CHAPTER XI

SEDATIVE POISONS

Cardiac

DIGITALIS

The common foxglove, _Digitalis purpurea_, (_N.O. Scrophulariaceæ_), grows wild in the hedges in the South of England. All parts of the plant are poisonous, from the presence of a glucoside _digitalin_, and in addition it also contains the glucosides digitoxin, digitonin, and digitalein; according to Kopp, digitoxin is six to ten times more toxic than digitalin.

_Symptoms._--Nausea, salivation, vomiting, purging, and severe abdominal pains are first noticed. The patient then complains of pain in the head, giddiness, and a gradual loss of sight. The eyes protrude, the pupils are dilated and insensible to light, and the sclerotics, according to Tardieu, are of a characteristic blue colour; the pulse weak, slow (forty in the minute) and jerky, sometimes intermittent. The surface of the body is cold, and bathed in perspiration. An aggravation in the symptoms takes place whenever the patient attempts to leave the recumbent position; hence, in all cases of poisoning, and in those where the therapeutical action of the drug is sought, the patient should be warned of the danger of leaving the recumbent posture. A marked depression in the action of the heart is a characteristic effect of this poison. The effect on the heart may be divided into three stages: (1) diminution in the frequency of the pulse, and rise of arterial pressure; (2) both of these become abnormally low; (3) frequency of pulse abnormally high, arterial pressure abnormally low. Convulsions have sometimes been noticed, and syncope and stupor are not uncommon.

_Post-mortem Appearances._--Congestion of the brain and its membranes, and some inflammatory redness of the mucous membrane of the stomach. The blood is fluid.

_Fatal Dose._--Uncertain. Large doses of the infusion and tincture have been given without any untoward results. Thirty-eight grains of the powdered leaves, and nine drachms of the tincture, have proved fatal. One-quarter to half a grain of digitalin might prove fatal to an adult.

_Fatal Period._--From three-quarters of an hour to twenty-four hours.

_Chemical Analysis._--If the leaves in an infusion be taken, these must be sought for and examined. The glucoside may be extracted by first removing the impurities by means of petroleum ether, then acidifying with acetic acid and extracting with chloroform.

The following are the tests for _digitalin_:

1. An almost amorphous, white, or fawn-coloured inodorous substance.

2. Almost insoluble in water.

3. Decomposes nitric acid, with the evolution of nitrous acid fumes. An orange-yellow-coloured solution is formed, which, in a few days, assumes a golden-yellow tint.

4. Sulphuric acid dissolves it, changing it to a reddish-brown colour, changed to violet by bromine vapour.

5. Hydrochloric acid with it at first forms a yellow solution, which, when heated, changes to a bright green colour.

The physiological test may be employed by injecting a solution of a carefully prepared extract of the contents of the stomach or vomited matters under the skin of a frog, dog, or rabbit.

_Treatment._--Purgatives and emetics should be given, followed by infusions containing tannin, green tea, oak bark, galls, strong coffee, and other stimulants. The patient should be kept in the recumbent posture, and on no account allowed to sit up.

TOBACCO

The consumption of tobacco, _Nicotiana Tabacum_ (_N.O. Solanaceæ_), has greatly increased of late years. In some countries its use was prohibited by stringent laws. In Russia amputation of the nose was the punishment. Several Popes have excommunicated those who smoked in St. Peter‘s at Rome; and in some parts of Switzerland it was ranked on the tables next to adultery. Amurath IV made smoking tobacco a capital offence. Be this as it may, the moderate use of tobacco does not appear to lead to injurious results; and it is found that workmen engaged in the manufacture of tobacco do not suffer from any diseases other than those affecting the generality of mankind.

_Nicotine_--the alkaloid--is a colourless or slightly amber-coloured, oily, volatile liquid. It is to this principle that the poisonous

## activity of the drug is due. It differs from the other oily alkaloid,

_conine_, in appearing of a green colour when a drop is placed on the surface of white enamelled glass--conine having a _pink_ colour. They both leave a greasy stain on paper. Nicotine has been detected by Stas‘s process in the tongue, stomach, lungs, and liver. A ptomaine not unlike nicotine has been discovered.

