Sulphuric ether and nitric ether are poisons of the same nature with alcohol. But the effects produced by them when taken in considerable doses are not very well known.
Orfila found that half an ounce of sulphuric ether introduced into the stomach of a dog and secured there by a ligature on the gullet, excited efforts to vomit, in ten minutes inability to stand, and in six minutes more, insensibility. In fifteen minutes more the animal revived a little, but soon became again comatose; and it died in three hours after the commencement of the experiment. The villous coat of the stomach was reddish-black, the other coats of a lively red colour.[2541]
The effects of the ethers on man have not been accurately ascertained. From some observations published in the Journal of Science, sulphuric ether appears to act energetically even in small doses. In moderate quantity it produces a strong sense of irritation in the throat, a feeling of fulness in the head, and other symptoms like those excited by nitrous-oxide gas. A gentleman, in consequence of inhaling it too long, was attacked with intermitting lethargy for thirty-six hours, depression of spirits and lowness of pulse.[2542] When long and habitually used, as by persons afflicted with asthma, its dose must be gradually increased; and it appears that considerable quantities may then be taken for a great length of time without material injury. I have been informed of an instance of an asthmatic gentleman about sixty years of age who consumed sixteen ounces every eight or ten days, and had been in the habit of doing so for many years. Yet, with the exception of his asthma, he enjoyed tolerable health.
An interesting case has been published which proves that nitric ether in vapour is a dangerous poison when too freely and too long inhaled. A druggist’s maid-servant was found one morning dead in bed, and death had evidently arisen from the air of her apartment having been accidentally loaded with vapour of nitric ether, from the breaking of a three-gallon jar of the spiritus etheris nitrici. She was found lying on her side, with her arms folded across the chest, the countenance and posture composed, and the whole appearance like a person in deep sleep. The stomach was red internally, and the lungs were gorged.[2543] The editor of the journal, where this case is related, says he is acquainted with a similar instance where a young man became completely insensible from breathing air loaded with sulphuric ether, remained apoplectic for some hours, and would undoubtedly have perished had he not been discovered and removed in time.
The physiological effects of these substances have not yet been extensively investigated. It has been already mentioned, that the empyreumatic oils of tobacco and other narcotic vegetables are active poisons; and that the emanations from candle snuffings and imperfectly consumed tallow probably owe their injurious properties to a peculiar oil. Many empyreumatic oils are known, and some are used in medicine, which act powerfully on the animal system as stimulants and antispasmodics. Among these may be enumerated naphtha, oil of galbanum, oil of guiaiac, oil of amber, oil of wax, and Dippel’s oil. The last in particular, which is the rectified empyreumatic oil of hartshorn, but is prepared also from blood and various animal matters,[2544] has been a good deal used of late on the continent for medical purposes, and has even been resorted to as a poison for the purpose of self-destruction.
The only one of these substances whose physiological properties have been examined with particular care, is the empyreumatic oil procured by the destructive distillation of lard. When freed of adhering acid by rectification from quicklime, this oil is limpid and very volatile, has an insupportable smell, and when diffused in the air, irritates the eyes and nostrils, and even excites giddiness. Buchner found it to possess simple narcotic properties. When a mouse was confined under a jar, into which a little of its vapour was introduced, it suddenly tried to escape, immediately fell down exhausted, and, although soon afterwards removed into the open air, expired in about fifteen minutes, without convulsions. It is much less powerful when introduced into the stomach, yet is still a dangerous poison through that channel; for five drops projected into the throat of a chaffinch very nearly proved fatal; and the only symptoms were excessive exhaustion, slow respiration, and insensibility.[2545]
Similar effects have been occasionally observed in man. The late Professor Chaussier has related a case of poisoning in the human subject from the oil of Dippel, or rectified empyreumatic oil of hartshorn. It is merely mentioned, however, that the individual, on taking a spoonful by mistake, died immediately; and that no morbid appearance could be discovered in the dead body.[2546] Another case has been more recently related, where the poison was the impure oil of commerce, from which the oil of Dippel is prepared by rectification. The subject was a woman, who took it intentionally in the dose of an ounce and a half. The symptoms induced could not be ascertained; but it appeared, that she had been attacked with vomiting, and, finding the action of the poison either less speedy, or less supportable than she expected, had thrown herself into a well and been drowned. The appearances in the body clearly showed that in this instance the poison had not acted as a pure narcotic. The whole body exhaled the peculiar fetid odour of the oil. The palate, tongue, throat, and gullet, were white and shrivelled. The stomach had outwardly a diffuse rose tint, crossed by gorged black veins, which here and there had burst and formed patches of extravasation. The contents of the stomach consisted of remains of food, a good deal of the oil, some water, and likewise some extravasated blood. Its villous coat was thick, covered with red points, corrugated into prominent rugæ, but not eroded. The intestines also presented signs of irritation, but in an inferior degree.[2547] Dr. Kurtze, a German author, mentions that the impure oil [Oleum Animale Fœtidum] was given with malicious intention in repeated doses to an infant eighteen days old, whom he attended, and that it caused crying and vomiting; and he quotes Froriep’s Notizen, for the case of a woman of thirty, who swallowed nearly two ounces, and, after repeated attacks of vomiting, threw herself into a well and was drowned.[2548]
These facts seem to establish sufficiently the propriety of arranging the empyreumatic oils among the narcotico-acrids.
