It is strange that a plant, so universally considered a potent poison, and so frequently the cause of fatal accidents, has not yet been made the subject of physiological investigation. A few imperfect experiments by M. Cormerais and his companion, made with the resinoid matter of the roots, show that this substance produces in animals dulness, convulsions of the voluntary muscles, a semi-paralytic state of the hind legs, and sometimes shortness of breath, vomiting, and fluid evacuations by stool. All the animals experimented on recovered. On repeating these experiments with larger quantities I found the resin of the root, grown near Woolwich, and kindly sent to me by Dr. Pereira, to be a poison of great energy and singular properties. Twenty-four grains obtained from eight ounces of roots in the middle of December, when introduced in the form of emulsion between the skin and muscles of the rabbit, caused in half an hour depression, uneasiness, and hurried breathing,—then twitches of the ears, neck, and fore-legs,—next combined spasm and convulsive starting of the head and limbs,—then, after a quiet interval, a more violent fit of the same kind, affecting the whole body with a singular combination of tetanus and convulsive starting,—finally, after several such fits, a paroxysm more violent than before, ending in immoveable tetanic rigidity, which speedily proved fatal, 78 minutes after the application of the poison. No morbid appearance could be detected in the body. The heart contracted vigorously for some time after death. These phenomena correspond in the main with what has been recorded of the symptoms caused by the roots in man.—Dr. Pereira informs me he had found the juice both of the root and leaves to act as a poison, either when introduced into the peritonæum, or when injected into the veins; and in the latter way it was so energetic as to prove fatal in one minute.
Symptoms in Man.—Since Lobel first took notice of the poisonous properties of the œnanthe root in 1570, an uninterrupted series of observations has been published, down to the present day, showing that in France, Germany, Holland, Spain, and various parts of England as far north as Liverpool, it is at all seasons of the year, even in October and in the beginning of January, a poison of great activity. In several of the cases death has been occasioned by a single handful of the roots, in one instance by a piece no bigger than the finger, or even in consequence of the individuals merely tasting them. A girl seems to have had a narrow escape after eating, with an interval of three hours, two pieces of the size of a walnut. Very seldom has death been delayed beyond four hours, and on some occasions a single hour has been sufficient. Sometimes the symptoms have been slow in making their appearance, an hour and a half having occasionally elapsed before the effects were evident; but in every instance their progress was rapid, once the symptoms had fairly set in; and some died in convulsions almost immediately after being taken ill.
The particular effects have been variable. Most generally the first symptoms have been giddiness and staggering, as if from ordinary intoxication, occasionally headache, and often extreme feebleness of the limbs. Stupor has then generally succeeded, sometimes with the intervention of efforts to vomit, sometimes too with an interval of delirium. Convulsions have also commonly made their appearance in the next place; and ere long a state of insensibility has ensued attended in every instance with occasional violent convulsive fits like epilepsy, and with permanent locked-jaw; which symptoms have continued till near death. In one or two cases the individual has suddenly, without any premonitory symptoms, fallen down convulsed, and died almost immediately. In one or two instances again, the effects have rather been those of irritant poisoning, namely, inflammation of the mouth and throat, spasms of the muscles of the throat, vomiting, and excessive weakness and faintness, without any convulsions or insensibility.—It appears then that this plant is a true narcotico-acrid poison. The emanations from the plant are said on some occasions to have proved injurious; but the effect here was probably the work of the imagination.
Aware of these singular properties being generally ascribed to the Œnanthe crocata, I was anxious to make a methodical examination of the subject, physiologically as well as chemically,—especially as the plant grows in great abundance and very luxuriantly in a locality not far from Edinburgh. But I have found it in that situation, to all appearance, quite inert. The juice of fourteen ounces of the root in the end of October had no effect on a little dog when secured in the stomach by a ligature on the gullet. The juice of sixteen ounces in the middle of June was also without effect. An alcoholic extract of four ounces of the full grown leaves in the end of June, introduced into the cellular tissue in the form of emulsion, had no effect on a rabbit. An alcoholic extract of three ounces of the ripe seeds was administered in the same way with the same result. Finally, the resinoid extract of eight ounces of the root, analogous to that which had proved so deadly in my hands when obtained from Woolwich plants, had also no effect whatever, when prepared from those growing in the neighbourhood of Edinburgh. Relying upon these results, I ate a whole tuber weighing an ounce, without observing any effect, except its disagreeable taste; which was the only circumstance that prevented me from trying a larger quantity.—It may be well to add, that, amidst the numerous cases of poisoning with œnanthe now on record, there is not one that has occurred in Scotland. At the same time, the common people in Scotland are not at all given to rash experiments in cookery, or to make use of vegetables not produced by the care of the gardener or farmer.[2241]
The only other locality from which I have been hitherto able to obtain plants for examination is the neighbourhood of Liverpool, where a fatal case of poisoning with it occurred near the close of last century. When the juice of sixteen ounces of this root in the beginning of September was secured in the stomach of a dog, efforts to vomit were produced, followed by several fits of violent convulsions and spasm of the voluntary muscles, a paralytic state of the fore-legs, and a constant tendency to fall backwards; but the animal recovered.
No morbid appearances of any note have been observed after death in any of the fatal cases which are recorded.—The most appropriate treatment consists in the prompt employment of emetics, and diffusible stimulants.
Another umbelliferous plant of great activity is fool’s parsley, or Æthusa cynapium. It has occasioned several accidents by reason of its resemblance to parsley,—from which, however, it is at once distinguished by the leaves being dark and glistening on their lower surface, and by the nauseous smell they emit when rubbed. It contains an alkaloid, which crystallizes in rhombic prisms, and is soluble in water and alcohol, but not in ether. It was discovered by Professor Ficinus of Dresden.[2242]
Orfila found that six ounces of the juice, when retained in the stomach of a dog, by a ligature, caused convulsions and stupor, and death in an hour.[2243]
Symptoms in Man.—Some interesting information on the characters and properties of this plant is contained in the Medical and Physical Journal. Among other cases the writer relates those of two ladies who ate a little of it in a sallad instead of parsley, and who were soon seized with nausea, vomiting, headache, giddiness, somnolency, pungent heat in the mouth, throat, and stomach, difficulty in swallowing and numbness of the limbs.[2244] Gmelin has related the case of a child, who died in eight hours in consequence of having eaten the æthusa. The symptoms were spasmodic pain in the stomach, swelling of the belly, lividity of the skin, and difficult breathing.[2245] In two children who recovered, the chief symptoms at the height of the poisoning were complete insensibility, dilated, insensible pupil, and staring of the eyes. In one of them there was also frequent vomiting, in the other convulsions. The treatment consisted in the administration of milk, sinapisms to the legs, and cold spunging with vinegar.[2246]
The greater part of the poisons belonging to the Natural Family Ranunculaceæ are acrid only in their action, and have been already taken notice of among the irritants. Two only are yet known to possess narcotic properties, namely, monkshood, and black hellebore. The latter is a true narcotico-acrid. The former has till lately been always considered so; but its acrid properties seem doubtful or feeble, while its action on the nervous system is most intense.