_Symptoms._--Symptoms of poisoning by tobacco are by no means uniform, and have been variously described by observers. As a type of the effects produced, the following may be noticed as occurring to the tyro after his first or second “pipe”: The pulse is primarily quickened; then follow nausea and faintness, accompanied with an intense feeling of sinking. The face is blanched, the pulse slow; perspiration stands on the forehead, and ultimately he vomits, and then gradually recovers. Cold air blowing on the face, or sponging the face with cold water, materially hastens a return to comfort. Sometimes, as in the case related by Dr. Marshall Hall of a man who smoked two “pipes,” nausea, vomiting, and syncope occurred, followed by stupor, stertorous breathing, general spasms, and insensibility of the pupil. After an interval of a few hours, the above symptoms again returned, but from which the patient ultimately recovered. Death has resulted as a sequence to excessive smoking. Gruelin records two cases--one from seventeen, the other from eighteen, pipes smoked at a sitting. The symptoms after taking nicotine are more acute, and are a burning acrid taste in the mouth and throat, nausea, vomiting, unconsciousness, shock, sighing respirations, delirium, convulsions; the pupils first contracted then dilated.

The filthy habit of snuff-taking has also been accredited with one or two deaths. Santeuil, the French poet, died in two days from the effects of snuff mixed with his wine as a practical joke.

In animals, the symptoms are--nausea, vomiting, purging, convulsions, stupor, and death. The heart becomes paralysed. One drop of the empyreumatic oil on the tongue of a cat killed it in two minutes, the animal dying in convulsions.

_Post-mortem Appearances._--These are by no means uniform or characteristic. If much vomiting precedes death, the vessels of the brain may be engorged with blood. Inflammation of the stomach and intestines is also present in some cases. The odour of nicotine may be detected in the vomit or the stomach contents.

_Fatal Period._--The symptoms soon make their appearance, and death has occurred in three-quarters of an hour, or even less--in three minutes after taking the nicotine, in fifteen minutes after enema of tobacco.

_Fatal Dose._--One to three drops of nicotine would probably kill an adult in a few minutes; an enema containing half a drachm of the leaves has proved fatal.

As an enema, tobacco should be used with extreme care.

_Chemical Analysis._--Nicotine obtained by the usual process for alkaloid extraction, and mixed with water, may have the following tests applied after solution in dilute hydrochloric acid:

1. Chloride of platinum gives an orange-yellow crystalline precipitate.

2. Corrosive sublimate, a white crystalline precipitate.

3. Arsenio-nitrate of silver, a yellow precipitate.

4. Caustic potash added to the hydrochloride and warmed causes a strong odour of tobacco.

5. Solution of iodine in ether added to ethereal solution of nicotine is followed by the production of long needle crystals after some hours.

_Treatment._--Promote vomiting, wash out the stomach, cold water douches, and stimulants. Inject strychnine hypodermically.

LOBELIA

Lobelia, or Indian Tobacco, _Lobelia inflata_ (_N.O. Lobeliaceæ_), is extensively employed in North America in the treatment of asthma. The plant is officinal in the British Pharmacopœia. In small doses it possesses expectorant properties.

_Symptoms._--Nausea, vomiting, giddiness, cold clammy sweats, and great depression. The pulse becomes irregular, and very feeble. Taken together, the symptoms are not unlike those produced by tobacco.

_Fatal Period._--One to two days, or more.

_Fatal Dose._--One drachm of the powder.

_Chemical Analysis._--The alkaloid is fluid and may be extracted like nicotine; with it (1) strong sulphuric acid gives a red colour; (2) sulphomolybdic acid gives a violet colour.

_Treatment._--The same as recommended under tobacco. Stimulants should be given, ether hypodermically or alcohol _per rectum_.

