The Ruta graveolens, or rue, although its wild variety is expressly declared by Dioscorides to be mortal when taken too largely, has attracted little attention as a poison in recent times, and is indeed scarcely considered deleterious. Orfila seems to have found it by no means active; for the juice of two pounds of leaves, secured in the stomach of a dog by tying the gullet, did not prove fatal till the second day, the symptoms were not well marked, and the only appearances in the dead body were the signs of slight inflammation in the stomach. Even when the distilled water was injected into a vein, the only effects were a temporary nervous disorder similar to intoxication.[2318]
According to the late experimental inquiry, however, by M. Hélie,[2319] rue is possessed of peculiar and energetic properties. All parts of its organization, especially the roots and leaves, produce the effects of the narcotico-acrid poisons; and although he never met with any instance of a fatal result, its activity is such as to render this event not improbable, even when the dose is by no means very large. His attention was drawn to the subject in consequence of finding, that it was often employed in his neighbourhood for producing abortion,—a property ascribed to it immemorially by the country people of France; and all the instances he has seen of its poisonous action were cases in which it had been given with this object. Sometimes the juice of the leaves is given, sometimes an infusion of them, sometimes a decoction of the root; and in one instance a woman took a decoction of two roots, each about as thick as the finger. The effects were, severe pain in the stomach, followed by violent and obstinate vomiting, drowsiness, giddiness, confusion, dimness of sight, difficult articulation, staggering, contracted pupils, convulsive movements of the head and arms, like those of chorea, retention of urine, slowness of the pulse, and great prostration. There was never any purging. In the course of two days or a little more miscarriage took place, preceded by the usual precursors, and followed by abatement of the symptoms of poisoning. At the period of the milk-fever, however, these symptoms again increased, and the patient was also attacked with swelling and pain in the tongue and copious salivation. In about ten days the pulse began to increase in frequency; and a mild typhoid fever commonly succeeded, from which recovery took place slowly. In another case the symptoms throughout their whole course were so mild, that, although miscarriage occurred, the subject of it was not confined to bed, and in fifteen days recovered her health completely. M. Hélie adds, that with full knowledge of the doubts entertained by eminent authorities, whether any substance whatever possesses a peculiar property of inducing miscarriage, he is strongly persuaded that rue is really a substance of the kind, and that it will take effect even when there is no natural tendency to miscarriage, or any particular weakness of constitution.
Notwithstanding these statements, it may be suspected that M. Hélie has overrated both its poisonous properties and its virtues as a drug capable of inducing miscarriage.
Ipecacuan is well known as an emetic. It is procured from a plant of the natural family Rubiaceæ, the Cephaëlis ipecacuanha. It contains a peculiar principle, not yet crystallized, which is white, permanent in the air, sparingly soluble in water, easily soluble in alcohol and ether, fusible about 122° F., capable of forming crystallizable salts with acids, and possessing an alkaline reaction on litmus. It was discovered by M. Pelletier.[2320]
Ipecacuan itself is not known to be a poison; because in consequence of its emetic properties it is quickly discharged from the stomach. But in doses of considerable magnitude it would probably be dangerous. In some constitutions the odoriferous effluvia from the powder induce difficult breathing, anxiety, and imperfect convulsions. I have met with several instances of this singular idiosyncrasy, and one in particular where the subject of it, a surgeon’s apprentice, suffered so often and so severely as to be induced to abandon the medical profession. A German physician, Dr. Prieger, has published a remarkable case of a druggist’s servant, who, in consequence of incautiously inhaling the dust of ipecacuan powder, was attacked with a sense of tightness in the chest, vomiting, and soon after an alarming sense of suffocation from tightness of the throat. When these symptoms had continued several hours the uneasiness in the throat was removed after the use of a decoction of uva-ursi and rhatany-root; but the dyspnœa remained several days.[2321]
Its active principle, emeta, is a powerful poison. Two grains of the pure alkaloid will kill a dog; and the symptoms are frequent vomiting, followed by sopor and coma, and death in fifteen or twenty-four hours. In the dead body the lungs and stomach are found inflamed. The same effects result from injecting it into a vein, or applying it to a wound.[2322] It appears, then, to be a narcotico-acrid. But its irritant properties are so prominent that it might be properly arranged with the vegetable acrids.
The next group of the narcotico-acrids includes a few vegetable poisons that act in a very peculiar manner. They induce violent spasms, exactly like tetanus, and cause death during a fit, probably by suspending the respiration. But they do not impair the sensibility. During the intervals of the fits the sensibility is on the contrary heightened, and the faculties are acute.
Death, however, does not always take place by tetanus. In some cases the departure of the convulsions has been followed by a fatal state of general and indescribable exhaustion.
Besides thus acting violently on the nervous system, they also possess local irritant properties; but these are seldom observed on account of the deadliness and quickness of their remote operation on the spine and nerves.
They exert their action by entering the blood-vessels. The dose required to prove fatal is exceedingly small. The organ acted on is chiefly the spinal cord; but sometimes they seem also to act on the heart.
They seldom leave any morbid appearances in the dead body. Like the other causes of death by obstructed respiration, such as drowning and strangling, they produce venous congestion; but this is frequently inconsiderable. Sometimes, however, they leave signs of inflammation in the alimentary canal.
Their energy resides in peculiar alkaloids. The only poisons included in this group, are derived from the genus Strychnos. The bark of Brucea antidysenterica was long supposed also to possess similar properties; but it is now known that the bark of Strychnos nux-vomica was mistaken for the bark of that tree.
Several species of Strychnos have been examined, namely, the S. Nux-vomica, the S. Sancti Ignatii or St. Ignatius bean, the S. colubrina, or snake-wood, the S. tieuté, which yields an Indian poison the Upas tieuté, the S. Guianensis, and likewise the S. potatorum and Pseudo-kina; and all have been found to possess the same remarkable properties, except the last two, which are inert.
All of them, except the S. pseudo-kina, and probably the S. potatorum,[2323] contain an alkaloid to which their poisonous properties are owing. This is strychnia or strychnin, a substance which has lately been made the subject of many experiments by chemists and physiologists.