Monkshood, the Aconitum napellus of botanists, is an active poison, and has commonly been considered a true narcotico-acrid. But its effects have been hitherto much misunderstood. It has been used for criminal purposes in Ireland; and in 1841, a woman, M’Conkey, who was executed there for poisoning her husband, was proved to have administered this substance [see p. 61]. The root of another species, the A. ferox, is well known to be in common use as a poison, under the name of Bikh, in Bengal, and Nabee, in the Madras Presidency.
The toxicological history of the genus, and of this species in particular, has been rendered complex and obscure, by the extreme difficulty of distinguishing accurately the several species from one another. The whole genus, now a numerous one, is generally conceived to be eminently poisonous. But from some observations of my own, as well as an elaborate inquiry, not yet made public, by Dr. Alexander Fleming,[2247] a recent graduate of this university, I am inclined to think that this is a mistake, that the poisonous species are not numerous, and that many aconites are inert, at least in this climate.
The A. napellus, a doubtful native of Britain, and the most common species in our gardens, shoots up annually a leafy stem from a black, tapering, spindle-shaped root. The stem, which is from two to five feet high, ends in a long dense spike of fine blue flowers; and when the seeds ripen in autumn, it dies down, and the root also shrivels and perishes. But in the spring, while the stem is rising, one or more tubers form near the crown of the root; each tuber quickly assumes the spindle-shaped form of its parent, but has a light brown, instead of a brownish-black tegument; and when the plant is in flower, the new tuber, destined for the root of next year’s plant, is as large as the parent one, firmer, more amylaceous, and not so apt to shrivel in drying. This mode of propagation has led some to describe the root erroneously as sometimes palmated. Dr. Fleming considers the young, full-grown tuber to be the most active part of the plant; but the root of the existing plant, the leaves, and also the seeds, are highly energetic; and every part is more or less so.
Every part of the A. napellus, but especially the root, affects remarkably the organs of taste, producing a very singular sense of heat, numbness, and tingling of those parts of the mouth to which it is applied. Dr. Fleming has ascertained, that this peculiar taste, or rather sensation, is a property belonging to the narcotic principle of monkshood, and that in all probability it is a measure of the activity of the plant as a poison. It is most intense in the root, next in the seeds, and next in the leaves before the flowers blow. Geiger first ascertained, and I have since observed, that the sensation thus occasioned by the leaves diminishes in intensity as the flowers expand, and almost disappears when the seeds ripen. Contrary to what has been often stated, it is not diminished by drying the leaves, even with the heat of the vapour-bath. Nor is it materially lessened by time, if the dried leaves be preserved with care; for I have found it intense after six years. Geiger observed some years ago, that several species or varieties do not possess it. I have ascertained that A. napellus, sinense, tauricum, uncinatum, and ferox, possess it intensely, A. schleicheri and nasutum feebly, A. neomontanum very feebly; all of which are therefore probably poisonous, in proportion to the intensity of their taste. A. ferox, well known as a deadly poison in the East, and undoubtedly the most virulent of all the species, produces by far the most intense and persistent effect on the mouth of all the species I have had an opportunity of examining. Those which do not produce it at all, at least in this climate, are A. paniculatum, lasiostomum, vulparia, variegatum, nitidum, pyrenaïcum, and ochroleucum. It would be premature to say that all these species are inert; but I suspect they are: and, at all events, I have ascertained that the leaves of A. paniculatum, although the officinal species recognised in the London Pharmacopœia, are quite inactive in this climate; and Dr. Fleming has found the root inert in medicinal doses of considerable magnitude.
The properties of monkshood have been traced by Geiger and Hesse to a peculiar alkaloid, named aconitina: which is white, pulverulent, fusible, not volatile, soluble in ether and alcohol, sparingly so in water, and capable of forming crystallizable salts with acids. It produces most intensely the peculiar impression caused by the plant on the mouth, tongue, and lips; and it is a poison of tremendous activity, probably indeed the most subtle of all known poisons. Although not a volatile principle, it has been supposed peculiarly liable to decomposition by heat, at least in its natural state of combination in the plant or its pharmaceutic preparations. This opinion is founded on the uncertainty of the medicinal action of the common extract of the shops, and on the results of experiments on animals by Orfila.[2248] In one experiment he found that half an ounce of the extract of the Parisian shops had no effect at all on a dog, while a quarter of an ounce killed another within two hours. Careless preparation may account for such differences; but at the same time an error in choosing the species of plant is an equally probable explanation. The properties of monkshood appear to me to resist a heat of 212°, either in drying the plant or in preparing an extract from it.
The medico-legal chemistry of monkshood has not been studied. If any of the suspected matter be obtained in a pure state, its best character is its remarkable taste; to which I have found nothing exactly similar in the numerous trials I have made with other narcotic and acrid plants. A complex substance, such as the contents of the stomach, or vomited matter, should be evaporated over the vapour-bath to the consistence of thin syrup, and agitated with absolute alcohol. The filtered alcoholic solution being then evaporated, the extract may be subjected to the sense of taste.