VERATRINE

The alkaloid _Veratrine_ is obtained from the dried fruit of _Asagrœa officinalis_ (_N.O. Melanthaceæ_).

The alkaloid is in the form of a white amorphous powder, bitter and acrid to the taste. It acts as a powerful errhine, causing violent sneezing. Insoluble in water, it is readily dissolved by alcohol, ether, and chloroform. When gently heated on a plate with strong sulphuric acid, it first turns yellow, then crimson. Veratrine is entirely dissipated by heat.

Two grains of the alkaloid killed a cat in one minute; a dog being destroyed in two hours by a dose of three grains. The one-sixteenth of a grain (?) of veratrine in a pill caused alarming symptoms in an adult woman, for whom it was ordered by a medical man.

_Symptoms._--Acrid burning sensation in the throat and down the œsophagus to the stomach, vomiting, great thirst, diarrhœa may occur with tenesmus. The pulse is feeble and respiration slow. The pupils may be dilated or contracted. Collapse and twitching of muscles, loss of consciousness and convulsions, or delirium and stupor may come on.

_Post-mortem Appearances._--Are the same as in poisoning by any of the vegetable irritants.

_Treatment._--Stomach pump, and emetics. Astringent infusions should be given, and alcohol and opium administered if the condition of the patient seems to require them.

_Chemical Analysis._--Extract in the usual way for alkaloids.

1. Strong sulphuric acid produces a yellow colour, changing to red, produced rapidly if heated.

2. Strong hydrochloric acid and heat produces a red colour.

3. Sulphomolybdic acid produces a reddish colour, changing to dirty brown, greenish, and finally blue.

These tests should be done with the solid veratrine.

HYDROCYANIC ACID

Hydrocyanic acid is a compound of cyanogen and hydrogen. It was first obtained by Scheele in 1782, but it was not until 1815 that Gay-Lussac pointed out its real nature. Anhydrous hydrocyanic acid may be obtained by passing over cyanide of mercury, gently heated, a stream of dry sulphuretted hydrogen. It is now made by mixing ferrocyanide of potassium with dilute sulphuric acid, and applying heat, when the acid is distilled over and collected in a cooled receiver.

Dilute hydrocyanic acid, the only important form of the acid from a toxicological point of view, is a colourless, feebly acid liquid, with a peculiar odour, like that of bitter almonds or peach kernels (specific gravity, 0.997). The Pharmacopœial acid contains 2 per cent. of anhydrous acid; that of Scheele 5 per cent. According to Taylor, however, the percentage of the acid varies from 1.3 to 6.5. Taking into consideration the smallness of the dose, and the shortness of the time before death occurs, it is the most deadly of all known poisons. Prussic acid is not regarded as a cumulative poison--that is, it does not gradually accumulate in the body and then break out with dangerous or fatal violence.

_Symptoms._--These will be more or less modified by the quantity of the dose, and in some cases closely resemble an attack of epilepsy. In most cases, the symptoms of poisoning are seldom delayed beyond _one_ or _two_ minutes; and if the dose be large, the symptoms of poisoning may come on while the person is drinking. Giddiness, followed by almost complete insensibility, mark the accession of the symptoms. The eyes are fixed, staring, and glassy; the pupils are dilated, and insensible to light. The muscles of the extremities are relaxed, and the limbs flaccid. A white or bloody froth surrounds the mouth, and the jaws are fixed. The surface of the body is cold and clammy to the touch; the respiration is sometimes long-drawn and spasmodic; and the pulse so reduced as to be almost imperceptible. The breathing is sometimes _stertorous_ in character. This is an important fact; for, in ignorance of the occasional presence of this symptom, it was argued that Walter Palmer, whose breathing was stertorous, died of apoplexy, and not from prussic acid as was alleged. When the dose is small (between twenty and thirty drops of the dilute acid), the patient complains of nausea, giddiness, and a feeling of constriction round the head. The mind is confused, the pulse hurried, and the breathing irregular. Salivation may also be present. Tetanic spasms and involuntary evacuations precede the fatal termination. When the dose is from ten to twenty drops, the patient complains of nausea, giddiness, and a feeling of impending suffocation. These symptoms under treatment may soon pass off, or leave the patient more or less confused and listless. In most cases, where the dose is very large, death takes place suddenly, without convulsions; but the period of death does not appear to be as short in man as in the lower animals.

