.—Heart empty, blood fluid, rigor mortis persistent. Hands usually clenched; feet arched and inverted. Congestion of brain, spinal cord, and lungs.
Treatment.—Emetics or stomach-pump if the patient is deeply anæsthetized. Tannic acid and permanganate of potassium. Bromide of potassium 1/2 ounce with chloral 30 grains, repeated if necessary.
Fatal Dose (Smallest).—Quarter of a grain.
Fatal Period (Shortest).—Ten minutes; usually two to four hours.
Method of Extraction from the Stomach.—The alkaloid may be separated by the process of Stas-Otto.
Tests.—Strychnine has a characteristic, very bitter taste; it imparts this taste to even very dilute solutions; it is unaffected by sulphuric acid, but gives a purple-blue colour, changing to crimson and light red, when the edge of this solution is touched with dioxide of manganese, potassium bichromate, ferricyanide of potassium, or permanganate of potassium. This test is so delicate as to show the 1/25000 of a grain of the alkaloid. A very minute quantity (1/5000 grain) in solution placed on the skin of a frog after drying causes tetanic convulsions.
Brucine.—This alkaloid, found associated with strychnine, possesses the same properties, though in a less powerful degree. Nitric acid gives a blood-red colour, changed to purple with protochloride of tin.
Cantharides.—Spanish fly, or blistering beetle, is the basis of most of the blistering preparations. It is sometimes taken as an abortifacient or given as an aphrodisiac, but whether it has any such action is open to question. It acts as an irritant to the kidneys and bladder, and sometimes produces haæmaturia and a good deal of temporary discomfort.
Symptoms.—Burning sensation in the throat and stomach, with salivation, pain and difficulty in swallowing. Vomiting of mucus mixed with blood. Tenesmus, diarrhœa, the motions containing blood and mucus. Dysuria, with passage of small amounts of albuminous and bloody urine. Peritonitis, high temperature, quick pulse, headache, loss of sensibility, and convulsions.
Post-Mortem.—Gastro-intestinal mucous membrane inflamed, with gangrenous patches. Genito-urinary tract inflamed. Acute nephritis.
Treatment.—An emetic of apomorphine; demulcent drinks, such as barley-water, white of egg and water, linseed-tea and gruel (but not oils), with a hypodermic injection of morphine to allay pain.
Tests.—The vomited matter often contains shining particles of the powder. The urine will probably be albuminous.
Emmenagogues are remedies which have the property of exciting the catamenial flow; ecbolics, or abortives, are drugs which excite contraction of the uterus, and are supposed to have the power of expelling its contents. The vegetable substances commonly reputed to be abortives are ergot, savin, aloes (Hierapicra), digitalis, colocynth, pennyroyal, and nutmeg; but there is no evidence to show that any drug possesses this property. Lead in some parts of the country is a popular abortifacient. A medicine may be an emmenagogue without being an ecbolic. Permanganate of potassium and binoxide of manganese are valuable remedies for amenorrhœa, but will not produce abortion. The vegetable substances frequently used as abortives are savin and ergot.
Savin (Juniperus Sabina).—Leaves and tops of the plant yield an acrid oil having poisonous properties, and which has even produced death.
Symptoms.—Those of irritant poisons. Purging not always present, but tenesmus and strangury.
Post-Mortem Appearances.—Acute inflammation of alimentary canal. Green powder found. This, washed and dried and then rubbed, gives odour of savin.
Test.—A watery solution of savin strikes deep green with perchloride of iron, and if an infusion of the twigs has been taken the twigs may be detected with the microscope. The twigs obtained from the stomach, dried and rubbed between the finger and thumb, will give the odour of savin.
Ergot (Secale Cornutum).—A parasitic fungus attacking wheat, barley, oats, and rye, which is reputed to have the power of causing contraction of unstriped muscular fibre, especially that of the uterus.
Symptoms.—Lassitude, headache, nausea, diarrhœa, anuria, convulsions, coma. Small quantities frequently repeated have in the past produced gangrene of the extremities, or anæsthesia of fingers and toes.
Tests.—Lake-red colour with liquor potassæ; this liquid filtered gives a precipitate of same colour with nitric acid.