Action.—The action of monkshood is a subject of great interest, but has hitherto been much misunderstood. Sir B. Brodie, who was the first to examine it in recent times, found that the leading phenomena in animals, were staggering, excessive weakness, slow laborious respiration, and slight convulsive twitches before death.[2249] Had these observations been followed up by his successors with a discriminating eye, toxicologists would not have been so much misled as they have been. Orfila, who was the next to examine the subject experimentally, failed to appreciate the phenomena with exactness.[2250] He thinks monkshood acts peculiarly upon the brain, causing delirium, and that it is a local irritant, capable of developing more or less intense inflammation. A single experiment made in 1836 convinced me that the former statement is incorrect, and led me to consider that the symptoms depend in a great measure on gradually-increasing paralysis of the muscles, which terminates in immobility of the chest and diaphragm, and consequent asphyxia. Dr. Pereira, in some experiments with an alcoholic extract, published in 1842, took notice of two remarkable phenomena,—an extraordinary diminution of common sensation, evidenced by the animal being insensible to pinching and pricking,—and the total absence of stupor, as shown by the animal following its owner, and recognizing him when called.[2251] Similar observations have been made in poisoning with monkshood in man. The ablest investigation yet undertaken into the actions of this substance is contained in the unpublished Inaugural Dissertation of Dr. Fleming.
He found that the most remarkable symptoms are weakness and staggering, gradually increasing paralysis of the voluntary muscles, slowly increasing insensibility of the surface, more or less blindness, great languor of the pulse, and convulsive twitches before death. He farther observed that the pupil becomes much contracted; that the irritability of the voluntary muscles is impaired; that the veins are congested after death, the blood unaltered, and the heart capable of contracting for some time after respiration has ceased. Lastly, he maintains that this poison has not, as is generally thought, any irritant properties, that neither the plant, nor its extract, nor its alkaloid occasions vascularity in any membrane to which it is applied, even, for example, in the lips or tongue while burning and tingling from its topical action; that this peculiar effect is therefore merely a nervous phenomenon; and that he never could observe either the diffuse cellular inflammation described by Orfila to arise from the application of monkshood to a wound, or the inflammatory redness of the alimentary canal noticed by others as one of its effects when swallowed.
Orfila ascertained that monkshood exerts its action through the medium of the blood; for its effects are greater when it is introduced into a wound, than when it is swallowed, and they are still greater when it is injected directly into a vein. It is a poison of very great activity. I have found that thirty grains of an alcoholic extract, the produce of three-quarters of an ounce of fresh leaves, will kill a rabbit in two hours and a quarter, if introduced between the skin and muscles of the back. Five drachms of the root in one of Orfila’s experiments with the dog, occasioned death in twenty-one minutes, when swallowed.
The alkaloid, aconitina, seems to produce in animals precisely the same effects as the plant or its extract. Orfila and Dr. Pereira agree in this; and my own observation, limited to a single experiment, is to the same effect. It is probably the most subtile of all known poisons. Dr. Pereira mentions that the fiftieth part of a grain has endangered life when used medicinally.[2252] In my experiment the tenth of a grain, introduced in the form of hydrochlorate into the cellular tissue of a rabbit, killed it in twelve minutes.
Symptoms in Man.—A perplexing discrepance exists in the accounts that have been published of the effects of monkshood on man; which seems to have arisen, less from any actual contrariety in the phenomena, than from loose observation, or a misunderstanding of the facts; for most of the recent statements of competent observers are consistent with one another.
Dr. Fleming says that in medicinal doses it occasions warmth in the stomach, nausea, numbness and tingling in the lips and cheeks, extending more or less over the rest of the body, diminution in the force and frequency of the pulse, which sometimes sinks to 40 in the minute, great muscular weakness, confusion of sight or absolute blindness; and if the dose be unduly large, there is a sense of impending death, sometimes slight delirium, and a want of power to execute what the will directs, but without any loss of consciousness. The warmth which is excited is unattended with any elevation of temperature, vascularity of the skin, or acceleration of the pulse. No true hypnotic effect is produced; but by inducing serenity, or deadening pain, it may predispose to sleep. The highest degree of these effects is not unattended with danger.
When it is administered in doses adequate to occasion death, it seems in general to operate by inducing extreme depression of the circulation. Dr. Fleming recognizes two other modes of death in animals,—first, by an overwhelming depression of the nervous system, proving fatal in a few seconds, without arresting the action of the heart,—and secondly, by asphyxia, or arrestment of the respiration, the result of paralysis gradually pervading the whole muscular system, respiratory, as well as voluntary. But these effects, he thinks, cannot be recognized in the cases which have been published of poisoning in man, because the dose required to produce either of them is very large. The least variable symptoms in the human subject are, first, numbness, burning, and tingling in the mouth, throat, and stomach,—then sickness, vomiting, and pain in the epigastrium,—next, general numbness, prickling, and impaired sensibility of the skin, impaired or annihilated vision, deafness, and vertigo,—also frothing at the mouth, constriction at the throat, false sensations of weight or enlargement in various parts of the body,—great muscular feebleness and tremor, loss of voice, and laborious breathing,—distressing sense of sinking and impending death,—a small, feeble, irregular, gradually-vanishing pulse,—cold, clammy sweat and pale bloodless features,—together with perfect possession of the mental faculties, and no tendency to stupor or drowsiness,—finally, sudden death at last, as from hemorrhage, and generally in a period varying from an hour and a half to eight hours. The symptoms may begin in a few minutes, as in a case observed by Dr. Fleming, which was occasioned by the tincture of the root; or they may be postponed for three-quarters of an hour, as in an instance recorded by Dr. Pereira,[2253] which arose from the root being used by mistake for horse-radish. Two or three drachms of the root are sufficient to kill a man; and Dr. Fleming mentions one instance where two grains of the alcoholic extract occasioned alarming effects, and another where four grains proved fatal. I may observe, however, that I have given six grains of a carefully prepared alcoholic extract (the same of which thirty grains killed a rabbit in little more than two hours), to a female suffering from rheumatism, without being able to observe any effect whatsoever.