Strychnia was discovered by Pelletier and Caventou soon after the discovery of morphia.[2324] For an account of the best process for preparing it, the reader may consult a paper by M. Henry in the journal quoted below.[2325]
Its leading properties are the following. Its crystals when pure are elongated octaedres. It has a most intensely bitter taste, perceptible, it is said, when a grain is dissolved in 80 pounds of water.[2326] It is very sparingly soluble in water, but easily soluble in alcohol and the volatile oils. Its alcoholic solution has an alkaline reaction. It forms neutral and crystallizable salts with the acids. In its ordinary form it is turned orange-red by the action of nitric acid; which tint becomes violet-blue on the gradual addition of hydrosulphate of ammonia. The action of nitric acid is owing to the presence of a yellow colouring matter, or of another alkaloid, brucia, which is also contained in nux vomica, but exists in larger quantity in the false angustura bark. Pure strychnia is not turned orange-red by nitric acid.[2327]
No poison is endowed with more destructive energy than strychnia. I have killed a dog in two minutes with a sixth part of a grain injected in the form of alcoholic solution into the chest; I have seen a wild-boar killed in the same manner with the third of a grain in ten minutes; and there is little doubt that half a grain thrust into a wound might kill a man in less than a quarter of an hour. It acts in whatever way it is introduced into the system, but most energetically when injected into a vein. The symptoms produced are very uniform and striking. The animal becomes agitated and trembles, and is then seized with stiffness and starting of the limbs. These symptoms increase till at length it is attacked with a fit of violent general spasm, in which the head is bent back, the spine stiffened, the limbs extended and rigid, and the respiration checked by the fixing of the chest. The fit is then succeeded by an interval of calm, during which the senses are quite entire or unnaturally acute. But another paroxysm soon sets in, and then another and another, till at length a fit takes place more violent than any before it; and the animal perishes suffocated. The first symptoms appear in 60 or 90 seconds, when the poison is applied to a wound. When it is injected into the pleura, I have known them begin in 45 seconds, and Pelletier and Caventou have seen them begin in 15 seconds.[2328] M. Bouillaud has recently found that it has no effect when directly applied to the nerves.[2329] The experiments of Mr. Blake tend to show, that its action is exerted solely on the nervous system, and that it has no direct action on the heart, even when directly admitted into the blood by the jugular vein.[2330] It appears to act peculiarly by irritating the spinal cord.
Dangerous effects have often been occasioned by an accidental over-dose in ordinary medical practice. These are well exemplified by a case communicated to Dr. Bardsley by Dr. Booth of Birmingham. A man of 46, affected with hemiplegia for nearly four weeks, began to use strychnia, and had been affected by it for eleven days without particular inconvenience. During this period he took twice a day gradually increasing doses, till the amount of one grain was attained; when the usual physiological effect having ceased to occur, the quantity was increased to a grain and a half. But the first dose caused anxiety and excitability, in three hours stupor and loss of speech, and at length violent tetanic convulsions, which proved fatal in three hours and three-quarters.[2331] A fatal case, occasioned by the large dose of two scruples, has been recorded by a German physician, Dr. Blumhardt. In fifteen minutes, imperfect vomiting was brought on by emetics. At this time, the patient, a lad of seventeen, lay on his back, quite stiff, and with incipient fits of locked-jaw. The spasms gradually extended to the rest of the body, till at last violent fits of general tetanus were established, under which the whole body became as stiff as a board, the arms spasmodically crossed over the chest, the legs extended, the feet bent, so that the soles were concave, the breathing arrested, the eyeballs prominent, the pupils dilated and not contractile, and the pulse hurried and irregular. In the second severe fit he died, one hour and a half after taking the poison.[2332] I have known very dangerous tetanic spasm induced by so small a dose as two-thirds of a grain of the ordinary impure strychnia of the shops; and Dr. Pereira describes a case, communicated by a friend, where death was occasioned by a dose of half a grain administered three times a day.[2333] As each fit of spasm went off, respiration, which was found to have ceased, was maintained artificially; but no sooner did natural breathing return, than the paroxysm of tetanus returned also; and at length artificial inflation of the lungs failed to restore life.
The only accounts I have seen of the morbid appearances after death from strychnia are in the cases of Dr. Booth and Dr. Blumhardt. In the former, the muscles were in a rigid state, the fingers contracted, the vessels of the brain gorged, the membranes of the spinal cord highly injected; and four patches of extravasated blood were found between the spinal arachnoid and the external membrane. In the latter, twenty-four hours after death, there was general lividity of the skin, and extraordinary rigidity of the muscles. Fluid blood flowed in abundance from the spinal cavity, where the veins were gorged, the pia mater injected, the spinal column softened at its upper part, and here and there almost pulpy. There was also congestion and softening of the brain. The head and great vessels were flaccid, and contained scarcely any blood. The inner membrane of the stomach and intestines presented some redness, but not more than is often seen independently of irritation there.
Strychnia has been found by Pelletier and Caventou in four species of Strychnos, the S. nux vomica, Sancti Ignatii, Colubrina, and Tieuté; and from the researches of MM. Martius and Herberger on the composition and properties of the American poison Wourali, it is also probably contained in the S. guianensis.[2334] Vauquelin could not find it in the S. pseudo-kina, which is destitute of bitterness.
Tests of Nux Vomica.—Nux vomica, the most common of these poisons, is a flat, roundish seed, hardly an inch in diameter, of a yellowish or greenish-brown colour, covered with short silky hair, and presenting a little prominence on the middle of one of its surfaces. In powder it has a dirty greenish-gray colour, an intensely bitter taste, and an odour like powder of liquorice. It inflames on burning charcoal, and when treated with nitric acid acquires an orange-red colour, which is destroyed by the addition of protochloride of tin. Its infusion also is turned orange-red by nitric acid, and precipitated grayish-white with tincture of galls.