Oil of turpentine possesses somewhat similar properties; but is much less active. It was found by Professor Schubarth, that two drachms of this oil administered to a dog produced immediate staggering, cries, tetanus, failure of the pulse and breathing, and death in three minutes; and in the dead body he remarked flaccidity of the heart, gorging of the lungs, and redness of the stomach.[2549] It is likewise well known to be a powerful poison for vermin, such as lice, fleas, and worms.—On man its effects are capricious. It is frequently used along with other laxatives against obstinate constipation of the bowels, and either in the same manner or alone as a remedy for intestinal worms. For these purposes it has been at times administered in very large doses, for example in the quantity of two, three, or four ounces, without any other effect than brisk purging. But on the other hand it has sometimes, in much inferior doses, induced violent hypercatharsis, or acted severely on the urinary organs, producing strangury and bloody micturition, or affected the brain, producing a state like intoxication, followed by trance for many hours.[2550] I am not aware that it has ever proved fatal.
Oil of tar, a composite substance obtained by the distillation of wood-tar, is another pyrogenous fluid of poisonous properties. Messrs. Slight of Portsmouth have related the case of a seaman, who, after taking nearly four ounces by mistake for spirits, was attacked with frequent vomiting of a matter having a strong odour of tar, attended with excessive pain in the bowels and loins. Nothing was done for his relief till about seven hours afterwards, when he was freely bled and purged, with immediate relief; and next morning he was so better as to be able to resume his work. The urine had a strong tarry odour, and for some time he suffered from heat in passing it.[2551] A case occurred in the London Hospital, in which the symptoms were very different. A lad of eighteen, while intoxicated, took two or three draughts of oil of tar, although aware of its being poisonous. Not long afterwards he became insensible, and had laborious, rattling respiration, coldness of the extremities, suffusion of the conjunctiva, contraction of the pupils, and an exceedingly feeble pulse. The stomach-pump brought away a liquid with an overpowering smell of tar. Stimulants, external as well as internal, venesection, and turpentine clysters were of little avail; the insensibility continued, with only a short and imperfect interval; and he died about twenty-four hours after swallowing the poison. The pulmonary mucous membrane was highly injected, the lungs gorged with blood and of a tarry odour, the stomach and intestines natural, except that the whole valvulæ conniventes were yellow,—the brain and its membranes also natural.[2552] It is mentioned in the paper of Messrs. Slight that a gentleman at Brighton died in consequence of a druggist using oil of tar by mistake for something else in making up a prescription.
Creasote is another pyrogenous substance possessing considerable activity as a poison. It is now extensively used in small doses as a medicine for a variety of purposes.
It has been made the subject of physiological experiment by various inquirers, and especially by Dr. Cormach; who found that doses of twenty-five or forty drops caused death in a few seconds when injected into the jugular vein of a dog, by arresting the heart’s action, and without visibly altering the condition of the blood; that a quantity somewhat larger caused only sopor and spasmodic twitches of the muscles, if injected into the carotid artery, and without proving fatal; that thirty drops introduced into the stomach of a rabbit excited convulsions, acute cries, and death in one minute, apparently from arrestment of the action of the heart; and that the same dose given to a dog brought on salivation, giddiness, tetanic spasm, a feeble, fluttering, almost imperceptible pulse, and general insensibility, with dilated immovable pupils; but recovery took place under the employment of blood-letting.[2553]—The effects of too large a medicinal dose in man are pain in the stomach and vomiting, and also, according to Dr. Elliotson, giddiness, headache, and stupor.[2554] Dr. Pereira alludes to a case, mentioned in the Times newspaper, of death caused in 36 hours by two drachms taken at once; and in this instance acute pain in the abdomen was a prominent symptom.[2555] I presume this is the same case which is mentioned in the Edinburgh Medical and Surgical Journal as having occurred at Liverpool.[2556]—The results of Dr. Cormack’s experiments on animals lead to the conclusion, that in poisoning with creasote, this substance may always be detected in the body, if it has not been removed by artificial means a considerable time before death.
