A MANUAL OF TOXICOLOGY A CONCISE PRESENTA TION OF THE PRINCIPAL FACTS RELATING TO POISONS, WITH DE- TAILED AND DESCRIPTIVE DIRECTIONS FOR THE TRE A TMENT OF POISONING A TA RLE OF DOSES OF THE PRINCIPAL AND MANY NEW REMEDIES AND VARIOUS STATISTICAL TABLES By ALBERT H. BRUNDAGE, A. M„ M. D., Phar. D., M. S. Toxicologist to the Bushwick Hospital, Etc. Formerly Professor of Toxicology and Physiology in the Departments of Medicine, Dentistry and Phar macy of Marquette University. Formerly President of the Board of Pharmacy of the State of New York, and Examiner in Toxicology in same ; Etc. Honorary Member of the Brooklyn Medical Society; Life Member of the New York State Pharmaceutical Association; Member of the Ameri- can Medical Association, the American Associa- tion for the Advancement of Science, Etc. ELEVENTH EDITION REVISED AND ILLUSTRATED Price, $2.50 net NEW YORK: THE HENRY HARRISON CO. Linden Street, Brooklyn, New York 1020 Copyright, 1901 Copyright, 1920 By The Henry Harrison Co. BURR PRINTING HOUSX NEW YORK, U. S. A. PREFACE TO SEVENTH EDITION. In this seventh edition, the author has endeav- ored to make more or less material alterations and additions without appreciably increasing the bulk of the book. He has striven to keep in view the original plan of having it compact and strictly man- ual in size, but comprehensive in scope. As heretofore, elegance of diction and convention- ality of typographical and other forms have been made uncompromisingly subordinate to economy of space, directness in statement and the most ser- viceable emphasis. The author has hoped to produce a practical, truly serviceable manual, and if those into whose hands 11 comes, consider it to be possessed of these admirable qualities, his efforts will have been com- pensatingly fruitful. The hearty and very generous recognition ac- corded the book by college professors, experts, physicians, pharmacists and others, is most highly appreciated by the author. ALBERT H. BRUNDAGE. Brooklyn-New York, N. Y., June 1, 1909. CONTENTS. PART I. PAGES General Considerations:- Definitions, Classifications, Descriptions, General Directions, Illustrations (with Colored Plate) 11-60 Poisons and Acute Poisoning:- History, Symptoms and Treatment in Detail.... 61-229 Principal Poisonous Plants, etc 230-244 A Key to Treatment 247-250 PART II. PART III. The Indications of Various Symptoms 253-260 PART IV. Simulation of Poisoning by Disease 261-263 Relation of Poisoning to Disease 264-268 Action and Elimination of Poisons ... 269-272 PART V. Table of Identification Tests for Poisons 273-294 Crystals (Under the Microscope) 294 Chart for Detection of Metals 295 Chart for Detection of Acidulous Radicals 296 VIII CONTENTS. PART VI. PAGES Outline of Procedure in Searching for Poisons 297-310 The Corpus Delicti 310 The Signs of Death-Tests to Determine Death 311-312 PART VIL PART VIII. Sudden Death-Causes-Modes of Death 313-316 PART IX. Pharmacological Toxicology 317-328 The Fatal Dose and Causes of Death 328 Peculiar Food and Drug Effects 329 Substances Causing Skin Eruption or Itching 330 Substances Altering Color of Urine 330 Substances Producing Odorous Urine 330 Substances Altering Color of Feces 330 Suspicious Symptoms of Poisoning 331 Transfusion 332 Unconsciousness or Coma-Interpretation, Treatment, etc 333-336 Hints on Brain and Heart Poisons 338 PART X. PART XI. Guide to Post-Mortem Procedure (In Suspected Poi- soning) 339-340 Directions for Making Post Mortems 341-343 Weights and Measures of Viscera 343 Height, Weight, etc.. Averages 344 Post-Mortem Appearances in Poisoning 345-363 Post-Mortem Key to Poison; Occupation Poisons.... 364-366 PART XII. Chronic Poisoning and Drug Habits:- Alcohol, Arsenic, Chloral, Cocaine, Ether, Lead, Mercury, Opium and Morphine, Paraldehyde, Phosphorus, Sulphonal, Wormwood-Ab- sinthe 367-392 CONTENTS. IX APPENDIX. PAGES Dose Table (Single Dose) 393-410 [Prepared by comparing and averaging doses stated by leading American and European authorities.] Antidote Bag 410 Dose Table (Maximum Daily Doses) 411-412 Key to Uranalysis (For Exclusion) 413-414 Abnormal Constituents of Urine 414 Tables of Weights and Measures 415-417 Temperature Equivalents 418 Tables Showing Frequency of Respiration at Various Ages, and Frequency of Pulse 418 Income and Expenditures, of Life 418 Tables Showing Frequency of Poisoning by Various Poisons 419-420 Important Facts 420 Order of Eruption of Teeth 421 Eruptive Fevers 422-423 Table for Making Percentage Solutions 423 Epitome of Important Incompatibles 424 Freezing Mixtures „ 425 Laws Relating to Sales of Poisons 425-426 Questions for Self-Examination 426-434 Index .....435-444 A MANUAL OF TOXICOLOGY. PART I. Toxicology is the science of poisons; i.e., the sci- ence which treats of the nature, properties, effects, and detection of poisons, and the treatment of poisoning. A Poison (in a strict sense, i.e., a True Poison) is any substance which upon entering into solution in the circulating blood or by chemically acting upon it is capable uniformly of producing serious bodily injury, disease or death (e.g., arsenic, alka- loids, toxins, chloral) ; or (in a broad sense), is any substance which, independent of any mechanical ac- tion, uniformly causes serious bodily injury, disease or death, when applied to, introduced into, or de- veloped within the body (e.g., "True Poisons," mineral acids, alkalies, etc.). A person's individual susceptibility, i.e., idiosyn- crasy, or his diseased state, whereby a certain sub- stance injures him or causes his death but does not so affect others in health, does not warrant classify- ing that substance as a poison; nor does the avenue of body entrance (by mouth or otherwise) ; but, in order to be classed as a poison, its effects must be uniformly injurious to persons in health. It has been proposed (not generally adopted) to recognize as a poison any substance which produces harmful effects in quantity of a drachm or less. A Corrosive Poison is one which by contact, chemically causes local destruction of tissue. When swallowed, it usually produces nausea, vomiting, and great local distress. A Corrosive Poison is not GENERAL CONSIDERATIONS. N. B. Special attention is called to N. B., page 61. 12 A MANUAL OF TOXICOLOGY. strictly a true poison. If highly diluted with water it ceases to be corrosive (e.g., Nitric Acid). A True Poison is still poisonous no matter how highly diluted (e.g,, Atropine, Strychnine, etc.). A Cumulative Poison is one which increases sud- denly in its intensity of action after slow additions of it (e.g., Digitalis). THE LEGAL DEFINITION OF "POISON." The legal definition of "POISON" is very suc- cinctly and clearly stated by Kobert as follows: The statutes of the State of New York and those of the United States, do not define the word "poison." Words are there used to indicate their general meaning, unless some- thing is found in the context to denote some special or re- stricted use. According to its generally received meaning, we can say: In most cases a poison is a substance which, when given even in small doses, owing to its chemical constitution, is capable of destroying health or life. The following statement, by Herold, very con- cisely expresses the generally accepted scientific and legal views of this matter: A Poison is a substance which, when applied to the body externally, or introduced into the system either by the mouth, rectum, vagina, skin, lungs, etc., without acting mechanically, but by its own inherent qualities, is capable of altering or de- stroying some or all of the functions necessary to life. The intent with which such a substance is given enters into the legal conception of a poison. The law never regards the manner in which a substance acts, and it is of little conse- quence, so far as the responsibility of the accused person is concerned, whether its action on the body be of a mechanical or of a chemical nature, so long as the substance administered is capable of causing disease or death. Broken or crushed glass, needles, pins, and like bodies are not poisons in the medical signification of the term; yet, when taken inwardly, may be destructive to life. Any substance which causes dis- ease or death, given with homicidal intent, may be regarded as a legal definition of a poison. THE LEGAL DEFINITION OF "POISON?' 13 The English law declares that: "Whoever shall administer, or cause to be administered to, or taken by any person, any poison or other destructive thing, with intent to commit mur- de^ shall be guilty of felony." And also: "That whosoever shall unlawfully or maliciously administer to, or cause to be taken by, any other person any poison or other destructive or noxious thing, so as thereby to endanger the life of such per- son, or so as thereby to inflict upon such person any grievous bodily harm, shall be guilty of felonyand "Whoever shall unlawfully apply, or administer to, or cause to be taken by, any person any chloroform, laudanum, or other stupefying or overpowering drug, matter, or thing, with intent, in any such case, thereby to enable himself or any other person to commit, or with intent, etc., to assist any other person in committing, any indictable offence, shall be guilty of felony." The German statute provides that: "Whoever wilfully ad- ministers (beibringt) to a person, for the purpose of injuring health, poison, or any other substance having the property of injuring health, w#l be punished by from two to ten years' imprisonment. If by such act a serious bodily injury is caused, the imprisonment is not to be less than five years; if death is the result, the imprisonment is to be not under ten years or for life." If the death is wilfully caused by poison, it comes under the general law: "Whoever wilfully kills a man, and if the killing is premeditated, is on account of murder punishable with death." The French law (Art. 301, Pena! Code) says: "Every at- tempt on the life of a person, by the effect of substances which may cause death, more or less suddenly, in whatever manner these substances may have been employed or administered, and whatever may have been the results, is called poisoning." There is also a penalty provided against any one who "shall have occasioned the illness or incapacity for personal work of another, by the voluntary administration, in any manner what- ever, of substances which, without being of a nature to cause death, are injurious to health." Blyth's scientific definition of a poison is: "A sub- stance of definite chemical composition, whether mineral or organic, may be called a poison, if it is capable of being taken into any living organism, and causes, by its own inherent chemical nature, impairment or destruction of function." Acufe Poisoning is produced by taking an exces- 14 A MANUAL OP huXICOLOGV. sive single dose of a poison, or several smaller doses with such frequency as to result in prompt and marked disturbance of function or death within a definite time. Chronic Poisoning is produced by taking or ab- sorbing for a protracted period small doses of a poison, thereby producing gradual but progressive deteriora- tion of function or tissue (e. g. ,By lead, morphine, etc.) An Antidote (in a general sense) is any agent which neutralizes a poison, or otherwise counteracts or op- poses it or its effects. It may either so alter a poison as to make it harmless, remove it from the body, mechan- ically prevent its absorption, or so act upon the func- tions of the body as to more or less overcome the effects of its absorption. There are three kinds of antidotes: Chemical, Mechanical, and Physiological. A Chemical or True Antidote is one which makes the poison insoluble or harmless by chemically alter- ing it. (It acts directly upon the Poison.) A Mechanical Antidote or Antidotal Measure is one which removes the poison without changing it, or so coats the stomach or mechanically suspends the poison that absorption is prevented. (It acts directly upon or against the Poison.) A Physiological Antidote or Antagonist is an agent which so acts upon the system as to counteract, more or less completely, the effects of another sub- stance (e. g., atropine counteracts the effects of mor- phine, to a certain extent). (It acts directly upon the functions of the body.) In a strict sense, a measure which tends to overcome the remote systemic effects of a poison, (as artificial respiration, cold affusions, etc. ), is not an antidote, but a Physiological or Antagonistic Measure. A Medicine is a substance administered to cor- rect a disordered or diseased state of the system. Posology treats of the form and quantity of med- icine to be administered at one time, or within a certain period. A Dose is the quantity of medicine to be adminis- tered or within a certain period, usually EFFECTS OF POISONS. 15 a day. It may be a single, or daily dose, a safe, or poisonous dose, a minimum, or maximum dose, a mouth, hypodermic, or rectal dose, etc. Only a certain amount of some medicines may safely be administered in twenty-four hours; there- fore, the daily dose may be disproportionate to the single dose. (See dose tables in Appendix.) A Safe Dose may be useless if too small; conse- quently a dose called the Minimum Dose is fixed as the smallest amount from which physiological effect is commonly assumed to result, or beneficial action upon the sick is secured. No arbitrary quantity of a poison can be stated above which it is poisonous, and below which its effects are both safe and salutary. (2 grains of ar- senic or ounce of oxalic acid may be fatal.) A Toxic or Poisonous Dose is the dose that is harmful to both the healthy and the sick, but is not fatal. It begins where the limit of safety, commonly called the Maximum Dose, ends. A Lethal or Fatal Dose is the dose which kills, and although ordinarily more, may. under certain conditions, be less than the ordinary maximum dose. Considering the foregoing facts, it is important that the Minimum and Maximum Doses of medi- cines be well known, and especially that the Maxi- mum Doses be not exceeded except for some special reason, lest poisoning result.* EFFECTS OF POISONS. Poisons may have local or remote effects, or both. • The local effect of a poison is the impression made directly upon that part of the body with which the poison comes in contact: Such as corrosive effects produced upon stomach and intestines by immediate contact of concentrated mineral acid or caustic alkali; or irritative, inflammatory, or local specific effect of such substances as corrosive sublimate or aconite. The remote effect is the impression made upon a * The author has arranged a Table of Doses of the principal and many Dew remedies. This table will be found in the Affendix. 16 A MANUAL OF TOXICOLOGY. distant part of the body (e. g., belladonna taken into the stomach produces paralysis of the ciliary nerves resulting in dilatation of the pupil of the eye). The usual symptoms of poisoning are the remote effects of the poison. Certain poisons, such as arsenic, carbolic acid, potassium cyanide, etc., have both local and remote effects; e.g., arsenic has a local effect upon the stomach, and a remote effect upon the brain; can- tharides locally produces blisters, remotely influ- ences the kidneys and bladder, causing strangury and sometimes bloody urine. A Poison, unless it be a corrosive poison, must first pass into the circulating blood, be incorporated or dissolved in it or chemically act upon it, and the poison or altered blood then be carried (circulated) to distant parts of the body, in order to produce the full poison-effects upon the system. Some poisons are more rapidly taken into the general circulation than others. The corrosives often produce local ef- fects so severe as to cause death. Poisoning cannot occur by nervous communica- tion or by simple approximation of tissue. We know that poisons are absorbed into the cir- culation because we find them in the blood, secre- tions, and various organs of the body, such as the kidneys, liver, spleen, brain, lungs, etc. Some poisons are absorbed without undergoing any change, and pass out of the circulation and body still unchanged. Some are chemically altered during absorption, or in the blood or organs, and thus de- stroyed. The liver actively protects the body against poisoning. It arrests most of the poisons brought to it through the portal vein: arrests mor- phine, strychnine, atropine, cocaine, and various other alkaloids, ammonia, putrid poisons, toxic pro- ducts of intestinal fermentations, mineral poisons, etc. Some poisons it modifies, some it stores up (various mineral poisons, etc.), and some it elimi- nates. When a poison enters the blood it probably causes some change in that fluid. Some poisons so Diagram showing chief organs concerned in absorption and circulation of poisons. (See pages 16 to 21.) A MANUAL OF TOXICOLOGY Diagrammatic scheme of circulation. (See pages 16 to 21.) EFFECTS OF POISONS. 17 alter the blood as to make it unfit to perform its functions. (See also Part IV.) According to Da Costa, the following blood effects have been recog- nized : Substance. Alcohol, Amyl nitrite, Acetanilid, Ammonium hydroxid, Antipyrin, Bromin, Chloral, Chromic acid, Ether, Guaiacol, Hydrogen cyanid, Illuminating gas, lodin, Lead, Nitrobenzene, Nitroglycerin, Phenacetin, Phosphorus, Potassium chlorate, Sodium nitrite, Poisonous mushrooms, Effects. Anemia, often leucocytosis. Methemoglobinemia. Methemoglobinemia. Leukocytosis. Methemoglobinemia. Methemoglobinemia. Leukocytosis. Methemoglobinemia. Oligochromemia, Hemocytolysis, leukocytosis. Methemoglobinemia, [mia.] Methemoglobinemia, polycythe- Leucocytosis,methemoglobinemia Anemia, granularbasophilia, of- ten leukocytosis. Methemoglobinemia, megalo- blastic anemia. Methemoglobinemia. Methemoglobinemia. Polycythemia, occasionally leu- kocytosis. Methemoglobinemia, anemia, leukocytosis. Methemoglobinemia. Hemoglobinemia. In toxicological examinations, it is important to find the poison in some of the body secretions or organs. Poisons may be absorbed with remarkable rapidity, especially if hypodermically injected. The rapidity of absorption depends upon- i. The solubility of the poison. If it is absolutly insoluble it cannot be absorbed. But although insoluble in water it may be soluble in the fluids of the alimentary canal and consequently be absorbed. There are some poisons of an animal nature, which, if swallowed, seem to undergo a change by digestion or otherwise which makes them practically harmless: (e. g., the virus of glanders, smallpox, syphilis, etc.). [After burial, arsenic, etc., may enter body from soil, etc.] 18 A MANUAL OF TOXICOLOGY. 2. The character of the surface to which the poison is applied. Poisons may enter the system through the skin, as by the use of washes and salves (e. g., such poisons as arsenic, tartar emetic, corrosive sublimate, opium, etc.). If the skin is removed beforehand, the absorption is of course more rapid. If the surface is rich in blood vessels and the intervening walls thin, the poison is likely to be very promptly taken up. When poisonous vapors or gases are inhaled, the effects are exceedingly prompt, be- cause of the rapidity of absorption in the respiratory tract. Poisons act more rapidly when given by the mouth than by the rectum; and still more so when given by hypoder- matic injection; when injected directly into the blood ves- sels of the body they have an almost instantaneous effect. A poison taken into the stomach when the latter is full of food usually acts very slowly, or may expend its power upon the contents (potassium permanganate introduced into a stomach containing much organic matter expends its oxidizing power upon such matter) ; but if the stomach is empty the action usually is very prompt, and apt to be directed against the walls of the stomach. The lungs may absorb fine dust. [Apparently arsenic oxid and trioxid have only a local effect if given subcutaneously, but by mouth poison.] 3. The quantity of blood in the blood vessels. If the vessels contain but little blood, the poison is more rapidly absorbed. The less circulating fluid there is, the more rapid the absorption. Therefore, bleeding or purg- ing will favor absorption by producing depletion of the vascular system. It is evident that the fatal effects of a poison are due to absorption, inasmuch as the poisoning con- tinues as long as the blood circulates between the place where the poison has been introduced and the organ affected by it. Also by the fact that the effect ceases when the circulation, from the place where the poison was introduced, has been cut off. This has been proved by experiments upon animals. As a poison, which has been absorbed into the blood, passes through the different organs of the EFFECTS OF POISONS. 19 body, some of it is at once separated by them and promptly removed in their secretions, such as the saliva, urine, sweat, bile, pancreatic juice, etc. The kidneys remove many poisons, and should be aided. Some of the poison may, however, be temporarily deposited in the liver, spleen, kidneys, heart, lungs, brain, pancreas, muscles, or bones. This is true of mineral and some vegetable poisons. Gaseous poisons are not deposited, but promptly removed by way of the lungs. Lead and some other mineral poisons are par- ticularly inclined to deposit in the spinal cord and brain. These various depositions are invariably in the form of an albuminoid combination. A poison which is not known to have any selective action is most likely to be found in either the liver or kidneys. Although only a small portion of a poison circu- lates in the capillaries at any one time, it is this portion which produces the poisonous effects. That portion which still is in the stomach or otherwise un- absorbed, or has been temporarily deposited in the various organs, is harmless while it remains there. Hence, an unabsorbed poison in the stomach is not the cause of death as is commonly supposed. The cause of death is that portion of the poison which was absorbed; and the unabsorbed portion in the stomach is the surplus of what was capable of producing death. Exception is, of course, made re- garding the local action of corrosives. A poison which, for the time being, is deposited in the organs, is harmless while there, but nevertheless is a menace to life, as at any time it may be reab- sorbed and thus become again active. Therefore, it is evident a poison should be removed entirely from the system as soon and as completely as possible. The length of time required for the removal of an absorbed poison from the circulation, either by the secretions or by its being deposited in the organs or tissues, depends upon the poison and the state of the system. Potassium iodide, turpentine, antimony, 'uid carbolic acid may often be found in the urine a 20 A MANUAL OF TOXICOLOGY. few minutes after being swallowed. It is believed that mineral poisons are rapidly separated from the blood. Lithium salts pass through the entire circulatory sys- tem within a few minutes after being given and may be detected in the perspiration. Arsenic has been found in the urine within an hour and an half and in the liver within four hours after it was taken. It takes nearly two weeks to remove it from the system. Antimony may be found four months, and lead and copper eight months after they have been taken. Early vomiting and purging after only a moderate dose of poison may prevent the deposition of the poison, but without saving life, there being just enough poison absorbed to kill. As the various poisons circulate throughout the body in the blood, they come in contact with the great centres of life-the heart, lungs, brain, and spinal cord, -and exert their influence upon those organs, which are peculiarly sensitive to their actions, or show their elective affinity for various organs and produce their specific effects; one, as opium, affecting the brain producing narcotism; another, as prussic acid or digitalis, the heart, producing asthenia; another, as strychnine, the spinal cord, producing tetanus, etc. Morphine given hypodermatically promptly seeks the stomach; mercury applied to the skin in the form of a salve promptly seeks the small intestine, etc. We do not know why they so act any more than we know why different poisons prefer different methods of removal from the system; as, potassium iodide prefers removal by the urine, mercury by the saliva, arsenic by the stomach glands, lead by the secretions of the liver and kidneys, etc. (See Part IV.) Death by poisoning may result from shock to the general nervous system, or from a specific disturb- ance of some vital organ or center of life, as from paralysis of the heart, paralysis of the respiratory centers, asphyxia, etc. The strong corrosives produce death by shock through their severe local action, producing a gen- EFFECTS OF POISONS. 21 eral depression of the system like that caused by a severe burn or other serious injury to the surface of the body. Most poisons cause death by producing a general devitalizing effect. The effects of a poison may be modified by the physical state, quality, or mode of administration of the drug, the size of the dose, the association with other poisons, the age, sex, idiosyncrasy, habit, or mental or physical state of the individ- ual, the condition of the stomach, and the char- acter and amount of the stomach contents. Men as a rule bear larger doses of medicines than women. As a general rule, the larger and more robust the in- dividual, the less easily he is influenced by drugs, and the greater his vital resistance. Regarding mode of administration : dilute diuretics are more effective than concentrated ones ; but saline purgatives are most effective when concentrated. Of alcoholic, watery and oily solutions, the first is most readily absorbed, the last least so. Hot solutions are usually more rapidly absorbed than cold ones. Dilution of a poison by water frequently favors its speedy absorption, hence the promptness and sever- ity of its action; to this, corrosives are exceptions. A poison is absorbed more rapidly in gaseous than in solid or even liquid state; consequently it is most active in gaseous, less active in liquid, and least ac- tive in solid state. It appears that alcohol, hydro- cyanic acid, nicotine, etc., may enter the circulation directly through walls of lips, mouth, nose or stomach. A diseased or disordered stomach may delay absorption of a poison or prove highly suscep- tible to the action of an irritant poison; or acidity, alkalinity, or other character of its contents or the character of the vehicle in which the poison is given may determine the solution, absorption, destruction or intensity of action of a poison (e.g., an acid or alkali may be neutralized; corrosive sublimate, taken in milk or eggs, modified; mercurous chloride de- composed by an alkali thereby acting severely; etc.). Certain toxalbumins, such as snake venom, are 22 A MANUAL OF TOXICOLOGY. almost or quite inert when taken into stomach, but very poisonous if introduced directly into the blood. Some poisons are severely irritant in large doses. Although some substances are very irritant poisons in large doses, in small doses are not; but if continued, gradually salivate (e.g., certain salts of mercury). As a rule, the larger the dose, the quicker and frequently more emphatic the action. Some irritant substances, however, act as emetics in large doses, while small ones have no emetic effect, and conse- quently remain and poison (e.g., arsenic). A large dose quickly absorbed may exhibit so severe central nervous system effects as to obscure or prevent gastro-intestinal ones (e.g., arsenic). A large dose of a poison may cause death in a dif- ferent way from a small dose. Oxalic acid in large dose quickly produces death by shock ; in small doses, slowly kills by its action upon heart and nerve centers.