If all the reports of cases now on record are to be trusted, the following anomalies have occurred. Some persons are said to have presented convulsions. Slight spasmodic twitches of the muscles are not uncommon, and probably depend, as Dr. Fleming suggests, on venous congestion, the result of incomplete asphyxia. Stupor and even apoplectic insensibility are also sometimes represented to have been observed. If really ever present, they must depend on the same cause; but there is reason to apprehend, that extreme nervous depression and faintness have been mistaken for stupor and coma. Delirium of the frantic kind, mentioned by some of the older authors, is justly considered by Dr. Fleming to be of doubtful occurrence, as it has never been observed in recent times. Irritation in the alimentary canal is distinctly mentioned as indicated by prominent symptoms, even in some cases observed but a few years ago, and apparently with care. Dr. Fleming properly objects to nausea, vomiting, or pain in the epigastrium as evidence of irritation in the stomach; for these symptoms may all depend on the same local nervous impression which is produced on the organs of taste. And he denies that purging is ever produced in any genuine case of poisoning with monkshood. The following, however, seem unequivocal examples of irritation in the alimentary canal. M. Pallas[2254] mentions, that three out of five persons, who took a spirituous infusion of the root by mistake for lovage [Ligusticum levisticum], died in two hours with burning in the throat, vomiting, colic, swelling of the belly and purging. A similar set of cases is described by M. Degland.[2255] Four persons took the tincture of the root by mistake for tincture of lovage; and three of them were seized with burning pain from the throat to the stomach, a sense of enlargement of the tongue and face, colic, tenderness of the belly, vomiting, and purging. One of these, who ultimately recovered, had frantic delirium for some time after the other symptoms went off. The two others died, one in two hours, the other half an hour later. Dr. Pereira[2256] and Dr. Fleming doubt the authenticity of these cases; and it may be, that such unusual symptoms may have arisen either from some other root mistaken by the narrators for monkshood, or from irritant substances given along with or after it. At the same time I may mention, that in the first trials I made with monkshood as a medicine, using a carefully prepared extract of the root, I was deterred from proceeding by two patients being attacked with severe vomiting, griping, and diarrhœa.
It may be well to conclude these general statements by the particulars of a few well authenticated cases. Dr. Pereira describes two that were occasioned by the root having been dug up in February by mistake for horse-radish.[2257] The parties, a gentleman and his wife, ate, the former about a root and a half, the latter not much more than half a root. Both of them in three-quarters of an hour had burning, and numbness in the lips, mouth, and throat, extending to the stomach and followed by vomiting. The husband had subsequently violent and frequent vomiting, partly owing to an emetic. His extremities became cold, the lips blue, the eyes glaring, and the head covered with cold sweat. There was no spasm or convulsion, but some tremor. He had no delirium, or stupor, or loss of consciousness, but complained of violent headache. The respiration was not affected; and although he felt very weak, he was able to walk with a little assistance only a few minutes before death; which took place, as if from fainting, about four hours after the poison was swallowed.—His wife, in addition to the early symptoms already mentioned, had such weakness and stiffness of the limbs that she was unable to stand; and she could utter only unintelligible sounds; but she had no spasms or convulsions. She experienced a strange sensation of numbness in the hands, arms, and legs, diminution of sensibility over the whole integuments, especially of the face and throat, where the sense of touch was almost extinguished. She had also some dimness of vision, giddiness, and at times an approach to loss of consciousness, but no delirium, sleepiness, or deafness. She recovered, under the use of emetics, laxatives, and stimulants. In neither of these cases was there any diarrhœa.—A patient of Mr. Sherwen,[2258] five minutes after taking a tincture of the root, suffered from the same incipient symptoms as above, but without actual vomiting. The face seemed to her to swell, and the throat to contract; she became nearly blind, and excessively feeble, but did not lose her consciousness. The eyes were fixed and protruded, and the pupils contracted, the jaws stiff, the face livid, the whole body cold, the pulse imperceptible, the heart’s action feeble and fluttering, and the breathing short and laborious. An emetic was followed first by violent convulsions, and then by vomiting; after which she slowly recovered. At all times she was so sensible as to be able to tell how the accident happened.—Dr. Ballardini of Brescia met with twelve simultaneous cases of poisoning with the juice of the leaves, used by mistake for scurvy-grass [Cochlearia officinalis]. Each person had three ounces of juice. Three of them died in two hours; but the rest were saved. The chief symptoms were extreme weakness and anxiety, paleness and distortion of the features, dilatation of the pupils, dulness of the eyes, giddiness, headache, chiefly occipital, some distension and pain of the belly, vomiting of a green matter, and in some diarrhœa. The whole body was cold, the nails livid, the limbs cramped, the pulse small and scarcely perceptible. In the fatal cases there were convulsions.[2259]—MM. Pereyra and Perrin mention, that, while using the alcoholic extract in the Hospital of St. André at Bordeaux, the sample of the drug happened to be changed when the dose had been raised so high as ten grains; and that the patients who were taking it were then all seized with burning in the mouth and throat, vomiting, pungent pains in the extremities, cold sweating, anxiety, extreme general prostration, great slowness and irregularity of the pulse, convulsions, and congestion in the venous system. One patient died; the others recovered under no other treatment than stimulant friction along the spine.[2260] An infant at Suippe, in the French Department of the Marne, ate a few leaves and flowers of monkshood, while walking in a garden. Soon afterwards he began to stagger as if tipsy, and to complain of pain in the belly. In two hours an emetic was given; but a few minutes afterwards, the eyes became convulsed, the jaws locked, the trunk bent rigidly backward, and the limbs convulsed; and death ensued in five minutes more.[2261]
Morbid Appearances.—In Ballardini’s fatal cases the pia mater and arachnoid were much injected; there was much serosity under the arachnoid and in the base of the cranium; the lungs were considerably gorged with blood; the heart and great vessels contained but a little black fluid blood: the villous coat of the stomach was spotted with red points; and the small intestines presented inwardly red patches and much mucus. In the Bordeaux case there was venous congestion in the head and chest, the lungs particularly being much gorged with blood. The right side of the heart was full of blood, of gelatinous consistence. In Pallas’s cases the gullet, stomach, small intestines and rectum were very red, the lungs dense, dark, and gorged, and the cerebral vessels turgid.
