CHAPTER X
INEBRIANT POISONS
The poisons grouped under this head are characterised by causing delirium, followed by narcotism. Recovery is not infrequently slow, the system suffering more or less severely from the effects of the poison.
In the case of alcohol, loss of appetite, accompanied with considerable gastric irritation, are among the after-effects of the poison.
The chief of this group are--Alcohol, Cocculus Indicus, Poisonous Fungi, Nitro-Benzene.
Others of less importance will be briefly considered.
ALCOHOL
It will be necessary to consider poisoning by this substance under two forms--acute and chronic. So many anomalies present themselves that it is difficult to give a clear outline of the symptoms.
_Acute._--In most cases the symptoms come on within a few minutes after the poison is swallowed. Giddiness, confusion of ideas, and a difficulty in walking straight are among the first effects produced, these being followed by stupor and coma. Nausea and vomiting are the early signs of recovery. In some cases there may be _no_ premonitory symptoms, sudden and complete stupor supervening some time after a large dose of alcohol has been taken.
The patient not infrequently recovers from the first symptoms. A relapse takes place; he becomes insensible, and dies convulsed. The countenance wears a vacant expression, the face flushed and bloated, the lips livid, and the pupils dilated and insensible to light. The pupils may be contracted, but dilate on irritating the skin by a pin-prick or pinch. The sensibility of the pupil to the action of light should be regarded as a favourable symptom. The rapidity with which alcohol acts is not so great as to prevent the individual from walking some distance and performing certain acts of volition. The rapidity with which the symptoms show themselves will depend upon the previous habits of the individual, and the strength and quantity of the alcohol taken. Alcohol, when diluted, induces a preliminary stage of excitement, followed by stupor; but when concentrated, stupor may come on almost immediately after the spirit is swallowed.
The vapour of alcohol may act as a poison, giving rise to the symptoms above mentioned.
Congestion of the lungs or brain, or both together, is in most cases the cause of death in acute poisoning by alcohol.
_Chronic._--The habitual dram-drinker suffers from many diseases. The appetite becomes impaired; there is considerable irritation of the stomach and bowels, marked by vomiting and purging. Then follows a long list of organic diseases. The structure of the liver becomes changed; it may increase in size, become lighter in colour and cirrhotic, being then known as “hobnailed” or _dram-drinker‘s liver_. Jaundice and dropsy may be present as the result of this altered condition of the gland. The kidneys also suffer from granular degeneration. Then follow a long series of nervous complaints: congestion of the brain, paralysis, _delirium tremens_, and insanity. Sudden death by coma not infrequently ends the career of the drunkard.
_Delirium tremens_ is one of the most common results of the habit of drinking; and this affection, it is stated, may be induced by the sudden discontinuance of alcohol in those who are habitually given to its use.
_Post-mortem Appearances._--The stomach may present the usual signs of inflammation, due to the irritant action of alcohol. The colour of the mucous membrane of the stomach may be bright red, dark red, brown, or quite pale. The brain and its membranes are sometimes congested, and the intracranial vessels gorged with blood. The odour of alcohol may be present in the contents of the stomach; and alcohol may, in some cases, be detected in the lungs, brain, and other organs of the body. The lungs are not infrequently found congested, and the right cavities of the heart full of dark-coloured blood. Casper examined a case in which the cavities of the heart were empty. The blood is remarkably fluid, and of a dark colour. “Lymphatic exudation between the cerebral meninges, so that the pia mater upon the cerebral hemispheres is seen here and there whitish as if varnished, is not a result of death from drinking, but is the result of the chronic irritation of the brain by habitual drunkenness, and is therefore a very common appearance in the bodies of all drunkards, from whatever cause they have died.” One other condition occurring in those dying from the effects of alcohol, is the remarkably long continued presence of the _rigor mortis_, and perfect freedom from putrefaction, even up to the ninth day, in an atmosphere by no means unfavourable to early decomposition. A condition of the skin known as _cutis anserina_, or “goose skin,” was present in some of the cases examined by Casper.