* Combining poisons sometimes increases (as mor- phine with chloral), sometimes diminishes, their power; or, their action may actually be antagonized or neutralized by such combining. The action of one poison may be suspended by the action of the other. The antagonistic action of poisons is well known. Certain poisons decidedly antagonize each other, one more or less neutralizing the effect of the other upon the system. The antagonistic action may be either physi- ological or toxic. Calcium salts in poisonous doses will produce such contraction of a frog's heart that the animal dies-the heart contracted. Potassium salts in poisonous doses produce dilatation of the heart, and death in that state. A balance dose of the two salts will control the action of each salt, the physiological effects of one being neutralized by the other, so that the heart acts normally and the animal lives. There is a similar antagonism between the potassium salts and veratrine. Morphine, aconite, and conium are more or less neutralized, respectively, by atropine, dig- italis, and strychnine. And atropine neutralizes strych- nine. Furthermore, a combination of poisons may so * For comments on fatal dose and cause of death., see page 318. EFFECTS OF POISONS. 23 modify the action upon the system as to obscure the symptoms, and even interfere with the chemical tests. As indicated in the foregoing, such conditions and peculiarities of the system, as Habit, Idiosyncrasy, and Disease also modify the action of poisons. Habit, as a rule, lessens the effect of poisons; (e. g., opium, alcohol, arsenic, etc.) Gradual increase in dose of a poisonous substance, commonly, produces toleration of it, but habitues die from overdoses. With vegetable substances, such as opium and gelsemium, it is usually necessary to increase the dose frequently to maintain the effects; however, with min- eral substances, the contrary is, as a rule, the case; anti- mony and mercury cannot be long taken without risk.- Idiosyncrasy (constitutional peculiarity; distinc- tive characteristic; personal susceptibility or tolerance, respecting certain poisons) is noted when morphine, calomel, etc., are administered to some persons. Some persons are affected by the tonic influences of even minute doses of arsenic; some are salivated by a minute dose of a mercurial; some are poisoned by a very small amount of turpentine. Other persons can- not take the iodides; with some, even quite dilute solu- tions of cocaine applied to any mucous membrane will cause severe symptoms of poisoning; opium produces wakefulness; etc. Some can take enormous doses. Some persons are very susceptible to the effects of certain plants, while others are unaffected by them. Some cannot take quinine, others opium or bella- donna, etc. Some persons are made seriously ill by partaking of, or only smelling, substances which are very agreeable to others; among these are various drugs, and such foods as fish, eggs, honey, lobster, and other shell-fish, mutton, raspberries, strawberries, etc.; also the odors of musk or of sewer gas, the smell of various animals, the scent of flowers, etc. Among the symptoms produced are: Nettle-rash after partak- ing of raspberries, strawberries, tomatoes, crabs, or other red dishes; sneezing in the presence of the ob- noxious animals: colic after cocoa; fainting, illusions, 24 A MANUAL OF TOXICOLOGY. and other nervous phenomena from the scent of the lily, rose, violet, hyacinth, etc. Disease also modifies the action of certain poi- sons ; as, opium in tetanus, peritonitis, delirium tre- mens, etc., where the power of the poison is dimin- ished ; or, as opium in apoplexy and inflammation of the brain, where tolerance of it is lessened. In paralysis, strychnine acts less readily. In typhoid fever very large doses of alcohol are tolerated. In organic disease of kidney, lessened eliminative power seems to increase susceptibility to poisons. Sleep usually diminishes or retards the action of poisons, owing to diminished vital functions (e.g., arsenic and other irritants). Exhaustion usually in- creases the susceptibility to certain poisons, par- ticularly those having a depressing effect. In maniacs and in some convulsive disorders, seda- tives may be almost inactive. The Evidences of Poisoning may be divided into: i. Circumstantial, or Moral; 2. Symptomatic; 3. Chemical; 4. Post-Mortem; 5. Experimental. 1. Circumstantial or Moral Evidence is that con- tributed by the circumstances or deduced from vari- ous occurrences and facts. Among these are motives for poisoning; the possession or purchase of the par- ticular poison found; previous attempts to poison; active efforts for secrecy regarding medicine used, or matters vomited; undue haste in burial, etc. 2. Symptomatic Evidence is that contributed by the symptoms. It may be subjective or objective. While very important in determining a poisoning, it is, nevertheless, only presumptive evidence of it. There are no absolutely characteristic symptoms of any poison. If there were, symptoms would be de- terminative evidence, and chemical investigation un- necessary. The local action of strong mineral acids and alkalies may be somewhat of an exception. ^Inasmuch as most poisons act very promptly, the occurrence of severe symptoms, such as violent pain, vomiting, purging, convulsions, delirium or drowsi- ness, soon after a person, previously in a state of health, *See also pages 251, 321. EFFECTS OF POISONS. 25 has taken food or drink, indicates cause for investiga- tion. And even if the symptoms come on gradually and are supposed to be caused by disease, they may be due to slow poisoning resulting from taking small re- peated doses of a poison. Furthermore, the symptoms or other evidences of certain poisons resemble those of certain diseases or disorders. Irritant poisoning is simulated by cholera morbus, food poisoning, malig- nant cholera, gastro-enteritis, peritonitis, gastric and intestinal ulceration, strangulated hernia, etc. Nar- cotic poisoning is simulated by autoinfection, epilepsy, apoplexy, meningitis, tetanus, certain heart diseases, etc. It is also well known that intoxication will mask the effect of narcotics. Arsenic poisoning and cholera morbus give very similar symptoms. Opium poisoning may be quite readily mistaken for apoplexy or uremia. The symptoms of strychnine poisoning and tetanus are very similar. 3. Chemical Evidence is the evidence obtained by means of a chemical analysis of the substance sup- posed to have caused the poisoning, or of that which has been vomited, or of material found in some part of the body, or in its excretions. The consideration of the physical properties of the suspected poison should be associated with the chemical investigation. Poison found in the stomach has in some cases been introduced there after death. Care must, therefore, be exercised to exclude such possibility. There is no known distinctive chemical test for certain poisons. Consequently those poisons cannot always be identified. Furthermore, the poison may have been decomposed in the blood or tissues, or so thoroughly eliminated or otherwise removed as not to be discoverable. The more unstable of the alkaloids and organic poisons are known to be oxidized while passing through the lungs. It is believed that many poisonous princi- ples, which enter the blood, are either destroyed or their effects neutralized by the white blood corpuscles. 26 A MANUAL OF TOXICOLOGY. Sometimes the chemical'investigation is interfered with by the presence of certain ptomains. Ptomains (Animal Alkaloids, Cadaveric Alka- loids, or Putrefactive Alkaloids) are alkaloidal sub- stances, resulting from the decomposition of albu- minous materials under the influence of bacteria. Some ptomains are poisonous, the majority are not. Ptomains have been found in mussels, oysters, eels, sausage, ham, canned meats, etc. Tyrotoxicon is a ptomain from poisonous cheese, poisonous milk, poisonous cream, etc. A Toxin is a poisonous substance or mixture of substances produced by bacterial action. It may be an alkaloid or proteid substance with poisonous proper- ties, or a mixture. The term toxin is usually re- stricted to poisonous proteid substances produced by disease producing microorganisms-as diphtheria toxin, or tetanus toxin. In a crude way, bacteria may be likened to bees and toxins to their honey. Food Poisons: Certain foods, when undergoing decomposition, may become poisonous from develop- ment of ptomains or toxins. Symptoms of food poi- soning are usually those of a gastro-intestinal irritant. 4. Post-Mortem Evidence is that obtained by an examination of the organs and tissues of the body after death. In post-mortem absorption the poison is found chiefly in the external portion of the organ. In ante-mortem absorption the blood circulation and other vital processes would produce more uniform dif- fusion throughout the interior of the organ. If evi- dent changes in the histological character of the organ are observed, it is presumptive evidence of ante-mortem introduction of the poison. Perforations produced by corrosives are invariably large and ragged, while those caused by disease are, as a rule, small with smooth edges. But, inasmuch as certain diseases simulate cer- tain poisons, a post-mortem examination is not alto- gether a positive evidence of poisoning. Redness, ulceration, softening of the mucous mem- brane of the alimentary canal, and perforation, are the principal evidences encountered post-mortem EFFECTS OF POISONS. 27 Irritants produce their chief effects upon the stom- ach and intestines, causing irritation, inflammation and corrosion; they sometimes produce ulceration, perforation, and even gangrene. They may cause thickening or thinning, and softening of visceral walls. The post-mortem appearances resulting from the narcotic poisons are not well defined. Poisons which are narcotico-irritant in their effects, may affect either or both the alimentary canal and brain. Death may result from irritants or narcotics without producing any appreciable post-mortem changes. Redness of mucous membrane of stomach and small intestine may be post-mortem sign from the action of an irritant poison, or from disease, suffocation, drown- ing or strangulation. A deep red color of the stom- ach wall is sometimes caused by transudation of blood from liver or spleen. Gravitation of blood, also, some- times causes a similar appearance in intestinal wall. Ante-mortem symptoms or some chemical evi- dence is therefore important. In ulceration of stomach from irritant poison, mu- cous membrane usually is destroyed in small circular patches, and redness from ulceration is diffused; not diffused when from disease. Stomach mucous mem- brane softening is not characteristic of poisoning. Disease produces same. When caused by corrosives, mouth, etc., will invariably show effects of poison. Perforation may result from poison or disease, and follow corrosion or ulceration. As said, in perforation from disease, opening is usually small, oval or round- ed, with smooth edges; from acids, large and ragged. The diaphragm, stomach, spleen, liver and other viscera sometimes spontaneously soften. The pre- ceding facts indicate necessity for caution in draw- ing conclusions from post-mortem appearances. 5. Experimental Evidence is evidence obtained by administering the suspected substance to some liv- ing animal and observing the effects. Apparently only dog and cat similarly affected as man by same poi- sons, but fatal dose, rapidity of action, rate of absorp- 28 A MANUAL OF TOXICOLOGY. tion, deposition or elimination of a poison adminis- tered to man cannot be determined by experiments upon the lower animals. But the administration of a suspected substance to a lower animal may serve as corroborative evidence of the poisonous nature. But remember that: A rabbit can take more morphine and atropine than a man who weighs fifty times as much; amygda- lin kills rabbits, but has no effect upon dogs; an adult man cannot bear as much strychnine as the smallest snail; insects are unaffected by many of the strongest heart poisons; hedge- hog unaffected by bite of most venomous snake, and not in- jured by large doses of hydrocyanic acid or cantharides; although frog easily affected by the digitalis poisons, toad quite unaffected by them; dogs narcotized by morphine, but can take more than most men; it crazes cats, hares and cows; etc. THE CLASSIFICATION OF POISONS. It is almost impossible to arrange a satisfactory classification of poisons. In an ideal one the same poison would appear but once, and the line between each poison would be sharply drawn. Some writers upon toxicology classify poisons ac- cording to the kingdoms; that is, as animal, mineral, and vegetable poisons. Poisons have also been clas- sified as organic, mineral, and volatile poisons. But these classifications have proved unsatisfactory. A quite satisfactory classification, based upon the origin or nature of poisons, but somewhat less definite than the author's Chemical Classification, arranges poi- sons as: (i) Inorganic, (2) Alkaloidal, (3) Non-alka- loidal Organic, (4) Gaseous, (5) Food Poisons. Poisons may very advantageously be classified either physiologically or chemically. Physiological classification usual and most satis- factory. Is based upon effects of poisons upon healthy animal, or upon system when in healthy condition. Chemical classification is a classification based upon chemical composition or chemical behavior. The author herewith presents a physiological, also a chemical classification which, he believes, will be found useful. But for the reader's convenience, Tanner's Blyth's, Robert's, and other classifications are presented also, for purposes of comparison. THE CLASSIFICATION OF POISONS. 29 PHYSIOLOGICAL CLASSIFICATION OF POISONS. Bromine; Cantharides; Carbolic Acid; Creo- sote; Croton Oil; Castor Beans; Chlorine; Compounds of Antimony, Arsenic, Copper, Chromium, Iron, Lead, Tin and Zinc; Food Poison; Gelsemium; Hellebore; Iodine; Mushrooms; Phosphorus; Ptomains; Sa- vin; Trichina; Veratrum, Pot. Cyanide, etc. 1. IRRITANTS. True Irritants. Acetic, Carbolic, Chromic, Lactic, Oxalic and Salicylic Acids; The concentrated min- eral acids; Creosote; Corrosive Sublimate; Concentrated Lye; Potassium Chlorate; Po- tassium Nitrate; Potassium and Sodium Hy- droxides and Carbonates; Quick Lime; Soluble Salts of Barium; Water of Am- monia, etc. Corrosives, Alcohol; Apocynum; Bella- donna ; Chloral; Chloroform, Ether, etc. (Anesthetics); Car- bonic Oxide; Carbon Dioxide; Opium, etc. Cerebral, Narcotics. Spinal. Tetanies. Nux Vomica, Strychnine, Bru- cine ; Ignatia; Thebaine, etc. Belladonna; Camphor; Cannabis Indica; Cocaine; Fishberries (Picrotoxin); Fungi; Hyoscya- mus; Stramonium; Solanine, etc. 2. NEUROTICS. Deliriants. Arnica; Antipyrine; Phenacetin, and many other Phenol and Benzene derivatives; Colchicum; Cocaine; Hemlock; Lobelia; Tobacco (Nicotine). Depressants. Cerebro- spinal. Aconite; Conium, Curare, Physostigma, Poke Root (Par- alyzants) ; Digitalis; Fishber- ries (Picrotoxin); Gelsemium; Hydrocyanic Acid; Nitro-Ben- zol; Pink Root; Potassium Cy- anide; Veratrum Viride; Animal and Insect Poisons, etc. Asthenics. 30 A MANUAL OF TOXICOLOGY. IRRITANTS. An Irritant Poison is one which produces irrita- tion or inflammation. When swallowed such poi- son produces an irritant effect upon the mucous lin- ing of the alimentary canal, resulting in nausea, vomiting, purging, pain in the abdomen, cramps in the stomach and other parts of the body. Some- times blood accompanies the vomited or purged matters. The post-mortem changes are found to be more or less inflammation of the gastro-intestinal mucous membrane. Sometimes ulceration, perforation, and gangrene result. A Corrosive Poison is a highly active Irritant Poi- son and causes local destruction of tissue. Such poison, when swallowed, usually produces nausea, vomiting and great local distress. A Neurotic Poison is one which acts chiefly upon the nervous system. Although highly diluted with water it continues to be poisonous. It is a true poison in the strict sense. The symptoms are directed especially to the brain and spinal cord. The chief symptoms are: Drowsiness, giddiness, headache, delirium, stupor, coma, and sometimes convulsions or paralysis. Cerebral Neurotics affect chiefly the brain. Spinal Neurotics affect chiefly the spinal cord. Cerebro-Spinal Neurotics affect both brain and spinal cord. Narcotics are those agents which produce stupor, complete or incomplete insensibility or loss of ieel- ing. Of these the opium group produce sleep ; the belladonna group produce illusions and delirium; the alcohol group produce exhilaration succeeded by sleep or delirium. Anesthetics (General) are narcotics. NEUROTICS-. THE CLASSIFICATION OF POISONS. 31 Tetanies are agents which act directly upon the spinal cord, producing such spasmodic and continu- ous contraction of muscles as result in stiffness or immobility of the parts to which they are attached. The tetanic spasm lasts from one to five minutes, fol- lowed by intervals of complete relaxation. Nux Vomica and its alkaloids belong to this class. Deliriants are those agents which so act upon the brain as to disorder the mental faculties and pro- duce confusion of will power or delirium (such as Belladonna, Hyoscyamus, Stramonium, Solanine, Cocaine, etc). Depressants or Sedatives, are agents which re- tard or depress the physiological action of an organ (e. g., Tobacco, Nicotine, Lobelia, etc.). Asthenics, or Exhaustives, are agents which pro- duce exhaustion; they cause marked loss of vital or muscular power. A typical member of this class of poisons is Hydrocyanic Acid, which is one of the most deadly poisons. It is found in bitter almonds, wild cherry, peach and apricot kernels, the seeds of apples, and in the flowers and leaves of cherry laurel, peaches, etc. Physostigma and Digitalis exhaust heart. Some poisons have the properties of both a cor- rosive or irritant and of a neurotic poison (e. g., Corrosive Sublimate, Arsenic, Carbolic Acid, etc.). The following-named drugs act directly upon the heart: Aconite, Antimony salts, Chloral, Hydro- cyanic Acid, Veratrum Viride, Digitalis, Sparteine, Strophanthus, etc. The first five decrease the number and force of the heart beats, the last three increase the force of the heart contractions. Poisons which affect the heart cause death by sud- den shock, collapse, or syncope. Among poisonous gases directly affecting the lungs are: Carbonic-Acid Gas, Chlorine, Illuminat- ing Gas, Muriatic-Acid fumes, Nitrous fumes, Sewer air, Sulpheretted Hydrogen, Sulphurous Oxide, etc. Neurotic symptoms are caused by poisonous gases, through the poisoning of the blood. 32 A MANUAL OF TOXICOLOGY. CHEMICAL CLASSIFICATION OF POISONS. Volatile Non-Metallic Poisons. Bromine; Chlorine; Iodine; Fluorine; Phosphorus; Arseniuretted, Phosphoret- ted, and Sulphuretted Hydrogen; etc. 1. INORGANIC. Metallic Poisons. Antimony; Arsenic; Barium; Copper; Lead; Mercury; Silver; Tin; Zinc, etc. Arsenic, Arsenous, Chromic, Hydro- bromic, Hydrochloric, Nitric, Phos- phoric and Sulphuric Acids. Mineral Acids. Ammonium, Potassium, and Sodium, Hydroxides and Carbonates. Mineral Alkalies. Alcohol; Acetanilid; Aniline and its de- rivatives ; Antipyrine; Phenacetin, etc. Benzene and its derivatives, including Car- bolic Acid; Creosote; Carbon Monoxide; Coal Gas; Cyanogen; Picric Acid; Nitro- benzene; Chloral; Chloroform; Coniine; Ether; Hydrocyanic Acid; Nicotine; Sparteine, etc. Volatile Organic Poisons. Aconitine; Apomorphine; Atropine, Bru- cine; Cocaine; Codeine; Colchicine; Coniine; Curarine ; Emetine; Hyoscyamine; Morphine; Narceine; Narcotine; Nicotine; Physostigmine; Pilocarpine; Ptomaines; Sparteine; Strychnine; Veratrine, etc. 2. ORGANIC. Alkaloids. Bee, Wasp, and Hornet stings, and bites of various other insects or of animals. Venom of various snakes, such as the Co- bra, Copperhead, Rattlesnake, Mocassin, etc. Animal Poisons. Bacterial Poisons. Food Poisons; Ptomains; Septic Poi- sons; Toxins. Digitalin; Salicin; Santonin; Solanin; Strophanthin, etc. Glucosids. Organic Acids. Acetic, Meconic, Oxalic, Salicylic, Tartaric, etc., Acids. THE CLASSIFICATION OF POISONS. 33 Tanner classifies poisons as : Corrosives, Simple Irritants, Specific Irri- tants, and Neurotics; "the last group is, however, further subdivided." He declares: The group of corrosives should comprehend all poisons which by contact destroy the bodily textures, and so by chemi- cal action alone occasion death. These same substances, when diluted, may be incapable of destroying the tissues directly, but may do so by setting up inflammation; these, with certain others having like effects, would form the group of simple irritants. They kill by virtue of their secondary effects on the constitution. But some sub- stances, like arsenic, are not only capable of inducing local inflammations, with their secondary effects, but are also pos- sessed of certain specific and well-marked properties differing in each case. These are specific irritants. Neurotics comprehend all poisons whose effects are refer- able to the nervous system, necessarily a most diverse group, which we are not yet in a position to minutely analyze. Some, however, act mainly on the brain (opinin'), some on the spinal chord (strychnine), some on certain nerves only (cu- rare), or on the vasomotor system of nerves (amyl nitrite). There was an old group of septic poisons. To this might still be referred certain noxious gases, such as hydrogen sulphide; or were it made to include all poisons acting directly on the blood, it would include the still more dangerous gas, carbon monoxide. The following table exhibits these subdivisions, and some of the poisons contained in each: Strong Mineral Acids Sulphuric. Nitric. Hydrochloric. > tn o g 6 Vegetable Acids.. • • Oxalic. Organic Deriva- tives Carbolic Acid. Alkalies Strong Alkalies. Alkaline Carbonates, etc. The above diluted. Lime. Zinc. Silver, etc. Simple Irritants 34 A MANUAL OF TOXICOLOGY. Arsenic. Mercury. Antimony. Phosphorus. Iodine, etc. Specific Irritants. Opium. Prussic Acid. Chloroform. Belladona. Aconite. Strychnin. Conium. Tobacco. Phenol, etc. Neurotics. Corrosive Poisons are characterized by these three things: I. Immediate action. 2. Local effects, such as destruction of tissue and staining; and in many cases by, 3. Death from shock. Irritant Poisons give rise to- 1. Pain in the stomach and bowels. 2. Faintness and sick- ness; and 3. Purging with straining. 4. The evacuations are often tinged with blood. 5. The pulse is feeble and irregular; and 6. The skin is cold. Many of the substances of this class, from irritating the tissues with which they come in contact, produce a severe burning sensation in the mouth and oesophagus, as well as in the stomach. The degree of local destructive action produced will of course vary in proportion to the amount of the vehicle with which the noxious agent may be diluted. Irritants cause death by inducing collapse or convulsions, or by exciting severe inflammation; or, in some cases, after a variable inter- val, by leading to stricture of the oesophagus. The diseases which most resemble the action of irritants are, malignant, cholera, severe diarrhoea, colic, cholera morbus, gastritis, en- teritis, rupture of the stomach or intestines, and obstruction of the bowels, mechanical or otherwise. Neurotic Poisons.-The symptoms of certain diseases bear a resemblance to those caused by some of the poisons of the neurotic class. Thus, belladonna gives rise to delirium with special illusions or convulsions. Sometimes there is tetanus, as in strychnine poisoning; sometimes coma (opium and car- bolic acid), or syncope (digitalis). Diseases of the brain and spinal chord, likely to be confounded with the effect of these poisons, are often very insidious in their progress, and hence may suddenly give rise to suspicious symptoms. The history, THE CLASSIFICATION OF POISONS. 