Few trustworthy observations have been made on the effects of the other species of aconite. Dr. Pereira found the A. ferox of the East Indies to be a much more deadly poison to animals than common monkshood; but its effects were otherwise identical.[2262] Three grains of the root put into the throat of a rabbit, killed it in nineteen minutes; one grain of the alcoholic extract, introduced into the peritonæum, proved equally deadly. Nine grains will kill a cat in four hours.[2263]——Of the other aconites the A. cammarum, and A. lycoctonum are said to have proved fatal frequently in Germany; but no accurate facts on the subject are on record.—It was stated above that the A. paniculatum, supposed by De Candolle to have been the true aconite of Baron Störck, is inert in this country. I introduced the alcoholic extract of three ounces of the fresh leaves collected near the end of June, into the cellular tissue between the skin and muscles of a young rabbit, having previously converted the extract into an emulsion with mucilage and water. This was four times the dose of A. napellus, which I had found sufficient to kill a strong adult rabbit in two hours and a quarter; but no effect whatever was produced.—Mr. Ramsay of Broughty Ferry has described a case of fatal poisoning with a handful of aconite leaves which were mistaken for parsley, and which he supposes to have been those of A. neomontanum. The subject, a boy of fourteen, was attacked with a sense of burning in the mouth, throat, and stomach, afterwards with vomiting and convulsions, and died considerably within five hours.[2264] The very feeble taste of this species—which besides is little cultivated in Scotland,—inclines me to doubt whether it was the species that produced such violent effects.
Black hellebore, or Christmas-rose, the Helleborus niger of botanists, is a true narcotico-acrid poison. It is a doubtful native of this country. It produces a large white ranunculus-like flower about midwinter. The root, the only part used in medicine, or to be found in the shops, consists of a short root-stock and numerous, long, black undivided rootlets. The fresh root in January is not acrid to the taste. Its active principle appears from the researches of MM. Feneulle and Capron, to be an oily matter containing an acid.[2265]
Its action has not yet been examined with particular care. Two or three drachms of the root killed a dog in eighteen hours, when swallowed; two drachms killed another in two hours, when applied to a wound; and six grains in a wound caused death in twenty-three hours. In all cases the leading symptoms are efforts to vomit, giddiness, palsy of the hind-legs, and insensibility.[2266] Ten grains of the extract introduced into the windpipe killed a rabbit in six minutes.[2267] Orfila found redness of the rectum, when the animals survived a few hours. But none of these experiments show the powerful irritant action exerted by the root upon man.
The Bulletins of the Medical Society of Emulation mention two cases of poisoning with hellebore, which arose from the ignorance of a quack doctor. Both persons, after taking a decoction of the root, were seized in forty-five minutes with vomiting, then with delirium, and afterwards with violent convulsions. One died in two hours and a half, the other in less than two hours.[2268] Morgagni has related a case which proved fatal in about sixteen hours, the leading symptoms of which were pain in the stomach, and vomiting. The dose in this instance was only half a drachm of the extract.[2269] In a case not fatal, related by Dr. Fahrenhorst, the symptoms were those of irritant poisoning generally, that is, burning pain in the stomach and throat, violent vomiting, to the extent of sixty times in the first two hours, cramps of the limbs, and cold sweating. The most material symptoms were at this time quickly subdued by sinapisms to the belly and anodyne demulcents given internally; and in four days the patient was well. The dose here was a table-spoonful of the root in fine powder.[2270] In small doses of ten or twenty grains, it is well known to be a powerful purgative to man. I have known severe griping produced by merely tasting the fresh root in January.
The morbid appearances in Morgagni’s case were the signs of inflammation in the digestive canal, particularly in the great intestines. In the case described in the French Bulletins, there was gorging of the lungs, and the stomach had a brownish-black colour as if gangrenous.
The other species of hellebore have not been carefully examined; but it is probable that they all possess similar properties. The H. hyemalis and viridis are said by Buchner to be weaker than the H. niger; and the H. fœtidus is the most poisonous of all.[2271]
The natural family Liliaceæ, and the allied family, Melanthaceæ, contain many species which possess narcotico-acrid properties. Those which are best known in Europe are squill, meadow-saffron, cevadilla, and white hellebore. To these may be added foxglove, as possessing properties in some measure analogous, and also rue and ipecacuan.
The root of the squill, or Squilla maritima, possesses the properties of the narcotico-acrids. Orfila’s experiments on animals, indeed, assign to it only an action on the nervous system. He found that two ounces and a half of the fresh root, when secured in the stomach of a dog by a ligature on the gullet, excited efforts to vomit, dilated pupil, and lethargy; and in two hours the animal suddenly fell down in a violent fit of tetanus, and expired. From thirty-six grains injected into the jugular vein no effect followed for sixteen hours; when at last, as in the former case, the animal dropped down convulsed and died immediately.[2272]
The effects, however, caused by squill on man leave no doubt that it is also an active irritant; for it causes sickness, vomiting, diarrhœa, gripes, and bloody urine, when given in over-doses. It has likewise produced narcotic symptoms in man. Lange mentions an instance of a woman, who died from taking a spoonful of the root in powder to cure tympanitis. She was immediately seized with violent pain in the stomach; and in a short time expired in convulsions. The stomach was found every where inflamed, and in some parts eroded.[2273]—A woman, whose case is mentioned in a French journal, after taking from a female quack a vinous tincture made with seventy-five grains of extract of squill, was seized with nausea and severe colic, to which were added in twenty-four hours a small contracted pulse, extreme tenderness of the belly, and cold extremities; and she died in the course of the second day.[2274] Twenty-four grains of the powder have proved fatal.[2275] I have seen a quarter of an ounce of the syrup of squills, which is a common medicinal dose, cause severe vomiting, purging, and pain.
An acrid principle, named scillitin, has been discovered in the squill. A difference of opinion prevails as to its nature. Some chemists consider it to be a resin; but Landerer has obtained it in the crystalline form, with alkaline properties. A grain of it will kill a dog.
White hellebore, the root-stock of Veratrum album, and cevadilla, the seed and capsules of Asagræa officinalis, and possibly of Veratrum sabadilla, seem to be characteristic examples of the narcotico-acrid poisons. They both possess a strong bitter taste, followed by acridity. The cevadilla-seed in particular has an intensely disagreeable and persistent bitter taste, and produces at the same time a combination of acridity and numbness of the lips, tongue, and cheeks. They owe their active properties chiefly to an alkaloid of great energy, termed veratria.