_Absorption and Elimination._--From experiments on animals, it has been shown that alcohol is rapidly absorbed, and then eliminated from the system, and that all traces of alcohol may disappear in a few hours, and yet death be the result of its action. Alcohol is supposed to be decomposed in the body, but the exact changes it undergoes do not appear to be very clearly made out.
_Fatal Period._--Death has occurred in a few minutes after a large dose of alcohol had been swallowed. The average fatal period is about twenty-four hours. Death may also be an indirect result of the action of alcohol on the system.
_Fatal Dose._--Uncertain. The age and habits of the individual must be considered. Between three and four ounces proved fatal to a boy seven years of age.
Table showing the Points of Distinction between Concussion of the Brain, Alcoholic Poisoning, and Poisoning by Opium. -----------------------+---------------------+--------------------- Concussion of the Brain.|Alcoholic Poisoning. | Poisoning by Opium. -----------------------+---------------------+--------------------- 1. Marks of violence | 1. The absence of | 1. Same as under on the head. |marks of violence, |alcohol. |unless the person has| |fallen on the ground.| |The history of the | |case will help in | |forming an opinion. | | | 2. Stupor comes on | 2. Excitement | 2. The symptoms suddenly. |previous to the |slow in appearing; |stupor, which comes |drowsiness, stupor, |on suddenly. |lethargy. Muscles | |relaxed, and loco- | |motion impossible. | |The patient may be | |roused by a sharp | |question. | | 3. Face pale and | 3. Face flushed; | 3. The face pale, cold; the pupils |and pupils generally |pupils contracted. sluggish and insensible|dilated. | to light, sometimes | | dilated | | | | 4. Remissions are | 4. Partial recovery| 4. Remissions are, rare, the patient |may take place, |as a rule, rare in recovering slowly, |followed by death |this form of and with some |after the lapse |poisoning. confusion of ideas. |of some hours. | | | 5. Absence of the | 5. Presence of the| 5. Odour of opium odour of alcohol in |odour of alcohol in |in the breath. breath; if present, |the breath. | it is probably due | | to the treatment of | | bystanders. | | | | -----------------------+---------------------+---------------------
_Chemical Analysis._--Tests for Alcohol:
1. Characteristic smell.
2. It dissolves camphor.
3. Treated with dilute sulphuric acid and a strong solution of bichromate of potash, the green oxide of chromium is set free, and the vapour of _aldehyde_ may be detected by the smell.
4. Burnt under the mouth of a test tube, moistened with solution of baryta or lime-water, a deposit is formed in the tube of carbonate of baryta or lime.
5. If a few drops of a solution of iodine in iodide of potassium be added to alcohol, and then sufficient caustic potash be added to decolourise it, a crystalline precipitate of iodoform with its characteristic odour will be formed.
6. If copper turnings be added to a solution containing alcohol, then some strong nitric and sulphuric acid, and the mixture warmed, the odour of sweet spirit of nitre will be given off.
7. On warming with sodium or lead acetate and sulphuric acid the odour of acetic ether is evolved.
_Alcohol in the Contents of the Stomach or in the Tissues._--The contents of the stomach, or the tissues bruised and macerated in distilled water, should be carefully distilled in a water bath. It will be necessary to neutralise the liquid prior to distillation. The distillate should be mixed with chloride of calcium or anhydrous sulphate of copper, and re-distilled. The liquid thus obtained is shaken with dry carbonate of potash, and allowed to settle. The alcohol rises to the top of the mixture, whence it may be removed by the aid of a pipette, and tested as before mentioned.
_Treatment._--Immediate use of the stomach pump and emetics; to empty the stomach a hypodermic injection of apomorphine may be given. Affusion of cold water to the head, or the injection of cold water into the ears, may be tried. The administration of ammonia, and the employment of galvanism, have been of service in some cases.