_External Application._--Applied to the unbroken skin, prussic acid does not appear to have caused any alarming symptoms; but it should be used with the utmost caution where the skin is at all abraded or ulcerated.

_Post-mortem Appearances._--In making an inspection, care should be taken; for, if the dose be large, the vapour from the corpse on opening it has been known to produce giddiness and fainting. Externally, the skin is pale, livid, or of a violet colour. The hands are clenched, and the nails blue. The jaws are firmly set, and there is usually some froth around the mouth. The internal organs are greatly congested, and the venous system gorged with fluid dark-coloured blood. The stomach and intestines are sometimes inflamed, but in many cases they present no material alteration in colour.

The appearances, when only a small dose has been taken, are not unlike those of asphyxia. The detection of the odour of hydrocyanic acid in the body is of importance; but this may be absent from the following causes:

1. Smallness of the quantity of the acid present.

2. Volatilisation from exposure of the corpse to the air.

3. The smallness of the dose, and its absence the result of absorption and elimination, if death has not rapidly taken place.

4. The amount of dilution of the poison.

5. Concealed by other odorous substances.

In some cases, the smell may be detected in the stomach seven or eight days after death. The viscera should, in all cases of suspected poisoning, be placed in a glass-stoppered jar, and the stopper covered by bladder and tinfoil. Hydrocyanic acid is so volatile that, unless the greatest care be taken, all traces of it may vanish; and thus the guilty person may be allowed to escape.

_Fatal Period._--From a few seconds to as many minutes. Under active treatment, if a patient survive forty minutes, he will generally recover.

_Fatal Dose._--Thirty minims of the dilute acid of the Pharmacopœia. This contains six-tenths of a grain of the anhydrous acid. Recovery has, however, taken place even after comparatively large doses. The strength and age of the individual, and also the emptiness or fulness of the stomach at the time the poison is swallowed, will materially affect the issue.

Experiments on Animals

Numerous experiments on animals have been made to ascertain the rapidity with which prussic acid kills. The late Sir R. Christison found that three drops projected into the eye acted on a cat in twenty seconds, and killed it in twenty more. The same quantity dropped on a fresh wound in the loins acted in forty-five, and proved fatal in one hundred and five seconds. In the cases where death did not occur so rapidly, there were regular fits of violent tetanus; but in the very rapid cases, the animals perished, just as the fit was ushered in, with retraction of the head. In rabbits opisthotonos, in cats emprosthotonos, were the chief tetanic symptoms.

As a proof that the acid acts equally on the brain and spinal cord, may be noticed the presence of coma and tetanus in some cases of poisoning by this substance.

In the experiments on animals certain effects were noticed, which are as follows:

_Expulsion of the Fæces and Urine._--In some cases only the fæces, in others the urine alone, was involuntarily expelled; and in some other cases neither the one nor the other was present.

_The Shriek or Cry._--This cry, though a common, is by no means a constant symptom.

_Convulsions._--These are sometimes present.

_Acts of Volition._--Only slight acts are possible; in the case of one of the dogs experimented on by Mr. Nunneley, the animal “went down, came up, and then went down again the whole flight of a steep, winding staircase.”