35 mode of attack, etc., will generally negative any suspicion of poisoning. The above facts show the necessity of extreme caution in diagnosing a poison from the symptoms exclusively. As may be observed in the foregoing- table, Tanner places under his first group, "Corrosives/* first, the "strong" or "concentrated mineral acids," such as sulphuric acid (oil of vitriol), nitric acid (aqua fortis), hydrochloric acid (muriatic acid, spirit of salt), and such "mixed acids" as nitro-muriatic (aqua regia), and nitro-sulphuric (aqua reginse), and also sulphate of indigo; second, the "corrosive vegetable acids," including, oxalic acid (the so- called acid of sugar), acid potassium oxalate (salt of sorrel, essential salt of lemons), acetic acid, and tartaric acid; third, the "corrosive organic deriva- tives," under which he places creosote, and carbolic acid (phenol), and in this connection he also classes the "derivatives from coal tar," such as antipyrin, anti- febrin (acetanilid), phenacetin, salicylic acid, and salol; fourth, the "caustic alkalies and carbonates " under which he places potash (potassium hydroxid), potassium carbonate (pearl ash), caustic soda (sodium hydroxid, sodium carbonate (washing crystal), ammonia (ammonium hydroxid), and ammonium car- bonate. Under his second group, "Simple Irritants,** he places, ist. Salts of potassium, etc.: Potassium nitrate (nitre, saltpetre, sal prunelle), potassium sulphate, potassium bitartrate (cream of tartar, argols), liver of sulphur (an impure potassium sulphid), and lime; 2d. Zinc, silver, etc., Zinc sulphate (white vitriol), zinc chlorid, silver nitrate (lunar caustic), tin chlorides, bismuth subnitrate, potassium bichromate, iron sulphate (green vitriol, copperas), and ferric chlorid; 3d. Such "simple Vegetable irritants" as "aloes, colocynth, jalap, gamboge, scammony, elaterium, croton oil, castor-oil seeds, various specifics of arum, euphorbium, bryony, mezereon, physic nut, and others less commonly 36 A MANUAL OF TOXICOLOGY. known;*7 and also such "simple animal irritants" as poisonous fish, and poisonous meat, and such foods as milk and cheese which have undergone such changes as make them poisonous; 4th. Such "irritant gases" as chlorin, sulphurous acid, nitric oxid, hydrochloric acid gas, and ammonium hydroxid. Under his third group, "Specific Irritants/* he places, 1st. Such "specific mineral irritants" as iodin and potassium iodid, bromin and potassium bro- mid; also phosphorus, arsenous acid (arsenic, white arsenic), hydrogen arsenid, copper arsenite (Scheele's, Brunswick, or mineral green), antimony chlorid (ter- chlorid or butter of antimony), tartar emetic (tartarized antimony, potassio-antimony tartrate), mercury and its compounds, such as corrosive sublimate, calomel, the red oxid (red precipitate), the red sulphid (cinna- bar or vermilion), the cyanid, the nitrates, and the subsulphate (turpeth mineral) ; also lead acetate (sugar of lead), lead subacetate (Goulard's extract), lead carbonate (white lead), copper sulphate (blue vitriol or bluestone), copper subacetate (verdigris), barium chlorid, barium nitrate, and barium acetate. 2d. Such "specific vegetable irritants" as laburnum, "cenanthe crocata, phellandrinum aquaticum, aethusa. cynapium, etc." Also black hellebore. 3d. Such "specific animal irritants" as cantharides (Spanish flies), etc. His fourth group, Neurotics, he divides into "Narcotics (neurotics acting on the brain and producing sleep)," in which he includes opium and iG various preparations and alkaloids; "Anesthetics (neurotics acting on the brain and producing loss of sensation)," in which he includes chloroform, chloral methylene dichlorid, ether, and nitrous oxid; " Ine- briants (neurotics acting on the brain and producing intoxication)," in which he includes alcohol, nitro- benzene, anilin, cocculus indicus, darnel seeds (loliu.a temulentum), camphor and fungi; "Deliriants (neu- rotics acting on the brain and producing delirium), THE CLASSIFICATION OF POISONS. 37 in which he includes belladonna and its alkaloid, stramonium (thorn apple), dhatoora (seeds of datura alba), henbane and its alkaloids, nightshade with its active principle solanin, cocain and eucain; " Con- vulsants (neurotics producing convulsions)," in which he includes nux vomica, strychnin and brucin; "Paralysants (neurotics producing paralysis of the motor nerves)," in which he includes calabar bean and its active principle eserin, conium (common or spotted hemlock) and its alkaloid conin; "Hypos- thenisants or Syncopants (neurotics producing death by syncope)," in which he includes aconite and its alkaloid aconitin, hydrogen cyanid (prussic acid), potassium cyanid, also gelsemium and its alka- loid gelsemin, etc./'Depressants(neurotics producing marked depression of the heart's action)," in which he includes digitalis and its active principle digitalin, tobacco and its alkaloid nicotin, lobelia, colchicin, white hellebore and green hellebore and veratrine; "As- phyxiants (noxious gases, producing neurotic symp- toms by means of blood poisoning)," in which he in- cludes carbon monoxid, carbon dioxid (carbonic acid gas), hydrogen sulphid (sulphuretted hydrogen), and the so-called "coal gas;" "Abortives (substances pro- ducing abortion)," in which he includes ergot of rye, savin and its oil, oil of tansy, the yew, and extract of cotton root. To the foregoing, Taylor adds the following in the appendix of his book: I. " Bites of venomous reptiles," with chief ref- erence to the bites of such serpents as the cobra of India, the adder (or common viper) of England, the .brown and black snake of Australia, also the tiger snake, the rattlesnake, the copperhead, etc. II. " Bites of rabid animals," such as mad dogs, etc. • III. "The stings of bees, etc.," including those of bees, wasps, hornets, scorpion, etc.; also the bites ,of ants and other insects. 38 A MANUAL OF TOXICOLOGY. KOBERT'S CLASSIFICATION OF POISONS. I. Poisons Which Cause Coarse Anatomical Changes ok the Organs. A. Those which especially irritate the part to which they are applied. 1. Acids. 2. Caustic alkalies. 3. Caustic salts, especially those of the heavy metals. 4. Locally irritating organic substances, which neither can be classified as corrosive acids nor alkalies, nor as corrosive salts. Such are: Cantharidine, phrynine, and others in the animal kingdom, croton oil and savin in the vegetable kingdom; locally irritating colors, such as the aniline dyes. 5. Gases and vapors which cause local irritation when breathed, such as ammonia, chlorine, iodine, bro- mine, and sulphur dioxide. B. Those which have but little effect locally, but change anatomically other parts of the body, such as lead, phosphorus and others. 1. Blood poisons interfering with the circulation in a purely physical manner, such as peroxide of hydro- gen, ricine, abrine. 2. Poisons which have the property of dissolving the red blood corpuscle, such as the saponins. 3. Poisons which, with or without primary solution of the red blood corpuscles, produce in the blood methae- moglobin, such as potassic chlorate, hydrazine, nitro- benzene, aniline, picric acid, carbon disulphide. 4. Poisons having a peculiar action on the coloring mat- ter of the blood, or on its decomposition products, such as hydric sulphide, hydric cyanide, and the cyanides and carbon monoxide. II. Blood Poisons. III. Poisons Which Kill Without the Production of Coarse Anatomical Change. 1. Poisons effecting the cerebro-spinal system, such as chloroform, ether, nitrous oxide, alcohol, chloral, cocaine, atropine, morphine, nicotine, coniine, aconi- tine, strychnine, curarine, and others. 2. Heart poisons, such as digitalis, helleborin. muscarine. THE CLASSIFICATION OF POISONS. 39 IV. Poisonous Products of Tissue Change. 1. Poisonous albumin. 2. Poisons developed in food. 3. Auto-poisoning, e.g., uriemia, glycosuria, oxaluria. 4. The more important products of tissue change, such as fatty acids, oxyacids, amido-fatty acids, amines, diamines, and ptomaines. CLASSIFICATION OF POISONS ACCORDING TO THE MOST PROMINENT SYMPTOMS.-(Blyth.) A. Poisons Causing Death Immediately, or in a Few Minutes. There are but few poisons which destroy life in a few min- utes. Omitting the strong mineral acids, carbon monoxide, carbon dioxide, with the irrespirable gases, prussic acid, the cyanides, oxalic acid and occasionally strychnine are the chief poisons coming under this head. B. Irritant Poisons (Symptoms Mainly Pain, Vomiting and Purging.) Arsenic, antimony, phosphorus, cantharides, savin, ergot, digitalis, colchicum, zinc, mercury, lead, copper, silver, iron, baryta, chrome, yew, laburnum, and putrid animal substances. C. Irritant and Narcotic Poisons (Symptoms Those of an Irritant Nature, With the Addition of More or Less Pro- nounced Cerebral Indications.) To this class more especially belong oxalic acid and the oxalates, with several poisons belonging to the purely nar- cotic class, but which produce occasionally irritant effects. D. Poisons More Especially Affecting the Nervous System. 1. Narcotics (chief symptom insensibility, which may be preceded by more or less cerebral excitement), opium, dhloral, chloroform. 2. Deliriants (delirium for the most part a prominent symp- tom), belladonna, hyoscyamus, stramonium, with others of the solanaceae, to which may be added poisonous fungi, In- dian hemp, lolium temulentum, aenanthe, crocata, and camphor. 3. Convulsives. Almost every poison has been known to produce convulsive effects, but the only true convulsive poi- sons are the alkaloids of the strychnos class. 4. Complex Nervous Phenomena. Aconite, digitalis, hemlock, calabar bean, tobacco, lobelia inflata, and curara. 40 A MANUAL OF TOXICOLOGY. Analyst Blyth, of England, states his views, re- garding the best classification of poisons, as follows: "I have preferred an arrangement which, as far as possible, follows the order in which a chemical expert would search for an unknown poison, hence an arrangement partly chemical and partly symptomatic. First, the chief gases which figure in the mortality statistics are treated, and then follow in order other poisons." A chemist given a liquid to examine would naturally test first its reaction, and, if strongly alkaline or strongly acid, would at once direct his attention to the mineral acids or to :he alkalies. In other cases he would proceed to separate zolatile matters from those that were fixed, lest substances such as prussic acid, chloroform, alcohol, and phosphorus be dissipated or destroyed by his subsequent operations. Distillation over, the alkaloids, glucosides, and their allies would next be naturally sought, since they can be extracted by alcoholic and ethereal solvents in such a manner as in no way to interfere with an after-search for metals. The metals are last in the list, because by suitable treat- ment, after all organic substances are destroyed, either by actual fire or powerful chemical agencies, even the volatile metals may be recovered. The metals are arranged very nearly in the same order as that in which they would be sep- arated from a solution, viz., according to their behavior to hydric and ammoniac sulphides. There are a few poisons, of course, such as the crxalates of the alkalies, which might be overlooked, unless sought for specially, but it is hoped that this is no valid objection to the arrangement suggested, which, in greater detail, is as follows: A. Poisonous Gases. Carbon monoxide; Chlorine; Hydric sulphide. 1. Sulphuric acid; 2. Hydrochloric acid; 3. Nitric acid; 4. Potash; 5. Soda; 6. Ammonia; 7. Neutral sodium, potas- sium, and ammonium salts. B. Acids and Alkalies. In nearly all cases of death from any of the above, the analyst, from the symptoms observed during life, from the surrounding circumstances, and from the pathological appear- ances and evident chemical reactions of the fluids submitted, is put at once on the right track, and has no difficulty in ob- taining decided results. THE CLASSIFICATION OF POISONS. 41 C. Poisonous Substances Capable of Being Separated by Distillation From Either Neutral or Acid Liquids. 1- Hydrocarbons; 2. Camphor; 3. Alcohols; 4. Amyi- nitrite; 5. Chloroform and other anaesthetics; 6. Carbon di- sulphide; 7. Carbolic acid; 8. Nitro-benzene; 9. Prussic acid; 10. Phosphorus. The volatile alkaloids, which may also be readily distilled by strongly alkalizing the fluid, because they admit of a rather different mode of treatment, are not included in this class. D. Alkaloids and Poisonous Vegetables Principles Sep- arated for the Most Part by Alcoholic Solvents. Division I.-Vegetable Alkaloids. 1- Liquid volatile, alkaloids, alkaloids of hemlock, nicotine, piturie, sparteine, aniline; 2. The opium group of alkaloids; 3. The strychnine or tetanic group of alkaloids, strychnine, brucine, igasurine; 4. The aconite group of alkaloids; 5. The mydriatic group of alkaloids, atropine, hyoscyamine, solanin, cytisine; 6. The alkaloids of the veratrines; 7. Physostigmine; 8. Pilocarpine; 9. Taxine; 10. Curarine; 11. Colchicin; 12. Muscarine and the active principles of certain fungi. There would, perhaps, have been an advantage in arranging several of the individual members somewhat differently, e.g., a group might be made of poisons which, like pilocarpine and muscarine, are antagonistic to atropine; and another group suggests itself, the physiological action of which is the oppo- site of the strychnos class. Solanin (although classed as a mydriatic and put near to atropine), has much of the nature of a glucoside, and the same may be said of colchicin, so that, if the classification were made solely on chemical grounds, solanin would have followed colchicin, and thus have marked the transition from the alkaloids to the glucosides. Division II.-Glucosides. 1- The digitalis group; 2. Other poisonous glucosides acting on the heart; 3. Saponin. The glucosides, when fairly pure, are easily recognized; they are destitute of nitrogen, neutral in reaction, and split up into sugar and other compounds when submitted to the action of saponifying agents, such as boiling with dilute min- eral acids. 42 A MANUAL OF TOXICOLOGY, Division III.-Certain Poisonous Anhydrides of the Organic A cids. 1. Santonin; 2. Mezerein. It is probable that this class will in a few years be extended, for several other organic anitrogenous poisons exist, which, when better known, will most likely prove to be anhydrides. Division IV.-Various Vegetable Poisonous Principles, Not Admitting of Classification Under the Previous Three Divisions. Ergot, picrotoxin, the poison of illicium religiosum, cicu- toxin, sethusa cynapium, oenanthe crocata, croton oil, savin oil, the toxalbumins of castor oil, and abrus. The above division groups together various miscellaneous toxic principles, none of which can at present be satisfactorily classified. E. Poisons Derived From Living or Dead Animal Substances. 1. Poisonous amphibia; 2. Poison of the scorpion; 3. Poison- ous fish; 4. Poisonous insects, spiders, wasps, bees, beetles, etc.; 5. Snake poison. Division I.-Poisons Secreted by the Living. Division II.-Poisons Formed in Dead Animal Matters. 1. Ptomaines; 2. Poisoning by putrid or changed foods- sausage poisoning. F. The Oxalic Acid Group. Division I.-Precipitated from a hydrochloric acid solution by hydric sulphide-precipitate, yellow or orange. Arsenic, antimony, cadmium. Division II.-Precipitated by hydric sulphide in hydrochloric acid solution-black. Lead, copper, bismuth, silver, mercury. Division III.-Precipitated from a neutral solution by hydric sulphide. Zinc, nickel, cobalt. Division IV.-Precipitated by ammonia sulphide. Iron, chromium, thallium, aluminium. Division V.-Alkaline earths. Barium. G. Inorganic Poisons. (1) Mineral.- (a) metallic poisons, (&) acids, (e) alkalies and (d) inorganic gases. (2) Vegetable.- (a) alkaloids, (&) organic acids, (c) poi- Victor C. Vaughan classifies poisons into: THE CLASSIFICATION OF POISONS. 43 sonous glucosids, and (d) poisonous vegetable proteins. (3) Synthetic.- (4) Animal.-The venom of serpents, the secretion of cer- tain fishes, the poisonous leukomains, etc. (5) Bacterial.-As "the toxins of diphtheria, tetanus and certain other infectious diseases. The bacterial poisons may be divided into: (a) basic poisonous products, or the pto- mains, (b) the so-called bacterial toxins, and (c) the protein poisons." R. A. Witthaus classifies poisons in two ways: one an analytical classification, somewhat different from most authors; the other a natural classification based chiefly upon the origin. His analytical one is : "I. Gaseous Poisons: Carbon monoxid, hydrogen sulfid, sul- fur dioxid. II. Volatile Poisons, separable from mixtures by mere dis- tillation with or without vapor of water and from acid neutral or alkaline liquids: Alcohol, chloroform, hydrocyanic acid, ammonia and its derivatives, phosphorus, etc. III. Acids, Alkalies, and Salts: Mineral poisons and cor- rosives, . which are best separated by extraction with water. Mineral acids and alkalies and certain soluble metallic salts. IV. Organic Poisons: Substances which do not withstand the action of powerful reagents and which are extracted from the mixtures in which they exist by neutral solvents or by dilute acids, either applied directly or in agitation methods with immiscible solvents-vegetable acids, glucosids, alka- loids, and bitter principles, and animal poisons. V. Mineral poisons: Substances of sufficient stability to permit of their separation by the decomposition and removal of the organic substances with which they may be mixed, followed by the usual methods of mineral analysis, somewhat modified to meet the requirements of the case." His other natural group classification is: "I. Corrosives: Substances which act chemically upon the tissues with which they are brought into immediate contact- Mineral acids, alkalies, halogens, etc. . II. Poisons: Substances which act after entrance into the circulation, followed by solution in the blood or chemical action upon the blood itself. A. Mineral Poisons: Arsenic, antimony, phosphorus, the salts of copper, lead, mercury, etc. B. Vegetable Poisons: Vegetable acids, alkaloids, bitter principles, glucosids, etc. C. Animal Poisons: Leukomains, ptomains, toxins, tox- albumins. D. Synthetic Poisons: Chloroform, alcohol, chloral, phenol, antipyrin, etc." 44 A MANUAL OF TOXICOLOGY. PROMPT TREATMENT FOR POISONING. When symptoms and circumstances indicate that a poison has been taken, the following course should be pursued: i. If there is a known chemical antidote and it is at hand, use it at once (either alone or in con- junction with an evacuant), and in sufficient quan- tity to thoroughly neutralize the poison. If the chemical antidote is not known or not at hand and it is believed no corrosive poison strong enough to produce a prohibitive caustic effect, has been taken, or the patient is not in a condi- tion of extreme exhaustion, at once evacuate the stomach (i. e., resort to 2). Or where evacuation is impossible or improper, promptly employ such mechanical antidotes as will coat the walls of the stomach, etc., mechanically suspend the poi- son, or remove the latter by catharsis. 2. In absence of prohibitive caustic action of poison, inflammation, or extreme exhaustion, evacuate and wash out stomach by means of stom- ach-tube, stomach pump, or emetics, and warm water. If a chemical antidote is now for the first time convenient, employ it. Demulcents should usu- ally be employed after evacuation of stomach. 3. Use the proper antagonist to counteract the effects of any of the poison which may have been absorbed. (If the patient is not treated promptly after the poisoning, it may be advisable to at once resort to the physiological antidote (antagonist). Also encourage the natural processes of removal (i. e., urination, perspiration, etc.). 4. Employ the proper antagonistic measures to stimulate flagging organic functions. ANTIDOTES. Mechanical and True Antidotes directly affect a poison either mechanically or chemically, or both, so as to remove it from the body, alter its character before absorption, or hinder absorption, and thus pre- MECHANICAL ANTIDOTES. 45 vent its poisonous action upon the system. They act in the respiratory passages or alimentary canal and may be employed for vegetable, animal or mineral poisons. Mechanical Antidotes include: use of stomach tube orpump; employment of Emetics, Cathartics, Demul- cents, Injections, Ligatures, Poultices, Washes, etc. Chemical Antidotes include: Oils, Soap, Milk, Acids, Albumin, Alkalies, Charcoal, Carbonates, Hydrates, Sulphates, Iodine, Potassium, Permanga- nate, Sodium Chloride, Starch, Tannic Acid, Tur- pentine, preparations of Iron, etc. Physiological Antidotes are antagonists and act directly upon the functions, counteracting effects. MECHANICAL ANTIDOTES. THE STOMACH TUBE AND THE STOMACH PUMP. When active measures are to be employed to evacuate the stomach, this is most readily accom- plished by means of the stomach tube (Figs, i and 2), the stomach pump (Fig. 3), or by emetics. I 3 2 The stomach tube (with or without an exhaust bulb) is introduced into the stomach by forcibly keep- ing the poisoned person's mouth open, by means of a gag, or other substance, and passing the tube down; well to use the finger to guide it in the mouth. Avoid passing tube into windpipe in front of gullet. If spasm of gullet interferes with passage, apply cocaine ointment to tube. Sometimes necessary to intro- duce tube through nose instead of mouth. Tepid water may be introduced into the stomach through the funnel and tube, and by lowering the tube and 46 A MANUAL OF TOXICOLOGY. turning the funnel down, the stomach may be more or less emptied of fluid and poison by siphonage, or by using the exhaust bulb. Washing out process should be repeated until all poison apparently has been removed from stomach. Washing often advisable even after free vomiting as some poisons adhere to stomach walls. The proper antidote or emetic may frequently advantageously be dissolved in the water used. The stomach pump is a harsher, but sometimes more effective apparatus than the stomach tube. Although the stomach pump and stomach tube are so efficient and do not weaken the person as emetics do, yet neither should be used when there is severe corrosion of the stomach or esophagus, lest perforation result. Both may be difficult to use or inefficient when the poison is in a solid form (as meat, fish, etc.). EMETICS. Emetics are agents which produce vomiting They may conveniently be divided into two classes: Local Emetics, and Systemic or General Emetics. Local Emetics produce their effects by their irri- tation of the terminal nerve filaments of the phar- ynx, esophagus or stomach. The emetic action results from a reflex stimulation of the vomiting center in the medulla oblongata. Systemic or General Emetics produce their effects through the medium of the circulation. The emetic action is due to a direct stimulation and irri- tation of the vomiting center in the medulla. Alum-a tablespoonful in water, syrup or honey. (Unreliable.) Ammonium Carbonate-30 grs. or more in water. Copper Sulphate-10 grains in water in one dose ; or 3 to 6 grains every 15 minutes until acts. Mustard-2 to 4 teaspoonfuls in a cupful of warm water, stirred to a cream. (Good and stimulating). LOCAL EMETICS. MECHANICAL ANTIDOTES. 47 Olive Oil, Melted Fats, Soapsuds, Vaseline, etc. -freely. (Fats and Oils and substances containing them are contra-indicated in poisoning by Cantharides, Carbolic Acid, Copper Salts, or Phosphorus, be- cause fats and oils facilitate the absorption of these poisons.) Quassia and other vegetable bitters-in strong infusion as a drink. Sodium Chloride-(common salt) 2 tcaspoonfuls or more in a cupful of water. (Frequently effective). (Sodium Chloride is contra-indicated in poison- ing by Tartar Emetic, or Mercuric Chloride. Also do not give it after Zinc Sulphate.) Tepid Water-in quantity freely, (4 to 8 glasses). Tickling Throat with feather or finger. (Good). Yellow Mercuric Sulphate (Turpeth Mineral)-• 2 to 5 grains. (Unsafe unless it vomits.) Zinc Sulphate-10 to 30 grains in a wineglassful of water; repeat if necessary. Or 30 grains in 2 ounces of water, giving a tablespoonful every 10 to 20 min- utes until effective. Children 5 grains. (This is the best emetic.) It is prompt and safe, but do not give it after giving salt and water. SYSTEMATIC OR GENERAL EMETICS. Antimony, Wine of-An ounce or more in water. Apomorphine Hydrochlorate-gr. 1/16 to hypodermically when the use of emetics by the mouth is prevented by narcosis or otherwise. By giving Strychnine with it lessen depressive effects. Emetine-gr. to %. Ipecac, Fluid Extract of-% to I teaspoonful. Ipecacuanha, Pulverized-15 to 30 grains or more in water, repeated in 10 or 15 minutes. Does not ir- ritate the mucous membrane of the stomach. Ipecac, Syrup of-1 to 4 teaspoonfuls, or a tea- spoonful every 10 minutes until vomiting is produced. Ipecac, Wine of-1 or 2 tablespoonsfuls in water. (Slow and unsatisfactory). Squill, Syrup of-A teaspoonful. 48 A MANUAL OF TOXICOLOGY Squill, Compound Syrup of-% to teaspoonful. Tartar Emetic-1 to 3 grains. Children 54 grain. (Slow and depressing). In poisoning it is better to use almost any emetic at once than to lose valuable time getting just the right emetic. Some persons vomit very readily, others with the greatest of difficulty. Some vomit from a drink of tepid, greasy or dirty water, with or without the introduction of the fingers into the throat. In narcotic poisoning it is frequently very difficult to induce vomiting. It is sometimes de- sirable to give a combined emetic. May begin with a tablespoonful of mustard in a small tumbler- ful of water and follow soon after with Zinc Sul- phate 30 grains, and powdered Ipecacuanha 30 grains, mixed in water. The action of an emetic is aided by giving plenty of tepid water. Emetics are contra-indicated when there is a severe corrosion of the alimentary canal or an abdominal inflammation. CATHARTICS. Cathartics are agents which produce intestinal evacuations. They include Castor Oil, Croton Oil, Magnesium Sulphate, Senna, Sodium Phosphate, etc. They are generally used after a chemical anti- dote to remove from the intestinal canal the com- pounds formed by such antidote. Castor Oil protects the mucous membrane and interferes with absorption, but should not be used in poisoning by Cantharides, Carbolic Acid, Copper Salts or Phosphorus, absorption of which it seems to aid. Croton Oil is rapid and active in a I to 5 minim dose in bread pill. Magnesium Sulphate is useful 111 doses of p2 to 4 ounces, in water. Sodium Sulphate in same doses. Such cathartics as Senna and Gamboge are often the best ones for narcotic poisoning. CHEMICAL ANTIDOTES. 49 DEMULCENTS. Demulcents are substances which soothe and protect the parts to which they are applied. They include Almond, Olive, and other bland Oils, Aca- cia, Barley, Cetraria, Elm, Figs, Flaxseed, Gelatin, Glycerine, Honey, Isinglass, Liquorice Root, Marsh- mallow Root, Starch, Tragacanth, and White of Egg, each with or without water. CHEMICAL ANTIDOTES. OILS, ALBUMIN, TANNIN, ETC. Oils and Fats (almond, cotton seed, linseed and olive oils, melted butter, lard, etc.). Oils and fats are useful against the corrosive acids and alkalies, metallic oxides and salts; they are, however, con- sidered to be contra-indicated in poisoning by Can- tharis, Carbolic Acid, Creosote, Copper Salts and Phosphorus, because they encourage the absorp- tion of these poisons. Oils and fats unite with the caustic alkalies to form soaps; thus liberating gly- cerine. As antidotes to the metallic salts they are not as good as albumin. As antidotes to the alkalies they are inferior to acids, owing to their slow action. Soap (Castile Soap, etc.). Castile soap dissolved in four times its bulk of hot water to form "suds," and administered by the cupful, is an excellent antidote for corrosive acids and metallic salts, par- ticularly Corrosive Sublimate, Potassium Bichro- mate, and Tin and Zinc Salts; but Albumin is better for these last two. Soap is better than caus- tic alkalies for acids, because it has no corrosive action. It should not be used as an antidote to alkalies. Albumin.