CHAPTER IX
DELIRIANT POISONS
Under this head will be noticed those poisons whose action on the animal economy is characterised by _delirium_, illusion of the senses, and marked _dilatation_ of the pupil. In some cases there is considerable irritation of the digestive organs, accompanied with a difficulty in passing water, sometimes ending in complete suppression of urine. The mydriatic alkaloids atropine, hyoscine, hyoscyamine, daturine, duboisine, scopolamine, are practically identical in chemical composition and action, and produce similar symptoms.
The following are among the most important poisons of this group:--
1. Belladonna. 2. Hyoscyamus. 3. Stramonium. 4. Solanum Dulcamara. 5. Solanum Nigrum. 6. Solanum Tuberosum.
Those of less importance are _Œnanthe crocata_ or Dropwort, Camphor, Salicylic Acid, and Yew--the last already described among the Vegetable Irritants.
BELLADONNA
_Symptoms._--Taken internally or applied externally, belladonna, _Atropa Belladonna_ (_N. O. Solanacea_), or its alkaloid atropine, causes dryness of the mouth and throat, with intense thirst. Nausea and vomiting are present in most cases, accompanied with giddiness, double or indistinct vision, active delirium, convulsions, ending in stupor and coma. In the majority of cases an erythematous rash appears on the skin, with elevation of temperature resembling scarlet fever. A very marked characteristic of poisoning by solanaceous plants is _dilatation of the pupil_, the iris in some cases being reduced to a mere line round the pupil. The symptoms in some cases which have been recorded are almost identical with those of delirium tremens. In other instances there has been little or no delirium, the patient at once passing into fatal lethargy. Alarming symptoms have followed from drinking a decoction of belladonna leaves, which were mistaken and supplied for those of the ash. Accidental poisoning has also frequently occurred among children from their eating the ripe berries of the belladonna plant. Slight symptoms of poisoning are sometimes met with from the use of belladonna plasters to remove the milk from the breasts of women delivered of still-born children, or in cases where the child has died soon after birth. In these cases the patients complain of intense dryness of the mouth, dimness of vision, and itching of the skin. The removal of the plasters will at once arrest the unpleasant symptoms.
In the _Gazette des Hôpitaux_, July 1859, a case is recorded of poisoning by the outward application of belladonna in the form of the following liniment: Camphorated oil of henbane, ten ounces; extract of belladonna, four scruples. The patient was seriously ill for some days, but ultimately recovered.
Poisoning has also resulted from the use of a solution of atropine (four grains to one ounce) dropped into the eye in the treatment of iritis. (See _British Medical Journal_, 1876, vol. i.)
_Post-mortem Appearances._--Congestion of the vessels of the brain, sometimes with fluid blood, at other times with thick black blood. The stomach may or may not be congested; but in cases where the ripe berries have been taken, the mucous lining may be seen deeply dyed by the juice of the berries. The pupils are usually found dilated.
_Fatal Dose._--One teaspoonful of belladonna liniment and one drachm of tincture have proved fatal. Recovery has taken place after half an ounce of liniment and extract. Children are less affected than adults. Of atropine half a grain has proved fatal. Recovery has taken place after five grains of the sulphate.
_Fatal Period._--Twelve hours to several days.
_Chemical Analysis._--From organic mixtures the alkaloid may be obtained by Stas‘s process, and treated according to Vitali with a little fuming nitric acid, and then dried in a water bath: when cold, it must be moistened with a drop of potassæ dissolved in absolute alcohol. A violet colour changing to red is produced, the violet being characteristic, as strychnia when treated as above gives a red colour. The physiological action on the pupil must also be noted. When the berries are taken, the mucous membrane of the stomach may be found dyed of a purple colour, turned green by alkalies and red by acids. Fragments of the berries may also be found in the stomach.
To a small quantity of solid atropine add a drop or two of strong sulphuric acid, then a crystal of sodium nitrite; a yellow colour is produced, which alcoholic solution of potash changes to reddish-violet and then pale rose.
Free atropine gives a red colour with phenolpthalein; the colour is discharged with alcohol, but reappears on evaporating it.
_Gerrard‘s Test._--Mercuric chloride dissolved in alcohol gives a red colour.
_Blyth‘s Test._--To the solid alkaloid add strong solution of baryta, evaporate, to dryness, and heat the residue, when the smell of hawthorn blossom is given off.
_Wormley‘s Test._--An alcoholic solution of bromine gives a crystalline yellow precipitate.
_Treatment._--Wash out the stomach and give hypodermic injections of one-third of a grain of pilocarpine, which is the best antidote. Emetics and purgatives, castor-oil and animal charcoal may be administered. The symptoms as they present themselves must be treated on general principles.
_N.B._--Belladonna has been stated to act in antagonism to opium, and its administration recommended in poisoning by that drug.
HYOSCYAMUS
Hyoscyamus, _Hyoscyamus niger_, or henbane (_N.O. Solanaceæ_), alkaloids hyoscine, hyoscyamine, taken in large doses, produces symptoms not unlike those due to belladonna. There is the same affection of sight--double vision; the same dilatation of the pupils, delirium, confusion of thought, insensibility, and coma. Hyoscine has a hypnotic effect in comparison to the deliriant action of belladonna. But its action varies very much on different people. A form of mania, with wild hallucinations, has sometimes been observed to follow the administration of this drug.