The _Post-mortem Appearances_ were not well marked in the animals subjected to experiment. In chronic cases, Mr. Nunneley states that both sides of the heart were distended with black blood. The pure acid is stated to completely destroy the irritability of the heart and voluntary muscles, galvanism producing no effect whatever. “In eight experiments on cats and rabbits with the pure acid, the heart contracted spontaneously, as well as under stimuli, for some time after death, except in the instance of the rabbit killed with twenty-five minims, and one of the cats killed by three drops applied to the tongue. In the last two the pulsation of the heart ceased with the short fit of tetanus which preceded death; and in the rabbit, whose chest was laid open instantly after death, the heart was gorged, and its irritability utterly extinct.”

=Detection of Hydrocyanic Acid in Cases of Poisoning=

The “_Vapour Tests_” are those most readily applied to organic mixtures; but in some cases it may be necessary to make a distillation of the suspected substance, in order to isolate the poison.

The first point to be noticed is, whether any _odour_ of the acid can be perceived in the substance under examination. In any case, the contents of the stomach or finely-divided tissues should be mixed with water, and examined as to the reaction with test paper. If the mixture be found to be _alkaline_, it must be neutralised by the addition of tartaric acid; if, on the contrary, it be _acid_, carbonate of soda must be carefully added to neutralisation. A state of neutrality is always necessary previous to distillation, for the following reasons:

An _alkaline_ state of the liquid would, on the one hand, prevent, or, at all events, retard, the evolution of the hydrocyanic acid; whilst, on the other, the existence of any _free acid_ would decompose any cyanide which might be present, and thus give rise to an evolution of hydrocyanic acid not existing as such in the mixture.

The organic mixture is then placed in a flask, and the contents distilled at as low a temperature as possible by the aid of a water bath.

Should hydrocyanic acid be present, the distillate will yield all the characteristic reactions of the dilute acid.

1. Nitrate of silver will give a curdy-white precipitate, insoluble in cold but soluble in boiling nitric acid. A portion of the precipitate, on the addition of some liquor potassæ, sulphate of iron, ferric chloride and hydrochloric acid, forms Prussian blue. In this test, which may be taken as quite conclusive, the hydrochloric acid decomposes the cyanide of silver; and on the addition of the sulphate of iron, Prussian blue is formed.

2. If a portion of the dry precipitate formed by the nitrate of silver be heated in a test tube, cyanogen gas will be evolved, known by its characteristic odour of peach blossoms, and by its burning at the mouth of the tube with a rose-coloured flame.

3. To the solution containing hydrocyanic acid add a few drops of potassium nitrite, two or three drops of ferric chloride solution and dilute sulphuric acid until a yellow tint is obtained; heat to boiling, cool, precipitate excess of iron with ammonia, filter, and add one or two drops of a very dilute solution of colourless ammonium sulphide. A very minute quantity of hydrocyanic acid gives a violet-red colour, changing to blue, green, and finally yellow.

4. If a solution of starch be tinged blue with iodine, the colour will be discharged by a minute quantity of hydrocyanic acid.

=Vapour Tests.=--There are three tests for the presence of hydrocyanic acid when present in organic mixtures, which have the advantage of being applicable without the addition of anything extraneous to the mixture to be tested. They are all dependent on the volatile nature of hydrocyanic acid, and may be applied as follows, the suspected mixture being divided into three portions:

1. _Iron or Prussian Blue Test._--The liquid mixture to be tested is placed in a small beaker glass, and covered with a glass plate the centre of which is smeared with a mixture of potash and proto-sulphate of iron. The whole is now left undisturbed for some time. The glass is eventually removed, and the mixture of potash and iron treated with hydrochloric acid, which, should hydrocyanic acid be present, will cause the development of Prussian blue.

2. _Sulphur Test, or Liebig‘s Test._--A second portion of the original mixture is placed in a beaker, and a watch-glass containing a few drops of bisulphide of ammonium is suspended over the liquid, the mouth of the beaker being closed. A short time is allowed to elapse; the watch-glass is then removed, and its contents evaporated to dryness at a low temperature. A blood-red colour is developed on the addition of a little perchloride of iron to the _dry_ residue. This effect is due to the absorption of the hydrocyanic acid vapour by the bisulphide of ammonium--sulphocyanide of ammonium being formed, which, on the addition of perchloride of iron, gives the blood-red colour of the sulphocyanide of iron, which is bleached by corrosive sublimate.