White hellebore root is familiarly known to be a virulent poison. The best account of its effects is contained in a Thesis by Dr. Schabel, published at Tübingen in 1817. Collecting together the experiments previously made by Wepfer, Courten, Viborg, and Orfila, and adding a number of excellent experiments of his own, he infers that it is poisonous to animals of all classes,—horses, dogs, cats, rabbits, jackdaws, starlings, frogs, snails, and flies;—that it acts in whatever way it is introduced into the system,—by the stomach, rectum, windpipe, nostrils, pleural membrane of the chest, an external wound, or the veins;—that it produces in every instance symptoms of irritation in the alimentary canal, and injury of the nervous system;—and that it is very active, three grains of the extract applied to the nostrils of a cat having killed it in sixteen hours.[2276]
Symptoms in Man.—Its effects on man are similar. A singular account of several cases of poisoning with the root is contained in Rust’s Journal. A family of eight people, in consequence of eating bread for a whole week, in which the powder of the root had been introduced by mistake instead of cumin seeds, were attacked with pains in the belly, a sensation as if the whole intestines were wound up into a clue, swelling of the tongue, soreness of the mouth, and giddiness; but they all recovered by changing the bread and taking gentle laxatives.[2277]
Another set of cases of a more aggravated nature, though still not fatal, is given in Horn’s Archives.[2278] Three people took the root by mistake for galanga. The symptoms that ensued were characteristic of its double action. In an hour they all had burning in the throat, gullet, and stomach, followed by nausea, dysuria, and vomiting; weakness and stiffness of the limbs; giddiness, blindness, and dilated pupil; great faintness, convulsive breathing, and small pulse. One of them, an elderly woman, who took the largest share, had an imperceptible pulse, stertorous breathing, and total insensibility even to ammonia held under the nose. Next day she continued lethargic, complained of headache, and had an eruption like flea-bites. A fatal case is quoted by Bernt from Schuster’s Medical Journal. A man took twice as much as could be held on the point of a knife, was attacked with violent and incessant vomiting, and lived only from morning till night. The gullet, stomach, and colon were here and there inflamed.[2279]
No detailed inquiry has yet been made respecting the properties of cevadilla; but there can be no doubt that it will prove an energetic poison, similar in its effects to white hellebore, and probably more active. Wibmer quotes Villemet for the fact, that half a drachm of the seeds excites vomiting and convulsions in the cat and dog, and Lentin for the case of a child, who died in convulsions in consequence of the powder having been used inwardly and outwardly.[2280]
The alkaloid, veratria, has been made the subject of experiment by various physiologists. The most complete investigation yet undertaken is that of Dr. Esche;[2281] who found that it causes in a few minutes restlessness, anxiety, salivation, slowness and irregularity of the pulse, slow respiration, nausea, violent vomiting, borborygmus, spasms of the abdominal muscles and brisk purging of watery mucus, often tinged with blood;—that by and by the muscles become extremely feeble, so that the animal cannot support itself;—that coldness of the surface succeeds, together with spasmodic contractions of the throat, face, and extremities, but without any stupor;—and that finally the respiration and pulse gradually become extinguished, extreme prostration ensues, and death takes place in a fit of tetanic spasm. No particular morbid appearance was found in the dead body, and especially no sign of inflammation. Magendie found, that one grain in the form of acetate killed a dog in a few seconds when injected into the jugular vein, and in nine minutes when injected into the peritonæum; and that the principal symptom in such rapid cases was tetanic spasm.
The Colchicum autumnale, meadow-saffron, or autumn-crocus, is a more familiar poison in this country than white hellebore, and seems to possess very similar properties. Two parts of the plant are met with in the shops, the cormus or bulb, and the seeds; both of which are poisonous. Both have a strong, disagreeable, persistent, bitter taste. The seeds, and probably the bulb also, contain a bitter crystalline principle, called colchicina, which is soluble in water, neutralizes acids, and possesses intense activity as a poison.
A good physiological investigation into the action of colchicum as a poison is still wanting. Baron Störck found that two drachms of the dried bulb caused in dogs violent diarrhœa and diuresis, ending fatally.[2282] Sir Everard Home observed that the active part of about two drachms dissolved in sherry, caused in a dog, when injected into the jugular vein, slow respiration, languor of the pulse, vomiting, diarrhœa, extreme prostration, and death in five hours.[2283]—Geiger and Hesse, the discoverers of colchicina, gave a cat a tenth of a grain, which occasioned salivation, vomiting, purging, staggering, extreme languor, colic, and death in twelve hours.[2284]
The effects of colchicum on man, like those observed in animals, rather associate it with the acrid than with the narcotic poisons.
In the Edinburgh Journal a case is briefly noticed of a man who took by mistake an ounce and a half of the wine of the bulb, and died in forty-eight hours, after suffering much from vomiting, acute pain in the stomach, colic, purging, and delirium.[2285]—Chevallier has described a similar case arising from the wine of the bulb having been given intentionally as a poison. In a few minutes burning pain, urgent thirst, and frequent vomiting of mucus ensued; and death took place in three days.[2286]—Three American soldiers, who drank by mistake a large quantity of colchicum wine prepared from the bulb, died with similar symptoms. One of them, who took eighteen ounces, and died in two days, presented the leading symptoms of malignant cholera, namely, frequent vomiting, copious rice-water stools, cramps of the abdominal muscles and flexion of the extremities, coldness of the skin, tongue, and breath, blueness of the nails, dull, sunken eyes, contracted pupils, and collapse of the features. The two others had at first similar symptoms, which passed into those of chronic dysentery, and proved fatal in a few weeks.[2287]—M. Caffe has related the case of a young lady who destroyed herself by taking five ounces of the wine containing the active matter of rather more than the fourth part of one bulb. She was soon seized with acute pain in the stomach, then with frequent vomiting, general coldness and paleness, a sense of tightness in the chest and oppression of the breathing, a slow thready pulse, and extreme prostration,—and subsequently with severe and constant cramps in the soles of the feet. In eleven hours she had less frequent efforts to vomit, but was excessively exhausted; in twenty hours the pulse was imperceptible; and in two hours more she died. There was no suppression of urine, no purging, no diminution of sensibility, delirium, convulsions, or change in the state of the pupils.[2288] About a twelvemonth afterwards the sister of this patient put an end to herself with the same preparation, of which she took the same quantity; and she died, with precisely the same symptoms, in twenty-eight hours.[2289] M. Ollivier met with two cases of death within twenty-four hours, in consequence of a tincture being taken which contained the active part of forty-eight grains of the dry bulb; and a third case of death in three days caused by three doses of a watery decoction made each time with 46 grains of the bruised bulb collected in July. Severe purging and prostration followed each dose. There was no symptom of any affection of the brain.[2290]—Mr. Henderson describes a case occasioned by an ounce of the tincture. No injury accrued for three hours. The patient then had gnawing pain in the stomach followed by vomiting, and then by purging, at first bilious, afterwards watery, and attended with numbness in the feet, and subsequently a sense of prickling. In the course of the second day there was intense gnawing pain in all the joints of the extremities, profuse acid sweating, tightness in the head, and pain in the hindhead and nape of the neck. Blood-letting, laxatives, and hyoscyamus were employed with success; but the case seems very nearly to have proved fatal.[2291]