COCAINE
Cocaine is an alkaloid obtained from the _Erythroxylon Coca_. It produces a paralysing effect upon the endings of sensory nerves, and is used as a local anæsthetic. When absorbed into the blood it paralyses the vagus and causes increased rapidity of the pulse. Applied to the eye it causes dilatation of the pupil. It first has a stimulating
## action on the centres of the brain and spinal cord, finally paralysing
them. It produces death by paralysis of respiration, according to Mosso, by causing tetanus of the respiratory muscles.
_Symptoms._--The symptoms produced are pallor, cyanosis, faintness, and cold sweats, pain in the precordial region, rapid pulse, intermittent heart beat, laboured respiration. The pupils are dilated. Speech becomes incoherent, there may be trismus of the jaws, the ideas are confused, and there may be delirium. Tetanic spasms of muscles may occur, and convulsions, also loss of consciousness.
Chronic poisoning, following the cocaine habit, produces a long series of symptoms which are manifestations of mental and physical degeneration, which in extreme cases may pass on to insanity, with hallucinations and delusions.
_Fatal Dose._--Half a grain injected into the gum of an adult has caused alarming symptoms, and two-thirds of a grain has caused death. Recovery has taken place after forty-three grains were taken by the mouth.
_Fatal Period._--Death has occurred in twenty minutes after three and a half grains by hypodermic injection.
_Chemical Analysis._--The alkaloid may be separated from the stomach contents or viscera by the usual procedure for extraction of alkaloids.
1. On the addition of strong nitric acid and evaporating to dryness, the residue when treated with alcoholic solution of potash gives off an odour like peppermint or meadow-sweet.
2. _Goeldner‘s Test._--Strong sulphuric acid and resorcin when mixed with cocaine gives a blue colour, changing to rose-pink on addition of caustic potash. Goeldner considers this a reaction peculiar to cocaine.
3. _Metzer‘s Test._--If a few drops of a 5 per cent. solution of chromic acid in water be added to a solution of cocaine hydrochloride, each drop gives a yellow precipitate which redissolves. The addition of strong hydrochloric acid produces a yellow precipitate of chromate of cocaine. Metzer considers this reaction peculiar to cocaine.
4. When applied to the tongue or lips a feeling of numbness is produced; it is rendered more effectual if a solution of sodium bicarbonate be first applied to the mucous membrane.
_Treatment._--Wash out the stomach and encourage vomiting. Stimulants and ammonia should be given freely, and if convulsions occur chloroform should be inhaled. Tannic acid or gallic acid in thirty-grain doses have been recommended, also iodine one grain with potassium iodide ten grains, in a wine-glassful of water between the stomach-washing or emesis. Oxygen inhalations and artificial respiration may be resorted to in failure of the respiration.
COCCULUS INDICUS
The fruit of Cocculus Indicus, _Anamirta paniculata_ (_N.O. Menispermaceæ_), is poisonous, and is frequently used by poachers to capture fish. The berries are ground to powder, mixed with bread, and then thrown into the water. When taken by the fish, they become stupefied, float to the surface, and are then taken.
The poisonous properties are due to a crystalline alkaloid, _Picrotoxin_. Fraudulent publicans have used this drug for the adulteration of beer. The strength of the beer is first reduced by the addition of salt and water, and then the cocculus indicus is added, to give to it an intoxicating property. The effect produced on the unfortunate customers is a strong desire to sleep, with more or less wakefulness. Loss of voluntary power is present, but consciousness is not lost, the sufferer lying in a state bordering on nightmare. Cocculus is not used in medicine or the arts, and yet a large quantity is imported, and mysteriously disappears in this country.
_Symptoms._--The symptoms which have been noticed in poisoning by this substance are--nausea, vomiting, severe abdominal pains, stupor, and intoxication. Two deaths at least have been reported as resulting from it. In the case of R. _v._ Cluderay, “the defendant administered to a child two cocculus indicus berries, entire in the pod, with intent to murder the child.” The kernel is a poison; the pod is not, and will not dissolve in the stomach; and they were therefore harmless. This was held to be administering poison with intent to murder, within the section of the Statute.