Having now investigated the three great classes of poisons in their relations to physiology, practice of physic, and medical jurisprudence, it will be necessary to offer a few observations on a subject of considerable medico-legal importance, which has been almost overlooked in systems of Toxicology,—Compound Poisoning.
When two poisons of different or opposite properties are administered about the same time in poisonous doses, the effects of the one may overpower and prevent the operation of the other, or they may merely modify the action of one another. In this manner the usual symptoms produced by one or by both may be entirely or in a great measure wanting; and even in the dead body the usual appearances occasioned by one or both may be modified or perhaps altogether absent.
Although in the course of reading I have met with a sufficient number of cases of the kind to show that compound poisoning is an object of some consequence to the medical jurist, the facts hitherto made public are not so numerous as to render a systematic arrangement of them practicable. The most advisable course, therefore, seems to be merely to describe for the present the cases which have been brought under my notice. These are as follows:
1. Poisoning with Arsenic and Alcohol.—A man, after taking twelve ounces of whisky at a debauch, swallowed, an hour afterwards, while in a state of excitement, but not particularly drunk, a quantity of arsenic, the dose of which could not be ascertained. Fifteen minutes after the arsenic was taken medical aid was procured, upon which repeated attempts were made to produce vomiting by means of ipecacuan and sulphate of zinc, but to no purpose. The stomach-pump was therefore resorted to; and, after at least an hour had been spent in previous attempts by emetics, the stomach was cleared of a fluid in which arsenic was unequivocally detected. No symptom of poisoning with arsenic followed. As the man took the arsenic seven hours after a meal, when of course the powder would at once be brought freely in contact with the villous coat of the stomach, it must, I think, be inferred, that the operation of the arsenic was impeded or prevented by the narcotism previously induced by the ardent spirits. For this case I am indebted to a former pupil, Mr. King.
Poisoning with Arsenic and Alcohol.—A case of the same description with the last, but which proved fatal in consequence of the large quantity of arsenic taken, has been related by Dr. Wood of Dumfries. A lad of seventeen, after a night’s debauch, swallowed half an ounce of arsenic early in the morning. In two hours and a half, when Dr. Wood first saw him, there was no symptom of poisoning with arsenic,—no symptom at all indeed but languor and drowsiness. A few minutes afterwards he had slight vomiting, which was repeatedly renewed by artificial means. For some hours the pulse was but little elevated. In eighteen hours he began to sink, and presented the usual constitutional symptoms of poisoning with arsenic; and in forty-one hours he expired. But from first to last he had scarcely any local symptom except vomiting, even although the stomach presented after death signs of violent irritation.[2557]
3. Poisoning with Tartar-Emetic and Charcoal Fumes.—Under the head of poisoning with antimony, notice has already been taken of the case of a man who, after swallowing seventeen grains of tartar-emetic, attempted to commit suicide by suffocating himself with the fumes of burning charcoal. He recovered from both attempts, suffered severely from the usual narcotic effects of carbonic acid gas, but showed scarcely any symptom of the irritant action of tartar-emetic.[2558]
4. Poisoning with Alcohol and with Laudanum.—Under the head of poisoning with opium, allusion has already been made to a remarkable case related by Mr. Shearman, where the usual effects of opium were much retarded in an individual who, at the time of swallowing the opium, was in a state of excitement from intoxication. For five hours there was no material stupor. But after that the usual narcotic symptoms supervened and eventually proved fatal.[2559] The excitement of intoxication, however, has not always the effect of suspending the action of opium; for in a case which came under my notice in the Infirmary of this city,—that of a woman, who swallowed an ounce and a half of laudanum while much intoxicated,—the usual narcotic symptoms were fully formed in an hour: and although the stomach-pump was applied soon afterwards, she expired in less than five hours from the time the laudanum was swallowed,—those who had charge of her before she was brought into the hospital having neglected to use the proper means for keeping her roused.