Orfila and Barruel have made some experiments on the mode of detecting it in the stomach, and the following is the plan recommended by them. The contents of the stomach, or the powder, if it can be separated, must be boiled in water acidulated with sulphuric acid. The liquid after filtration is neutralized with carbonate of lime, and then evaporated to dryness. The dry mass is then acted on with successive portions of alcohol, and evaporated to the consistence of a thin syrup. The product has an intensely bitter taste, yields a precipitate with ammonia, becomes deep orange-red with nitric acid, and will sometimes deposit crystals of strychnia on standing two or three days.[2335] By this process Dr. R. D. Thomson, in a case which proved fatal in three hours, detected nux-vomica, although vomiting had been induced by emetics.[2336]
These experiments it is important to remember, because, contrary to what takes place in regard to vegetable poisons generally, nux vomica is often found in the stomachs of those poisoned with it.
Its Mode of Action and Symptoms in Man.—The poisonous properties of nux vomica are now well known to the vulgar; and in consequence it is occasionally made the instrument of voluntary death, although no poison causes such torture. It is difficult to conceive, considering its intensely bitter taste, how any one could make it the instrument of murder. But a fact is stated in Rust’s Journal, which shows that it may be used for that purpose. At a drinking party one man wagered with another, that if he took a little Cocculus indicus in beer, he would be compelled to walk home on his head. The wager was taken and the potion drunk; but nux vomica was substituted for the Cocculus indicus, itself too a virulent poison; and the man went home and died in convulsions fifteen minutes afterwards.[2337]
Many experiments have been made on animals with nux vomica; but the first accurate inquiry was that of Magendie and Delille read before the French Institute in 1809. The symptoms they remarked were precisely the same with those produced by strychnia. Half a drachm of the powder killed a dog in forty-five minutes, and a grain and a half of the alcoholic extract thrust into a wound killed another in seven minutes. The animals uniformly experienced dreadful fits of tetanic spasm, with intervals of relaxation and sensibility, and were carried off during a paroxysm.
The cause of death appears to be prolonged spasm of the thoracic muscles of respiration. The spasm of these muscles is apparent in the unavailing efforts which the animals make to inspire. The external muscles of the chest may be felt during the fits as hard almost as bone; and, according to an experiment of Wepfer, the diaphragm partakes in the spasm of the external muscles.[2338]
On account of the singular symptoms of irritation of the spinal cord, uncombined with any injury of the brain, this poison is believed to act on the spinal marrow alone. This is farther shown by the experiments of Mr. Blake with strychnia alluded to above. But from some experiments by Segalas it appears also to exhaust the irritability of the heart: for in animals he found that organ could not be stimulated to contract after death, and life could not be prolonged by artificial breathing.[2339] A similar observation was made long ago by Wepfer, who found the heart motionless and distended with arterial blood in its left cavities;[2340] and a case of poisoning in the human subject to the same effect will be presently related. The pulse is always very weak, often wholly suppressed during a paroxysm; and in the case alluded to it was found on dissection pale, flaccid and empty, having been apparently affected with spasm. The action exerted through the medium of the spinal cord on the muscles is wholly independent of the brain; for Stannius found that in frogs the removal of the brain does not interfere with the effects.[2341]
Of late poisoning with nux vomica has been common. The most characteristic example yet published is a case related by Mr. Ollier, of a young woman, who in a fit of melancholy, took between two and three drachms of the powder in water. When the surgeon first saw her, half an hour afterwards, she was quite well. But going away in search of an emetic, and returning in ten minutes, he found her in a state of great alarm, with the limbs extended and separated, and the pulse faint and quick. She then had a slight and transient convulsion succeeded by much agitation and anxiety. In a few minutes she had another, and not long afterwards a third, each about two minutes in duration. During these fits, “the whole body was stiffened and straightened, the legs pushed out and forced wide apart; no pulse or breathing could be perceived; the face and hands were livid, and the muscles of the former violently convulsed.” In the short intervals between the fits she was quite sensible, had a feeble rapid pulse, complained of sickness with great thirst, and perspired freely. “A fourth and most violent fit soon succeeded, in which the whole body was extended to the utmost from head to foot. From this she never recovered: she seemed to fall into a state of asphyxia, relaxed her grasp, and dropped her hands on her knees. Her brows, however, remained contracted, her lips drawn apart, salivary foam issued from the corners of the mouth, and the expression of the countenance was altogether most horrific.” She died an hour after swallowing the poison.[2342]—A case precisely similar, produced by three pence worth of the powder, and fatal in little more than an hour, is related by Mr. Watt of Glasgow.[2343]—Another apparently also similar but fatal in three hours, is related by Dr. R. D. Thomson.[2344] There is in fact very little variety of symptoms in different cases, where death occurs in the primary stage.—Occasionally even in such rapid cases there is a little vomiting in the first instance. This was remarked in Mr. Watt’s case, and also in another described by MM. Orfila and Ollivier.[2345]
When death does not take place thus suddenly in a fit of spasm, the person continues to be affected for twelve or sixteen hours with similar, but milder paroxysms; and afterwards he may either recover without farther symptoms, or expire in a short time apparently from exhaustion, or suffer an attack of inflammation of the stomach and intestines, which may or may not prove fatal.
M. Jules Cloquet has described a case, where the patient seemed to die of the excessive exhaustion produced by the violent, long continued spasms. The tetanic fits lasted about twenty-four hours, the sensibility in the intervals being acute. Slight signs of irritation in the stomach succeeded; and death ensued on the fourth morning.[2346]
In the Bulletins of the Medical Society of Emulation another case is related, which arose from an over-dose of the alcoholic extract being taken by an old woman who was using it for palsy. She took three grains at once. Violent tetanus was soon produced; and afterwards she had a regular attack of inflammation of the stomach and intestines, which proved fatal in three days.
The last instance to be noticed exemplifies very well the effects of the poison when the quantity is insufficient to cause death. A young woman swallowed purposely a drachm mixed in a glass of wine. In fifteen minutes she was seized with pain and heat in the stomach, burning in the gullet, a sense of rending and weariness in the limbs succeeded by stiffness of the joints, convulsive tremors, tottering in her gait, and at length violent and frequent fits of tetanus. Milk given after the tetanus began excited vomiting. She was farther affected with redness of the gums, inflammation of the tongue, burning thirst, and pain in the stomach. The pulse also became quick, and the skin hot. Next day, though the fits had ceased, the muscles were very sore, especially on motion. The tongue and palate were inflamed, and there was thirst, pain in the stomach, vomiting, colic and diarrhœa. These symptoms, however, abated, and on the fourth day disappeared, leaving her exceedingly weak.[2347]
This and the previous case show clearly the double narcotico-acrid properties of the poison.