-An excellent Chemical Antidote, form- ing Compounds, more or less inert with most of the corrosive alkalies, metallic salts, mineral acids, Anilin, Bromine, Chlorine, Creosote, Iodine, and with alcoholic solutions of most of the alkaloids. 50 A MANUAL OF TOXICOLOGY. It is particularly valuable as an antidote to inor- ganic poisons and a good application for the bites and stings of insects. Albumin should be well diluted when used (the whites of four eggs to one quart of tepid water). It is important to follow it first by an emetic and then by a cathartic, inasmuch as many of its compounds are soluble in an excess of albumin, or in acid or alka- line solutions. Milk.-The antidotal action of milk is similar to that of albumin and due to its albumin, casein and free alkali. Milk is a good substitute for albumin, and especially suitable for metallic salts, corrosive acids and alkalies (particularly Ammonia), and the alkaline earths. Owing to the fat in milk it is to be avoided when fatty antidotes are contra-indi- cated, except in poisoning by Phenol. White of egg and milk together are good antidotes to iodic preparations and Phenol. - Acids, Inorganic.-Diluted Sulphuric Acid % drachm mixed in water is used as an antidote to the soluble salts of Barium and Lead, forming in- soluble Sulphates. It is also used to prevent ab- sorption of lead in Lead Poisoning. Acids, Organic.-Acetic Acid (such as vinegar), Citric Acid (such as lemon, lime, or orange juice), and Tartaric Acid in water are used as antidotes to the alkalies and the alkaline carbonates. Ammonia (diluted), by inhalation, is an excellent antidote to the vapors of corrosive acids and Nitro- benzol, Formaldehyde, and to Bromine, Chlorine, and Hydrocyanic Acid, also to relieve the stupor of alcoholic poisoning. Ammonium Carbonate, by hypodermic injection (in 5 grain doses in aqueous solution), in the vicinity of a wound through which arrow poison has entered the body, is very efficient against such poison. Locally applied it is also very efficient in the bites of venomous serpents and insects. Taken internally it is capable of promptly suspending a high degree of alcoholism. Calcium Hydrate and CHEMICAL ANTIDOTES. 51 Carbonate (Lime Water, powdered chalk mixed with water (Mistura Cretae), egg shells, pulverized oyster shells, etc.) may advantageously be em- ployed as an antidote to neutralize Oxalic Acid and the Acid Oxalates and convert them into insoluble Calcium Oxalate. Charcoal (powdered) has an antidotal action against many alkaloids, metallic salts and Phos- phorus, and apparently against Opium, Nux Vom- aca, and Aconite, delaying the poisonous action and effects of all of them. It may either absorb the poison or protect the walls of the stomach. It ab- sorbs gases but does not form a fixed compound with any mineral or vegetable poison. Fresh Ani- mal Charcoal is preferable to wood charcoal, and is Used in tablespoonful doses, frequently repeated, fe should be followed by an emetic or the stomach-tube. Alcohol.-Concentrated alcohol has a dehydrating ef- fect upon animal tissues with which it comes in contact, fe is considered a valuable antidote in Carbolic Acid poi- soning. Four ounces of Alcohol in as much or more wa- fer may be administered repeatedly, each time removing by means of the stomach-tube; or Apomorphine may be given hypodermically, to empty the stomach, and to prevent acute alcoholism. Magnesium Sulphate or Sodium Sulphate in i to 2 ounce doses in water should then be given. A half pint or more of brandy or whiskey may be substituted for the alcohol and water. Although alcohol is so applicable to ser- pent poisoning it is not a direct antidote to it. As a heart stimulant in certain kinds of poisoning alco- hol is invaluable, but should be avoided in case of injury to the brain, or excessive cardiac action. Ether has been extensively employed as a stimu- lant, in the collapse of Opium and Chloral poisoning, in fifteen minim doses hypodermically injected (not deeply) and repeated as often as necessary. Chlorine, employed externally in the form of 'Chlorine Water, . Labarraques' Solution (a solution of Sodium Hypochlorite), or Javelle Water (a solu- tion of Potassium Hypochlorite), is a good antidotal 52 A MANUAL OF TOXICOLOGY. wash for snake-bite, insect stings, and other pois- oned wounds; it may be employed internally when well diluted, as an antidote to alkaloids and other vegetable and animal poisons; may also be inhaled as a spray, as an antidote against coal gas (Car- bonic Oxide), Ammonia, Phosphoretted and Sul- phuretted Hydrogen, and Hydrocyanic Acid. Sodium Hyposulphite is the antidote to the Chlor- ine and Iodine solutions. Copper Sulphate, as an emetic, may be given in doses of three or four grains or more in water, until vomiting occurs. It is more irritating than -Zinc Sulphate and hence acts more readily. If it fails to act it must be promptly removed (by stom- ach tube or otherwise) or it will cause local in- flammation. In Phosphorus poisoning Copper Sulphate is of special application, as it is supposed to coat the particles of Phosphorus, primarily with a layer of Copper Phosphide, secondarily with Copper itself, thus preventing the solution of the Phosphorus particles in the stomach fluids. Gelatin is an antidote to the Alums, Bromine, and Iodine. The chief objection to it is that it has to be broken up, soaked in water half an hour and reduced to a fine consistency. It has a sooth- ing effect upon irritated mucous membranes. Gluten is sometimes employed as an antidote to Corrosive Sublimate, but it is not readily procured nor as efficient as Albumin. Gum Arabic in the form of mucilage is chiefly serviceable as a protective in the alimentary canal, against irritant or corrosive poisons. It is also used as an antidote to the Bismuth salts. Iodine, well diluted, is sometimes given as an antidote to the alkaloids and their salts, to other vegetable poisons and to snake venom. It is one of the most reliable applications to wounds made by venomous serpents and rabid animals. All Iodine compounds are more or less soluble and poisonous and must on this account be promptly removed from CHEMICAL ANTIDOTES. 53 •Mie system. The following antidote (Bouchardat's) for vegetable poisons is considered very good: Iodine, 3 grains; Potassium Iodine, 30 grains; Distilled Water, 11 ounces; mix. Dose, to 3 ounces, frequently repeated. Iron-Ferri Oxidum Hydratum (Hydrated Fer- ric Oxide), also Ferri Oxidum Hydratum cum -Magnesia (the Official Arsenic Antidote), Ferrum Oxidatum Saccharatum, Dialyzed Iron and the basic ferric Acetate are all used as antidotes to Arsenic Poisoning to form Ferric or Magnesium Arsenite. The union of Iron with the salts of Arsenic is nmited, even though the Iron be in great excess. A better action is obtained if a small amount of Ammonia or other caustic alkali is added to it, or M the basic Ferric Acetate is mixed with it. Ferri Oxidum Hydratum - Ferric Hydroxide (Hydrate), Hydrated Oxide of Iron-is a chemical Antidote for Arsenous Acid and the Arsenites with ^hich it combines to form a ferric arsenite and also ^cts locally as a protector of the mucous mem- brane of the alimentary canal. It is a reddish- Urown, smooth magma, entirely soluble, without effervescence, in Acetic Acid. When required for Use it should be freshly prepared by mixing to- gether Solution of Ferric Sulphate 100 parts, Am- monia Water no parts, and water enough to make 25° parts. The solution of Ferric Sulphate and the Ammonia Water should be kept on hand in separate Pottles all ready for mixing, 200 Cc. of the first and 220 Cc. of the latter. When mixed together in these proportions a precipitate forms which may -Pe washed by pressing it in a wet muslin strainer Until no more liquid passes, then suspending it in ^50 parts of water. The dose is a teaspoonful in Water, repeated every 5 or 10 minutes.* , Although such is in accordance with the U. S. P. direction, it would '■eetn desirable and more convenient for the solutions to be made of such strength that a mixture of equal volumes of them would cause them to Neutralize each other. 54 A MANUAL OF TOXICOLOGY. Ferri Oxidum Hydratum cum Magnesia (Ferric Hydrate with Magnesia, Arsenic Antidote), dose, a teaspoonful in water, repeated every 5 or 10 min- utes, is a more convenient and better arsenic anti- dote than the preceding preparation. In this the excess of the alkaline precipitant is not an irritant and is itself an antidote to Arsenic. The following solutions (1 and 2) should be kept on hand: No. 1. Solution of Ferric Sulphate 50 cc., in water 100 cc. No. 2. Magnesia (Magnesium Oxide), io grammes, rubbed up with water 750 cc., in a bottle of 1000 cc. capacity. When the preparation is re-r quired, shake No. 2 to a homogeneous magma and add it gradually to No. 1, after which shake them together to a uniform smooth mixture. This should be given in large doses of an ounce or more, and frequently repeated. Sesqui-Oxide of Iron (freshly prepared), made by precipitating Tincture of Perchloride of Iron with Sodium Carbonate and filtering through a cloth, may be given as an antidote to Arsenic. It should be freely administered in hot water. Dialyzed Iron may be given in ounce doses or less, frequently repeated, for the same purpose. Magnesia (Calcined Magnesia; Magnesium Ox- ide; Mg. O.). Magnesia mixed with twenty-five, times its weight of warm water gelatinizes, be- coming suited to antidotal use. It may be given in; 1% to 2 ounce doses of such mixture, frequently av first, then after a few doses less often. An excess merely acts as a cathartic. Magnesium Oxide is better than Magnesium Carbonate as an antidote' to the acids, because of the production of Carbon Dioxide, which might injure the stomach by its ex- pansive action. Magnesia is one of the best anti- dotes against the acids and the acid salts, in- cluding even Oxalic Acid, and the Acid Oxalates, if the Calcium antidotes are not at hand. It is CHEMICAL ANTIDOTES. 55 also a good antidote in poisoning by Arsenic, Phos- phorus, Mercury, Corrosive Sublimate, and other metallic salts. With most of these it forms in- soluble compounds; with the mineral acids its value is chiefly due to its power to neutralize them; by alkalinizing the stomach contents it hinders the ab- sorption of alkaloids. Magnesium Sulphate (Epsom Salt), and Sodium Sulphate (Glauber Salt) are soluble Sulphates and especially efficient in poisoning by Carbolic Acid or by the salts of Barium or of Lead. With the last two they form insoluble Sulphates. With Car- bolic Acid they apparently do not form a Sulpho- carbolate of Magnesium or of Sodium in the stom- ach, but encourage elimination of the Carbolic Acid after it has been absorbed. Sodium Sulphate seems to be superior to Magnesium Sulphate as an eliminative in poisoning by Carbolic Acid. These salts should be administered in to 2 ounce (or I to 2 tablespoonful) doses in water, repeated at fre- quent intervals, and a pint or more of a solution one-fourth that strength should be left in the stom- ach, after repeated lavage, to be absorbed and wholly neutralize the absorbed Carbolic Acid. Car- bolic Acid appears in the urine as Potass-Phenyl- Sulphate, not as a Sulpho-Carbolate, and when no soluble sulphate has been given. Potassium Ferrocyanide is efficient as an anti- dote to the Copper salts, and may be given in 5 to 30 grain doses in water to form the brown, in- soluble cupric ferrocyanide. Albumin, however, is just as good and as a rule more convenient, and safer. Potassium Permanganate. - If Potassium Per- manganate be administered promptly, before absorp- tion of the poison has taken place, it is the best anti- dote to all organic poisons, inasmuch as it rapidly destroys them by oxidation. It has been claimed that this result is secured not only when the Permanga- nate encounters the poison by direct contact with it in the stomach, but also after both poison and anti- 56 A MANUAL OF TOXICOLOGY. dote have been absorbed into the circulation; but the latter claim has not been satisfactorily sub-' stantiated. Potassium Permanganate is particu- larly applicable to Eserine (Physostigmine), Opium, Phosphorus, Morphine, and Strychnine salts, in the stomach. As an antidote to organic poisons in general, it should be given in 3 to 4 grain doses in about 4 ounces of water, every half hour until four or more doses have been taken. As an antidote to Morphine or its salts, 10 to 15 grains may be dissolved in IT to 1 pint of water and given. It is common to repeat the dose every half hour until three or four doses have been taken. When the poisoning is by Laudanum a few drops of Dilute Sulphuric Acid or two teaspoonfuls of Dilute Acetic Acid or white vinegar should be added to the antidote. Potassium Permanganate is promptly decomposed by Alcohol, and by the usual stomach contents, urine, etc. So organic mat- ter in stomach may interfere. Locally, this antidote is good in snake poison, in a one per cent, solution, by hypodermic injection about the wound, if applied promptly before absorption of the venom. Potassium Bicarbonate and the Carbonate, So- dium Bicarbonate and the Carbonate, may be used as antidotes to most of the poisonous metallic salts, particularly those of Zinc, which they immediately decompose, forming insoluble basic compounds. They are also used against Bromine, Iodine, and Potassium Bichromate. They form the neutral Chromate with Potassium Bichromate and harm- less salts with Iodine. They may be used in dilute solutions against non-concentrated acids, but should not be used against the concentrated min- eral acids, as they generate large volumes of Car- bon Dioxide which might distend and rupture the >eroded stomach. Chalk is inapplicable for the same reason. No alkaline Carbonates or Bicarbonates should be administered in poisoning by Oxalic Acid, as CHEMICAL ANTIDOTES. 57 the resulting oxalates are soluble and almost as poisonous as the Acid itself. Potassium Iodide in 5 to 30 grain doses three times a day in chronic poisoning by Arsenic, Mercury, or Lead, or their salts, encourages their elimination. Sodium Chloride (common salt) is the best anti- dote against the silver salts, as it converts them into the insoluble Chloride of Silver. It should be given in dilute solution and may be combined with albumin, which is also good for the same purpose. A strong salt solution is employed as an antidote to the stings and bites of insects. Two teaspoonfuls of salt in water frequently serves as an efficient emetic. (Also see Salt Sol. p. 118, No. 5.) Little's Saline Solution: Sodium Chloride 1 drachm, Potassium Chlorate 6 grains, Sodium Phosphate, 3 grains, Sodium Car- bonate, 20 grains, Alcohol, 2 drachms, Distilled Water 20 ounces; mix. "Blood lavage" (drawing off blood by bleeding,' then infusing at least twice as much salt solution intravenously or otherwise) has been found serviceable in poisoning by illuminating gas, Potassium Chlorate, Amyl Nitrite, Nitrobenzol, Hydrocyanic Acid, etc. Avoid in edema, andnephritis. Sodium Hyposulphite (Sodium Thiosulphate) is an efficient antidote for Iodine, Potassium Iodide, Bleaching Powder (Calcium Hypochlorite), Labar- raque's Solution, and Javelle Water reducing them to chlorides and itself oxidizing into the Sulphate. Starch, made into paste by mixing one part of Starch with fifteen parts of hot water gradually added, is the antidote for Iodine and Bromine, pro- ducing compounds which are almost harmless. It has a slight antidotal action against corrosive acids, Cor- rosive Sublimate, Copper Sulphate, and Zinc Sul- phate. Wheaten flour is also a good antidote to the foregoing. Cooked Starch is more efficient than the raw Starch, but the delay necessary to procure the former is not warranted by the degree of superiority over the latter. In poisoning by Iodine preparations, free vomiting or lavage should be encouraged as long 58 A MANUAL OF TOXICOLOGY. as the rejected liquid tinges blue a solution of Starch. The blue color which Starch strikes with Iodine offers the surest test for the presence of Iodine in the urine and other secretions of the body, after the Iodine has been set free by Chlorine Water and Nitric Acid. Iodide of Starch has been employed as an antidote to poisons in general, and in poisoning by the salts of Lead or Mercury it is thought to aid their elimi- nation. It is not an irritant and can be given in large doses but must be removed from the alimentary canal by emetics and cathartics. Acid Tannic (Tannin) precipitates and forms Tannates with the alkaloids and their salts, with An- timony and Zinc compounds, and the glucosides. The Tannates are nearly insoluble, but not abso- lutely inactive, being somewhat soluble in dilute hydrochloric acid of the gastric juice, also readily soluble in dilute alcohol; therefore use emetics and active purgatives for their prompt removal from the alimentary canal. Tannin renders Tartar Emetic harmless (but albumin does not) by forming an in- soluble Tannate of Antimony. Tannin should be given in doses of 20 grains in a coffee-cupful of water or as much as 45 grains in a pint of water every fif- teen minutes. By combining about ten per cent, of its weight of Iodine with it, its efficacy as an anti- dote to vegetable poisons is increased, but not over ten grains of such mixture should then be given. When Tannin is not at hand, use decoctions or in- fusions of Tea, Coffee, Nut-galls, Kino, Rhatany, Catechu, Oak, Willow or Cinchona barks, or other substances containing Tannin. Turpentine, Oil of.-Old, crude, resinified, and French Oil of Turpentine are antidotes against poisoning by Phosphorus, forming an almost in- soluble mass with it-the so-called Turpentine- Phosphoric Acid. The fresh, ordinary Oil of Turpen- tine is of doubtful value as an antidote to Phos- phorus poisoning, but Oil of Turpentine which has CHEMICAL ANTIDOTES. 59 long been exposed to the air and hence contains much oxygen is a very good antidote. One hundred times as much Oil of Turpentine should be given as there was Phosphorus taken; give it in hot water or alone (floated on the water or in capsules) immedi- ately after the Phosphorus is taken, or as soon there- after as possible; considered valueless if not given within twelve hours. Do not give it with an oil, soup, milk, white of egg or other albuminous sub- stance; nor should mucilaginous or alcoholic drinks be allowed with it; nothing but the capsule or hot water. If it cannot be determined what quantity of Phosphorus has been taken, the Oil of Turpentine may be given in four doses of % drachm (2 cc.) each, at 15 minute intervals. If the stomach will not retain the Turpentine inject it into the rectum, atomize it into the lungs, saturate the air of the room with its fumes, or rub it into the skin in the form of a liniment. The acid French Oil of Turpen- tine, forms a crystalline, spermaceti-like mass with the Phosphorus, and although an efficient antidote is soluble in Ether and Alcohol. Water may be given as an emetic, used tepid and in large quantities. Washing out the stomach with the stomach tube is now resorted to in nearly all cases of poisoning. However, in Sulphuric Acid poisoning the introduction of water, unless very copiously, is inadvisable, if much of the acid has been taken, as severe heat is evolved. In Oxalic Acid poisoning it is contra-indicated if it is possible the poison may have been taken in the solid form, as solution and absorption of the poison is favored by water; and otherwise an emetic may be given even in water if vomiting did not occur spontaneously, and the symptoms of corrosion have not been marked. In all cases in which a large dose of a concentrated corrosive poison has been taken, the stomach pump should not be employed. 60 A MANUAL OF TOXICOLOGY. GENERAL ANTIDOTES WHEN THE NATURE OF THE POISON IS UNKNOWN. When the nature of the poison is unknown the following is a good and harmless antidote to most poisons, but of little or no value in poison- ing by Antimony, caustic alkalies or Phosphorus: Equal parts of Magnesia, Charcoal (Wood), and the Hydrated Oxide of Iron, mixed and freely given in plenty of water. Two ounces of each to 12 ounces of water recommended by Jeannel. (The Magnesia is given to neutralize any acid that may be present. The Charcoal to precipitate or absorb any alkaloid. The Hy- drated Oxide of Iron to combine with any arsenical compound). On a similar basis, the following may be given: Magnesia, 1 tablespoonful; Tannic Acid, 1 tablespoonful; Charcoal, 2 tablespoonfuls. Mix and give 1 teaspoonful, stirred-in water, every 5 to 15 minutes. Evacuate stomach soon after using this antidote. The following antidotal preparation delays the action of the salts of Copper, Morphine, and Strych- nine. It has also some effect on compounds of Mercury. It is a perfect antidote to Arsenic, Digi- talin, Zinc, etc., but it is of no value against Mer- curic Cyanide, Hydrocyanic Acid, the caustic alka- lies, Tartar Emetic, or Phosphorus. The prepara tion is as follows: Liquor Ferri Sulphatis (specific gravity 1.45) 2% ounces kept in one bottle, Magnesia Calcinata 2 ounces, Carbo Animalis 1 ounce, Aqua 20 ounces, mixed and kept in another bottle. When this anti- dote is required, the contents of the first bottle should be poured into the second bottle and the mixture thoroughly shaken. The dose of the mix- ture is ip2 to 3 ounces. Reference must here again be made to Bou- chardat's antidote for vegetable poisons, consisting of: Iodine, 3 grains; Potassium Iodide, 30 grains; Distilled Water, 11 ounces; mixed together. The dose is ij4 to 3 ounces, frequently repeated. Note: The chief poisons are alphabetically paged in this "Part II" of the book. Read N.B. below. PART II. POISONS AND ACUTE POISONING: HISTORY, SYMPTOMS AND TREATMENT* N. B.-The doses in this chapter are for adults, and are to be modified according to the urgency of the symptoms, and discontinued or reduced when the symptoms are relieved. The Digitalin referred to is the "German." Frequently it is necessary to repeat antidote and evacuant, and to give lukewarm water freely to wash out the stomach. The author has endeavored to place together poisons exhibiting similar phenomena or for which the same treatment is eminently applicable. The symptoms of those poisons with which, in the opinion of the author, even the pharmacist should be familiar, are in bold face type. The prin- cipal procedures in treatment are in the same type. The resort to oxygen inhalations and to artificial respiration manually or by pulmotor is always jus- tifiable, and the neglect to do so may be censurable. The Pulmotor is an apparatus for rhythmical and protracted inflation of the lungs with oxygen, and removal of the air when the lungs are distended. It therefore produces artificial respiration. Such ap- paratus often is used at hospitals and elsewhere in suffocation and in collapse. ACETANILID (ANTIFEBRIN) - ANILIN - ANTIPYRINE - EXALGIN - PHENACE- TIN-ETC. All of these drugs are more or less dangerous. Probably Acetanilid and Antipyrine the most so. Fatal dose: Death has resulted from 5 grains of Acetanilid, and a recovery from poisoning by 340 grains of it. 30 grains of Phenacetin has caused death. 3 ounces of marking ink, consisting mainly HISTORY: *For hints on suspicious symptoms of poisoning, see page 331. Diag- nostic hints, pages 253, 261, 313, 329, 331, 338. 62 A MANUAL OF TOXICOLOGY. of Anilin, has caused death within 12 hours. Anilin is an oily fluid having a peculiar and distinctive odor. The fatal dose of Anilin is considered to be about 6 grammes, but recovery has occurred after 10 grammes. Poisoning has resulted from 7 grains of Antipyrine; also from 3)4 grains; recovery has occurred from an ounce after 14 hours' unconscious- ness. A Vienna report in 1890 attributes 17 deaths to this drug, by arrest of the heart. Death from these poisons is the result of cardiac depression. More or less sweating, depression, cyanosis, and collapse. [In Acetanilid poisoning, hemoglobin and he- matin are found in the urine. Symptoms of poi- soning by Exalgin sometimes resemble those of angina pectoris or those of Carbolic Acid, with dys- pnoea, cyanosis and renal disturbances. In Antipy- rine poisoning a rash resembling measles usually appears. In Anilin poisoning the pulse is small and frequent; the patient smells of Anilin; the urine may be brown to brown-black; at the end coma and convulsions; jaundice often follows re- covery. The outward application of Anilin causes eczema. (Use Hydrog. Perox. or Pot. Permang.) In chronic poisoning by Anilin the perspiration has a reddish color.] SYMPTOMS: Put patient in the recumbent position. Loosen clothing; supply fresh air and give Oxy- gen if possible, to overcome the cyanosis. i. Evacuate the stomach; syphon out the stomach with a stomach-tube, or give an emetic of Zinc Sul- phate (20 grains dissolved in a wineglassful of water, repeated once in 15 minutes if necessary), or Mus- tard (a tablespoonful in a small cupful of warm water, repeated in 15 minutes if vomiting has not recurred). Give saline purgative. 2 Stimulate with Caffein Citrate (1 to 4 grains TREATMENT: ACID ACETIC. 63 every to 1 hour), or Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypo- dermically every to 1 hour). Encourage respiration by giving Strychnine Sul- phate (1/60 to 1/20 gr. doses every to 2 hours). Sustain blood pressure by Atropine Sulphate (1/120 to 1/60 gr. hypoderm, every % to 2 hours). 3. Employ artificial heat (apply bags or bottles of hot water, or bricks, stove-lids, or bags of salt, heated), to maintain the bodily temperature. 4- Perform artificial respiration if necessary (rhythmically raise arms extended at sides to up over head and back again, 18 times a minute). In poisoning by inhaling Anilin, fresh air, oxy- gen inhalations, ether injections and general stimu- lation are the best measures to employ. ACID ACETIC-VINEGAR. HISTORY: Glacial Acetic Acid, used to destroy warts, may be mistaken for medicine. A large quantity of Vin- egar may be taken by mistake and act as a poison. Concentrated Acetic Acid is very corrosive. Fatal dose : i oz. concentrated Acetic Acid. Symptoms and treatment as in Mineral Acids (q. v.). [Q.V.