3. _Silver Test._--This is the most successful of the vapour tests, a single apple pip yielding all the reactions. If a watch-glass containing a few drops of nitrate of silver solution be suspended in a beaker (as in 2), the silver solution will become white and opaque, from the formation of cyanide of silver; examined under the microscope it is seen to consist of small prismatic crystals. The cyanide as formed, treated with hydrochloric acid, liquor potassæ, and sulphate of iron, will give Prussian blue.

_The Quantitative Analysis._--Use the precipitate of cyanide of silver, 100 grains being equal to 20.33 of pure anhydrous acid.

=Treatment.=--The treatment of poisoning by prussic acid is now to be considered. As part of the general treatment, the stomach pump should be at once employed, and the stomach emptied and then washed out with water.

_Ammonia._--The use of this substance was first advocated by Mr. John Murray of London, and is no doubt a valuable remedy if given early. Care should be taken that the mucous membrane of the air passages and alimentary canal be not inflamed by using too strong a solution.

_Chlorine._--Recommended by Riauz in 1822. Water impregnated with the vapour of chlorine may be given internally, and the gas may be breathed under proper precautions.

_Cold Affusion._--First proposed by Dr. Herbst of Göttingen. Its success is most to be looked for when it is employed before the convulsive stage of the poisoning is over. The cold water should be poured on the head and down the spine.

[Illustration: Fig. 39.--Photo-micrograph of crystals of cyanide of silver obtained by the vapour test, × 50. (R. J. M. Buchanan.)]

_Bleeding from the Jugular Vein._--In one case treated by Magendie, bleeding from the jugular vein was attended with success.

_Chemical Antidotes._--The administration of a solution of carbonate of potash, followed by a solution of the mixed sulphates of iron, has been suggested. The formation of Prussian blue is the result. The only objection to this treatment is, that prussic acid is so rapidly absorbed that death may result from the already absorbed acid before the antidote can be given.

_Atropine._--This should be given hypodermically.

_Peroxide of hydrogen_ should be given freely by means of the stomach tube.

_Cobalt_ nitrate 0.5 to 1 per cent. solution has been advocated hypodermically.

_Sodium thiosulphate_, in 10 per cent. solution, repeated hypodermically.

Cyanide of Potassium

This substance is used largely by photographers and electro-platers. It acts as a poison in a similar manner to hydrocyanic acid, and the symptoms are the same. As a commercial preparation it frequently contains undecomposed potassium carbonate, and may exert a corrosive

## action on the mucous membranes of the mouth and stomach, leading to the

production of blood-stained mucus in the stomach.

_Post-mortem Appearances._--These are the same as those described under hydrocyanic acid, with the addition of the corrosive effects.

_Fatal Dose._--Five grains have proved fatal in a quarter of an hour; recovery has taken place after forty grains.

_Chemical Analysis._--Same as for hydrocyanic acid.

_Treatment._--As for hydrocyanic acid.

PREPARATIONS CONTAINING HYDROCYANIC ACID

The following plants contain prussic acid, and are therefore more or less poisonous in proportion to the quantity of the acid which they severally contain:

Nat. Ord. Rosaceæ

_Amygdalus Communis._--The Almond and its varieties. _Prunus Domestica._--The Plum and its varieties. _Cerasus._--The Cherry and its varieties. _Pyrus Aria_, or White Bean Tree.--The seeds are poisonous.

Nat. Ord. Euphorbiaceæ

_Jatropha Manihot_, or Bitter Cassava.