_Picrotoxin_, the alkaloid, is in fine white crystals, intensely bitter to the taste, soluble in boiling water, slightly so in cold. Alcohol and ether readily dissolve it. Strong nitric acid dissolves it, without change of colour; and sulphuric acid produces an orange-yellow colour, changed to pale yellow by dilution. In organic liquids it might be mistaken for sugar, or _vice versa_, as it precipitates the oxide of copper when boiled with the sulphate of copper and potash. In examining beer supposed to be adulterated with picrotoxin, the beer should be acidulated with hydrochloric acid, and then shaken up with ether. On spontaneous evaporation of the ether, the picrotoxin is left in crystals.
_Treatment._--Stomach pump, emetics, apomorphine subcutaneously; then chloral and the bromide of potassium. Chloroform may be inhaled. Paraldehyde is said to be a specific antidote.
LOLIUM TEMULENTUM
The seeds of _Lolium temulentum_, or common darnel, are poisonous. Cases of poisoning have occurred from these seeds being accidentally ground with wheat or rye, and then made into bread.
_Symptoms._--Gastric irritation, nausea, and vomiting followed by giddiness, deafness, loss of vision, and, in some cases, delirium. Not infrequently the symptoms resemble those produced by ergot. No death has been recorded as resulting from the use of these seeds. Three ounces of paste made from darnel flour, given to a dog, did not cause death.
POISONOUS FUNGI
Accidental poisoning by mushrooms is by no means rare. The _Agaricus campestris_, and a few others, are edible; but it is a fact worthy of notice that the poisonous properties of mushrooms are modified by climate and the seasons of the year at which they are collected. Idiosyncrasy may have something to do with the injurious effects produced on some persons by the fungi.
The _Agaricus campestris_, or common mushroom of this country, is sometimes poisonous; and in some countries--Italy and Hungary--it is usually avoided. In Russia and in France certain fungi are eaten which are regarded as poisonous by us.
Bentley gives, in his _Botany_, the following table, by which edible and poisonous mushrooms may be known:
-----------------------------------+--------------------------------- Edible. | Poisonous. -----------------------------------+--------------------------------- 1. Grow solitary in dry airy | 1. Grow in clusters in woods places. | and dark damp places. | 2. Generally white or brownish. | 2. Usually with bright colours. | 3. Have a compact, brittle | 3. The flesh tough, soft, and flesh. | watery. | 4. Do not change colour by the | 4. Acquire a brown, green, or
## action of the air when cut. | blue tint when cut and
| exposed to the air. | 5. Juice watery. | 5. Juice often milky. | 6. Odour agreeable. | 6. Odour commonly powerful and | disagreeable. | 7. Taste not bitter, acrid, | 7. Have an acrid, astringent, salt, or astringent. | acid, salt, or bitter taste. -----------------------------------+---------------------------------
_Symptoms._--Two sets of symptoms may follow the use of mushrooms as food--those of irritant and those of narcotic poisoning. In the latter class, giddiness, double vision, and even delirium, have been present. Nausea, vomiting, purging, and convulsions characterise those of the former class. In some cases the individual has presented all the appearances of intoxication.
_Post-mortem Appearances._--These will depend to a great extent upon the character of the symptoms prior to death. If signs of irritation have been present, inflammation of the stomach and bowels will most probably be found; but if, on the other hand, narcotic symptoms were predominant, congestion of the vessels of the brain will most likely be present. Arsenic and other poisons have been mixed with mushrooms with intent to kill; the probability of this occurring should be borne in mind, and a rigid examination of the contents of the stomach made in all doubtful cases.
_Treatment._--Castor-oil and emetics, atropine hypodermically.
NITROBENZENE, OR ESSENCE OF MIRBANE
This substance, prepared by acting on benzene by nitric acid, is largely used for flavouring sweets, &c. Nitrobenzene is a heavy, yellow, oily substance with a strong odour of bitter-almond oil, from which, however, it differs by undergoing no change of colour when agitated with strong sulphuric acid. The natural oil acquires a fine crimson colour when treated with strong sulphuric acid.