The seeds produce similar effects. Bernt has noticed the cases of two children who were poisoned by a handful of colchicum seeds, and who died in a day, affected with violent vomiting and purging.[2292] Mr. Fereday of Dudley relates a carefully detailed case of a man who died in forty-seven hours after swallowing by mistake two ounces of the wine of the seeds, and in whom the symptoms were acute pain, coming on in an hour and a half, then retching, vomiting, and tenesmus, feeble pulse, anxious expression, afterwards incessant coffee-coloured vomiting, suppression of urine, excessive weakness of the limbs and feeble respiration, and, for a short period before death, profuse, dark, watery purging. There was neither insensibility nor convulsions.[2293]—Blumhardt relates a similar case caused by an infusion of a large table-spoonful of the seeds. In three-quarters of an hour the man was seized with griping, and then profuse diarrhœa and vomiting. Next morning, twelve hours after the poison was taken, his physician found him still affected with vomiting and purging, but not with pain. He seemed, indeed, to suffer so little, and to improve so much under the use of emollients, that he was thought to be fairly recovering. But next day the pulse was almost imperceptible, the countenance and extremities were cold, the voice hoarse, the breathing hurried, the eyes sunk, the pupils dilated, the epigastrium tender, and the forehead affected with pain; and he died at twelve the same day.[2294]
The leaves, too, are poisonous. Dr. Bleifus has related a case in proof of this. A man gathered the leaves in the middle of May, and, after cooking them, ate about two ounces for supper. In six hours he was seized with violent colic, vomiting, and purging. In fifteen hours, when his physician first saw him, the countenance was ghastly as in malignant cholera, the pupils dilated and scarcely contractile, but the mind entire. He complained of rheumatic pains in the neck, and burning pain in the pit of the stomach. He had frequent vomiting and purging, spasms of the muscles of the belly, coldness of the skin, a slow, small, wiry pulse, and cramps of the fingers and the calves of the legs. Coffee and lemon-juice allayed the vomiting, and a temporary amendment ensued. But early on the third morning he became worse, and soon afterwards the narrator of the case found him dying.[2295]
The flowers are not less poisonous than the bulbs, leaves, and seeds. A case is noticed in Geiger’s Journal of poisoning with a decoction of some handfuls of the flowers, where death occurred within twenty-four hours, under incessant colic, vomiting and purging.[2296]
Doubts exist as to the degree of activity of colchicum. Some practitioners direct half an ounce of the tincture of the seeds to be given as a medicinal dose,[2297] even four times a day.[2298] Others administer from one to two drachms night and morning. According to more general experience, these are dangerous doses. Dr. Lewins, junior, has seen dangerous symptoms from a drachm given thrice a day for a week;[2299] a fatal case occurred a few years ago in the Edinburgh Infirmary, from this amount having been given for a few days only; I have known very violent effects produced by half an ounce taken by mistake, although most of it was brought away by emetics in an hour; and, in medical practice, I have seldom seen the dose of a sound preparation gradually raised to a drachm thrice a day, without such severe purging and sickness ensuing as rendered it prudent to diminish or discontinue the remedy. There is no doubt, however, that larger doses have occasionally been taken without any ill effect. Constitutional peculiarity can alone account for such differences in the instance of the tincture of the seeds. As to the preparations of the bulb, an additional source of diversity of effect is a difference in the activity of the bulb according to season. On this point no accurate facts have yet been brought forward. The bulb is usually directed to be gathered in July, when it is most plump and firm, and most charged with starch. Orfila, however, says that three bulbs, collected at this time, had no effect whatever on a dog;[2300] and Buchner maintains that it is most energetic in the autumn, when the flowering stem is rising.[2301] I suspect, on the other hand, that it is very energetic in the spring, when it is watery, more membranous, and shrivels much in drying; for it is then very bitter.
The morbid appearances are chiefly those of inflammation of the alimentary canal.
In the bodies of the children mentioned by Bernt there was considerable redness of the stomach and small intestines; in Geiger’s case inflammation of the stomach and duodenum only; in the case mentioned in the Edinburgh Journal, and in that related by Chevallier, there was no morbid appearance at all to be found. In Mr. Fereday’s case the omentum was curled and folded up between the stomach on the one hand, and the liver and diaphragm on the other; the stomach and intestines were coated with much mucus; there was no appearances of inflammation there but on two points, one in the stomach, the other in the jejunum, where a red patch appeared, owing to blood effused between the muscular and peritoneal coats; the bladder was empty, the pleura red, the lungs much gorged, their surface, as well as that of the diaphragm and heart, covered with ecchymosed spots; and the skin over most of the body presented patches of a purple efflorescence.—In Blumhardt’s case the muscles were rigid twenty-three hours after death; the heart and great vessels contained coagulated blood; the cardiac end of the gullet was internally dark-violet; the stomach externally of a clear violet hue, and its veins turgid; the gall-bladder turgid with greenish-yellow bile; and the inner membrane of the whole small intestines chequered here and there with red, inflamed-like spots.[2302]—In one of M. Caffe’s cases there was congestion of the cerebral vessels, coagulated blood in the heart, uniform grayness, softness, and brittleness of the mucous coat of the stomach, and enlargement of the muciparous follicles of the small intestines, as well as unusual distinctness and lividity of the Peyerian glands. In the other case putrefaction was so far advanced in forty-eight hours as to make the appearances equivocal.
The treatment consists in evacuation of the stomach and bowels by emetics and oleaginous laxatives in the early stage, and afterwards in the employment of opium, stimulants, the warm bath, and occasionally blood-letting.
