Edward Curtis Hill.

A text-book of chemistry, for students of medicine, pharmacy, and dentistry online

. (page 32 of 48)
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giddiness, cramps in the legs, torpor, coma, and convulsions are
common symptoms. Dilute mineral acids and other corrosives
may act as irritant poisons.

MINERAL.

Arsenic is present in white arsenic, fly-paper, fly-powder,
"Hough on Rats," Scheele's green (candy, wall-paper), Paris
green, cancer cures, colored crayons, and artificial flowers.
Special symptoms of arsenical poisoning are the suffused and
reddened eyes, brown vomit often mixed with bloody mucus,



346 TOXICOLOGY.

bloody or choleraic stools with tenesmus, subnormal tempera-
ture, and prominent nervous symptoms. The skin is cold and
clammy. The urine is often partly suppressed. Pain is gen-
erally severe, but may be slight or 'absent; numbness and
tingling are complained of. The symptoms usually begin in
from fifteen to sixty minutes. The smallest fatal dose was 1 1 / 2
grains; fatal period, two to twenty-four hours; average, ten.
A simple test for As is the garlicky odor noticed on heating
the powder, or the lemon-yellow ppt. with H 2 S.

After thoroughly emptying the stomach with the pump,
tube, or emetic, one should neutralize the remaining poison
that cannot be washed away. This is done by means of mag-
nesia with freshly made magma of ferric hydrate (made by
mixing equal parts of tincture of iron and ammonia-water, and
straining and washing the precipitate), of which the dose is a
tablespoonful every half-hour for four to six doses. This forms
insoluble Fe 3 (As0 4 ) 2 .

Demonstration of Antidote for Arsenical Poisoning. Render
Fe 2 Cl 6 solution alkaline with NH 4 OH, throwing down ppt. of Fe 2 (HO)
on a cloth; wash clear of NH 3 , and then stir the ppt. into a beaker con-
taining an arsenic solution. After five minutes filter and prove absence
of As in filtrate.

Another good antidote for arsenic is dialyzed iron. Stimu-
lants (brandy, aromatic spirit of ammonia, strychnin) should be
given hypodermically for faintness, and, if the patient is cold,
use hot blankets. After the sickness subsides an ounce or two
of castor-oil should be given.

Antimony poisoning is characterized especially by excessive
vomiting and depression; also by a strong metallic taste, by
early salivation, profuse sweats, and rice-water stools. The
urine is usually increased, with painful micturition. Two
grains of tartar emetic have caused death. Tannin is the best
antidote; ferric hydrate is next best. Encourage vomiting with
warm drinks, stimulate freely, and keep patient warm with hot
blankets and bottles.

Acute lead poisoning is manifested by intense abdominal
pain, with hard, retracted abdomen and constipation; the stools
are black. If the case is protracted, local paralyses and the
blue line on the gums appear. Any lead salt or solution turns
black with H 2 S; lead salts are also easily reduced to a bead.
One ounce of sugar of lead has proved fatal. Any sulphate
(preferably MgSOJ will ppt. Pb solutions and act as an anti-
dote. A hypodermic of morphin will usually be required for
the pain.



IRRITANTS. 347

Copper poisoning (blue vitriol, verdigris) excites greenish
vomit and a very marked metallic taste. In acid solution me-
tallic copper is pptd. on a knife-blade. Milk and eggs are
antidotes.

The chlorid of tin used in dyeing has sometimes given rise
to toxic effects. It is more depressant than irritating. A frag-
ment of Zn ppts. the metal in arborescent form. Milk and eggs
are in order; magnesia is also an antidote.

Both copperas and tincture of iron have caused death
when taken in very large doses (1 Y 2 ounces of tincture). Iron
solutions turn black with tannin or tea, and cause a dark-
greenish fur on the tongue. Baking-soda or magnesia and milk
and mucilaginous drinks are indicated.

Common alum in very large doses may produce toxic
symptoms. It has a sweetish, styptic taste, and there is some-
times frothing at the mouth. The chief antidotes are milk and
baking-soda.