=Quod Vide=which see]. PHENOLS: ACID CARBOLIC (PHENOL, PHENIC ACID, BENZOPHENOL) - CARBOLINEUM - CREOSOTE - GUAIACOL - CRESOLS: CREOLIN; LYSOL; SAPROL - PYRO- GALLOL-ZIRATOL-ETC. Carbolic Acid, a coal tar, is a colorless product when anhydrous; upcn adding 5 per cent, of water it becomes liquid; upon exposure to light it may turn red. It is a powerful escharotic ^nd neurotic poison. Probably Phenol, Lysol, Oxalic Acid and Gas are the poisons most commonly used for sui- HISTORY: 64 A MANUAL OF TOXICOLOGY. cide; but they are rarely used for murder. A Car- bolic lotion has been given fatally by mistake for medicine. Poisoning has occurred from using too strong a solution as injection; from a spray; from a strong salve for itch or other skin affections; also from absorption when used as an antiseptic in sur- gical dressings. If urine becomes dark colored in using Carbolic Acid, discontinue use. When fatal, death usually occurs in from % to 4 hours after the poison has been taken. The shortest time has been in one case 3 minutes, in another 5 minutes; longest time, 60 hours, also 5 and 7 days. Fatal dose of Phenol, from drachm up; usually to 2 ounces. As a rule, % ounce fatal; 6 or 7 grains have caused dangerous symptoms; recovery from over an ounce. Death from % ounce Cresote; recovery from an ounce. Death from 1 drachm Lysol; recovery from 3 ounces. Death is due to cardiac and respiratory paralysis. Death, if prompt, may result from syncope; if prolonged, from apnoea. Caution: Restored consciousness and apparently almost complete recovery may be followed, shortly or in some hours, by collapse and death. Patient should be kept quiet until recovery is fully estab- lished. Usually, but not always, an immediate burning pain from mouth to stomach, accompanied some- times by vomiting; usually a whitening of lips and mouth, also of esophagus and stomach; the breath- ing is labored; as a rule there is dizziness and later loss of consciousness; early low temperature, some- times later very high; diminished and greenish, brownish or black urine, the urine and breath having characteristic odor of Carbolic Acid, or Creosote, or such; pupils contracted; collapse. Lysol stains brown and causes slippery feeling on lips and mouth. SYMPTOMS: Usually treatment must be prompt to be effective. Remember that Carbolic Acid, although so called TREATMENT: ACID CARBOLIC. 65 is noc an acid, but belongs to the class of bodies known as phenols, and has but feeble acid properties. Phelps says: "Alcohol is a perfect antidote to the corrosive effects of Carbolic Acid." The corrosion produced by Carbolic Acid is superficial as a rule. In absence of extreme damage to mucosa of stomach (as indicated by small quantity of poison taken, its not being in pure state, just taken, or pain not being very se- vere), the stomach-tube may, as a rule, safely be intro- duced. When corrosion severe, omit evacuant treat- ment, and limit alcohol to 4 ounces, well diluted. Avoid use of oils and glycerine (except milk), as they favor solution and absorption of the poison. Antidotes : Alcohol, any soluble sulphate, soap- suds, vegetable demulcents, albumin, magnesia. 1. Give a cupful of Alcohol and water (4 ounces of each, or less water) and at once remove it with the stomach-tube, if possible, syphoning it out. If the stom- ach-tube is not at hand, may use Mustard (a tablespoon- ful in a small cupful of water), or much better, Apo- morphine Hydrochlorate, hypodermically (l/io grain). The Alcohol protects the stomach from the corrosive ef- fects of the Carbolic Acid, probably by its dilution of the Carbolic Acid and its effects upon the walls of the stom- ach, delaying or presenting absorption. It also acts as a stimulant. The Apomorphine not only has a prompt emetic effect upon the more or less paralyzed stomach, but also controls any inclination to acute alcoholism. (Owing to the anesthesia of the mucous membrane of the stomach, emetics are, as a rule, not very effective). If Alcohol is not at hand, use a cupful of clear Whisky, Brandy, Gin, Cider Vinegar, or Rum for the Alcohol they contain. The administration of the alcoholic preparation, followed by evacuation of the stomach (if possible by the stomach-tube), should be repeated every 5 to 10 minutes, from 4 to 8 times, according to the severity of the poisoning. Washing out freely with much water is also good secondary treat- ment. In the absence of Alcohol, a very dilute Acetic Acid 66 A MANUAL OF TOXICOLOGY. has been employed. Chiefly owing to its albuminous nature, milk is beneficial; also white of egg. 2. Administer one of the soluble sulphates next, such asSodium or Magnesium Sulphate (in y2 to 2 ounces, or i to 2 tablespoonfuls, doses in a cup- ful of water) to hasten the-elimination of such por- tion of the Carbolic Acid as may have entered the circulation. Half a pint of such solution, the strength, should be left in the stomach for continued absorption. 3. Stimulate heart, circulation, and respiration by Atropine Sulphate (1/120 to 1/60 grain hypoder- mically every y2 to 2 hours), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handker- chief, using one every 15 to 30 minutes). A hypo- dermic injection of Sulphuric Ether (15 minims) may be employed. A hypodermic injection of Strychnine Sulphate (1/60 to 1/20 grain every to 2 hours), or Tincture of Digitalis (5 to 10 drops), or Digitalin (1/100 grain) every to 2 hours, may be helpful. Artificial respiration, also saline (5, Page 118), if required. 4. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, ap- plied to the feet and sides of the body), to maintain bodily temperature. 5. Give demulcents (such as milk, white of egg, flaxseed, or elm tea, gruel or magnesia in water), as -in after treatment, to soothe and protect the mu- cous membrane. When egg and milk are given, they serve to also nourish and sustain the patient. Apply mustard paste to abdomen. Employ fric- tion and faradism to extremities. Among other treatments which have been recom- mended are Lime Water and Syrup of Lime; also soap-suds. Also Sodium Carbonate as a mouth wash. 6. May give Opium (Powdered Opium, 1 or 2 grains every ^2 to 2 hours), or Laudanum (20 drops every / to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sul- phate grain by mouth or hypodermically every ACID CARBONIC. 67 % to 2 hours), to relieve severe pain and nervous irritability and to sustain the resisting force. The treatment for poisoning by Creosote, etc., is the same as that for Carbolic Acid. In poisoning by absorption from antiseptic dress- ings, a lotion of 5 per cent, solution of Sodium Sul- phate is said to be an efficient antidote. Vinegar, especially Cider Vinegar, or oil (after alcohol), are efficient dressings in external injury or corrosion. ACID CARBONIC [GAS] (CARBON DIOXIDE) -CHOKE DAMP (CO and CO2). HISTORY: Poisoning by breathing foul air of an over- crowded room or one in which there is a charcoal or gas stove and insufficient ventilation; air of wells, cellars, mines, or other excavations or inclosures illy ventilated or poisoned by decomposition or gas following explosions. (When flame of lowered candle is dimmed, air is poisonous. If there is about 15 per cent CO2. present the flame is extinguished.) Fatal dose : 10 to 15 per cent, of this gas in the atmosphere is considered fatal; 2 per cent, is dan- gerous if long breathed. SYMPTOMS: Throat inflamed; sense of weight and pains in head; drowsiness; giddiness; ringing in ears; loss °f muscular power; dyspnoea; lividity of face and body; violent heart action; convulsions; coma; death; face may be swollen or livid and pale. TREATMENT: i. Carry patient at once into pure air. If possible give Oxygen inhalations. If respiratory move- ments have ceased, dash cold water on the face and chest to awaken by reflex action ; if there is no effect, resort to artificial respiration, and keep it up for an hour. If heart has stopped, strike sharp, 68 A MANUAL OF TOXICOLOGY. quick blows upon the chest, in the heart region. Inhalations of Ammonia, or of Amyl Nitrite, or an enema of strong coffee is sometimes serviceable. If the heart does not begin to beat soon after begin- ning artifical respiration, the jugular vein may be opened (avoid entrance of air) to relieve distension of the right ventricle. [The jugular vein is selected because there are no important valves between it and the heart.] Recovery may occur after long in- sensibility. 2. Friction and heat applied to the extremities. Electricity (interrupted current to limbs). Stimu- lants. Inject a pint of hot strong coffee into rec- tum. Use catheter if long unconscious. ACID CHROMIC - NEUTRAL CHROMATE OF POTASH - BICHROMATE OF POT- ASH-NEUTRAL CHROMATE OF LEAD (CHROME YELLOW). Persons engaged in the manufacture of Potassium Bichromate experience a nauseating bitter taste in the mouth, sneezing, irritation of nose and eyes,, sores on the hands and body. Wherever skin de- nuded it acts as a cautery. Has a tendency to at- tack septum of nose, which it may destroy. Potassium Bichromate is much used for dyeing purposes. 2 drachms have caused death in 4 hours, but ^2 ounce has been recovered from. A piece of' Chromate of Potash the size of a hazel nut hast caused death. Breathing Chromate of Lead dust has caused death, also eating cake ornaments con- taining this poison. [Deaths in 40 min. to to days.] HISTORY: SYMPTOMS: Pain in stomach; colic; cramps in legs; vomiting; purging; dilated pupils; great depression; collapse.) Chromic Acid vomit produces yellow stain on cloth- ACID CHROMIC. 69 TREATMENT : i. Evacuate the stomach. In poisoning by the acid employ stomach tube and much water to sy- phon out stomach; or use Mustard (a tablespoonful in a wineglassful of tepid water, repeating every 15 minutes until vomiting occurs). If Mustard is not at hand, may use Zinc Sulphate (20 grains, repeat- ing in 15 minutes if necessary), or give Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 minutes until ef- fective), or give Apomorphine Hydrochlorate, hy- podermically (1/10 grain, repeating in 15 minutes if necessary). Give Calcined Magnesia, or Mag- nesium Carbonate (1 to 4 tablespoonfuls stirred up in a cupful of milk or water) freely, as an antidote. Lime water, or chalk in water may be freely used. 2. Stimulate heart, circulation, and respiration by Atropine Sulphate (1/120 to 1/60 grain hypoder- mically every to 2 hours), and by inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief, using one every 15 to 30 minutes). A hypodermic injection of Sulphuric Ether (15 min- ims) may be employed. A hypodermic injection of Strychnine Sulphate (1/60 to 1/20 grain every % to 2 hours) may be helpful. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body) to main- tain bodily temperature. 4. Protect mucosa of stomach by administering demulcents (as milk, gruel, flaxseed or elm tea). 6. Give Opium (Powdered Opium, 1 or 2 grains every JG to 2 hours), or Laudanum (20 drops every % to 2 hours by mouth, or ^2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every % to 2 hours), to relieve pain and nervous irritability if Present and severe. 70 A MANUAL OF TOXICOLOGY. ACID HYDROCYANIC (PRUSSIC ACID) - BITTER ALMONDS, AND THEIR OIL - CHERRY LAUREL WATER-SCHEELE'S ACID-PEACH KERNELS-ETC. HISTORY: Poisoning may be the result of accident, suicidal intentions, or the effort to commit murder. It has resulted from inhaling the vapor of the anhydrous acid, from the use of the cyanides, from the acid itself, or from vegetable substances containing amygdalin. This latter substance readily under- goes decomposition, resulting in Hydrocyanic Acid and other products. Hydrocyanic Acid is a con- stituent of bitter almonds, cherry laurel, cherry, peach and plum pits. The Dilute Hydrocyanic Acid should contain 2 per cent, of the anhydrous acid. Oil of Bitter Almonds contains 10 to 15 per cent, of Hydrocyanic Acid. The acid is equally severe in its action whether swallowed, inhaled, dropped into the eye, or ap- plied externally. It may cause death in 2 minutes. Death has been delayed to i%, hours, but usually occurs within 15 minutes; may occur instantly. Inhalation of-the vapor has caused death. Hydrocyanic Acid enters the blood, forming a compound with its hemoglobin, passes to the me- dulla oblongata, and paralyzes centres of respiration. Fatal dose : 6/10 to 9/10 gr. of the anhydrous Acid; 40 min. of Dilute Hydrocyanic Acid (U. S. P.); re- covery after oz. 2^ sol. (4.8 gr.); recovery after 1 drachm of Scheele's Acid (equal to 22/s grains of the anhydrous acid); 80 almonds fatal; 4 to 6 will poison a child. Death after 17 drops of Oil of Bitter Alm- onds; also recovery after 4 drachms; but 20 drops is considered a fatal dose. Death in 2 min. to 3^ hrs. SYMPTOMS : The symptoms come on in the very act of swal- lowing or almost immediately. The breath has the ACID HYDROCYANIC. 71 characteristic odor of Bitter Almonds. Respiration difficult, expiration prolonged ; pulse imperceptible ; eyes glassy, prominent; pupils dilated; wild cries; involuntary urination and defecation; convulsions; asphyxia; cyanosis; paralysis; general collapse; coma; death. In small doses, giddiness, weakness. TREATMENT: i. The most serviceable methods in great emer- gency are artificial respiration, the use of Ammonia, by inhalation, hypodermically and by mouth di- luted; Chloride of Lime alone or moistened with vinegar and held to the nose; the employment of douches of cold water poured from a height, cold affusions to the spine, friction and stimulation. (Put patient in a horizontal position out in the air.) If there is time, immediately vomit, or wash out the stomach with a dilute (i to 3) solution of Hydrogen Peroxide, or of Potassium Permanganate (20 grains to a pint of water) in order to change, if possible, the Hydrocyanic Acid into the nearly harmless oxamid. May give Javelle Water (1 teaspoonful in a cupful of water), or Chlorine Water (a tablespoon- ful in a cupful of water), or use a Chlorine spray. May give a hypodermatic injection of the ordinary solution of Hydrogen Peroxide (% teaspoonful every 5 minutes until respiration and circulation improve, then occasionally) ; or give by mouth. There is no known, altogether reliable, antidote, although it has been claimed that Ferrous Sulphate is a good chemical antidote. Hence may well wash out with or give: Potassium Carbonate (20 grains in a wineglassful of water), immediately followed by Ferrous Sulphate (Copperas) (10 grains) and Tinc- ture of Chloride of Iron (1 teaspoonful in 2 table- spoonfuls of water). Or give Magnesium Car- bonate (1 teaspoonful), stirred up in water to a thin cream; then dissolve Ferrous Sulphate (12% grains) and Solution of Ferric Chloride (16 drops) in a 72 A MANUAL OF TOXICOLOGY. wineglassful of water. Mix these and give them, to counteract about 1^2 drachms of the Dilute Acid. A mixture of the Ferrous and Ferric salts, as an antidote, to be followed by a solution of Potassium or Sodium Carbonate, or Hydroxide, the combina- tion producing the inert Prussian Blue in the stom- ach, has been highly recommended. Cobalt Nitrate (1 oz. of sol. subcutaneously) has proved ef- ficacious. 2. Evacuate the stomach (after antidote), with stomach-tube until odor of acid absent, or tickle fauces with feather, or press finger down throat, or give emetic of Mustard (tablespoonful in wineglass- ful of water). When bitter almonds or similar kernels, which contain amygdalin, have been eaten, Zinc Sulphate (20 grains in a tablespoonful of water), or Apomorphine Hydrochlorate (1/10 grain hypodermically) usually required promptly. 3. Employ douches; pour cold water on face, and alternately hot and cold water on chest and spine. 4. Stimulate. Give inhalations of Ammonia. Also give Aromatic Spirit of Ammonia, Brandy or Whiskey (1 teaspoonful in a little water every 5 to 15 minutes by mouth, or in double quantity by rec- tum, or in half quantity hypodermically). Also stimulate with hypodermic injections of Atropine Sulphate (1/120 to 1/60 grain doses), or Strych- nine, or use Ether 15 minims (hypoderm), or same of Camphorated Oil. Hot normal salt sol. enema. 5. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature. 6. Apply electricity. Employ a faradic current, applying it to the chest walls, particularly over the heart. Sometimes must resort to tracheotomy. If can keep patient alive for about half an hour, recovery is as a rule quite certain. ACIDS MINERAL. 73 ACIDS MINERAL (CONCENTRATED): HY- DROCHLORIC (MURIATIC ACID, SPIR- IT OF SALT)-NITRIC (AQUA FORTIS) -PHOSPHORIC-SULPHURIC (OIL OF VITRIOL) -NITRO-HYDROCHLORIC (AQUA REGIA) - NITRO-SULPHURIC (AQUA REGINAE). When Hydrochloric Acid poisons, it is usually the result of mistaking it for beer or other beverages. Poisoning by Nitric Acid is usually the result of acci- dent or attempted suicide. Poisoning by Sulphuric Acid is usually the result of mistaking it for a bever- age or attempted suicide. Although primary effects of these acids may be recovered from, secondary effects, consisting of stricture of esophagus or stom- ach, or perforation of esophagus, resulting in death, are apt to occur in a year or two. But the effects are local, not remote. The dangerous qualities of Sulphuric Acid are in proportion to its degree of concentration rather than to the quantity taken. Fatal dose: Hydrochloric Acid, to i ounce; usually i ounce; recovery has occurred from i, also 2 ounces; shortest fatal period, 2 hours. Nitric Acid, 2 drachms; % ounce has been recov- ered from; shortest fatal period, 1^4 hours. Sulphuric Acid, 1 drachm; greatly depends upon the quantity of food in the stomach; recovery has taken place after 2 ounces; average fatal period, 16 to 24 hours; shortest period, 1^4 hours. Death from Concentrated Mineral Acids by as- phyxia or collapse or perforation of the stomach. Death usually occurs within 24 hours. May be days. HISTORY: SYMPTOMS: . Pain in digestive tract; thirst intense; swallow- mg. difficult; vomit dark-colored, acid, and con- taining mucous shreds, parts of membrane of eso- 74 A MANUAL OF TOXICOLOGY. phagus and stomach, perhaps blood ; feeble pulse, clammy skin; collapse; cough, difficult respiration; sometimes constipation; usually stains on lips. Hy- drochloric Acid produces on dark cloth first bright red color, which after some days becomes a reddish-brown or yellow. White stains on skin. Mucous membrane of mouth and tongue is gray or white. Nitric and Nitrohydrochloric Acids produce first white, then yel- low, and finally brownish-red stains on lips and skin. Stain clothing yellow. Sulphuric Acid causes white to black stains and corrosion on lips, and chars clothing, or stains white linen black, dark cloth red or brownish-red; stains other colored materials a bright reddish or yellowish; mixed with water generates heat. (These acids may not stain lips.) TREATMENT: Do not use stomach-tube, stomach-pump, or emetics with concentrated acids, lest the former perforate the wall of the esophagus or stomach, or the latter rupture the stomach. Chalk, Potassium, or Sodium Carbonate or Bicarbonate, although anti- dotes, should not be used, lest the gas generated rupture the weakened wall of the stomach. Avoid water, unless given rapidly in very large quantity, in poisoning by Sulphuric Acid, as it gen- erates heat, thus increases injury to the stomach. Antidotes: Much water, magnesia (forms Epsom Salt with Sulphuric Acid), soap, albumin, lime water, whiting, wall plaster, demulcents. i. Give much water at once and Calcined Mag- nesia in frequent doses (2 tablespoonfuls in a cupful of tepid water or milk). Lime water ad libitum. Soap- suds (castile soap, dissolved in 4 times its bulk of hot water), by the cupful until stomach is soothed. After neutralizing acid give tepid water to aid emesis. 2. Give demulcents freely (white of egg, 1 in cupful of water; barley water, flour, flaxseed tea, gruel, starch water, olive oil, or milk), to soothe and protect. 3. May give Opium or Morphine Sulphate (a hy- podermic injection of or X grain), or Deodorized ACID OXALIC. 75 Tincture of Opium (10 to 15 drops) or Cocain by mouth, to relieve pain. Give ice for pain and thirst. Apply heat to body. If required, stimulants (hypoderm.), nutrient enemas, also tracheotomy. Oil enemata benefit. . External parts injured by these acids (as in "vit- riol throwing") are benefited by bathing with soap and water, and treating like burns. ACID OXALIC (ACID OF SUGAR)-POTAS- SIUM BINOXALATE (SALT OF SOR- REL, SALT OF LEMON)-ETC. Acid Oxalic is a crystalline substance whose crys- tals sufficiently resemble Magnesium Sulphate and Zinc Sulphate as to be mistaken for them. It is sometimes taken with suicidal intent. Salt of Sor- rel is used for straw bleaching and removing ink and iron stains from linen, leather, paper, etc. It has been taken for suicidal purposes. It is an acid oxalate of Potassium, and is commonly called Salt of Lemon. It has been taken for Epsom Salt and Cream of Tartar, owing to similarity in appearance. Fatal dose : i drachm of the solid acid has killed; usually to i ounce is fatal, but i ounce in solution has been recovered from. The solid acid or a strong solution of it has a corrosive effect. The local effect of a dilute solution is slight, usually, but the poison is absorbed and acts as a systemic poison. Half an ounce of the Salt of Sorrel has produced death. Al- though the soluble salts of Oxalic Acid are almost as poisonous as the acid itself, they are not as cor- rosive. The Acid stains skin white or brown, cloth- ing brown or orange-red. Death has occurred in from 3 to 10 minutes, but usually occurs in about an hour. Death has oc- curred as late as the fourteenth day. Death by paralysis of respiration and heart. The time of death is not dependent upon the amount and concentration of the poison. HISTORY: 76 A MANUAL OF TOXICOLOGY. SYMPTOMS: A hot acrid or intensely sour taste in mouth; burning sensation in esophagus and stomach; in- tense thirst; distressing cough; severe pain in head, abdomen, and back; tongue swollen; sense of suffo- cation; usually vomiting of highly acid, greenish, blackish-brown or bloody mucus; black and blue colored face; cold skin; coma; collapse; sometimes convulsions; urine contains crystals of Oxalate of Lime, albumin, and tube casts. Oxalic Acid, in substance or in strong solution, acts locally as a corrosive upon the tissue with which it comes in contact, and also acts as a true poison. Upon the concentration of the solution de- pends the predominance of either action. Oxalic Acid in a large dose, and dissolved in a small quan- tity of water, produces immediate and severe symp- toms. In the reverse state the symptoms are de- layed and less severe. Death may be caused by dilute solutions without either pain or vomiting hav- ing been present, the symptoms being similar to those produced by narcotic poisoning. TREATMENT: Treatment must be prompt. The chemical anti- dote is Lime in any form (such as slaked lime, chalk, whiting, or wall plaster, given freely in water). I. Give at once Magnesia (2 tablespoonfuls in a gill of milk or water), or slaked lime suspended in a small quantity of water or mucilaginous fluid; forms in- soluble oxalate. Saccharated Solution of Lime, a teaspoonful often, or a soluble Salt of Calcium, or Magnesium, suspended or dissolved in a very small quantity of water, or in some demulcent, as milk, mucilage, or oil, is the proper antidote. Calcium Car- bonate, in the form of Prepared Chalk (2 teaspoonfuls at a dose), or Precipitated Calcium Carbonate (2 tea- spoonfuls at a dose), is very satisfactory, as with Oxalic Acid it forms Calcium Oxalate, an inert sub- stance. Ordinary chalk, wall plaster, whiting, or powd- ACID OXALIC. 77 ered oyster or egg shells, in water, or syrup of lime, or a large quantity of lime water, may be administered when better antidotes are not readily obtainable. Alkalies, such as Ammonia, Potash or Soda, and their Carbonates or Bicarbonates should not be ad- ministered, as they form soluble compounds which are almost as poisonous as the acid itself. If the poison has been taken in a solid form, or it is not known in what form it was taken, avoid use of much water, as by dissolving the poison it favors the absorption of the same. 2. May conditionally evacuate the stomach. If poison was not taken in solid form, and was not concentrated enough, or has not been swallowed for a long enough time to have destroyed the mucous membrane (as indicated by severe burning pain, often accompanied by signs of collapse) and vomit- ing has not occurred spontaneously, may use a stomach-tube to syphon out the stomach, or resort to an emetic. Avoid the use of the stomach pump. In syphoning out the stomach, use Lime Water, with or without oil, followed by pure water. Milk of Mag- nesia may be substituted for the Lime Water. Except in very aggravated cases, emetics may be employed, even though it be unsafe to use the stom- ach-tube. Tickling the fauces with a feather or the finger will often produce vomiting, and is the safest method. If not successful may give: Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated every 15 minutes if necessary), or Mustard (a tablespoon- ful in a small cupful of water, repeated in 15 min- utes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains), or Syrup of Ipecac, a tea- spoonful every 10 to 15 minutes until vomiting results; or still better, Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 min- utes until effective). 3. Give Castor Oil (2 tablespoonfuls), or Magne- 78 A MANUAL OF TOXICOLOGY. sium Sulphate (i to 2 tablespoonfuls in a cupful of water), to clear out the intestines. When water is admissable, much should be given to encourage elimination of the poison by the kid- neys. Apply poultices to the abdomen, and hot fomenta- tions to the loins. 4. Employ stimulants freely upon signs of col- lapse (such as Brandy or Whisky (in tablespoonful doses in a little water), but only per rectum). 5. Give Opium (Powdered Opium, 1 to 2 grains), or Laudanum (20 to 30 drops at a dose), or give Morphine Sulphate, hypodermically (% grain every % to 2 hours), if pain is severe. 6. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, or flour and water, or crushed bananas) , to soothe and protect the irritated and inflamed surface, as an after treatment. ACID SALICYLIC - SALOL. HISTORY: Salicylic Acid is used as a preservative for keep- ing cream, wine, lager beer, cider, jams, etc. Death from about an ounce taken in 4 days. Death results from paralysis of respiration. SYMPTOMS: Dilated pupils; quick, deep respirations; dys- pnoea; flushed face; ringing in ears; deafness; de- lirium ; may be nose-bleed. TREATMENT: i. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to 10 minutes until ACID SULPHURIC 79 it acts), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 min- utes until vomiting results), or Apomorphine Hy- drochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective. After emetic, always give plenty of luke-warm water to encourage vomiting. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypoder- mically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every ^2 to 2 hours), or Tincture of Belladonna (20 drops in water every to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically every y2 to 1 hour), or Caffein Citrate (1 to 4 grains every y to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every y^ to 1 hour if necessary) may be used for the same purposes. Draughts of strong coffee may also be given. 3- Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature. 4- Give demulcents: milk and white of egg. ACID, SCHEELE'S. (See Acid Hydrocyanic.) ACID SULPHURIC. (See Acids Mineral.) 80 A MANUAL OF TOXICOLOGY. ACID TARTARIC. HISTORY: Taken by mistake for an aperient. Fatal dose: 1 ounce. SYMPTOMS: Abdominal pain; vomiting; prostration; convul- sions ; collapse; death. Antidote: Lime or chalk. i. Give Lime Water freely; or Prepared Chalk (in 2 teaspoonful doses in a small cupful of water every 15 to 30 minutes), or Magnesia (2 tablespoon- ful doses in a small cupful of water, repeated every 10 to 15 minutes), or may give with benefit soap suds, or Carbonate or Bicarbonate of Sodium or Potassium in water. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and protect the irritated and inflamed surfaces. 3. Give Castor Oil (2 tablespoonfuls) to clear out. the intestines. 4. Stimulate if necessary (as described under Jalap (q. v.). ACIDS, VEGETABLE (CORROSIVE): ACETIC-OXALIC-TARTARIC. Symptoms and treatment under each name (q. v.). ACONITE (MONKSHOOD, WOLSFBANE)- ACONITINE-PULSATILLA- ANEMONIN. Aconite is an active poison. The plant Monks- hood, Wolfsbane or Blue Rocket (Aconitum Na-' pellus) is found growing in cottage gardens. All parts of it are poisonous. The root may be mis- HISTORY: ACONITE. 81 taken for horse-radish, and the leaves have been eaten in salad by mistake. Tincture of Aconite has been mistaken for cordial, and Fleming's Tincture mistaken for a harmless medicine, and Aconite lini- ment taken instead of medicine. An overdose of strong tincture is sometimes taken for a cold. Aco- nite has been used for purposes of suicide and for murder. Pills containing Aconite are .sold and in- discreetly used in the treatment of neuralgia. Aco- nite has been much used by the Hindoos to poison wild beasts and also human beings. Fatal dose: i drachm of the root; 25 drops of the 'tincture; 4 grains of the extract; 1/16 of a grain of the alkaloid; 1/50 grain nearly caused death; about T/35 grain by the mouth is believed to be fatal as a rule; hypodermically 1.5 mgrms. Fatal results usu- ally within 3 or 4 hours; has occurred in 8 minutes 1 and has been delayed to 4 days. 80 drops of the Tincture of Aconite taken in 10 doses caused death ni 4 days. Death results from asphyxia or syncope. SYMPTOMS: Tingling in mouth, throat and extremities; anes- thesia of surface; muscular weakness, hence stag- gering; dizziness; burning pain in stomach or ab- domen ; dilated pupils; slow, weak, irregular pulse; voice suppressed; skin covered with cold sweat; shallow, slow, feeble respiration; face pale; sight often poor; eyes fixed and staring; deafness; vomit- ing not common, but may begin in an hour, and is then severe; syncope. Patient often conscious to the last. TREATMENT: Put the patient in a horizontal position, the head lower than the feet, to prevent syncope. Maintain absolute quiet. If there is time to do more than employ artificial resoiration and stimulation, resort to the following: 82 A MANUAL OF TOXICOLOGY. I. Endeavor to wash out the stomach, syphoning with a stomach-tube and much water containing Lugols Solution %-i drachm to form insoluble Aconitin compound. Usually advisable to avoid emetics, as they act poorly and exhaust the patient. If given, give cautiously. Give Tannic Acid as an antidote (in 5 grain doses), followed by water, or Animal Charcoal (powdered and stirred up in water), or the follow- ing mixture may be given, to arrest the solubility of the poison: Iodine, )4 grain; Potassium Iodide, 2 grains; water, 1 ounce. Or give Pot. Permang.4 gr. Give a dose of Castor Oil. 2. Stimulate heart, circulation, and respiration with hypodermic injections of Ether (10 minims every 10 to 30 minutes), or with Brandy or Whisky (in 2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently) ; also with Ammonia inhalations or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes by mouth, or % teaspoonful hypodermically as frequently) ; also with Strych- nine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every J4 to 2 hours). Tinc- ture of Digitalis, as the physiological antidote (30 drops by mouth, or half as much hypodermically, every *4 to 2 hours), or Digitalin (1/100 grain hypo- dermically every % to I hour), should be given. Caffein Citrate (1 to 4 grains every % to I hour), may be used for supporting purposes. Draughts of strong coffee may be given. Also Nitroglycerine. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature. 4. May give Opium (Powdered Opium, 1 or 2 grains every % to 2 hours), or Laudanum (20 drops every *4 to 2 hours by mouth, or )4 teaspoonful in ALCOHOL 83 gruel by rectum as frequently) or Morphine Sul- phate (% grain by mouth or hypodermically every %-2 hrs.) to relieve pain and nervous irritability. Apply a mustard paste to the pericardium, and rub the back and legs with hot towels. Resort to artificial respiration if necessary (rais- ing and lowering arms from straight at sides to up over head and back again, 18 times per minute). ALCOHOL, AMYL ("FUSEL OIL," POTATO SPIRIT). HISTORY: A poisonous and hypnotic preparation from corn- whisky and potato-whisky. SYMPTOMS: Slow, shallow respiration; small pupils; breath 'resembling odor of Amyl Nitrite; muscular rigidity. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of Water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 3° grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until' effective). After giving the emetic, give plenty of luke-warm Water to encourage vomiting. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonfnl in a little TREATMENT: 84 A MANUAL OF TOXICOLOGYo water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every J4 to 2 hours), or Tincture of Belladonna (20 drops in water every *4 to 2 hours). Tincture of Digitalis (15 to 20 drops by mouth, or half as much hypodermically every to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. ALCOHOL, ETHYL OR GRAIN-BRANDY - WHISKY - GIN - RUM - WINES - BEER-CIDER. [Acute Poisoning.] HISTORY: Symptoms of poisoning usually appear within an hour. The fatal dose of Alcohol varies. 2^ ounces killed a boy of 9 and a girl of 5 years of age. 4 ounces of Brandy killed a child of 7. The toxic dose of Ab- solute Alcohol, contained in Brandy, Gin, etc., con- sidered to be 2^ to 5 ounces; smallest fatal dose cone. Alcohol, 3^ to 7 ounces. Death has resulted in adults from half a pint of Gin; from 2 bottles of Port. Recovery from a quart of Gin, a quart of Whisky, 2 bottles of Port, a pint and a half of mixed Gin and Brandy. Death in child from pint of Gin; also from 2 ounces of Gin; from 1 ounce of Brandy. Recovery from 3 ounces of Rum. Death by paralysis of heart in minutes, hrs. or days. "Absolute Alcohol " is Alcohol free from water. " Proof Spirit " is a mixture of spirit and water, con- taining 49.24 per cent, of Alcohol, i. e., about half and half. " Methylated Spirit " is spirit mixed with ALCOHOL. 85 10 per cent, of Wood Naphtha. Percentage of Al- cohol in some alcoholic drinks: Brandy, 53; Rum, 4° to 53; Whisky, 53 to 54; Gin, 40 to 51; Port, 20 to 25; Sherry, 15 to 19; Burgundy, 13 to 14; Claret, 10 to 17; Hock, 8 to 10; Strong Ale, 6; Stout, 6; Porter, 4; Small Beer, 1 to 2; Weiss Beer, 1; Cider, 6. SYMPTOMS: Confusion of mind; giddiness; relaxation of the whole body; tottering gait; hallucinations; stupor; anesthesia; coma; pulse rapid, weak, compressible; skin cool and moist; pupils usually dilated; face flushed, ghastly or bloated; temperature reduced; lips livid; conjunctivae red; breathing noisy; may be convulsions; coma. The symptoms of Alcohol poisoning often resemble apoplexy, concussion of brain, and Opium poisoning. There is an odor of Alcohol on the breath; may be bloody froth on lips. Important diagnostic sign: patient may usually be aroused for a short time. (See chart, Part X.) Sometimes apparent recovery, then sudden death after hours or days. TREATMENT: Provide fresh air. i. Evacuate the stomach - thoroughly syphon out the stomach with tepid water, or use an emetic of Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if necessary), or Zinc Sul- phate (20 grains in half a wineglassful of water, repeated every 15 minutes until effective). Ammonium Chloride or Ammonium Carbonate (30 grains in y2 pint of water given at one draught) and cold head-affusions sometimes remarkably re- store. 2. Support. Give Strychnine Nitrate (1/60 to 1/20 grain every % to 2 hours hypodermically). To counteract the stupor give Aromatic Spirit of Am- monia (in y2 teaspoonful doses every 15 minutes, or one-half as much hypodermically). Give inhala- tions of Aqua Ammonia, or use Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- 86 A MANUAL OF TOXICOLOGY. haled, using one every 15 to 30 minutes), to encour* age respiration. Also give Atropine Sulphate, hypo- dermically (in 1/120 grain doses every % to 2 hours), or Tincture of Belladonna (in 20 drop doses) every to 2 hours). Give Caffein Citrate (1 to 4 grains every % to 2 hours), or strong coffee (% pint). Dig- italin hypodermically (1/100 gr. every X to 1 hour). 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, ap- plied to the feet and sides of the body), to maintain bodily temperature. Cold affusions to head. Friction. For asphyxia employ galvanic current; for mania, Hyoscine and Morphine. Catheterize a dis- tended bladder. Give Oxygen. Arouse. ALCOHOL, METHYL (WOOD SPIRIT, WOOD ALCOHOL, "COLUMBIAN SPIRITS," ETC.) HISTORY: The swallowing, or even exposure to the fumes of Wood Spirit, has produced very serious results. The drinking of Bay Rum, Essence of Ginger and other preparations, which had been made from Wood Spirit, has produced violent symptoms and even permanent blindness. When swallowed, Wood Spirit uniformly attacks the optic nerve and retina. It is distilled from birch, beech, maple, oak, elm, and alder. From a drachm to an ounce or more of Wood Spirit usually produces severe symptoms and often results in blindness. Bathing in water containing Wood Spirit has injured. Death in 1 or 2 days. The symptoms usually appear about second 04 third day, unless dose large enough to produce coma, The principal symptoms are nausea, vomiting and headache. Disturbance of vision does not as a rule appear until the third, fourth, or even fifth day. Total blindness then occurs in from 12 to 48 hours,, if at all. In a few days slight vision is restored, but' SYMPTOMS: ALKALIES. 87 soon again lost. May be excitement, coma, semi- coma, depression, a sense of coming and going of sight, eyeballs sensitive to pressure and rotation. May be loss of color sense. Quite often death occurs. Pilocarpine Hydrochlorate (in % to ^4 gr. doses) is best remedy. Use early. Give Ethyl Alochol, rectal injections of normal salt solution, also hot coffee. Potassium Iodide is helpful. In coma: warm baths, then cold affusions. Remainder of treatment as for Ethyl Alcohol (q. v.). TREATMENT: ALKALIES : AMMONIA-BARYTA (see Bar- ium)-LIME (q.v.)-POTASSA-SODA, and Their Carbonates. Aqua Ammonia is sometimes taken by mistake for Lime Water or other liquid of similar appear- ance. Ammonia Liniment taken in similar way. Caustic Potash is rarely taken except by accident. Fatal dose: 2 drachms strong solution of Ammonia may be fatal; 4 drachms usually so, but an ounce has been recovered from. Death from )4 oz. Caustic Potash. Death usually in 24 hours, may be months. HISTORY: SYMPTOMS: Burning pain from mouth to stomach; difficulty in swallowing; vomiting (alkaline); may be vomiting and purging of mucous and blood; skin cold and clammy; pulse feeble; anxious countenance; rapid exhaustion; symptoms of suffocation; convulsions; stupor or coma may be developed. (Excessive inhalations of Ammonia are poisonous or fatal by the resulting bronchitis). (Baryta Muriate and Carbonate produce also headache, deafness, and dimness of sight). TREATMENT: I. As antidotes, give diluted acids, especially vege- table acids: Vinegar and water, equal parts; Acetic 88 A MANUAL OF TOXICOLOGY. Acid, diluted (a teaspoonful in % pint of water); Citric Acid or Tartaric Acid (% to 2 drachms in a pint of water), or clear lemon or orange juice, freely. Vinegar with Caustic Potash forms the almost harmless Potassium Acetate. The fixed oils (such as Castor, Cod Liver, Lin- seed, Almond, and Olive) form soaps with the free alkalies, and consequently destroy their caustic ef- fects. Butter may be employed. If there are signs of corrosion, as indicated by severe pain, collapse, etc., do not use stomach- pump, stomach-tube, or emetics, for fear of per- foration or rupture. Assist vomiting by copious draughts of tepid water. For inflammation apply leeches. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and protect the irritated or inflamed surfaces. Ice cream, ice. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypoder- mically as frequently) ; also with Strychnine Sul- phate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 grain hy- podermically every J4 to 2 hours), or Tincture of Belladonna (in 10 to 15 drop doses). Tincture oh Digitalis (30 drops by mouth, or half as much hypo- dermically, every ^4 to 2 hours), or Digitalin (1/100 grain hypodermicallly every % to I hour), or Caf- fein Citrate (1 to 4 grains every y^ to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to I hour if necessary) may be used for the same purposes. Strong coffee is helpful. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, ALKALOIDS. 89 applied to the feet and sides of the body), to main- tain bodily temperature. May apply cold over pain. 4. Give Opium (Powdered Opium, 1 or 2 grains every y2 to 2 hours), or Laudanum (20 drops every J4 to 2 hours by mouth, or teaspoonful in gruel by rectum as frequently) or Morphine Sulphate grain by mouth or hypodermically every to 2 hours), to relieve pain and nervous irritability. If life is threatened by oedema, promptly per- form tracheotomy. When a dangerous quantity of Ammonia has been inhaled, give inhalations of Acetic Acid, Hydrochloric Acid, Chlorine Water, or Vinegar. Relieve pain by slight Chloroform inhalation. Rectal feeding if required. ALKALOIDS. Tannin forms a comparatively insoluble tannate with alkaloids. Potassium Permanganate is useful for many alkaloids. [In poisoning by 2 alkaloids treat the prominent symptoms.] HISTORY: Give Tannic Acid, Potassium Iodide, Albumin, Iodine, Charcoal, strong coffee or tea, emetics and cathartics. For symptons and treatment in detail see each alkaloid under respective title. TREATMENT: ALOES-BRYONIA -COLOCYNTH -ELA- TERIUM (SQUIRTING CUCUMBER)- ELATERIN-E U P H O R B I U M-GAM- BOGE- "HIERAPICRA"-JALAP (q. v.) -MEZEREON-PHYSIC NUT- SCAM- MONY, and similar Vegetable Irritants. Fatal dose : Aloes, to oz.; Podophyllin, 5 to 10 gr.; Elaterium, 6 or 8 grs. HISTORY: Severe irritation of the intestinal canal, causing pain, vomiting, and purging; cold sweats; usually great prostration; sometimes convulsions; collapse. SYMPTOMS: 90 A MANUAL OF TOXICOLOGY. TREATMENT : i. Evacuate the stomach (if not emptied) : sy- phon out stomach with stomach-tube, using much water, with ^2 pint milk or oil. If stomach-tube not at hand, or poisonous substance is too large to be removed by it, use Zinc Sulphate (20 grains in a tablespoonful of water, repeated in 10 to 15 minutes if necessary), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated in 10 to 30 minutes if necessary). Give tepid water freely. If the irritant has passed out of the stomach into the intestines, but not away, a purgative, such as Castor Oil (1 to 2 tablespoonfuls), or Epsom Salt (1 to 2 tablespoonfuls) should be given to remove it. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, elm or flaxseed tea, oatmeal gruel, gelatin, starch or barley water, flour and water, or crushed bananas) to soothe the inflamed or irri- tated surfaces. Afterwards enemata of the same are soothing. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (a teaspoonful in water every 10 to 30 minutes, or % teaspoonful as often hypodermically). 4. Give Opium (Powdered Opium, in 1 to 2 grain doses every y2 to 2 hours), or Laudanum (10 to 20 drops in water every % to 2 hours), or Morphine Sulphate yy grain hypodermically or by mouth every y2 to 2 hours), to relieve the pain and quiet the nervous system. 5. Maintain the body heat (by applying hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to body and extremities). Apply hot fo- mentations to the abdomen. ALUM. TREATMENT: Administer Ammonium or Potassium Carbonate or Bicarbonate as antidote. Use emetic and demulcents. AMYL NITRITE. 91 AMYL NITRITE - NITRITE OF ETHYL - NITRITE OF POTASSIUM - NITRITE OF SODIUM. At first there is a violent heart action and flushing, from dilation of the capillaries; then there is di- minished heart action and contraction of the capil- laries ; then follow great muscular relaxation; grad- ual loss of reflexes; yellow vision; pallor; dilated pupils; slow pulse; irregular respiration; sometimes vomiting and convulsions. Blyth says "Warm blooded animals may be thrown by Amyl Nitrite in- to a cataleptic condition. It is not an anesthetic, and by its use consciousness is not destroyed, unless a condition approaching death be first produced. When this occurs, there is rarely recovery; the ani- mal passes into actual death." SYMPTOMS: TREATMENT: N. B.-Whether poison was swallowed or inhaled, put patient in horizontal position and provide plenty of fresh air. i. If the poison has been swallowed, evacuate th© stomach; syphon out stomach with a stomach-tube, or use a hypodermic injection of Apomorphine Hy- drochlorate (i/io grain). 2. Support. Give Brandy or Whisky (in table- spoonful doses every 5 to 10 minutes, or % tea- spoonful doses hypodermically every 5 to 10 min- utes). Give Strychnine Sulphate, hypodermically (1/60 to 1/20 grain every to 2 hours). Aid heart by Tincture of Digitalis (15 drops every 10 to 20 minutes), or give Digitalin (1/100 grain every to 2 hours). May give Atropine and Ergotin. 3. Douche. Use alternate hot and cold douches to the chest. 4. Resort to artificial respiration if necessary (rhythmically raise and lower arms from straight 92 A MANUAL OF TOXICOLOGY. at sides to up over head and back again, 20 times a minute). If the poison has been inhaled, employ Nos. 2, 3 and 4. ANESTHETICS: CHLOROFORM - ETHER -NITROUS OXIDE (LAUGHING GAS)- ETC. (Chloral, p.119.) HISTORY: Chloroform is sometimes swallowed by mistake, but usually for suicidal purposes. Death from it is, however, usually the result of inhaling too much as an anesthetic. Ether is a less dangerous anesthetic than Chloroform, usually less productive of vomit- ing, and stimulates heart action. A sleeping person awakens almost instantly upon being exposed to the vapor of Chloroform. A true sudden narcosis is im- possible. Chloroform kills I in 3000; ether, 1 in 16,000. Fatal dose: Fatal dose by inhalation of Chloro- form, from 15 drops up; by mouth, 1 drachm in boy of 14 years; half an ounce in adult; recovery from 5 ounces by mouth in adult. Probable fatal dose of Ether by mouth, 1 ounce; Chloroform, ounces. Death usually by paralysis of respiration. In a few cases by cardiac paralysis. But in poisoning by Nitrous Oxide death is invariably due to asphyxia. SYMPTOMS: Chloroform: Stertorous, irregular, shallow breath- ing; dilated pupils; appearance of cloud passing over face; conjunctiva may be touched without pa- tient flinching. Symptoms are same when taken by mouth as when vapor is inhaled, but fatal results are deferred. Ether (Sulphuric Ether): Cyanosis; jugular pul- sation ; action of diaphragm suspended, followed by thoracic paralysis; weak, rapid pulse; shallow, labored, stertorous breathing; great reduction of body temperature; dropping of jaw. (Effects longer in appearing than in Chloroform). ANESTHETICS. 93 Nitrous Oxide (Laughing Gas): A prominent symptom, usually, is delirious laughter. When inhaled: i. Remove anesthetic; invert patient; draw tongue well forward with forceps, or out and in 15 times a minute; maintain inverted position until pulse and respiration are good; expose patient to a current of pure air, or give Oxygen. Dash, alter- nately, hot and cold water on face and chest; in Ether poisoning also dash Ether on chest and abdomen. Resort to artificial respiration without delay (slowly and regularly sweep extended arms up over head and back to sides, repeating 18 times a minute). Employ a weak electric current to encourage the action of the diaphragm; one pole on the pit of the stomach, other on the larynx. May bandage ex- tremities and compress abdomen to confine blood to vital centers. 2. Give hypodermic injection of Atropine Sulphate (1/120 grain, repeated every to 2 hours) and Strychnine Sulphate (1/60 to 1/20 grain every % to 2 hours), and Tincture of Digitalis (10 to 20 minims), or Digitalin (1/100 grain every % to 2 hours. May also give Aromatic Spirit of Ammonia (15 minims in water every 10 to 30 minutes), by mouth or hypodermically. Give an enema of hot strong coffee (a pint). Amyl Nitrite, Nitroglycerine, or Adrenalinchlorid (subcutan.), may also be used. Apply Mustard to calves of legs and over heart. Avoid hypodermic injections of Ether or Alcohol. If heart is stopped, two or three blows on the chest may start it; sustain by rhythmical pressure over it. May arouse by slapping with wet towel. 3. Employ friction and apply external heat, in either poisoning (hot water bottles, or ordinary hotties containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to maintain bodily temperature. TREATMENT: 94 A MANUAL OF TOXICOLOGY. Dash Ether on chest and abdomen for shock stim- ulation. Also give inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), or inhalations of Ammonia. As relapse may occur, do not leave patient for some time after apparent recovery. When swallowed: If Chloroform or Ether have been swallowed. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using water freely, or tickle fauces with a feather, or give Mustard (a tablespoonful in a wineglassful of water and repeat in 15 minutes if necessary), or give Apomorphine Hydrochlorate, hypodermically (in 1/10 grain doses). Zinc or Copper Sulphate also after syphoning. Give copious draughts of water containing 1 to 2 teaspoonfuls of Sodium Bicarbonate or Carbonate as antidote. Use Oxygen, artif. resp., stimulants. Demulcents may be necessary. Glucose retards. 4. Give Opium, to relieve pain when necessary.- (Powdered Opium, 1 or 2 grains every % to 2 hours), or Laudanum (20 drops every *4 to 2 hours by mouth, or *4 teaspoonful in gruel by rectum as frequently) or Morphine Sulphate (% grain by mouth or hypodermically every to 2 hours), to relieve pain and nervous irritability. Remainder of treatment as in poisoning by in- halation. ANILIN INK OR DYES. (See Acetanilid, etc.). ANTIMONY AND ITS COMPOUNDS: AN- TIMONIAL WINE -TARTAR EMETIC - ETC. HISTORY: Antimony has been taken by mistake for Epsom Salt, also for Sodium Carbonate. Has also been considerably used for secret poisoning and murder. The ointment has poisoned externally applied. The ANTIMONY AND ITS COMPOUNDS. 95 action of Antimony has been mistaken for the effects of diseases, such as gastric or intestinal ulcer or cholera; also for Arsenic poisoning. Antimony is, however, sometimes contaminated with Arsenic, best urine and vomited matter for Antimony to dis- tinguish from disease. In poisoning by Antimony, urine never suppressed as in Arsenic. Prompt treat- rnent is highly important. In incessant vomiting suspect Antimony compounds or Zinc. Fatal dose: Tartar Emetic, pa grain has caused serious symptoms; grain killed a child in an hour; 2 grains killed an adult; % oz. has been re- covered from. Death from 2 oz. Antim. Trichlor. Death usually in 24 hours from cardiac paralysis. SYMPTOMS: Metallic taste in mouth; violent vomiting of mu- cus, bile, watery fluid, or blood; purging of intes- tinal contents, then mucus, bile, and perhaps blood, followed soon by rice water stools; pulse impercept- ible ; respiration shallow; face pinched, livid, and covered by cold sweat; cramps in legs; pain' and burning in stomach; difficulty in swallowing; great thirst; debility. Put patient in horizontal position, head lower than feet. The chemical antidotes are Tannic Acid, which forms the insoluble tannate (give 5 to 20 grains in a wineglassful of water), or Gallic Acid (same), in- fusion of oak bark, galls, etc., followed by white of egg. May give as an antidote Magnesium or So- dium Carbonate (2 to 4 tablespoonfuls in 4 to 8 ounces of water). 1. If patient has not vomited, syphon out stomach ■vith stomach-tube, or tickle fauces with feather or finger to induce vomiting, or give Apomorphine Hy- drochlorate, hypodermically (in 1/10 grain doses). Give plenty of strong coffee or tea. After syphon- ing may lavage stomach with solution Tannin (10 to 30 grs. to pint of water). Avoid tube in Chloride. TREATMENT: 96 A MANUAL OF TOXICOLOGY. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and protect the irritated or inflamed surfaces. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature. Mustard to epigastrium. 4. Give Opium (Powdered Opium, 1 to 2 grains every ^2 to 2 hours), or Laudanum (20 drops every 34 to 2 hours by mouth, or half a teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every % to 2 hours), to relieve pain, nervous irritability, etc. 5. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypoder- mically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or 34 teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every 34 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every 34 to 2 hours), or Tincture of Belladonna (20 drops in water every J4 to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypodermically every y^ to 1 hour), or Caffein Citrate (1 to 4 grains every 34 *° 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. ANTIPYRINE. (See Acetanilid). ARSENIC. 