With regard to the dose requisite to prove fatal, the smallest fatal dose of the alcoholic extract yet recorded is three grains, which was the quantity taken in the case from the Parisian bulletins: Hoffmann mentions a fatal case caused by two fifteen grain doses of the powder;[2348] and in Hufeland’s Journal there is another caused by two drachms, which was fatal in two hours.[2349]—A dog has been killed by eight grains of the powder, and a cat by five.[2350] It is even said that a dog has been killed by two grains.[2351]
It has been thought, from some observations by Mr. Baker on the medicinal use of nux vomica in Hindostan that, by the force of habit, the constitution may become to a certain extent accustomed to large doses of this poison, in the same manner as it acquires the power of enduring large doses of opium. The natives of Hindostan, often take it morning and evening for many months continuously, beginning with an eighth part of a nut, and gradually increasing the dose to an entire nut, or about twenty grains. If it is taken either immediately before or after meals, it never occasions any unpleasant effects; but if this precaution be neglected, spasms are apt to ensue.[2352] As it is found unsafe, however, to increase the dose beyond one nut, and the poison is taken in the form of coarse powder, in which state it must be slowly acted on by the fluid in the stomach, it is probable that the modifying influence of habit is inconsiderable. Habit certainly does not familiarize the system to strychnia used medicinally. The same dose, which has once excited its peculiar physiological action, will for the most part suffice to excite it again, however frequently the dose may be repeated.—The facts mentioned by Mr. Baker show that nux vomica is not a cumulative poison; and European experience, in the instance of strychnia, is to the same effect.
Morbid Appearances.—The morbid appearances differ according to the period at which death occurs. In Mr. Ollier’s case, where death took place in an hour, the appearances were insignificant. The stomach was almost natural, the vessels of the brain somewhat congested, the heart flaccid, empty, and pale. In the case in Hufeland’s Journal there was general inflammation of the stomach, duodenum and part of the jejunum. In Cloquet’s case, a slower one, there was very little appearance of inflammation. In that from the Parisian bulletins, on the contrary, the stomach was highly inflamed, the intestines violet-coloured, in many places easily lacerated and apparently gangrenous. In an interesting dissection of a case, which was quickly fatal,—that related by Orfila and Ollivier, there was found much serous effusion on the surface of the cerebellum, and softening of the whole cortical substance of the brain, but especially of the cerebellum. Blumhardt too, found softening of the cerebellum and congestion of the cerebral vessels, together with softening of the spinal cord and general gorging of the spinal veins. This is some confirmation of an opinion advanced not long ago in France by Flourence and others, that nux vomica acts particularly on the cerebellum.[2353] In Dr. R. D. Thomson’s case, which was examined by Mr. Taylor, there was found much congestion of the whole membranes and substance of the brain and cerebellum, and even some extravasation of blood within the cavity of the arachnoid over the upper surface of the former. Mr. Watt remarked in his case (sixty hours, however, after death in summer) softening of the substance of the brain and the lumbar part of the spinal cord.—In Orfila and Ollivier’s case the lungs were found much gorged with black fluid blood.—In Blumhardt’s case the heart and great vessels were entirely destitute of blood.—There is sometimes seen, as in Dr. R. D. Thomson’s case, a brown powder lining the stomach, even although vomiting may have occurred.
The body appears sometimes to retain for a certain period after death the attitude and expression impressed on it by the convulsions during life. In the instance mentioned by Orfila and Ollivier the muscles immediately after death remained contracted, the head bent back, the arms bent, and the jaws locked. This state may even continue for some hours, so that the body appears to pass into the state of rigidity which precedes decay, without also passing through the preliminary stage of flaccidity immediately after death. In the case related by Mr. Ollier, the body five hours after death “was still as stiff and straight as a statue, so that if one of the hands was moved the whole body moved along with it;” and in Blumhardt’s case the rigidity twenty hours after death was unusually great. This state of rigidity, however, does not invariably occur. On the contrary, in animals the limbs become very flaccid immediately after death; but the usual rigidity supervenes at an early period.[2354] In Dr. R. D. Thomson’s case flaccidity immediately followed death.
Treatment.—Little is known of the treatment in this kind of poisoning. But it is of the greatest moment to evacuate the stomach thoroughly, and without loss of time. Hence emetics are useful; but if the stomach-pump is at hand it ought to be resorted to without waiting for the operation of emetics. Torosiewicz describes the case of a young woman who, after the usual symptoms had begun to appear in consequence of the administration of a tea-spoonful of powder, recovered under the action of an emetic followed by rhatany-root.[2355] When nux vomica is taken in powder,—the most frequent form in which it has been used,—it adheres with great obstinacy to the inside of the stomach. Consequently whatever means are employed for evacuating the stomach, they must be continued assiduously for a considerable time. If the patient is not attacked with spasms in two hours, he will generally be safe.
M. Donné of Paris has stated that he has found iodine, bromine, and chlorine to be antidotes for poisoning with the alkaloid of nux vomica, as well as for the other vegetable alkaloids. Iodine, chlorine, and bromine, he says, form with the alkaloid compounds which are not deleterious,—two grains and a half of the iodide, bromide, and chloride of strychnia, having produced no effect on a dog. Animals which had taken one grain of strychnia or two grains of veratria, did not sustain any harm, when tincture of iodine was administered immediately afterwards. But the delay of ten minutes in the administration of the antidote rendered it useless. In the compounds formed by these antidotes with the alkaloids, the latter are in a state of chemical union, and not decomposed. Sulphuric acid separates strychnia, for example, from its state of combination with chlorine, iodine, or bromine, and forms sulphate of strychnia, with its usual poisonous qualities.[2356] It remains to be proved that the same advantages will be derived from the administration of these antidotes in the instance of poisoning with the crude drug, nux vomica, as in poisoning with its alkaloid.