Zinc sulphate in large doses causes excessive vomiting,
dilated pupils, and coma. One-half ounce has proved fatal in
about twelve hours. Vomiting should be encouraged by copious
draughts of warm water. Antidotes are lime-water, albumin,
soap-suds, and tannin.

Potassium dichromate has caused death in a number of
instances, 2 drams being the smallest fatal dose. The vomit
is yellow, the pupils dilated, and there is violent purging. Am-
monia-water gives a green ppt. Lime-water or magnesia and
milk are good antidotes.

Barium salts cause nervous symptoms, cardiac palpitation,
disturbed vision, and great weakness. One dram has proved
fatal. Epsom or Glauber salts are purgative antidotes, and
should be followed by emetics and by fixed oils to soothe. The
flame test is greenish.

The chlorate, sulphate, and bitartrate of potassium are all
capable of exciting toxic symptoms; 4 drams of chlorate have
caused death, and 1 1 / 2 ounces of cream of tartar likewise. The
chlorate is marked by rigid limbs, delirium, coma, and bloody
urine. The bitartrate poisoning resembles that by niter. So-
dium bicarbonate neutralizes the bitartrate. Opium, stimu-
lants, and demulcents are called for.

Bleaching powder taken internally acts as an irritant
poison. It has a sharp, acid taste and a distinct odor of chlorin.
It is best counteracted by lime-water and oils.

lodin solutions in large doses are marked by an acrid taste,
tightness about the throat, pain, vomiting, and purging; yellow
stains are noted on the mucous membrane. Starch or flour in



348 TOXICOLOGY.

warm water should be given till the blue color disappears from
the vomit. White of eggs and milk should follow.

Phosphorus .poisoning may occur from swallowing match-
heads, ratsbane, or phosphorated oil, or by inhalation of phos-
phine. Special symptoms are a garlicky odor and taste; grad-
ually increasing pain, beginning over the region of the liver
within an hour to several days; jaundice on second or third
day; muscular twitchings; albuminuria, hematuria, or sup-
pressed urine (contains leucin and tyrosin); paralysis, coma,
and collapse. The vomit is greenish or coffee-ground in color,
and both it and the stools are luminous in the dark, especially
on heating with sulphuric acid. One-fiftieth grain has caused
death in from one to four days. There is no direct antidote
for phosphorus. Useful oxidizing agents are potassium per-
manganate and ozonized turpentine ("French oil," 1 / 2 dram
every half-hour for five or six doses). As an emetic, copper
sulphate is commonly used: 3 grains well diluted every fifteen
minutes till vomiting occurs. Albuminous and mucilaginous
drinks and milk or magnesia should be given, but no oils or
fats. Oxygen inhalations are recommended. Post-mortem ex-
amination shows fatty degeneration of the liver, kidneys, heart,
and other muscles.

Demonstration of Antidote. Place a bit of P in CuSO 4 solution for
a few minutes, and note, on removal, the coating of Cu on the piece of P.

VEGETABLE.

Many resins (aloes, jalap, gamboge, scammony, bryony,
elaterium) in too large doses cause excessive mucous purging,
with intense griping pain and considerable depression. The
stomach should be emptied and castor-oil given. Morphin
hypodermically, mucilaginous drinks, emollient enemata, and
hot fomentations are also useful. It is important to counteract
great exhaustion.

Certain oils (savin, croton, castor, turpentine) may excite
choleraic vomiting and purging, with contracted pupils, ster-
torous breathing, strangury, and collapse. Fifteen minims of
croton-oil have proved fatal. The white of eggs is the chief
antidote. Epsom salts are useful against turpentine, for which
hot fomentations to the loins are also serviceable. Brandy,
aromatic ammonia, or other stimulant may be needed.

Colchicum preparations sometimes produce violent purg-
ing, with dilated pupils, cold skin, dyspnea, and rapid exhaus-
tion. Tannin or strong tea or coffee ppts. the active principle,
and stimulants are necessary.