The peculiar property of henbane is marked by its tendency to produce a general paralysis of the nervous system. The root has been eaten by mistake for parsnips, when all the foregoing symptoms were present. The seeds are more poisonous than the roots, the leaves being the least poisonous part of the plant.
_Post-mortem Appearances._--The morbid appearances are not unlike those which result from poisoning with belladonna.
_Fatal Dose._--Nothing certain can be stated as to the amount required to cause death. Alarming symptoms are said to have followed the administration of ten minims of the tincture, repeated every six hours. Twenty of the _seeds_ have caused active delirium. Idiosyncrasy may have something to do with this result. Half a drachm of the tincture is often given to an adult, and repeated every four hours, without any unpleasant result.
_Treatment._--As for belladonna, emetics and purgatives, to expel the poison from the system.
STRAMONIUM
The Thorn Apple, _Datura Stramonium_ (_N.O. Solanaceæ_), possesses powerful poisonous properties. These are marked by the production of giddiness, impairment of vision, and syncope. Furious delirium is not infrequent; and in one case where this state was present there was loss of speech. The face is usually flushed, the eyes glistening and restless, and the pupils dilated; in short, the countenance is that of one intoxicated. Taken together, the symptoms are not unlike those produced by belladonna.
Poisoning by stramonium seeds is a favourite mode of procedure among the Hindoos; but as the poison is most frequently given to facilitate robbery, death seldom results from its use. In India, the seeds are mixed with the boiled rice so commonly eaten there, and as they closely resemble the seeds of the common capsicum, the dangerous nature of the mixture is not readily detected. The seeds of the datura can be distinguished by the taste, which is slightly bitter, whereas that of the capsicum is hot and pungent. The outward application of the leaves may give rise to all the appearances of poisoning.
The active principle of stramonium is the alkaloid _Daturine_, which crystallises in colourless quadrangular prisms, with a bitter acrid taste. It resembles atropine and hyoscyamine in chemical properties.
_Post-mortem Appearances._--Congestion of the vessels of the brain and its membranes, with some slight gastric irritation.
_Treatment._--As for belladonna, emetics and purgatives, to get rid of the portions of the plant swallowed.
Some other solanaceous plants--_Solanum Dulcamara_, Bittersweet or Woody Nightshade, _Solanum nigrum_, or Garden Nightshade, and the _Solanum tuberosum_, or Potato--possess poisonous properties. They, like the other members of the order to which they belong, give rise to symptoms characterised by giddiness, dimness of sight, trembling of the limbs, and delirium. The water in which the potato has been boiled is sometimes used by the vulgar as an application to favus of the scalp.
The active principle of these plants resides in an alkaloid, _Solanine_, which is not a very powerful poison. A rabbit has been killed in a few hours by two grains of the sulphate of solanine.
ŒNANTHE CROCATA
Hemlock-Dropwort, or Dead-tongue, is a poisonous indigenous, umbelliferous plant.
Accidental poisoning by this plant has occurred, the root having been mistaken for parsnip. The symptoms in one of the cases which have been recorded were those of _delirium tremens_; in another, which terminated fatally, vomiting of blood was followed by convulsions. First contraction and then dilatation of the pupil, spasmodic respiration, and an almost imperceptible pulse were the effects noticed. Death may take place in a few hours.
_Post-mortem Appearances._--Congestion of the vessels of the brain, and gastric irritation. The face has sometimes a bloated expression, and blood may escape from the ears and mouth.
_Treatment._--Purgatives and emetics, to evacuate the bowel and stomach, and thus get rid of the poison.
CAMPHOR
Camphor is a concrete vegetable oil obtained from _Camphora officinarum_ (_N.O. Lauraceæ_). Its employment for the purpose of homicide is rare, but several cases of accidental poisoning from the use of the homœopathic solution have been recorded (_British Medical Journal_, 1873, vol. ii. p. 617).
The symptoms are--languor, giddiness, delirium, foaming at the mouth, vomiting of blood-tinged fluid, convulsions, gastric irritation, and great abdominal pain. In one case--that of a young lady aged twenty, who took twenty-five drops of “Epps‘ Concentrated Solution of Camphor” for a sore throat--all the above-mentioned symptoms were present; she was also unconscious for several hours, and partially paralysed for several days--perfect recovery from the nervous symptoms not taking place for more than six months.
The homœopathic solution (Rubini‘s) is stronger than that of the British Pharmacopœia in the proportion of 7.2 to 1. For its detection in organic fluids, it may be removed by chloroform; and from fixed oils, by distillation. Water precipitates it from its alcoholic solution.
_Post-mortem Appearances._--Those produced by irritants.
_Treatment._--Purgation and emetics, to empty the bowel and stomach.
SALICYLIC ACID
This substance, prepared by acting on a mixture of carbolic acid and sodium with carbonic acid at a moderate heat, is used largely for acute rheumatism. In some cases premonitory symptoms of poisoning have demanded a cessation in the administration of the drug. The most usual of these are noises in the ears, difficulty of hearing, amblyopia, delirium, and profuse perspiration. There may be hæmorrhages from the mucous membranes, and into the retina. When the drug is discontinued the symptoms pass off. The symptoms are held by some observers to be due to the artificial and not the natural acid.
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