In general little difficulty will be encountered in recognizing a case of poisoning with nux vomica. Tetanus or locked-jaw is the only disease which produces similar effects. But that disease never proves so quickly fatal as the rapid cases of poisoning with nux vomica; and it never produces the symptoms of irritation observed in the slower cases. Besides, the fits of natural tetanus are almost always slow in being formed; while nux vomica brings on perfect fits in an hour or less. It is right to remember, however, that nux vomica may be given in small doses, frequently repeated, and gradually increased, so as to imitate exactly the phenomena of tetanus from natural causes. Medical men will be at no loss to discover, on reflection, how the preparations of this drug may be rendered formidable secret poisons.
The Strychnos Sancti Ignatii, or St. Ignatius bean, contains about three times as much strychnia as nux vomica, namely, from twelve to eighteen parts in the 1000. It is very energetic. Dr. Hopf has mentioned an instance of a man, who was attacked with tetanus of several hours’ duration after taking the powder of half a bean in brandy, and who seems to have made a narrow escape.[2357]
The Strychnos tieuté is the plant which yields the Upas tieuté, one of the Javanese poisons. This substance has been analyzed by Pelletier and Caventou, and found to contain strychnia.[2358] From the experiments of Magendie and Delille, the Upas tieuté appears to be almost as energetic as strychnia itself.[2359] Mayer found that the bark of the plant which yields it, when applied in the dose of fifty grains to a wound, killed a rabbit in two hours and a half.[2360] Dr. Darwin has given an account of its effects on the Javanese criminals, who used formerly to be executed by darts poisoned with the tieuté. The account quoted by him is not very authentic; yet it accords precisely with what would be expected from the known properties of the poison. He says, that a few minutes after the criminals are wounded with the instrument of the executioner, they tremble violently, utter piercing cries, and perish amidst frightful convulsions in ten or fifteen minutes.[2361]
Besides these poisons of the genus Strychnos, the present group comprehends another, of the same properties, which was once supposed to be derived from a plant of a different family, the Brucea antidysenterica.
A species of bark, commonly called the false angustura bark, was introduced by mistake into Europe instead of the true angustura, cusparia, or bark of the Galipea officinalis. It was long supposed to be the bark of the Brucea antidysenterica; but it is now known to be the bark of S. nux vomica.[2362] It is a poison of great energy. It gave rise to so many fatal accidents soon after its introduction, that in some countries on the continent all the stores of angustura were ordered to be burnt. It contains a less proportion of strychnia, but more of the alkaloid brucia than nux vomica, the seed of the plant.
According to Andral, brucia is twenty-four times less powerful than strychnia;[2363] but the bark itself is as strong nearly as nux-vomica, for Orfila found that eight grains killed a dog in less than two hours.[2364]
The symptoms it induces are the same as those caused by nux vomica. They are minutely detailed in a paper by Professor Emmert of Bern.[2365] It appears that during the intervals of the fits the sensibility is remarkably acute: a boy who fell a victim to it implored his physician not to touch him, as he was immediately thrown into a fit. Professor Marc of Paris was once violently affected by this poison, which he took by mistake for the true angustura to cure ague. He took it in the form of infusion, and the dose was only three-quarters of a liqueur-glassful; yet he was seized with nausea, pain in the stomach, a sense of fulness in the head, giddiness, ringing in the ears, and obscurity of vision, followed by stiffness of the limbs, great pain on every attempt at motion, locked-jaw, and impossibility of articulating. These symptoms continued two hours; and abated under the use of ether and laudanum.[2366]
Some interesting experiments were made by Emmert with this poison to show that it acts on the spine directly, and not on that organ through the medium of the brain. If an animal be poisoned by inserting the extract of false angustura bark into its hind-legs after the spinal cord has been severed at the loins, the hind-legs as well as the fore-legs are thrown into a state of spasm; or if the medulla oblongata be cut across and respiration maintained artificially, the usual symptoms are produced over the whole body by the administration of it internally or externally,—the only material difference being that they commence more slowly, and that a larger dose is required to produce them, than when the medulla is not injured. On the other hand, when the spinal cord is suddenly destroyed after the symptoms have begun, they cease instantaneously, although the circulation goes on for some minutes.[2367]
The true angustura bark has a finer texture than the other, and is darker coloured, aromatic, pungent, and less bitter. The ferro-cyanate of potass causes in a muriatic infusion of the false bark a precipitate, which is first green and then becomes blue; and the same reagent converts into blue the reddish powder which lines the bark. No such effects are produced on the true angustura bark. Nitric acid renders the rusty efflorescence of the spurious bark deep dirty blue, but has no such effect on the true bark; which, besides, never exhibits a yellow efflorescence.
With the preceding poisons Orfila has arranged also some poisons used by the American Indians; but, as in Europe they are mere objects of curiosity, it is scarcely necessary to treat of them particularly here.
The most interesting and best known of them is the wourali poison of Guiana, variously called woorara, urari, or curare, by different authors. It is believed to have been traced by Martius to a new species of strychnos, the S. guianensis, and more recently by Dr. Schomburg to a different species, the S. toxicaria of that traveller. But the action it exerts does not correspond exactly with what would be expected of a plant belonging to that genus.
The effects of wourali have been investigated by Sir B. Brodie in the Philosophical Transactions for 1811–12, in Orfila’s Toxicology, in Magendie’s Memoir on Absorption, and in Fontana’s Traité des Poisons. But the most detailed inquiry is that by Emmert, published in 1818. It produces, not convulsions or spasm of the muscles, but on the contrary paralysis, and probably occasions death in this way by suspending the respiration, in the same way as hemlock and conia. According to Emmert’s experiments the spine only is acted on, and not the brain also.[2368] Some remarkable experiments were made in 1839 by Mr. Waterton, to show the power of artificial respiration in accomplishing recovery from its effects. After the animals had fallen down motionless from the action of the poison introduced through a wound, and when the action of the heart had become so feeble as not to affect the pulse, artificial respiration, continued in one instance for seven hours and a half, and in another for two hours, had the effect of restoring the animals to health.[2369]
The third group of the narcotico-acrids resemble strychnia in their action so far, that they occasion in large doses convulsions of the tetanic kind. But they differ considerably by producing at the same time impaired sensibility or sopor. They are camphor, Cocculus indicus, its active principle picrotoxin, the Coriara myrtifolia, the Upas antiar, a Java poison, and perhaps also the yew-tree.