IRRITANTS. 349

Black, green, and white hellebore or veratrum has a very
acrid and bitter taste, and causes, in poisonous doses, violent
vomiting, purging, and abdominal pain, with marked depres-
sion. It is treated like colchicum poisoning. Ergot, or the
fungus of rye, often taken to produce abortion, causes dizziness,
headache, mydriasis, dyspnea, delirium, coma, and heart-failure.
It has a peculiar, nutty odor. Tannic acid is the antidote.
Xitroglycerin is of service, and small doses of opium may be
given after the stomach and bowels are emptied. The patient
should be kept warm in the recumbent posture.

The symptoms of digitalis poisoning are chiefly a feeble,
slow, intermittent pulse; nausea, grass-green vomiting, and
purging; abdominal pain, vertigo, pale .face, dilated pupils;
severe headache, delirium, syncope; cold, clammy skin; chro-
mopsia, cyanosis, convulsions, paralysis, coma. Death occurs
from sudden heart-failure. Poisoning usually takes place
from the cumulative effect of the drug given in repeated doses,
rather than from a single large dose. The main point in treat-
ment is to keep the patient in a horizontal posture. Brandy is
useful, and aconite may be tried in very small doses and re-
peated if beneficial. Tannin or strong tea should be given to
antidote the glucosids.

Lathyrus, or vetches, are marked by an initial chill, pain
in the loins and legs, a girdle sensation, paresthesia, lameness,
and gangrene.

All parts of the yew- and laburnum- trees may cause toxic
symptoms, such as vomiting, abdominal pain, narcosis, con-
vulsive movements, and dilated pupils. They have a sweet
taste. Cytisin warmed with nitric acid gives an orange-yellow
color.

ANIMAL.

Cantharis, or Spanish fly, used either internally or exter-
nally, may cause a dull pain in the loins, vesic tenesmus, stran-
gury, priapism, salivation, and bloody vomit, stools, and urine.
It blisters skin or mucous membrane. One should look for the
shining gold-green wing-cases of the insects with a hand-lens.
One ounce of the tincture has resulted fatally. Give plenty of
water and a warm bath; empty the stomach and give castor-oil.
Charcoal, linseed-tea, mucilage, milk, morphin, and stimulants
(by the rectum) are all of service.

Botulismus (sausage or meat poisoning) is characterized by
dry mouth, vomiting, purging, constricted throat, vertigo, di-
lated pupils, ptosis, suffocation, fever, erythema, thready pulse,
and collapse. The putrid section of meat looks dirty grayish



350 TOXICOLOGY.

green, soft, and smeary. The chief indication is to wash out
the stomach and intestines as thoroughly as possible. Mor-
phin, atropin, and strychnin may also be required.

Galactotoxicons, or milk-poisons, are saprophytes causing
the summer diarrheas of infants, with vomiting, prostration,
and stupor. The chief indications are to stop the milk, give
white of egg and water, and flush the stomach and bowels fre-
quently with normal saline solution.

Tyrotoxicon (diazobenzene) is a poison sometimes formed
in cheese, ice-cream, custard, and cream-puffs. It produces dry-
ness and constriction of the throat, purging, vomiting, weak
pulse, nervous prostration, and delirium. Thorough washing
of the stomach and intestines should be performed, and hypo-
dermic injections of strychnin, brandy, or ammonia will prob-
ably be needed.

Ichthyotoxins, or fish-poisons, may be present in canned
fish, mussels, or "kakke." The symptoms are vomiting, purg-
ing, dyspnea, fever, scarlatinous or urticarial rash, often dilated
pupils, painful cramps in the limbs, marked prostration, con-
vulsions, delirium, and insensibility. The treatment is the
same as above.

GASES.

The more common acid vapors are bromin, chlorin, hydro-
chloric acid, and nitrous and sulphurous fumes. They excite
coughing and suffocation, conjunctival and pharyngeal conges-
tion, trembling and weakness. The concentrated gas may pro-
duce an immediate fatal result by closure of the glottis and
asphyxia. The peculiar odor and color of the fumes aid in the
diagnosis. Weak ammonia by inhalation is the antidote. Fresh
air and rest are most important. Congestion of the lungs should
be relieved, if necessary, by counter-irritants.