_Symptoms._--These may not make their appearance for three or four hours after the poison is swallowed or inhaled. The vapour is more powerful than the liquid. In some cases which have been described, the patient has complained of feeling drunk, with pain in the head, giddiness, faintness, distorted vision, drowsiness, ending in coma and death. The face is flushed, the jaws sometimes spasmodically closed, and the lips livid. Vomiting then supervenes, the vomited matters having the odour of bitter almonds. Symptoms not unlike those produced by prussic acid or the essential oil of bitter almonds have been noticed in one or two cases; but, as a rule, the insensibility is not immediate, as in prussic acid poisoning, and in this fact lies the distinction between the two substances. Rapidly fatal cases might be mistaken for apoplexy, but the odour betrays the cause of death.
_Post-mortem Appearances._--Nothing very characteristic is found after death due to this poison. The blood is sometimes black and fluid and gives the spectrum of acid hæmatin, the lungs congested, and the liver of a purple colour. The blood, contents of the stomach, and even the tissues, may smell strongly of this substance.
_Chemical Analysis._--Nitrobenzene may be separated by distilling the organic mixture with sulphuric acid, when the distillate will contain the poison if present. It is converted into aniline by heating it with acetic acid and iron filings. (See test for aniline, _infra._) On account of its odour, the only substance with which it can be confounded is the essential oil of bitter almonds, which owes its poisonous properties to the prussic acid it contains.
The following Table may assist in its Detection.
-----------------------+---------------------+----------------------- | Nitrobenzene. | Oil of Bitter Almonds. -----------------------+---------------------+----------------------- Strong sulphuric acid.| No change of colour.| A rich crimson colour. | | Proto-sulphate and the| No blue colour. | Prussian blue. persulphate of iron,| | liquor potassæ, and | | hydrochloric acid. | | | | Solution of sulphate | Insoluble. | Soluble. of soda. | | -----------------------+---------------------+-----------------------
_Treatment._--Stomach pump, emetics, stimulants, cold douche, artificial respiration.
DINITROBENZENE
This substance is a solid of a yellow colour, and is used in the manufacture of _roburite_, _bellite_, and _sicherite_, explosives used in coal mines for blasting. Poisoning by it occurs amongst the workmen who come in contact with it in factories where it is used, by inhaling either the vapour or fine particles, and by handling it may become absorbed through the skin.
_Symptoms._--In acute cases these are similar to poisoning by nitrobenzene. In chronic poisoning there is a marked and peculiar pallor of the face, with a livid blue colour of the ears, lips, fingers, and toes. Nausea and vomiting occur, with weakness, giddiness, and staggering. Amblyopia is a common symptom, with concentric contraction of the visual field and central scotoma. The blood resembles that of pernicious anæmia, and the urine is brown or blackish, due to some pigments of the aromatic series.
_Post-mortem Appearances._--The blood has been found chocolate-coloured, and ecchymoses have been noted in mucous membranes.
_Treatment._--As for nitrobenzene.
ANILINE
Aniline is a colourless oily liquid gradually changing to brown on exposure to air. The various aniline dyes are obtained by oxidation of aniline. Aniline is produced by reduction of nitrobenzene. It is slightly soluble in water, freely so in alcohol or ether. It can be absorbed through the unbroken skin as well as by the lungs and mucous membranes. It is used in the manufacture of marking inks. It has very toxic properties.
_Symptoms._--The symptoms come on rapidly--nausea and vomiting, with giddiness and drowsiness; the lips, face, ears, fingers, toes, conjunctivæ, and mucous membranes become cyanotic. The respirations are slow and laboured. The pulse may be full and slow, or small and irregular. The body surface is cold, the pupils react sluggishly to light. The blood is chocolate-coloured, and is said to give the spectrum of methæmoglobin. The blue colour is held to be due to pigment changes, and not to true cyanosis. Convulsions and coma may come on in fatal cases.