Camphor dissolved in oil soon causes in dogs paroxysms of tetanic spasm. At first the senses are entire in the intervals; but by degrees they become duller, till at length a state of deep sopor is established, with noisy laborious breathing, and expiration of camphorous fumes; and in this state the animal soon perishes. A solution of twenty grains in olive oil will kill a dog in less than ten minutes when injected into the jugular vein. When camphor is given to dogs in fragments, it does not excite convulsions, but kills them more slowly by inducing inflammation of the alimentary canal. These are the results of numerous experiments by Orfila.[2370]
They are confirmed by others performed more lately by Scudery of Messina; but this experimentalist likewise remarked, that the convulsions were attended with a singular kind of delirium, which made the animals run up and down without apparent cause, as if they were maniacal. He also found the urinary organs generally affected, and for the most part with strangury.[2371] Lebküchner discovered camphor in the blood of animals poisoned with it.[2372]
Symptoms in Man.—The symptoms caused by camphor in man may not have been observed; but so far as they have been witnessed, they establish its claim to be considered a narcotic and acrid poison. Its effects appear to be singularly uncertain: at least they are very discrepant; and the reason for this is not apparent.
Its narcotic effects are well exemplified in an account given by Mr. Alexander from personal experience, and by Dr. Edwards of Paris, as they occurred in a patient of his who received a camphor clyster.
Mr. Alexander, in the course of his experiments on his own person with various drugs, was nearly killed by this poison, and has left the best account yet published of its effects in dangerous doses on man. After having found, by a previous experiment, that a scruple did not cause any particular symptom, he swallowed in one dose two scruples mixed with syrup of roses. In the course of twenty minutes he became languid and listless, and in an hour giddy, confused, and forgetful. All objects quivered before his eyes, and a tumult of undigested ideas floated through his mind. At length he lost all consciousness, during which he was attacked with strong convulsive fits and maniacal frenzy. These alarming symptoms were dispelled, on Dr. Monro, who had been sent for, accidentally discovering the subject of his patient’s experimental researches, and administering an emetic. But a variety of singular mental affections continued for some time after. The emetic brought away almost the whole camphor which had been swallowed three hours before.[2373]
In Dr. Edwards’s patient, the symptoms were excited by an injection containing half a drachm of camphor. In a few minutes he felt a camphrous taste, which was followed by indescribable uneasiness. On then going down stairs for assistance, he was astonished to feel his body so light, that he seemed to himself to skim along the floor almost without touching it. He afterwards began to stagger, his face became pale, he felt chilly, and was attacked with a sense of numbness in the scalp. On then taking a glass of wine, which he asked for, he became gradually better; but for some time his mind was singularly affected. He felt anxious, without thinking himself in danger; he shed tears, but could not tell why; they flowed in fact involuntarily. For twenty-four hours his breath exhaled a camphrous odour.[2374]
Hoffmann has related a case analogous to those of Alexander and Edwards. The dose was two scruples taken in oil; the symptoms vertigo, chilliness, anxiety, delirium, and somnolency.[2375]
These cases would seem to indicate very considerable activity; yet there can be little doubt that even larger doses have been at times taken with much less effect. Thus, from an account given by Dr. Eickhorn of New Orleans, of its operation on himself, when incautiously swallowed to the amount of two drachms in frequent small doses within three hours, it would appear that the only result was great heat, palpitation, hurried pulse, and pleasant intoxication, then moisture of the skin, next profound sleep for some hours, attended with excessive sweating, and finally no ultimate ill consequence except great debility.[2376] I am assured by a correspondent, Dr. Jennison of Cambridge, U. S., that a medical friend of his has given 90 grains of camphor four times a day in phrenitis, with safety and advantage.
Professor Wendt of Breslau has related an instance, which proves the irritant action of camphor on man, and likewise the uncertainty of the dose required to act deleteriously. In the case of Mr. Alexander, two scruples would in all probability have proved fatal, had they not been discharged in time by vomiting. In the case now to be noticed, 160 grains were taken in a state of solution in alcohol, and were not vomited; yet the individual recovered. He was a drunkard, who took four ounces of camphorated spirit, prescribed for him as an embrocation. Soon afterwards he was attacked with fever, burning heat of the skin, anxiety, burning pain in the stomach, giddiness, flushed face, dimness of sight, sparks before the eyes, and some delirium. He soon got well under the use of almond oil and vinegar, but did not vomit.[2377]
Morbid Appearances.—The morbid appearances caused by camphor have not, so far as I know, been witnessed in man. In dogs examined immediately after death, the heart is no longer contractile, and its left cavities contain arterial blood of a reddish-brown colour. When the poison has been given in fragments, it leaves marks of inflammation in the stomach and intestines. Orfila found these organs much inflamed in such circumstances.[2378] Scudery found the membranes of the brain much injected, and the brain itself sometimes softened; the inner membrane of the stomach either very red, or checkered with black, gangrenous-like spots of the size of millet-seeds; the duodenum in the same state; the ureters, urethra, and spermatic cords inflamed; and every organ in the body, even the brain, impregnated with the odour of camphor.[2379]
The Menispermum cocculus, Cocculus suberosus, or Anamirta cocculus of botanists, is a creeping plant which grows in the island of Ceylon, on the Malabar coast, and in other parts of the East Indies. Its fruit, which is the only part of the plant hitherto particularly examined, is like a large, rough, grayish-black pea, and is known in the shops by the name of Cocculus indicus. It has a rough, ligneous pericarp, enclosing a pale grayish-yellow, brittle kernel, of a very strong lasting bitter taste. The medical jurist should make himself well acquainted with its external characters, because, besides being occasionally used in medicine, it is a familiar poison for destroying fish, and has also been extensively used by brewers as a substitute for hops,—an adulteration which is prohibited in Britain by severe statutes. It has been analyzed by M. Boullay of Paris,[2380] who found in it besides other matters, a peculiar principle termed picrotoxin. This principle constitutes, according to Boullay, about a fifth part of the kernel; according to Nees von Esenbeck, only a hundreth part:[2381] and my own experiments agree with the results of the latter. It is moderately soluble in water, and crystallizes readily from a hot acidulous watery solution. It is more soluble in hot alcohol, from which it crystallizes in granular masses. Ten grains of it killed a dog in twenty-five minutes in the second paroxysm of tetanus.