Bitter Almonds

The essential oil of bitter almonds is very poisonous. “The oil does not, like common essential oils, exist ready formed in the almond, but it is only produced when the almond pulp comes in contact with water. It cannot be separated by any process whatever from the almond without the co-operation of water--neither, for example, by pressing out the fixed oil, nor by the action of ether, nor by the action of absolute alcohol. After the almond is exhausted by ether, the remaining pulp gives the essential oil as soon as it is moistened; but if it is also exhausted by alcohol, the essential oil is entirely lost. The reason is, that alcohol dissolves out a peculiar crystalline principle named _Amygdalin_, which, with the co-operation of water, forms the essential oil by reacting on a variety of the albuminous principle in the almond, called _Emulsin_, or _Synaptase_.

The essential oil of bitter almonds may contain from 6.0 to 14.33 per cent. of hydrocyanic acid. Deaths from the incautious use of this oil for flavouring articles of confectionery are not infrequent. As the flavour is not in the least injured, it has been suggested to subject the oil to repeated distillation with caustic potassæ, by which means the oil is purified from prussic acid.

_Symptoms in Man._--Nausea, vomiting, and diarrhœa, due to gastric irritation, have occurred when the dose has been small, as is the case when confectionery owes its flavour to the use of the essential oil. Idiosyncrasy may have something to do with these effects, for cases are on record where a single almond has produced a state resembling intoxication, followed by an eruption not unlike urticaria or nettle-rash. Taken in large doses, the symptoms produced are identical with those described under poisoning by prussic acid. The breath is usually strongly impregnated with the odour of bitter almonds.

_Symptoms in Animals._--Vomiting, trembling, weakness, paralysis, tetanic convulsions, and coma.

_Post-mortem Appearances._--These are identical with those seen in poisoning by the pure acid.

_Fatal Dose._--The essential oil is from four to eight times as strong as the acid of the Pharmacopœia. From twenty to thirty drops have proved fatal. Death may take place in half an hour or less.

_Treatment._--The same as that recommended under prussic acid.

Cherry-Laurel

The cherry-laurel, _Prunus Laurocerasus_--the leaves of which have been used for flavouring custards, &c.--contains prussic acid, and is therefore poisonous.

In the British Pharmacopœia there is an _Aqua Laurocerasi_--laurel water--prepared from the leaves. It contains 0.1 per cent. of hydrocyanic acid. It should be used with extreme caution, as the amount of hydrocyanic acid contained in the leaves is uncertain. Death has frequently resulted from its use. The most important case, however, is that of Sir T. Broughton. His mother, who gave him his usual draught on the morning of his death, observed that it had a strong smell of bitter almonds. Two minutes after he took it she observed a rattling or gurgling in his stomach; in ten minutes more he seemed inclined to doze; and five minutes afterwards she found him quite insensible, with the eyes fixed upwards, the teeth locked, froth running out of his mouth, and a great heaving at his stomach, and gurgling in his throat. He died within half an hour after swallowing the draught. No light was thrown on the case by the carelessly conducted _post-mortem_; but the suddenness of his death, the improbability of apoplexy occurring at so early an age, and the odour of bitter almonds observed by his mother, pointed out clearly enough the true cause of death.

ACONITE

All parts of this plant, the _Aconitum Napellus_ (_N.O. Ranunculaceæ_), are poisonous. The poisonous properties depend upon the presence of an alkaloid--_aconitine_--chiefly found in the root.

Poisoning by the alkaloid came before the public mind in the case of Dr. Lamson, executed for the murder of his brother-in-law. The symptoms noticed in that case were very much as detailed below. When any part of the plant is chewed, a sensation of tingling is experienced in the mouth, and burning in the throat. Many of the aconites are, however, inert. The root, having been taken by mistake for horse-radish, has led to several cases of accidental poisoning.