Alkaline vapors, such as strong ammonia, produce the same
symptoms as acid vapors, with perhaps more burning in the
throat and with vomiting and giddiness. Vinegar inhalations
are antidotal. Otherwise the treatment is the same as for acid
gases.

NEUROTICS.

The members of this class act principally on the nervous
system, after absorption, the symptoms usually beginning in
about a half-hour. The class is variously divided into several
varieties, the simplest arrangement being into narcotics, de-
pressants, and convulsants.



NARCOTICS. 351



NARCOTICS.

These are characterized chiefly by stupor, delirium, and
insensibility, the latter supervening in from five minutes to
many hours. Convulsions may occur. The treatment in gen-
eral for narcotic poisoning is to give as an antidote for all the
alkaloids tannic acid or strong green tea, or potassium perman-
ganate grain for grain of the poison (the stomach may be
washed with a solution of permanganate, 2 to 4 grains to the
pint). Charcoal is also of some service as an antidote. The
physiologic antagonists most indicated are caffein (or strong
coffee by the rectum or mouth), atropin (Vi2o grain every fifteen
minutes for three doses in morphin or opium poisoning), am-
monia, strychnin, brandy, and amyl nitrite for heart-failure;
morphin (till pupils begin to contract) and pilocarpin ( l / 2 grain)
for belladonna, atropin, or other solanaceous poisons; and
faradism of the phrenic nerve in the neck. The stomach should
be emptied with tube, pump, or emetics (mustard is very good).
Slap the chest with towels wrung from cold water; apply cold
to the head and warmth to the extremities. Keep the bladder
empty to prevent resorption of the poison. Artificial respira-
tion may be needed for a time. In opium poisoning the patient
should be kept awake by walking him about. For alarming
symptoms during anesthesia invert the patient, hold up the
base of the tongue, clear the fauces, inject stimulants, use
nitrite of amyl by inhalation, and employ artificial respiration.
Atropin and caffein are the most generally useful stimulants.

Opium poisoning may take place by way of morphin, co-
dein, laudanum, paregoric, soothing and cough syrups, poppy-
tea, Dover's powder, black drop, Godfrey's cordial, McMunn's
elixir, etc. One grain of morphin by the mouth, 4 grains of
opium, and 2 drams of laudanum have each proved fatal. The
usual fatal period is from three to twelve hours, the earliest
having been forty-five minutes. The leading symptoms are
staggering, excitement, then coma; pin-point pupils (may be
dilated toward fatal end); slow, full pulse, becoming weak and
irregular; slow, stertorous breathing, becoming feeble and of
the Cheyne-Stokes type. The face is congested, becoming
paler; the skin is cold and clammy and may show urticaria or
itching. Convulsions are common in children, and may be
tetanic in nature. Children are particularly susceptible to
opiates.

Belladonna or atropin poisoning exhibits symptoms which
are almost entirely opposite, namely: dilated pupils and rapid
pulse and respiration. There is active delirium; sometimes



352 TOXICOLOGY.

high fever; hot, dry skin, throat, and fauces; and may be
strangury and suppressed urine. A drop of the patient's urine
instilled into the eye of a dog or cat will dilate the pupil in a
few minutes. One-half grain of atropin has caused death.
Poisoning by hyoscyamus, stramonium, or solanum (potato-
sprouts) shows similar symptoms. Hyoscin is a muscular
paralyzant. Stramonium excites cardiac irregularity and furi-
ous delirium.

Cannabis-Indica preparations have never caused death, but
often produce alarming symptoms, particularly dilated pupils
and exaltation of the senses. Minutes seem hours, and there
may be joyous delirium or double consciousness. In addition
to brandy and strychnin, lemon-juice freely is advocated.

Muscarin is the active principle of poisonous mushrooms
or toad-stools. These, when swallowed, produce gastro-en-
teritis; vertigo; dim vision; marked myosis; intense dyspnea;
feeble, rapid pulse; marked delirium; tremors, epileptiform
attacks; lethargy, and coma. Pieces of the fungi may be
found in the vomit. Death may occur in from two to one
hundred hours. Emetics and warm water to aid vomiting,
castor-oil and enemata, tannin, atropiri, and coffee will do the
most good.