The seeds themselves occasion vomiting soon after they are swallowed; so that animals may often swallow them, if not without injury, at all events without danger. But if the gullet be tied, the animal soon begins to stagger; the eye acquires a peculiar haggard expression, which is the sure forerunner of a tetanic paroxysm; and the second, third, or fourth fit commonly proves fatal. Three or four drachms will kill a dog when introduced into the stomach; less will suffice when it is applied to a wound; and still less when it is injected into a vein.[2382] Wepfer has related a good experiment, from which he infers that Cocculus indicus acts by exhausting the irritability of the heart. In the intervals of the fits the pulse could not be felt; and on opening the chest immediately after death, he found the heart motionless and all its cavities distended.[2383] Orfila also sometimes found the heart motionless, and its left cavities filled with reddish-brown blood.[2384]
This poison does not seem to possess distinct acrid properties in regard to animals. M. Goupil indeed found that it produced vomiting and purging,[2385] but Orfila could not observe any such effect. According to Goupil it possesses the singular property of communicating to the flesh of animals, more particularly of fish, that have been killed with it, some of the poisonous qualities with which it is itself endowed. The accuracy of this statement may be doubted, the alleged fact being contrary to analogy. Besides, this poison has been used immemorially in the East for taking fish; and it is familiarly used for the same purpose in some parts of France, though prohibited by statute. Chevallier mentions that in a particular parish the inhabitants live half the year on fish caught with this poison; and that a friend of his made trial of fish so caught, without the slightest injury.[2386]
Symptoms in Man.—Although it is well known that malt liquors have often been adulterated with Cocculus indicus for the purpose of economizing hops, cases of poisoning in the human subject are rare, because the quantity required to communicate the due degree of bitterness is small. Professor Bernt has shortly noticed a set of cases, which arose in consequence of an idiot having seasoned soup with it by mistake. Nine people were taken ill with sickness, vomiting, pain in the stomach and bowels; and one died in twelve days.[2387] The symptoms under which this person died are not stated; but the account of the accident sent to Bernt imputed death to the poison,—which is improbable, considering the length of the interval before death.
In the same group with camphor and Cocculus indicus Orfila has arranged Upas antiar, a Javanese poison. This poison is a very bitter milky juice or extract, which is known in Europe only as an article of curiosity. It has been sometimes confounded with the Upas tieuté. It owes its properties to a neutral principle called antiarin.[2388] From the experiments of MM. Magendie and Delille,[2389] as well as from those of Sir B. Brodie[2390] and of Emmert[2391] it appears to act in the same manner, and to produce the same effects, as camphor and Cocculus indicus. In small doses it acts as an irritant; in large doses it causes convulsions and coma.
It is here noticed principally because it is one of the poisons which act violently on the heart. If the body of an animal be examined immediately after death from the Upas antiar, the heart is found to have lost its irritability, and the left ventricle to contain florid blood: Schnell found, that, like many other active poisons, it has no effect when applied to the divided end of a nerve.[2392]
The Coriaria myrtifolia is also supposed by some to possess the properties of the present group, and is sufficiently important from its energy, and its occasional injurious effects on man, to claim some notice here.
Its toxicological action has been investigated by Professor Mayer of Bonn, who found that it excites in most animals violent fits of tetanus, giving place to apoplectic coma; and that in the dead body the brain is seen gorged with blood, the blood in the heart and great vessels fluid, the heart not irritable immediately after death, and the inner membrane of the stomach yellowish and shrivelled. A drachm of the extract of the juice killed a cat in two hours when swallowed; half a drachm applied to a wound killed another in eighty-five minutes; and six grains in the same way killed a kitten in three hours and a half. A drachm swallowed by a young dog killed it in two hours and a half. Ten grains of the extract of the infusion applied to a wound killed a kitten in six hours; and three grains another in three hours. A buzzard was killed in three-quarters of an hour by half a drachm of the extract of the juice. Frogs are also soon killed by it. Rabbits, it is remarkable, are scarcely affected by this poison, either administered internally, or applied to a wound,—a drachm in the former way, and half as much in the latter, having produced no effect at all. A grain, however, injected into the jugular vein occasioned in about five hours a single convulsive paroxysm, which proved immediately fatal.[2393]
Instances of poisoning with this substance have occurred in the human subject,—generally in consequence of its having been taken in various parts of the continent with senna, which it is employed to adulterate. Sauvages has recorded two cases of death occasioned by the berries. In one, a child, death took place within a day under symptoms like epileptic convulsions; and in the other, an adult, who swallowed only fifteen berries, convulsions, coma, and lividity of the face were produced, ending fatally the same evening, though the greater part of the berries were discharged by emetics.[2394] In recent French journals various similar cases are recorded. M. Fée describes five cases, one of them fatal. In this instance, a male adult, death occurred within four hours after he took an infusion of senna adulterated with the coriaria; and the symptoms were violent convulsions, locked-jaw and colic.[2395] M. Roux has noticed a great number of cases in the fullest paper yet published on its effects on man, and gives the details of three which came under his own notice, and of which one proved fatal. In the fatal case, that of a child three years and a half old, who took between eighty and a hundred berries, the symptoms were heat and pricking of the tongue, sparking and rolling of the eyes, loss of voice, locked-jaw, and convulsions recurring in occasional fits of eight or ten minutes in duration. Death ensued in sixteen hours and a half.[2396] Roux refers also among other instances to those of no fewer than ten soldiers, who were attacked at the same time in consequence of eating the berries, and of whom two died. In Roux’s fatal case there was injection of the membranes of the brain, and no other particular appearance; in that mentioned by Fée, there was inflammation of the stomach and bowels; and in one of Sauvages’s cases no morbid appearance at all was discovered.