Buchanan met with a case of aniline poisoning in a man who by mistake swallowed about half an ounce of marking ink. Vomiting came on early, with giddiness and staggering gait. The body became changed in colour very rapidly--the colour being between a slate and leaden hue. The eyeballs were of the same colour but of a lighter shade, the mouth and tongue exhibited the colour most markedly. The temperature was subnormal, the pulse quick and feeble, and the breathing occasionally interrupted with sighing respirations. The blood failed to give the spectrum of methæmoglobin. The symptoms passed off within twenty-four hours. During the illness, the man passed several green-coloured motions. The vomit was of a purplish-black colour--from the marking ink--and on analysis gave the reactions of aniline. Some of the ink was procured, and on being analysed was found to consist of hydrochloride of aniline and chloride of copper. The treatment consisted of stomach lavage and inhalations of oxygen, which gave the patient much relief.
Cases have been recorded of aniline poisoning in infants from absorption of the material from linen napkins, which were stamped with marking ink. Buchanan has seen lividity arise from the dry hydrochloride of aniline having been carried in a paper parcel in the waistcoat pocket for two or three days.
_Post-mortem Appearances._--None characteristic.
_Fatal dose._--Six drachms have proved fatal, probably less might do so.
_Chemical Analysis._--Aniline may be separated from organic matter by alkalising and distilling the mixture.
1. If chloride of lime (bleaching powder) be added slowly to an aqueous solution of aniline, a deep purple colour is produced, which changes to brownish-red.
2. If strong sulphuric acid be added to aniline in a porcelain capsule it forms a dirty-white mass; on adding water and then potassium bichromate a bronze-green colour is produced, which changes rapidly to blue and then black.
3. If aniline be dissolved in excess of aqueous solution of phenol, and bleaching powder dropped into the mixture, a yellow streak changing to blue follows each drop.
4. Heated with corrosive sublimate a rich crimson colour is produced.
5. If aniline be mixed with a little chloroform and alcoholic solution of potash and heated, the peculiar odour of phenyl-isocyanide is given off.
_Treatment._--As for nitrobenzene.
Fusel-oil, Amylic Alcohol, Potato-Spirit.--Fusel-oil, also known as amylic alcohol, is known by its unpleasant odour and burning taste; it acts like alcohol as an inebriant, giving rise to headache, giddiness, &c.
Nitro-glycerine.--In liquid or vapour, violent headache and throbbing in the temples are produced by this substance, which is used in the treatment of angina pectoris.
ACETANILIDE (ANTIFEBRIN), PHENAZONUM (ANTIPYRIN), AND PHENACETIN
These substances are used extensively as antipyretics. They have been known to cause poisoning when administered in large doses.
_Symptoms._--The symptoms are principally those of depression, impairment of sight, vertigo, sleepiness, and unconsciousness; collapse, cyanosis, and loss of body temperature; the pulse and respiration are lowered. Antipyrin causes tumultuous action of the heart, and there may be erythematous or herpetic eruptions on the skin. Aniline derivatives, like sulphonal and other synthetic drugs, tend to destroy the red corpuscles of the blood, and decompose hæmaglobin, producing hæmatoporphyrin which appears in the urine.
_Chemical Analysis._--Antifebrin may be extracted from an acid solution by chloroform; for antipyrin the solution should be alkaline.
_Antifebrin_ gives the phenyl-isocyanide reaction on warming with alcoholic solution of potash and chloroform. Bichromate of potassium dissolved in strong sulphuric acid gives a red colour, changing to brown and dirty green; sodium nitrite and strong hydrochloric acid give a yellow colour, changing to green and blue; on evaporation the residue is orange, and turns red on addition of ammonia.
_Antipyrin._--Heated with strong nitric acid and the liquid allowed to cool, a purple colour is produced; if water be added a violet precipitate is thrown down, and the filtered liquid will be purplish-red. Ferric chloride gives a blood-red colour, destroyed by a mineral acid. An aqueous solution of potassium nitrite and strong sulphuric acid gives a green colour.
_Phenacetin_ is coloured yellow by nitric acid, the colour persisting when heated. It dissolves in sulphuric acid without change of colour. Boiled with hydrochloric acid, then diluted with water and chromic acid solution added, gives a deep red solution.
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