5. Poisoning with Laudanum and Corrosive Sublimate.—Of all the cases of compound poisoning I have met with, the most remarkable is an instance which occurred in Edinburgh Castle, a few years ago, of poisoning with laudanum and corrosive sublimate. In this case, the individual, a young soldier, swallowed about the same time two drachms of the latter and half an ounce of the former. He had at first no violent symptoms whatever, indicating the operation of corrosive sublimate; which is an extremely rare occurrence. Afterwards he had frequent purging and tenesmus, with bloody stools and all the usual phenomena of violent dysentery, but no pain of belly, no tenderness even on firm pressure, no vomiting except under the use of emetics. On the fourth day a violent salivation set in; and under this and the dysenteric affection he became quickly exhausted, yet not so much, but that on the day of his death, the ninth after he took the poison, he was able to walk a little in his room without assistance. He died on the close-stool rather unexpectedly. I have unfortunately lost the original notes I had of this case, and have forgotten whether any narcotic symptoms were present at first; but my impression is that they were present, though in a slight degree only. Most of the previous particulars were communicated to me by the late Dr. Mackintosh. The stomach, duodenum, ileum, colon, and rectum were found after death enormously inflamed, ulcerated, and here and there almost gangrenous.—In this instance some of the corrosive sublimate must have been decomposed by the laudanum, and an insoluble meconate of mercury formed. But the quantity thus decomposed could have been but a small proportion of the whole,—as was indeed proved by the extensive ravages actually committed in the whole alimentary canal. I conceive, therefore, that there is no other way of accounting for the slight apparent effects of the corrosive sublimate, at the commencement particularly, than by supposing that the narcotic operation of the opium veiled or actually retarded the irritant action of the corrosive sublimate.
6. Poisoning with Opium and Belladonna.—A lady, who used a compound infusion of opium and belladonna as a wash for an eruption in the vulva, took it into her head one day to use the wash as an injection; and actually received three successive injections, containing each the active matter of a scruple of opium and half an ounce of belladonna leaves. Fortunately none of the three was retained above a few minutes, except the last, which was not discharged for ten minutes. In less than an hour, she was found in bed in a deep sleep, but the true cause was not suspected till three hours later. She was then completely insensible and motionless, with the face pale, the pupils excessively dilated and not contractile, the pulse frequent and small, and the breathing hurried. After the use of purgative injections, blood-letting, leeches to the head, and sinapisms to the legs, she began in five hours to show some sign of returning consciousness, which improved after a fit of vomiting. When thoroughly roused, her vision continued dim, the pupils excessively dilated, and the ideas somewhat confused. For three days the pulse continued frequent, and the pupils somewhat dilated.[2560] Here the opium seems to have prevented the delirium usually induced by belladonna in the early stage, while on the other hand the belladonna prevented the usual effect of opium on the pupils, and actually produced the opposite action.
7. In the following cases, the active poisons to which the individuals were exposed were so numerous, that it is impossible to say which or how many of them occasioned the symptoms. A colour-maker was superintending a process in which cobalt, arsenic, mercury, sal-ammoniac, and nitric acid were subjected to heat in a mattrass, when the mattrass suddenly gave way, and a dense vapour was instantly discharged. The manufacturer, before he could escape, fell down insensible; and though speedily removed, he died in no long time, affected with enormous swelling of the abdomen. A workman who was also present, escaped by a window; but was nevertheless immediately attacked with swelling of the belly, which speedily became very great, and was attended with pain in the jaws, and dimness of sight. These symptoms were very slowly dissipated under the use of cold bathing and purgatives, which brought away an enormous quantity of fetid gas.[2561]
These are not the only examples of compound poisoning which have come under my attention. But others I have noticed are not detailed with sufficient exactness to make it worth while to quote them. The instances given, however, are sufficient to show that poisons of opposite qualities given about the same time in large doses will disguise one another’s effects, or impede, or perhaps even prevent them, in a manner which renders such a combination of circumstances an important subject of inquiry for the medico-legal toxicologist.
It is probable that the modifying influence is established in one of two ways,—either by one poison producing a state of venous plethora or distension, which impedes, or for a time prevents, the absorption of the other,—or by one poison producing an insensibility of the membrane with which the other is in contact; so that not only the local injury actually done has not the usual remote effect on the constitution, or on distant organs, but likewise is at times substantially less extensive than in ordinary circumstances. These reflexions arise naturally from a review of the preceding cases; but of course further facts are necessary to give them weight.