-------------------------------------+------------------------------ Aconite | Horse-Radish -------------------------------------+------------------------------ _General Characteristics._-- | _General Characteristics._-- Root conical; dark brown externally,| Root cylindrical, of nearly and with numerous twisted rootlets; | the same thickness down its internally, the colour is whitish. | whole length. Externally, | buff-coloured; internally, | white. | _Taste._--Produces a tingling | _Taste._--Sweet and pungent. and numbing sensation in the mouth. | -------------------------------------+------------------------------

_Symptoms in Man._--The patient complains, within a short time after the poison is taken, of dryness of the throat, accompanied with tingling and numbness of the mouth and tongue. He then complains of nausea, vomiting, pain in the epigastrium, and distressing dyspnœa, of a sensation of formication or tingling, with numbness in his face and limbs, which appear to him heavy and enlarged. In attempting to walk he staggers, his limbs losing their power of supporting his body. He becomes giddy, his pupils dilated, and his sight and hearing imperfect; but he is seldom unconscious till near death. His pulse irregular, gradually becomes weaker, and at last almost imperceptible; his skin cold and clammy; his features pale and bloodless; and his mind clear: then suddenly he dies, in some cases from shock, in others from asphyxia; or he may die from syncope, especially after some exertion.

_Symptoms in Animals._--Weakness of the limbs and staggering, the respiration slow and laboured, loss of sensation, paralysis, dimness of vision, increasing difficulty in breathing, _convulsions_, and death by _asphyxia_.

Delirium is present in some cases, and dilatation of the pupil has also been noticed. In a case recorded in the _British Medical Journal_, 1877, vol. i. p. 258, two ounces of the tincture of aconite were drunk in mistake for _Succus Limonis_; recovery took place, but not before alarming symptoms had taken place, and death at one time appeared imminent.

_Post-mortem Appearances._--General venous congestion. The brain and its membranes are, in most cases, found congested and the stomach and intestines inflamed.

_Fatal Period._--The symptoms may come on immediately, or may be delayed for an hour or two. In the case mentioned in the _British Medical Journal_ the patient walked about five miles after swallowing two ounces of the tincture, which he drank at 11 o‘clock, returning home at 2.30 P.M. An excise officer, who died in about four hours, was able to walk from the Custom House over London Bridge. Death has taken place in so short a time as one hour and a quarter.

_Fatal Dose._--About two grains of the extract, and one drachm of the tincture. Much will depend upon the amount of the alkaloid present. One drachm of the scraped root is said to have proved fatal. One-fifteenth of a grain of aconitine has proved fatal.

_Chemical Analysis and Tests._--The alkaloid must be isolated from the contents of the stomach by the process of Stas. The physiological test consists in placing a small portion of the extract, or the alkaloid so obtained, on the tongue or lip, and noting if tingling be produced. To the pure alkaloid, nitric acid added produces no change of colour. Officinal phosphoric acid added, and the mixture carefully evaporated, a violet colour is produced; this reaction is due to impurities in the aconitine.

_Kundrat‘s Test._--A solution of ammonium vanadate in strong sulphuric acid produces a coffee colour with aconitine.

_Treatment._--Emetics, stomach lavage, castor-oil, and animal charcoal should be given. The administration of digitalis in aconite poisoning has been attended with good results. (See _British Medical Journal_, 11th December 1872.) The drug may be given hypodermically as an antidote. Stimulants will be required; and friction down the spine, together with galvanism and artificial respiration, may be tried.

=Synopsis of the Action of Aconite=

1. _On Nervous System._--Giddiness, numbness, and tingling in the limbs is a primary effect, followed by gradually increasing paralysis of the muscles, and insensibility of the surface of the body to pinching and pricking. Dr. Fleming asserts that it produces a _powerful sedative effect on the nervous system_. At any rate, it now seems to be proved that aconite paralyses the sensory nerves, commencing at their peripheral endings.

2. _On Vascular System._--Extreme depression of the circulation is produced by doses large enough to cause death. The pulse may become imperceptible at the wrist. In medicinal doses, aconite lowers the heart‘s action; in poisonous doses, it causes fatal syncope.

3. _On Digestive System._--Some have denied the irritant action of aconite on the alimentary canal, but Sir R. Christison states that he was deterred from the use of aconite “by two patients being attacked with severe vomiting, griping, and diarrhœa.”

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