Considering these very pointed proofs of the poisonous qualities of the coriaria, it is not a little singular that doubts have lately arisen whether it is a poison at all. Peschier of Geneva says he has ascertained that tanners, who use it in their trade on account of the powerful astringency of the leaves, also take it internally for gleet, and that he gave a decoction of an ounce to chickens, dogs, and men, without witnessing any ill effect.[2397]
The leaves and berries of the Taxus baccata, or yew, are known to be poisonous; but their effects have not been investigated with care. I have arranged it in the meantime with the present group.
M. Grognier, as quoted by Orfila, ascertained that a decoction of eight ounces of berries without seeds had no effect on a dog; that a pound and a half of seeds had no effect on a horse; that three ounces of the juice of the leaves given to a large dog merely caused vomiting; and that a decoction of twelve ounces of leaves, confined in the stomach of a dog by a ligature on the gullet, had also no effect. But two ounces of the juice of the leaves killed a small dog; and Orfila himself ascertained, that thirty-six grains of extract of the leaves, injected into the jugular vein, caused giddiness, stupor, and death.[2398]
Accidents have repeatedly happened to children in this country from yew-berries. Mr. Hurt of Mansfield has given the particulars of an interesting case. A child, three years and a half old, two hours after eating the berries, was observed to look ill at dinner, and became affected with lividity and heaviness of the eyes, as if he was about to fall asleep. Vomiting followed, without any pain; and he died before a medical man, who was sent for, could arrive. Four other children, somewhat older, who had eaten the seeds, were made to vomit by emetics, and got well. The dead body of the first child presented many livid spots, redness of the villous coat of the stomach, and gorging of the brain and membranes with blood. A mass of berries, seeds, and potatoes was found in the stomach.[2399]—Dr. Hartmann of Frankfort mentions that a girl, who took a decoction of the leaves to produce abortion, died in consequence, but without having miscarried.[2400]—Dr. Percival has related other cases in his essays.[2401]
A fourth group of poisons possessing narcotico-acrid proper ties, includes the poisonous fungi or mushrooms.
Accidents arising from the deadly fungi being mistaken for eatable mushrooms are common on the continent, and especially in France. They are not uncommon, too, in Britain; but they are less frequent than abroad, because the epicure’s catalogue of mushrooms in this country contains only three species, whose characters are too distinct to be mistaken by a person of ordinary skill; while abroad a great variety of them have found their way to the table, many of which are not only liable to be confounded with poisonous species, but are even also themselves of doubtful quality.
The present subject cannot be thoroughly studied without a knowledge of the appearance and characters of all the fungi which have been ascertained to be esculent, as well as of those which are known to be deleterious. This information, however, I cannot pretend to communicate, as it would lead to great details. In what follows, therefore, a simple list will be given of the two classes, with references to the proper source for minute descriptions of them, and some general observations on the effects of the poisonous species.
List of the wholesome and poisonous Fungi.—The only good account yet published of the innocent or eatable fungi of Great Britain is contained in an elaborate essay on the subject by Dr. Greville of this place. He enumerates no fewer than twenty-six different species, which grow abundantly in our woods and fields, and which, although most of them utterly neglected in this country, are all considered abroad to be eatable, and many of them delicate. They are the following: Tuber cibarium, or common truffle; T. moschatum and T. album, two species of analogous qualities; Amanita cæsarea or aurantiaca, the Oronge of the French, a species which is often confounded by the ignorant with a very poisonous one, the A. muscaria, or pseudo-aurantiaca; Agaricus procerus; A. campestris, the common mushroom of meadows; A. edulis, or white caps; A. oreades, or Scotch bonnets; A. odorus; A. uburneus; A. ulmarius; A. ostreatus; A. violaceus; A. deliciosus; A. piperatus; and A. acris; Boletus edulis; and B. scaber; Fistulina hepatica; Hydnum repandum; Morchella esculenta, the common morelle; Helvella mitra, and H. leucophæa. Of these the Agaricus acris, procerus, and piperatus are probably unwholesome; and the Amanita cæsarea is very rare in this country, if indeed it is indigenous at all. The A. muscaria, with which it is apt to be confounded, is common enough. The species to which our cooks confine their attention are the Tuber cibarium or truffle, the Agaricus campestris, or common mushroom, and the Morchella esculenta, or morelle. The Agaricus edulis is also to be met with in some markets, but is not in general use.[2402]
The best description of the poisonous species is to be found in Orfila’s Toxicology. He enumerates the Amanita muscaria, alba, citrina, and viridis; the Hypophyllum maculatum, albocitrinum, tricuspidatum, sanguineum, crux-melitense, pudibundum and pellitum; the Agaricus necator, acris, piperatus, pyrogalus, stypticus, annularis, and urens.[2403] To these may be added the Agaricus semiglobatus, on the authority of Messrs. Brande and Sowerby,[2404] the A. campanulatus,[2405] the A. procerus, on the authority of a case by Dr. Peddie of this city,[2406] the A. myomica, on the authority of Ghiglini,[2407] the A. panterinus on that of Dr. Paolini of Bologna,[2408] the A. bulbosus of Bulliard, or Amanita venenata, on that of Pouchet,[2409] the Agaricus vernus, insidiosus, globocephalus, sanguineus, torminosus and rimosus, on that of Letellier,[2410] and the Hypophyllum niveum on the authority of Paulet.
Circumstances which modify their qualities.—The qualities of the fungi as articles of food are liable to considerable variety. Some, which are in general eaten in safety, occasionally become hurtful; and some of the poisonous kinds may under certain circumstances become inert, or even esculent. But the causes which regulate these variations are not well ascertained.
It has been thought by some that most fungi become safe when they have been dried;[2411] and there may be some truth in this remark, as their poisonous qualities appear to depend in part on a volatile principle. But it is by no means universally true. Foderé mentions that the Agaricus piperatus continues acrid after having been dried.[2412]
Climate certainly alters their properties. The Agaricus piperatus is eaten in Prussia and Russia;[2413] but is poisonous in France. The Agaricus acris and A. necator, also enumerated above as meriting their names, are used freely in Russia.[2414] The Amanita muscaria in France and Britain is a violent poison, and is considered so even in Russia;[2415] but in Kamschatka it yields a beverage which is used as a substitute for intoxicating liquors.[2416]