Foxglove, or Digitalis purpura, a plant which is common in this country both as a native and in gardens, possesses powerful and peculiar properties. The leaves are considered its most active part. They contain an alkaloid; but chemists have not fixed its nature with precision. M. Le Royer of Geneva procured a pitchy, deliquescent, uncrystallizable substance;[2303] but more lately M. Pauguy obtained a principle in fine acicular crystals, soluble in alcohol and ether, but insoluble in water, alkaline in its reaction, and of a very acrid taste. This principle is called digitalin.[2304] It seems to be the same substance, which has also been detected by Radig, as quoted by Dr. Pereira.[2305] The leaves, like those of other narcotic vegetables, yield by destructive distillation an empyreumatic oil similar in chemical qualities and physiological effects to the empyreumatic oil of hyoscyamus.[2306]
From an extensive series of experiments on animals by Orfila with the powder, extract and tincture of the leaves, foxglove appears to cause in moderate doses vomiting, giddiness, languor, and death in twenty-four hours, without any other symptoms of note; but in larger doses, it likewise produces tremors, convulsions, stupor and coma. It acts energetically both when applied to a wound, and when injected into a vein.[2307] Mr. Blake has inferred from his researches, that when injected into the jugular vein, it occasions both obstruction of the pulmonary capillaries, and direct depression of the heart’s action. In the dog an infusion of three drachms of leaves arrested in five seconds the action of the heart; which was motionless after death, turgid, inirritable, and full of florid blood in its left cavities. An infusion of an ounce, injected back into the aorta from the axillary artery, caused in ten seconds great obstruction of the systemic capillaries, indicated by sudden increase of arterial pressure in the hæmadynamometer; the heart was unaffected for forty-five seconds, when it became slow in its pulsations, and the arterial pressure diminished; and in four minutes the heart ceased to beat, although for a little longer it continued excitable by stimulation. As no affection of the brain or spine was apparent before the heart became affected, the author infers that the action depends on the poisoned blood being circulated through the substance of the heart, and not on any intermediate influence upon the nervous centre.[2308]
Symptoms in Man.—Upon man its effects as a poison have been frequently noticed, partly in consequence of its being given by mistake in too large a dose as a medicine, partly on account of the singular property it possesses, in common with mercury, of accumulating silently in the system, when given long in moderate doses, and at length producing constitutional effects even after it has been discontinued. The effects of a dose somewhat larger than is usually given, are great nausea, frontal headache, sense of disagreeable dryness in the gums and pharynx, some salivation, giddiness, weakness of the limbs, feebleness and increased frequency of the pulse, in a few hours an appearance of sparks before the eyes, and subsequently dimness of vision, and a feeling of pressure on the eyeballs. These effects may be occasioned by so small a dose as two or three grains of good foxglove.[2309] The symptoms arising from its gradual accumulation are in the slighter cases nausea, vomiting, giddiness, want of sleep, sense of heat throughout the body, and of pulsation in the head, general depression, great languor and commonly retardation of the pulse, sometimes diarrhœa, sometimes salivation, and for the most part profuse sweating. A good instance of this form of the effects of foxglove is mentioned in the Medical Gazette. A man took it at his own hand for dropsy during twenty days, when the pulse sank to half its previous frequency, he was seized with restless, want of sleep, incoherent talking with imaginary persons, dilated pupils, nausea, thirst, and increase of urine; and these complaints did not materially subside for six days.[2310] The depressed action of the heart may be the occasion of death in particular circumstances. Mr. Brande mentions from the experience of Dr. Pemberton the case of an elderly woman, who, while under the full influence of foxglove, fell in a fainting fit on walking across the floor; after which, although she at first got better, there were frequent attacks of fainting and vomiting till she died.[2311] In other instances convulsions also occur; and it appears from a case mentioned by Dr. Blackall, that the disorder thus induced may prove fatal. One of his patients, while taking two drachms of the infusion of the leaves daily, was attacked with pain over the eyes and confusion, followed in twenty-four hours by profuse watery diarrhœa, delirium, general convulsions, insensibility, and an almost complete stoppage of the pulse. Although some relief was derived from an opiate clyster, the convulsions continued to recur in frequent paroxysms for three weeks; in the intervals he was forgetful and delirious; and at length he died in one of the convulsive fits.[2312]
A case which exemplifies the effects of a single large dose is related in the Edinburgh Journal. An old woman drank ten ounces of a decoction made from a handful of the leaves in a quart of water. She grew sick in the course of an hour, and for two days she had incessant retching and vomiting, with great faintness and cold sweats in the intervals, some salivation and swelling of the lips, and a pulse feeble, irregular, intermitting, and not above 40. She had also suppression of urine for three days.[2313]
A somewhat similar instance may be found in the Journal de Médecine. A man, fifty-five years old took by mistake a drachm instead of a grain for asthma, and was attacked in an hour with vomiting, giddiness, excessive debility, so that he could not stand, loss of sight, colic, and slow pulse. These effects continued more or less for four days, when the vomiting ceased; and the other symptoms then successively disappeared, the vision, however, remaining depraved for nearly a fortnight.[2314]
A very interesting fatal case, which arose from an over-dose administered by a quack doctor, and which became the ground of a criminal trial at London in 1826, is shortly noticed in the same Journal. Six ounces of a strong decoction when taken as a laxative early in the morning. Vomiting, colic, and purging, were the first symptoms; towards the afternoon lethargy supervened; about midnight the colic and purging returned; afterwards general convulsions made their appearance; and a surgeon, who saw the patient at an early hour of the succeeding morning, found him violently convulsed, with the pupils dilated and insensible, and the pulse, slow, feeble, and irregular. Coma gradually succeeded, and death took place in twenty-two hours after the poison was swallowed.[2315]
This is the only case in which I have seen an account of the appearances in the dead body, and they are related imperfectly. It is merely said that the external membranes of the brain were much injected with blood, and the inner coat of the stomach red in some parts.
The affections induced by poisoning with digitalis are often much more lasting than the effects of most other vegetable narcotics. Dr. Blackall’s case is one instance in point, and another no less remarkable in its details is described in Corvisart’s Journal. The usual local and constitutional symptoms were produced by a drachm of the powder being taken by mistake; and the slowness of the pulse did not begin to go off for seven days, the affection of the sight not for five days more.[2316]
The preparations of foxglove are very uncertain in strength. From what I have observed in the course of their medicinal employment, I conceive few powders retain the active properties of the leaves, and even not many tinctures. Two ounces of the tincture of the London College have been taken in two doses with a short interval between them, yet without causing any inconvenience.[2317] This assuredly could not happen with a sound preparation.