97 ARSENIC: ARSENOUS ACID - ARSENICAL FLY PAPER -COBALT SALTS - DONO- VAN'S SOLUTION - FLY STONE - FOWLER'S SOLUTION -RAT PASTE - "ROUGH ON RATS" - PARIS GREEN (ACETO-ARSENITE OF COPPER)- SCHEELE'S GREEN (ARSENITE OF COPPER)-POISONOUS INSECT POW- DER - ETC. HISTORY: Arsenic in one form or another is quite a common poison, has almost no taste and is therefore easily given. Poisoning occurs by intent, also from grinding Arsenic in mills,-from vapor in smelting copper, from handling °r manufacturing certain wall papers, etc., and from yarious uses in the arts. It is a constituent of various insecticides and used to destroy vermin, various Weeds, and in stuffing birds and animals; also for various preservative purposes, to improve the coats of horses, and by dentists in destroying nerves in teeth. Has been taken by mistake for " Salts " or Magnesia. Arsenic with Phosphorus and ground glass is said to be a constituent of a certain rat poison. (Some vermin killers contain Strychnine; some Corrosive Sublimate.) External applications of arsenic may inflame stomach and intestines and kill. Fatal Dose: Apparently a dose of 3 grains of Arsenic is fatal; but recovery from much more, and probable from 1 grain; also when a large dose produces prompt and copious vomiting. Death from 2 or 2^2 grains White Arsenic; also from % ounce Fowler's Solution. Death usually occurs within 24 hours. May occur in 20 minutes, or not for two weeks. SYMPTOMS: Burning pain in the esophagus and stomach; pain in stomach is increased by pressure, soon spreads over abdomen ; there is frontal headache; colicky pains; sense of constriction in throat, and irritating metallic taste in mouth; more or less 98 A MANUAL OF TOXICOLOGY. violent, often bloody vomiting and purging; rejected matters, first mucus, then bilious, of a yellowish, brownish, or greenish color, or blue (indigo), or black (soot) ; stools may become serous or bloody; pulse is small, feeble, and frequent; breathing diffi- cult and rapid; great thirst; urine suppressed; face swollen; extremities very cold; cramps in calves; cyanosis, followed by cramps; convulsions; coma; death. Nettle-rash-like, papular, vesicular or pustu- lar skin eruption in protracted cases. [Symptoms ap- pear in to 3 hours.] Atrophy and degeneration o£ gastric follicles may result. TREATMENT: I. Syphon out stomach with stomach-tube if pa- tient is seen soon after taking poison; if not, give Mustard (a tablespoonful in a wineglassful of water), or Zinc Sulphate (20 grains in 2 tablespoon- fuls of water every 15 minutes if necessary), or Cupric Sulphate (3 to 5 grains in a wineglassful of water every 5 to 10 minutes until vomiting re- sults), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac,* a teaspoonful every 10 to 15 minutes until vomiting results) ; or give a hypodermic injection of Apomorphine Hydro- chlorate (1/10 grain repeated every 15 minutes until effective). Give hot milk before or during evacuation. The chemical antidote should be given before or when evacuating the stomach; also evacuate after it. (p- 53-) The chemical antidote is Hydrated Sesquioxide of Iron. In emergency may prepare it by adding an ex- cess of weak Aqua Ammonia to the Tincture or Solution of Chloride of Iron 1 oz., Water 15 oz.; then after collecting the precipitate in muslin and wash- ing it with water, give 2 or 3 tablespoonfuls of pre- cipitate every 10 minutes until symptoms are im- proved ; then evacuate and repeat. Well to give with the antidote some Calcined Magnesia freely, in water. Ferri Oxidum Hydratum cum Magnesia-the of- ficial antidote-made by precipitating solution of Ter- sulphate of Iron by Magnesia, is usually considered ARSENIQ 99 best antidote. Give often in y oz. doses or more. Or give; Tr. Chloride of Iron 2 oz.; Water 2 pints; Mag- nesia to excess, in 4 doses 15-30 min. apart. May give dialysed Iron ( 3 %-6 followed by salt 3 1, every %to 4 hrs.) Follow any Iron antidote by % oz. Castor Oil. If no other antidotes, may use freely raw eggs beaten up in milk with Magnesia; also sugar in milk, which forms insoluble compound with ArsenoqsA-cid. 2. Give demulcents (such as white of egg milk, oil, grim arabic, flaxseed or elm tea, barley or starch .water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and protect the irritated or in- flamed surfaces. Also give alkaline mineral waters. 3- Give Opium (Powdered Opium, 1 or 2 grs. every % to 2 hours), or Laudanum (10 to 20 drops every y2 to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (^ grain by mouth or hypodermically every 14 to 2 hours), to re- lieve pain and nervous irritability. 4- Stimulate heart, circulation, and respiration With Brandy or Whisky (2 teaspoonful doses every to 15 minutes, or y^ teaspoonful doses hypoder- mically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or y^ teaspoonful hypodermically as frequently) ; for cramp Strychnine Sulphate (1/60 to 1/20 grain hypodermically every *4 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every y2 to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours) to prevent col- lapse. Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts, of strong coffee may also be given. Saline solution (5, p. 118). 5. Employ artificial heat (such as hot water 100 A MANUAL OF TOXICOLOGY. bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature. Also poultices over stomach. 6. Give large draughts of water containing Sweet Spirit of Nitre (2 to 4 teaspoonfuls), to relieve the tendency to suppression of urine. Ice for thirst. ATROPINE. (See Belladonna). AUTO-INTOXICATION, OR AUTO-INFEC- TION (SELF-POISONING). Auto-infection is perhaps best defined to be th§ result of an unnatural general metabolism or of an unnatural decomposition in the digestive tract. It seems probable that there are substances in the excretions of all plants and animals, which are poi- sonous to them. If we drank none but the purest water and took only that food which was absolutely void of adulteration and infection, and respired onh pure air, yet our excretions would undoubtedly con- tain poisons. / The bacteria which are always present in the natural contents of the intestines doubtless originate some of these poisons, which are truly ptomaines. Constipation interferes with elimination and as natural consequence a more or less serious train of symptoms frequently results. HISTORY: The common symptoms are: more or less head, ache; coated tongue; offensive breath; sense o? stupor and languor; etc. SYMPTOMS: TREATMENT: Evacuation of stomach and free catharsis, fol- lowed by a bitter tonic, and a temporary reduction the nitrogenous foods usually is all that is required May require temporarily stimulation, artificial respi- ration, and antiseptics (as Resorcin, etc.). (Also se'' Part IV.) BARIUM AND ITS COMPOUNDS. 101 barium and its compounds: barium ACETATE - BARIUM CHLORIDE - BARIUM NITRATE - BARIUM OXIDE (BARYTA)-ETC. HISTORY: Barium Chloride is sometimes mistaken for Ep- som Salt. Barium Nitrate has been mistaken for Sulphur. Fatal dost: Death has resulted from 100 grains of Barium Chloride in 15 hours; death has resulted morn a drachm of Barium Carbonate; half an ounce °f Barium Chloride has been fatal in 2 hours; half an ounce of the Nitrate of Baryta killed a man in hours. Recovery from 370 grs. Chloride. Abdominal pains; cramps; purging; vomiting; ^eble pulse; labored and short respiration; dilated Pupils'; excessive urination; loss of voice, sight or hearing; convulsions; collapse; death. SYMPTOMS: TREATMENT: I. Evacuate the stomach; syphon out the stomach 'vith a stomach-tube, or give Mustard (a tablespoon- ful in a wineglassful of water), or Zinc Sulphate (2o grains in % wineglassful of water), or inject Apomorphine Hydrochlorate, hypodermically (i/io 'grain). Repeat in 15 minutes if necessary. As an antidote, give Dilute Sulphuric Acid (% to t teaspoonful in a wineglassful of water), or give Aromatic Sulphuric Acid (same amount), or Mag- nesium or Sodium Sulphate (% to 1 ounce, or 1 to 2 tablespoonfuls, in a cupful of water, or all three may be given together in much water. The purpose in such treatment is to produce the insoluble Barium Sulphate. May give Pulverized Alum (1 drachm in cupful of water). Again wash out stomach. . 2. Give demulcents (such as white of egg, milk, °il, gum arabic, flaxseed or elm tea, barley or starch 'vater, oatmeal gruel, gelatin, flour and water, or 102 A MANUAL OF TOXICOLOGY. even crushed bananas), to soothe and protect the irritated and inflamed surfaces. 3. Stimulate, if there are signs of collapse, with Brandy or Whisky (2 teaspoonfid doses every 10 to 15 minutes, or 54 teaspoonful doses hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 min- utes, or % teaspoonful hypodermically as fre-, quently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every 54 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every 54 to 2 hours), or Tincture of Belladonna (20 drops in water every )4 to 2 hours), to prevent col- lapse. Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every 54 to 2 hours), or Digitalin (1/100 grain hypodermically every 54 to 1 hour), or Caffein Citrate (1 to 4 grains every 54 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every 54 to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. Chloral for spasm., 4. Give Opium (Powdered Opium, 1 or 2 grains e^ery to 2 hours), or Laudanum (20 drops every 54 to 2 hours by mouth, or J4 teaspoonful in gruel by rectum as frequently) or Morphine Sulphate (54 grain by mouth or hypodermically every 54 to 2 hours), to relieve pain and nervous irritability. 5. Apply poultices, mustard paste or hot water bag, or cloths wrung out in hot water to abdomen. BELLADONNA (DEADLY NIGHT SHADE). - ATROPINE - HOMATROPINE - HY- OSCYAMUS - HYOSCYAMINE - HYOS- CINE - STRAMONIUM (JAMESTOWN WEED, THORN APPLE, DEVIL'S AP- PLE) - DATURINE - DULCAMARA - SOLANINE - DUBOISIA - DUBOISINE - SCOPOLAMINE, ETC. HISTORY: Belladonna: Belladonna berries are sometimes' eaten by mistake. Infusion of leaves, and extracts, BELLADONNA. 103 have also been taken for other substances. The plaster has poisoned by application. Hyoscyamus has been eaten for parsnips by mistake. The seeds have likewise been accidentally mixed with celery seeds and used in cooking. The tincture has been mistaken for black draught. Stramonium has been used to intoxicate and for murder, in which case it is sometimes mixed with sugar, tobacco or flour. An infusion of the leaves has been accidentally taken for an herb tea, and children have been poisoned by eating the seeds. Extract of Stramonium has been accidentally substituted for an extract of Sarsapa- rilla. Atropine, etc., externally, poison. The prognosis usually is good. Fatal dose: Death from Atropine poisoning usu- ally takes place within 6 hours, and if life is pro- longed to 8 hours, recovery is very probable. Most cases recover under treatment. Death has resulted from a drachm of the Belladonna Liniment, and re- covery has occurred from an ounce. Fatal re- sults from a few ripe berries; recovery after eating 5o berries. Death from Extract of Belladonna 1 drachm in 2^4 hours; also recovery from 3 drachms °f it. Children will take almost as much as adults, as a rule. Death from 1/20 grain Atropine subcu- taneously; also from 1/12 grain by mouth, and death is likely when 1 grain has been taken and no treatment follows. Recovery from 5 gr. Sulphate. Death from % oz. Tincture. Death may occur in 1 or 2 hours; usually within 15 hours. Death by car- diac paralysis. 100 seeds of Stramonium killed child 2 years old. Recovery after y2 ounce of leaves in- fused in boiling water. SYMPTOMS: Heat and dryness in mouth and throat; great thirst, which nothing allays; greatly dilated pupils; indistinct and double vision; giddiness; dry skin, perhaps scarlatinal kind of rash; nausea; vomiting; stupor following delirium; may be excitement, wild talk, laughter and fanciful delusions; rapid pulse; convulsions; coma; death. Sometimes desire but 104 A MANUAL OF TOXICOLOGY. inability to urinate. Face sometimes red and swollen. The symptoms usually appear in from y2 to 2 hours after taking the poison. Scopolamine ef- fects are similar to those of Atropine, but do not pro- duce dryness of mouth or throat nor the intense thirst; and rash and vomiting may be absent. Before syphoning out the stomach or giving an emetic, give Tannic Acid or Gallic Acid (20 grains in a wineglassful of water, immediately followed by another glassful of water) as an antidote to the poison. Charcoal or a strong decoction of oak bark or tea may be given instead. If none of these are at hand, give a mixture of Iodine 1 grain, Potassium Iodide 10 grains, in a wineglassful of water. Empty the stomach in 5 or 10 min. 1. Evacuate the stomach; syphon out the stomach with a stomach-tube, using much water; or give Mustard (1 tablespoonful in a small cupful of water, repeated in 10 to 20 minutes if necessary), or Zinc Sulphate (20 grains in half a wineglassful of water, repeated in 10 to 20 minutes if necessary), or Ipe- cacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 15 minutes until vomiting results), or Apomorphine Hydro- chlorate, hypodermically (1/10 grain, repeated in 10 to 20 minutes if necessary). Follow with Swreet Spirit of Nitre (in teaspoonful doses), or Pilocarpine Nitrate, the most perfect antagonist (*4 grain), to encourage elimination of •the poison. Atropine dries, Pilocarpine moistens the skin; Atropine ac- celerates the respiration, Pilocarpine slows it. 2. Give Opium (Powdered Opium, in 1 to 2 grain doses every to 2 hours), or Laudanum (15 to 20 drops every p2 to 2 hours), or Morphine Sulphate (in % to grain doses hypodermically every y2 to 2 hours), or Eserine (in 1/60 to 1/30 grain doses every y2 to 2 hours), to quiet the brain. Morphine is the best antagonist to the effects of Atropine on the cerebrum, kidneys, heart, pupils, respiration and arterial tension. Muscarine is probably the best general antagonist (in doses of % to 1 grain). TREATMENT: BENZENE-BENZOL. 105 3- Draw the urine. Avoid overdose of Opium. 4. Employ heat; hot water to the feet, and hot bricks, bottles, or water bags to the body. Apply 3- mustard paste to the feet and over the heart. Arouse by alternate hot and cold douches to chest. Apply cold to head. Give Chloral for Hyoscine delirium. 5- Stimulate. Give 15 to 30 drop doses of Aro- matic Spirit of Ammonia, and Brandy or Whisky (a teaspoonful in water by mouth, or teaspoonful hypodermically every to 1 hour). Hold Am- monia Water to the nostrils. Give strong coffee. 6. Employ artificial respiration if respiration is interfered with (rhythmically raise and lower arms from sides to up over head and back again, 18 to 20 times per minute). BENZENE - BENZOL. HISTORY: Used in dyeing, cleaning and as a cough medi- cme. Death in 17 hours from 3 drachms of Ben- zene. SYMPTOMS: Nausea; gastro-intestinal distress; dizziness. TREATMENT: I. When swallowed, evacuate the stomach; sy- phon out the stomach with a stomach-tube, or give Mustard (a tablespoonful in a small cupful of Water, repeated in 15 minutes if not effective), or ^inc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 minutes if vomiting ;s not produced), or Apomorphine Hydrochlorate (1/10 grain hypodermically, repeated every 15 minutes until effective). After giving an emetic give plenty of luke-warm water to encourage vomiting. Sodium or Potassium Carbonate or Bicarbonate may be administered as an antidote. 1. When inhaled, provide much fresh air. Arti- ficial respiration should be resorted to if necessary 106 A MANUAL OF TOXICOLOGY. (rhythmically raise arms, extended at sides, to up over head and back again, 18 times a minute). Give Atropine Sulphate (in 1/120 to 1/60 grain doses hypodermically every *4 to 2 hours), or Tinc- ture of Belladonna (15 to 30 drops every *4 to 2 hours by mouth), to overcome depression. Douche the chest with hot and cold water alter- nated, to arouse. Use interrupted electric current over heart to sup- port heart and circulation. Give Ammonia or steam inhalations. (See Petroleum). BENZINE. BLOOD ROOT. (See Sanguinaria). BORIC ACID. (Treat as for Croton Oil.) BISMUTH. (Treat as for Arsenic, etc.) [Use of Bismuth Subnitrate for radiography of gas- tro-intestinal tract has produced fatal poisoning. Symptoms indicative of nitrates. Prostration, cya- nosis, convulsions or coma may occur. Treatment: wash out stomach, employ artificial respiration, oxygen, stimulants, catharsis, etc.] BROMIDES. SYMPTOMS: Nervous system greatly depressed; force and fre- quency of heart beat much lessened; reduction in temperature, and in number of respirations; muscular weakness, semi-somnolent state or maniacal excite- ment. (Bromides are eliminated by kidneys,skin,saliva,bron- chial and intestinal mucous membranes, and in milk.) I. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. Lf stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to 10 minutes until it acts), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effec- TREATMENT: BROMINE. 107 five), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomor- phine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm water to encourage vomiting. 2. Give Opium (Powdered Opium in 1 to 2 grain doses every 1 to 3 hours), or Morphine Sulphate (in grain doses every 1 to 3 hours by mouth or hypodermically) to combat mental symptoms. . 3- Support and stimulate. Give Caffein Citrate (in 1 to 5 grain doses every to 2 hours) to com- bat depression. Administer Tincture of Digi- talis (in 10 to 20 drop doses every 1 to 3 hours) to sustain and regulate the heart. Fluid Extract of Ergot (in 15 minim doses every 1 to 3 hours), or Atropine Sulphate (1/120 to 1/60 grain hypodermically every ^2 to 2 hours) or Tincture of Belladonna (in 10 to 20 drop doses) to stimulate heart, etc. Brandy or Whisky (in teaspoonful doses by mouth or % teaspoonful hypodermically every % to 1 hour) may be given with the Opium, as a nervous stimulant. BROMINE. HISTORY: An ounce on an empty stomach caused death in 7 hours. SYMPTOMS: Inhaled, its vapor greatly irritates the respi- ratory mucous membrane and the eyes, causing distressing cough, hoarseness, and dyspnoea. Swallowed, its action is that of an active cor- rosive poison. It causes violent gastritis, rapid prostration, great anxiety, rapid pulse, trembling of hands, collapse. 108 A MANUAL OF TOXICOLOGY. TREATMENT: When Inhaled, provide fresh air; give inhala- tions of Ammonia or steam; stimulate by Aromatic Spirit of Ammonia (J4 teaspoonful in water; also by Atropine as in Chlorine (q. v,). Give Caffein Ci- trate (in i to 5 grain doses every to 2 hours). Irri- tation to bronchi relieved by chloroform inhalations. I. When Swallowed, evacuate the stomach: Give starch water to form Starch-Brom. Then re- peatedly syphon out the stomach with a stomach- tube, or produce vomiting by Apomorphine Hydro- chlorate (hypodermically in 1/10 grain doses.) Give Magnesia freely, or Potassium or Sodium Carbonate, or Bicarbonate (a teaspoonful in a wineglassful of water.) 2. Counteract depression by giving a cupful of strong coffee, or Caffein Citrate (1 to 5 grain doses every % to 2 hours.) 3. Give demulcents (such as white of egg, milk, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas) to soothe and protect the irritated or in- flamed surfaces. (A 1 to 2 per cent, solution of Carbolic Acid relieves irritant effects on skin. (See Strychnine.) BRUCINE. BRYONIA. (See Aloes.) CAFFEINE. Recovery after 200 grains. HISTORY: SYMPTOMS: Burning pain in throat; giddiness; faintness; nausea; numbness; pain in abdomen ; dry tongue; great thirst; trembling of extremities;'free diu- resis; cold skin; weak pulse; collapse. CAFFEINE. 109 TREATMENT: I. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to 10 minutes until it acts), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effec- tive), or Ipecacuanha (Powdered Ipecacuanha 30 grains, or Syrup of Ipecac a teaspoonful every 10 to 15 minutes until vomiting results), or Apomor- phine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm Water to encourage vomiting. 2. Stimulate heart, circulation, and respiration, With Brandy or Whisky (in 2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hy- podermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every J4 to 2 hours), or Tincture of Belladonna (20 drops in water every to 2 hours). Morphine Sulphate hypodermically (in X grain doses every X to 2 hours) often helps. Digitalin (1/100 grain hypodermically every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every to 1 hour if necessary) may also be found useful. Resort to faradization or galvaniza- tion of respiratory muscles if required., 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates or stove-lids heated. 110 A MANUAL OF TOXICOLOGY. applied to the feet and sides of the body) to main- tain bodily temperature. CALABAR BEAN (PHYSOSTIGMA, THE WESTERN AFRICA ORDEAL BEAN) - PHYSOSTIGMINE (ESERINE). HISTORY: Poisoning occurs from beans eaten by children. The bean is used in decoction by the natives of the west coast of Africa as the ordeal test for witch- craft. They believe the innocent will vomit it, the guilty retain it and die. Fatal dose: Six beans caused death in boy of 6 years. The fatal dose of Physostigmine is consid- erably less than 3 grains. Death results from respiratory paralysis. SYMPTOMS: Effects are opposite to those produced by Strych- nine. Tumultuous heart action; complete muscular re- laxation and tremors; giddiness; contracted pupils; respiration irregular and slow; reflexes lost; may be vomiting and purging. I. Evacuate the stomach with stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to 10 minutes until it acts), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or, best of all the emetics, Apo- morphine Hydrochlorate, hypodermically (1/10 TREATMENT: CAMPHOR.-CAMPHORATED OIL. 111 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke- Warm water to encourage vomiting. Potassium Permanganate (10 grains in 1 pint of Water) introduced into stomach by stomach-tube and repeated in half an hour has been highly recommended. Give Tannic Acid (30 grains in cupful of Water) or draughts of strong tea. Give Spirit of Nitrous Ether (1 teaspoonful, repeated every y2 to 2 hours). If urine is suppressed, use Catheter. 2. Atropine is the best physiological antidote (antagonist). Give Atropine Sulphate (1/120 to 1/60 grain hypodermically every y to 2 hours for 4 doses, or until the pulse is quickened, or until the pupils dilate), or Tincture of Belladonna (10 to 20 drops in water by mouth or rectum every % to 2 hours, as preceding). If this treatment is ineffec- tive, give Chloral (in 10 grain doses every % to 1 hour in syrup and water by mouth, or. in water by Rectum). Give Strychnine Nitrate, hypodermic- ally (1/60 to 1/20 grain every y2 to 2 hours), or Tincture of Nux Vomica (10 to 20 drops). 3. Stimulate: Give Brandy or Whisky (in tea- spoonful doses every 15 to 30 minutes), or Alcohol (% teaspoonful in tablespoonful of water every T5 to 30 minutes). Coffee may be beneficial. 4. Artificial Respiration.-If respiration becomes labored, raise patient's stretched out arms, ryth- mically, from sides of body to up over head, and hack to sides again, 20 times a minute, with tongue hept forward. CALCIUM. (See Lime, also Alkalies). CAMPHOR.-CAMPHORATED OIL- SPIRIT OF CAMPHOR. A popular household remedy, occasionally taken by mistake. May cause very severe symptoms but HISTORY: 112 A MANUAL OF TOXICOLOGY. rarely fatal. (Spirit of Camphor is i to io; Cam- phorated Oil i to 5 in strength.) Fatal dose: 20 grains or more. Recovery after 200 grains. Dangerous symptoms from 20 grains and from 15 minims of the strong solution. Death by asphyxia. SYMPTOMS: Camphor odor; languor; giddiness;, clammy skin; headache; smarting in urinary organs; pulse' quick and weak; delirium; convulsions; collapse. No purging, vomiting or pain, unless dose very large, when may be burning pain along esophagus and at pit of stomach, and vomiting. TREATMENT: i. Give water to precipitate the Camphor, if in- alcoholic solution. If in oil, alcohol, then water. 2. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 21 tablespoonfuls of water every 10 to 15 minutes until it acts), or Mustard (a tablespoonful in a< small cupful of water, repeated in 15 minutes if not effective), or Syrup of Ipecac (a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effec- tive). After giving emetic always give plenty of luke-warm water to encourage vomiting. After emptying stomach give saline purgatives freely.-Some authorities favor giving Castor Oil and Alcohol or Brandy by mouth; others consider these aid in the solution and absorption of the Cam- phor. If give Alcohol or Brandy, it is better to give it hypodermically. 3. Allow patient to inhale Ether to check in, dination to convulsions. Relieve cramps with CANNABIS, AMERICAN. 113 alternate hot and cold douches. May give Aco- nite (Tincture of Aconite, 1 drop every 1 to 2 hours), Potassium Bromide (in 10 grain doses every % to 1 hour), or Opium (Powdered Opium 1 or 2 grains every to 2 hours), or Laudanum (20 drops in water every *4 to 2 hours) or Chloral to re- lieve the convulsions. Coffee by mouth or rectum. 4. Employ artificial heat (such as hot water bot- tles, or ordinary bottles containing hot water, or bags °f salt, bricks, plates or stove-lids, heated, applied to feet and sides of body) to maintain bodily tempera- ture. Artificial respiration if required. CANNABIS, AMERICAN (CANNABIS AMERI- CANA, AMERICAN HEMP)-CANNABIS, INDIAN (CANNABIS INDICA, INDIAN HEMP) - HASCHISCH - GUNJAH OR GANGA OR GANZA - CHURRUS OR CHARAS-BHANG OR SIDDHI. SYMPTOMS: Sense of exhilaration; pleasurable intoxication; peculiar prolongation of time; sense of double con- sciousness followed by drowsiness; anesthesia; loss of power, particularly of lower extremities; pupils dilated; pulse rapid; respiration slow; may cause increased sexual desire; catalepsy; some- times convulsions. TREATMENT: Caustic Alkalies are incompatible. i. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoon- fuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipe- 114 A MANUAL OF TOXICOLOGY. cacuanha, 30 grains; or Syrup of Ipecac, a tea- spoonful every 10 to 15 minutes until vomiting re- sults), or Apomorphine Hydrochlorate, hypo- dermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm water to encourage vomiting. Give strong tea freely; or Tannic Acid, or Gallic Acid (30 grs. in % wineglassful water). Apply heat. Give Sweet Spirit of Niter (in teaspoonful doses every % to 1 hour) to encourage excretion by kid- neys. Give orange or lemon-juice to neutralize poison. 