Alcoholic coma is manifested by gradual stupor; snoring
breathing; fixed, dilated pupils; and a ghastly, suffused, or
bloated face, with livid lips. There is an alcoholic or ethereal
odor of the breath. Two and one-half ounces have proved fatal
in from six to ten hours. Ammonium carbonate, capsicum, and
coffee are of special value.

Chloral poisoning ("knock-out drops") is manifested by
complete muscular relaxation; slow, feeble, irregular pulse and
breathing (sometimes stertorous); subnormal temperature; pale
or livid face; abolished reflexes; and an odor like bananas
or pears. Chloral heated with caustic alkali yields the odor of
chloroform. Death has been caused by 7 V 2 grains of the hy-
drate in from a few minutes to a day. Aromatic ammonia,
strychnin, coffee, brandy, and amyl nitrite are useful agents.
Mustard plasters may be used over the heart and the calves of
the legs. Artificial respiration should be kept up for hours, if
necessary.

Test for Chloral. Take */, test-tubeful of the urine"; add a drop
of anilin oil and a finger-breadth of an alcoholic solution of NaHO.
Heat, and, if chloral be present, the disagreeable odor of isocyanphenyl
is noted.

Death by chloroform inhalations is due apparently to
vasomotor paralysis. Sudden marked dilation of the pupils,



NARCOTICS. 353

not reacting to light, is a danger-signal of importance. The
breathing becomes shallow and the pulse feeble and frequent.
As little as 15 minims has caused sudden death in persons with
weak heart. By the mouth a dram has caused death in a boy
of four years. Atropin is of special service in stimulating the
sympathetic. Sodium bicarbonate is the antidote for poisoning
by the mouth.

Death under ether is generally from asphyxia, indicated by
shallow breathing, rapid pulse, and cyanosis. The pupils are
usually dilated. An ounce has caused death. The most impor-
tant indications are to clear the throat of mucus and employ
artificial respiration.

Large doses of camphor may excite toxic symptoms, such
as burning pain in throat and stomach; foaming at the mouth;
cold, clammy skin; retained urine; disturbed vision; tinnitus;
paresis; delirium; convulsions, and coma. Three drams have
caused death. Stimulants, warmth to the extremities, and hot
and cold douches are specially indicated.

A large proportion of C0 2 in the respired air causes giddi-
ness, ringing in the ears, irritation of the throat, loss of mus-
cular power, feeble pulse and breathing, and coma. The pure
gas terminates life instantly by apnea (asphyxia) from spasm
of the glottis. C0 2 is classified as a negative narcotic, suffoca-
tive poison. The main point in the management of these cases
is removal of the patient into the fresh air and the use of arti-
ficial respiration if the symptoms demand.

Carbon monoxid (coal-gas, water-gas) is a deadly narcotic
poison, driving out oxygen and combining with the hemoglobin
of the blood, which in extreme cases becomes of a markedly
bright-red appearance. Small quantities or the gas produce
headache, vertigo, muscular weakness, and nausea. A fatal
termination is preceded by asphyxia, local paralyses, subnormal
temperature, convulsions, and unconsciousness. The treatment
is not often successful, and includes removal into the fresh air
and slapping the chest with wet towels, or resort to artificial
respiration. Transfusion of blood from another person should
improve the chance of recovery. CO is the active agent in the
so-called charcoal poisoning practiced by suicides in France.
One per cent, in the atmosphere is dangerous.

Sewer-gas is a narcotic poison, and more than 1 per cent,
in the atmosphere may prove fatal. The symptoms are nausea,
vomiting, pains in the abdomen and extremities, vertigo, paresis,
convulsions, and insensibility. The best treatment is removal
into fresh air and the use of stimulants as needed.

Formaldehyd, when freely inhaled or swallowed, produces



354 TOXICOLOGY.

mucous congestion, unsteady gait, and sometimes coma. For
poisoning by inhalation, ammonia cautiously inhaled is recom-
mended. When formalin has been swallowed, the treatment is
the same as for acute alcoholic poisoning.

DEPRESSANTS.

Depressants, or hypostheniants, are marked especially by
feeble pulse and breathing, and cause death by paralysis of the
heart or respiratory center. Insensibility does not come on
until C0 2 narcosis supervenes. All depressants except the
cyanogen compounds have as antidotes tannic acid or strong
green tea. Hypodermics of strychnin, brandy, aromatic am-
monia, ether, digitalin, and atropin, and the administration of
strong coffee arid amyl-nitrite inhalations are in order. The
recumbent posture should be strictly maintained. Artificial
respiration may be required. Mustard poultices to the pericar-
dium do good. The patient should be kept warm. Faradization
or galvanization of the respiratory muscles is recommended by
some authorities.

Hydrocyanic acid and substances containing it (cyanids,
cherry-laurel, oil of bitter almonds, wild-cherry bark, cassava,
pits of stone-fruit, etc.) produce almost immediate salivation;
constricted throat; giddiness; falling; insensibility; convul-
sions; glassy, protruded eyes; sobbing or stertorous breathing;
frothing at the mouth; coldness, and collapse. The acid itself
usually kills in fifteen to thirty minutes. Death has followed
the ingestion of 30 minims of the official acid, 2 1 / 2 grains of
KCN, and 20 minims of oil of bitter almond. The peach-
blossom odor of HCN" and cyanids is very characteristic. A
watch-glass with a drop of AgN0 3 solution adhering to it, when
held before the mouth of the patient may show a white film
of AgCN. Whatever is to be done must be done quickly.
Empty the stomach immediately; slap the chest with a wet
towel; use artificial respiration; inject atropin, strychnin, or
ether; and use amyl nitrite or ammonia by inhalation. Chlorin-
water and calcium chlorid are mentioned as antidotes. For the
cyanids, which are somewhat slower in action, a mixture of
ferric and ferrous sulphates with sodium carbonate might be
of service.

Nitrobenzene (oil, or essence, of mirbane) is like prussic
acid in action, but much slower. It is marked by cyanosis,
Cheyne-Stokes breathing, and apoplectiform coma. The drug
smells like oil of bitter almonds, but does not turn crimson with
sulphuric acid. Fifteen grains have been fatal in from four to



DEPRESSANTS. 355

twenty-four hours. The treatment is the same as for H(M
poisoning.

The nicotin of tobacco produces nausea, vomiting, purging,
pallor, giddiness, slow pulse, great depression, tremors, cold
sweats, contracted pupils, and tetanic or clonic convulsions.
There is a strong tobacco-odor about the patient; nicotin itself
is colored blood-red or brown by chlorin. One minim of nicotin
has proved fatal, the period of death being from five minutes
to an hour or more.

Lobelia and its preparations give rise to symptoms very
similar to those produced by tobacco, but there is more nar-
cotism. The peculiar heavy, unpleasant odor of the plant may
be noted. One ounce of the leaves has led to a fatal result.

The fresh leaves of conium (hemlock) have been mistaken
for parsley. It causes gastric irritation; vertigo; diplopia;
ptosis; slow, labored breathing; dilated pupils; drowsiness;
staggering; motor paralysis; dysphagia; aphonia, and as-
phyxia. It has a peculiar odor. The fatal dose of coniin is
1 minim; period, one to three hours.

Cocain poisoning is accompanied by a small, rapid, inter-
mittent pulse; slow, shallow breathing; a sense of tightness
about the chest; dilated pupils; cold, clammy skin; hallucina-
tions; delirium; convulsions, and coma. The patient may
complain of feeling small foreign bodies under the skin. The
drug makes the tongue tingle, then anesthetic. A solution
dilates the pupil of a cat or dog when locally applied. Less
than a grain of the hydrochlorate has caused death in a few
minutes to several hours.

Gelsemium preparations produce vertigo; diplopia; ptosis;
dysarthria; dilated pupils; labored breathing; rapid, feeble



Online LibraryEdward Curtis HillA text-book of chemistry, for students of medicine, pharmacy, and dentistry → online text (page 32 of 48)