2. Stimulate : give draughts of strong coffee, or Caffein Citrate (in 2 or 3 grain doses every 1 to 3 hours), Atropine Sulphate (in 1/120 grain doses hypodermically every 1 to 3 hours), or Tincture of Belladonna (10 to 15 drops every 15 minutes, for 2 or 3 doses) as antagonists; Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled) to stimulate circulation. If respiration. is embar- rassed, resort to artificial respiration. May apply electricity to the chest muscles. Draw urine. CANTHARIDES (SPANISH FLIES) - CAN THARIDIN. (See p. 238.) HISTORY: The powder has been taken for jalap and for pepper. Also taken to produce abortion. Fatal dose: 24 grains of the powder, 1 ounce of the Tincture. Recovery from 2 drachms also an ounce of the powder, and from 6 drachms also an ounce of the Tincture. Fatal period usually from 24 to 36 hours. Death by paralysis of respiratory centres. A violent gastro-enteritis, with abdominal tenderness; burning sensation in pharynx and eso- phagus; sense of constriction of throat; burning nain in back, bladder, and urethra; frequently SYMPTOMS: CANTHARIDES. 115 great thirst; vomiting, the vomit containing shin- mg particles of the powder; constant desire to pass Water, but only blood or albuminous urine passed each time; priapism; sometimes sloughing of the genital organs; strangury; abortion; sometimes violent delirium and tetanic convulsions; coma. TREATMENT: There is no known chemical antidote. i. Evacuate the stomach: cautiously syphon out stomach with stomach-tube, using plenty of water. If stomach-tube not at hand, use emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of Water, repeated in 15 minutes if vomiting is not pro- duced), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effec- ^ve), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 1° J5 minutes until vomiting results), or Apomor- Phine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm ^ater to encourage vomiting. 2. Give demulcents (such as white of an egg, barley, elm, flaxseed tea, or gruel). Avoid oils or any oily emulsion, as Cantharidin is soluble in such. 3- Give Opium (Powdered Opium, 1 to 2 grains every ^4 to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or J4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (X grain by mouth, or hypodermically every % to 2 hours) to relieve pain and irritation. 4- Stimulate heart, circulation, and respiration With Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypo- dermically as frequently), or with Aromatic Spirit Ammonia (a teaspoonful in a little water every to to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate 116 A MANUAL OF TOXICOLOGY. (1/60 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hypodermic- ally every ^2 to 2 hours), or Tincture of Belladonna (20 drops every V2 to 2 hours), or Tincture of Digi- talis (15 to 30 drops by mouth, or half as much hypodermically every to 2 hours), or Digitalin (1/100 grain hypodermically every *4 to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour) and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary) may be used for the same purposes. Draughts of strong coffee may also be given. Finally, give alkaline diuretics. 5. Employ artificial heat (either hot water bottles, ordinary bottles of hot water, bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body) to maintain bodily temperature. Poultices to abdomen; anesthetics for convulsions. Wash out bladder with warm water for severe irri- tation of it. CARBON MONOXIDE (CARBONIC OXIDE) -CHARCOAL FUMES-ETC. HISTORY: A combustible, colorless, transparent, odorless, tasteless, very poisonous gas. Burns readily in air with blue flame. When cast-iron plates are red hot it readily diffuses through them; thus the gas may pass into air of a room heated by a stove. Open charcoal or stove coal fires, defective stove-pipes or furnace flues and escaping illuminating gas are among its sources. It also collects in mines, pits, wells, etc. This gas enters the blood, combining with the hemoglobin of the red corpuscles and displacing the oxygen. After the blood has been saturated with this gas recovery is almost impossible. The blood of those poisoned by this gas is of a persistent fluidity and bright, cherry red. Air containing i< per cent, of this gas will kill a dog in a minute and CARBON MONOXIDE. 117 a half. The gas is a narcotic poison. When pa- tient has been exposed to gas over 8 hours and coma exists, the chances of recovery are slight. If opposite exists, may expect recovery. Other things being equal, the chances of recovery or permanence of injury is in proportion to the length of time the blood has been exposed to the gas and the- degree of saturation with the gas. Carbon monoxide is chief constituent of coal gas and poisoning by latter mainly due to it. But suffo- cation by coal gas not to be confused with poisonous effects of coal gas. " Water gas " contains about 30^ Carbon monoxide. In Poisoning:- Dizziness; severe headache; weakness; may be nausea, vomiting and convulsions; face, as a rule, livid; pupils dilated. When the poisoning is very slow, the symptoms are languor, debility, anorexia, headache, and maybe a dry cough. Symptoms re- semble those of malaria. In Suffocation:- Symptoms are choking; gasping; suffused eyes; congested face; collapse. SYMPTOMS: TREATMENT: I. Promptly provide plenty of fresh air. Make cold wet applications to the head and neck. Employ artificial respiration if necessary (by rhythmically raising and lowering arms from ex- tended at sides to up over head and back again, 18 or 20 times per minute). 2. Give Oxygen, also Ammonia inhalations. 3. Douche face and chest with hot and cold water, alternated. Apply heat to the feet and body. 4. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth, or % teaspoonful hypodermically every 10 to 15 minutes), or with Aromatic Spirit of Am- monia (a teaspoonful in a little water every 10 to 15 118 A MANUAL OF TOXICOLOGY. minutes, or % teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours), and Atropine Sulphate (1/120 to 1/60 grain hypoderm- ically every Jd to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypo- dermically, every to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every *4 to 1 hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may also be em- ployed for the same purposes. Draughts of strong coffee or rectal injections of coffee may be given. Give lime water, milk or flour mixed in water. May advantageously give Camphor (2 grains dis- solved in Almond Oil), every 2 to 4 hrs., as required, or Camphorated Oil M.xv hypodermically. Nutrients. 5. Transfusion of blood has been recommended; also rectal, intravenous or intracellular injection of Saline Solution (sterilized normal salt solution=i39 grains of pure table salt in 34 ounces (a liter) of boiling water, a 9/10% solution; about 1 level tea- spoonful of salt in 1 quart of boiling water). In- ject 1 to 3 pts. at no° F., into rectum, flank, back, arm or abdomen (see p. 57). Injections of a solution of Sodium Hypochlorite, of the specific gravity of the blood (about 1060), has been recommended. CASTOR OIL BEANS. HISTORY: The activity of the plant is supposed to be due to Ricin, a poisonous toxalbumin from the seed of the castor oil plant. Ricinin is a crystallizable alka- loid from the plant. Fatal dose : 3 seeds were fatal to an adult male in 46 hours; 20 seeds killed an adult female in f days. Recovery from 30 seeds. Abdominal pain; cramps; prostration; vomiting; intense thirst; severe griping, purging, and tenes- mus; collapse. SYMPTOMS: CHLORAL. 119 TREATMENT: i. Evacuate the stomach: siphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoon- fuls of water, repeated in 15 minutes if vomiting is not produced) ; or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains, or Syrup of Ipecac, a teaspoonful every 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective). After giv- ing emetic, always give plenty of luke-warm water to encourage vomiting. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch Water, oatmeal gruel, gelatin, flour and water, or even crushed bananas) to soothe and protect the irritated and inflamed surfaces. 3. Employ artificial heat (such as hot water bottles, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body) to maintain bodily temperature. 4. Give Opium (Powdered Opium, 1 to 2 grains every to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every ^4 to 2 hours), to relieve pain, griping, and tenesmus. CHLORAL- CH LOR AL AM ID-ETC. HISTORY: Quite frequently injudiciously used by the public to quiet nerves and induce sleep. Is sometimes used for suicidal purposes. In frequent doses it may accumulate and kill by paralyzing the heart. A dose should very rarely exceed 20 grains and should not be repeated as often as hourly more than 3 times. It appears to be a cumulative noi- 120 A MANUAL OF TOXICOLOGY. son. 10 grains have caused alarming symptoms, 20 and 30 grains have each caused death; even 460 grains has been recovered from, and probably most persons would recover from any dose under 2 drachms if proper treatment given. 3 grains killed a child, a year old, in 10 hours. In some persons large doses temporarily suspend some of the mental facul-t ties without producing apparent unconsciousness. Children bear Chloral proportionately better than ' adults. Old persons, and particularly those with . weak hearts or inclined to apoplexy, are easily af- fected. Death in 1/6 to 40 hrs. Knock-out-drops often consists of a strong solution of Chloral. Loss of muscular power, followed by sleep and coma; respiration slow, shallow, feeble, labored;' pulse weak, first slow, then rapid and thready; face white, livid, covered with cold sweat; pupils con- tracted during sleep, dilated upon awakening; body- temperature greatly reduced. Maybe delirium ;Coma. SYMPTOMS ; Put in horizontal position and elevate feet. i. Evacuate the stomach : syphon out the stom- ach with a stomach-tube; or give Mustard (a table-, spoonful in a small cupful of water, repeated in 15 minutes if not effective), or Zinc Sulphate (in 20 grain doses every 10 to 15 minutes), or Apomor- phine Hydrochlorate, hypodermically (in 1/10 grain doses every 10 to 15 minutes, until vomiting results), or Ipecacuanha (Powdered Ipecacuanha, 30 grains^ or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes, until vomiting is produced). After giving an emetic, always give plenty of luke-warm water to , encourage vomiting. Liquor Potassae (2 teaspoonfuls in a cupful of, water is said to decompose 20 grains of Chloral in the^ blood); drachms y2 to 2 should be given hourly as rer quired. 2. Stimulate : give draughts of strong coffee by* mouth, or introduce 1 pt. into rectum through tube \ TREATMENT : CHLORINE. 121 give Citrate Caft'ein (in 5 to io grain doses every % to 3 hours). Give Strychnine Sulphate, hypo- dermically (in 1/60 grain doses every to 2 hours); or give Picrotoxin (in 1/100 to 1/50 grain doses, repeated every % to 2 hours to stimulate respiration. Also encourage heart action with in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief, using one every % to 1 hour if necessary), and Brandy or Whisky, hypo- dermically (% teaspoonful every 10 to 15 minutes). Keep patient awake, overcoming stupor by shaking, shouting, flagellation, or by shocks of electricity. Give inhalations of oxygen. May use Adrenalin. 3- Employ artificial heat (such as hot water bot- tles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, ap- plied to the feet and sides of body) to maintain bodily temperature. This is very important. Apply cold to head, and Ammonia to nostrils and hypodermically. Resort to artificial respiration, upon respiration becoming more labored. CHERRY, "Black" or "Wild:" Leaves, fruit and Kuit-seeds poison. Cause depression, convulsions. Evacuate and stimulate as in Acid Hydrocyanic (q-v.). CHLORINE - CHLORINATED LIME - JA- VELLE WATER - LABARRAQUE'S (or CHLORINATED SODA) SOLUTION. SYMPTOMS: Chlorine inhaled causes extreme laryngeal irrita- tion and may even cause cedema, resulting in asphyxia. Black eschars on tongue and pharynx may be produced. Usually cough, a sense of tight- ness across the chest, and inability to swallow. If a poisonous dose of these substances be swal- lowed, a sense of heat and burning results, and per- forations of the esophagus and stomach may be produced. 122 A MANUAL OF TOXICOLOGY. TREATMENT: When Chlorine vapor has been inhaled, the pa- tient should inhale Ammonia vapor to form Am- monium Chloride. Provide fresh air, artificial respi- ration, inhalations of steam, Ether or Chloroform. When Chlorine preparations have been taken into the stomach, albumin is the proper antidote. i. Evacuate the stomach. When Chlorine prepa- rations have been swallowed, the stomach should be gently washed out by means of a stomach-tube, or use an emetic, such as Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 min- utes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated;, in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes untiH, vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 min- utes until effective). After giving emetic, always give plenty of luke-warm water to encourage vonr iting. 2. Give Ammonia Water (% teaspoonful in £ wineglassful of water, repeated in 10 to 30 min- utes), or give Aromatic Spirit of Ammonia (in tea- spoonful doses, in a wineglassful of water, every' 10 to 15 minutes). 3. May also stimulate heart, circulation, and res- piration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonfiw doses hypodermically as frequently), also with Strychnine Sulphate (1/60 grain hypodermically every % to 2 hours) and Atropine Sulphate (i/i20j grain hypodermically every V2 to 2 hours), or Tinc- ture of Belladonna (20 drops every y2 to 2 hours)- Tincture of Digitalis (15 to 30 drops by mouth, of half as much hypodermically every y2 to 2 hours> or Digitalin (1/100 grain hypodermically ever) % to 1 hour), or Caffein Citrate (1 to 4 grains ever). y to 1 hour), and inhalations of Amyl Nitrite y CHLORODYNE. 123 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every to 1 hour if necessary) niay be used for the same purposes. Draughts of strong coffee may also be given. Give lime water, milk, or flour mixed in water. Artificial respiration. 4. Give raw white of egg as the antidote. May give other demulcents (such as flaxseed or elm tea, barley or starch water, oil, gum arabic, oatmeal gruel, gelatin, or even crushed bananas), to soothe and protect the irritated or inflamed surfaces. Give Sodium Thiosulphate (20 grains in % wine- glassful of water). 5- Give Opium (Powdered Opium, 1 to 2 grains every 14 to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or *4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (X grain by mouth or hypodermically every to 2 hours), to relieve pain and restlessness. CHLORODYNE. HISTORY: Irritant narcotic compound of Opium; probably Morphine Muriate, Chloroform, rectified Ether, Prussic Acid, Oil of Peppermint, Gum Acacia and Molasses. Patal dose: an ounce has caused death. Treatment as in Opium or Prussic Acid poisoning. CHLOROFORM. (See Anesthetics.) CHOKE DAMP. (See Acid Carbonic.) CHROMATE-BICHROMATE. CICUTA VIROSA - CICUTA MACULATA (WATER HEMLOCK) - CICUTOXIN - WATER PARSNIP-ETC. (See Acid Chromic.) Nausea, vomiting, pain, nervous symptoms, con- vulsions, collapse, coma. (Treat as in Conium. P. 130.) COAL GAS. (See Illuminating Gas.) 124 A MANUAL OF TOXICOLOGY. COCAINE-EUCAINE. Cocaine has a twofold action-it acts upon the central and upon the peripheral nervous system. In small doses it excites the spinal cord and brain: in large ones it may produce convulsions and then paralysis. The peripheral action is manifested by the numbing of sensation. Fatal dose: death rare; io grains or less in- ternally has caused death; 22 grains by mouth caused death within an hour; 7/10 of a grain killed a child; 23 grains, also 32 grains, have been recov- ered from. Death from 1% gr. hypodermically also recovery from 14 grs.; 1/20 gr. hypoderm, caused1 dangerous symptoms in girl 12 years old; 4^ grains swallowed have produced very alarming symptoms. A solution applied to the eye or mucous membrane may produce suddenly serious symptoms; 7 or 8 minims of a 4 per cent, solution, in eye, have pro- duced spasm and unconsciousness; 20 to 30 drops of a 4 per cent, solution applied to the teeth and gums have produced serious symptoms. Taken subcutaneously or applied to the mucous membrane' Cocaine acts very rapidly. Death has occurred in 40 seconds and has been delayed also to 4 minutes. Recovery is quite certain after 30 minutes. Death usually occurs from apnoea or heart failure. HISTORY: The symptoms vary. As a rule, great nervous^ excitement, sense of oppression and fulness in head sometimes associated with nausea and vomiting. Id beginning pulse and respiration may be more rapid but later they may be quite slow, and the breathing labored. The face may be cyanotic. The pupils are dilated and extremities cold. In fatal cases there is labored breathing, feeble, perhaps imperceptibly pulse, convulsions, coma and death. There may be early delirium and unconsciousness or almost nd symptoms except those of asphyxia. SYMPTOMS: COCAINE. 125 TREATMENT: Fresh air. Put patient in horizontal position. Artificial respiration at once, if necessary. Employ stimulants and electricity. Employ the following treatment as far as possible and required: If Cocaine was introduced hypodermically, give stimulants of hot Brandy or Whisky (2 to 4 tea- spoonfuls in water by mouth every 5 to 10 minutes, or more by rectum, or 15 to 30 minims hypodermi- cally every 5 to 10 minutes). Also give inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled). Ammonia inhalations, or Aromatic Spirit of Ammonia (1 teaspoonful in water by mouth, or teaspoonful hypodermically every den minutes), or Ether in 15 minim doses hypoder- ^ically, or more by rectum, often help; also Strych- nine Sulphate (1/60 grain hypodermically), and Atropine Sulphate (1/120 to 1/60 grain hypodermi- Cally), or Tincture of Belladonna (20 drops). Nitro- glycerine (hypodermically in 1/100 grain doses every X to 2 hours) has been highly recommended. Chloro- f°rm or Chloral may be required for convulsions. Morphine Sulphate (in to M grain doses) often is beneficial. f. If the Cocaine was swallowed, evacuate the Stomach if possible : syphon out the stomach with a stomach-tube, using plenty of water. If a stomach- tube is not at hand, use an emetic, such as Zinc Sul- phate (20 grains in 2 tablespoonfuls of water), or Mustard (a tablespoonful in a small cupful of water), °r Ipecacuanha (Powdered Ipecacuanha, 30 grains; br Syrup of Ipecac, a teaspoonful), or Apomorphine Mydrochlorate, hypodermically (1/10 grain). After giving an emetic, always give plenty of luke-warm Xvater, to encourage vomiting. Give Tannic Acid Or Gallic Acid (30 grains in M cupful of water). ■Again in 10 minutes wash out the stomach or empty A with an emetic. If the Tannic Acid is not at hand, give plenty of strong tea or decoction of oak bark (1 ounce to a small cupful of hot water); or 126 A MANUAL OF TOXICOLOGY. may give Iodine (i grain) and Potassium Iodide (io grains) in % wineglassful of water. Then use stomach-tube or emetic again. Give inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour, if necessary) to support heart. 2. Stimulate heart, circulation, and respiration with Ammonia inhalations and with Brandy or Whisky (2 teaspoonful doses every 5 to 15 minutes, or X teaspoonful doses hypodermically as fre- quently), or with Aromatic Spirit of Ammonia (a tea- spoonful in a little water every 5 to 15 minutes, or % teaspoonful hypodermically as frequently), and Atropine Sulphate (1/120 grain hypodermically), or Tincture of Belladonna (20 drops). To relieve impending collapse or paralysis of respiration, give Strychnine Sulphate (1/60 grain hypodermically every X to 2 hours), or Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically), or Digi- talin (1/100 grain hypodermically); the Strychnine may help the cerebral blood-vessels. Caffeine. 3. Apply artificial heat to heart and body. Apply sinapisms over heart, stomach and calves. Resort to friction of the extremities. Oxygen inhalations for inclination to asphyxia. 4. Artificial respiration if required (rhythmically raising and lowering extended arms from sides to overhead, 18 times a minute). Faradization or gal- vanization of respiratory muscles may be required. 5. Give opium, if necessary. To relieve nervous excitement or delirium, when present, give Mor- phine Sulphate, hypodermically (in X to X grain doses every X to 2 hours), or Laudanum (20 drops every X to 2 hours by mouth, or X teaspoonful in gruel by rectum as frequently). 6. Chloroform inhalations, or Chloral (in 40 to 60 grain doses) may be required to relieve the convul- sions. Nitroglycerine, hypodermically (in 1/100 grain doses) has been recommended. 7. Employ cathartic, enema, or both. COCCULUS INDICUS. 127 'OCCULUS INDICUS (LEVANT NUT, IN- DIAN BERRY, FISH BERRIES) - PICROTOXIN. HISTORY: Picrotoxin is used as a fish poison, as a bird poison, a medicine, sometimes as a "knock-out" drops, and sometimes to adulterate beer. Beer extract con- .aining Picrotoxin is fatal to flies. Picrotoxin poison- lng produces an extraordinary swelling of the ab- domen in frogs, which Strychnine does not. Nausea; vomiting; muscular weakness; drowsi- ness; sometimes convulsions; may be scarlet-fever- pke rash ; pain ; salivation ; diarrhoea ; coma. Fatal dose: 2 to 3 grains of Picrotoxin is consid- Tfed to be a dangerous dose. Death from paraly- se of heart in diastole. SYMPTOMS: .Treat as in poisoning by Strychnine (q. v.), and give Paraldehyde. TREATMENT: CODEINE. (See Opium). COLCHICUM (MEADOW SAFFRON, AU- TUMN CROCUS) - COLCHICINE. HISTORY: r All parts of the plant are poisonous. The wine kas been taken by mistake for sherry and other ■'wines. Fatal dose: 45 grains of dried bulb; a tablespoon- Ad of the seeds; of the Wine 3)4 drachms, and an ,°unce of the Tincture. 1% ounces has caused ' death; an ounce has been recovered from. The fatal dose of the alkaloid is less than J4 grain, faeath from paralysis of respiratory centres. Death Usually occurs within 24 hours; it has occurred in y hours, and has been delayed for several days. 128 A MANUAL OF TOXICOLOGY. SYMPTOMS: Burning pain in throat, esophagus, and stomach; great thirst; soreness; vomiting; violent purging; griping; intense abdominal pain ; urine suppressed; face pinched; pupils dilated; profuse salivation; pulse rapid, then slow; great weakness; skin cold, pale, and covered with sweat; frequent spasms; sometimes muscular pains and convulsions; con- • sciousness present until the last; collapse. TREATMENT: There is no altogether satisfactory known anti- dote. i. Evacuate the stomach: syphon out the stom- ach with stomach-tube, or, if vomiting has not oc- curred, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, re- peated in 15 minutes if not effective), or Ipe- cacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective. After giving emetic, always give plenty of luke-warm water to encourage vomiting. Give Tannic Acid (in 30 grain doses) or Gallic Acid (in 30 grain doses, in J4 wine- glassful of water), or a decoction of oak bark, or; strong tea. Irrigate colon with Tannic Acid water.'i 2. Give water freely, and administer demulcents^ (such as white of egg, milk, oil, gum arabic, elm or flaxseed tea, barley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and protect the irritated or inflamed sur- faces, particularly in later stages. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water? or bags of salt, bricks, plates, or stove-lids, heated/ CONIUM. 129 applied to the feet and sides of the body) to main- tain bodily temperature. 4. Give Opium (Powdered Opium, 1 to 2 grains every C2 to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or JT teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (/4 grain by mouth or hypodermically every y2 to 2 hours), to relieve pain and nervous irritability. 5- Stimulate heart, circulation, and respiration With Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hy- podermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or y teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 grain hy- podermically every y2 to 2 hours), or Tincture of ■belladonna (20 drops every y2 to 2 hours). Tinc- ture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically every y2 to 2 hours), or ^igitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every y to 1 hour if necessary), ruay be used for the same purposes. Draughts of strong coffee may also be given. Apply hot fo- ruentations to the abdomen. Finally, give a dose °f Castor Oil (1 to 2 tablespoonfuls). CONIUM MACULATUM ("Poison" or "Wild" Hemlock; Poison Root)-CONIIN-CICUTA MACULATA ("Spotted" or "Water" Hemlock; Cow Bane)-CICUTA VIROSA-CICUTIN. HISTORY: The bruised leaves of the Wild Hemlock have a ^ousy odor and nauseating taste. The poison is in the seeds, and when flowering (in July and August) also in the parsley-like leaves, which have been mis- 130 A MANUAL OF TOXICOLOGY taken for parsley and eaten in salad and soup. Serious results from 1/5 grain of Coniin. The poison of Water Hemlock is found chiefly in the roots. Fatal dose of Coniine is about 2s/10 grains. One drop may cause bad symptoms. Death in hrs. Giddiness; staggering gait; gradual loss of all voluntary power; pupils dilated and fixed; paralytic drooping of eyelids; loss of sight; inability to swal- low; nausea; maybe vomiting; frontal headache; pulse slow, then increased ; sometimes salivation and sweating. Asphyxia from paralysis of respiratory muscles. Paralysis ascends from feet. Is conscious. SYMPTOMS: Keep head low. i. Evacuate the stomach* syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effec-' tive), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effecj tive). After giving emetic, always give plenty o^. luke-warm water to encourage vomiting. Give Tannic Acid or Gallic Acid (30 grains in % wine-* glassful of water, repeated in 10 to 20 minutes, if required). If these are not at hand, may give' draughts of strong tea, or a decoction of oak bark: or give Iodine (1 grain) and Potassium Iodide (id grains) in a wineglassful of water. Then agaiv wash out the stomach, or cause vomiting. 2. Give demulcents (such as white of egg, milk oil, gum arabic, flaxseed or elm tea, barley or stare! water, oatmeal gruel, gelatin, flour and water, or TREATMENT: CONVALLARIA. 131 even crushed bananas), to soothe and protect the irritated and inflam ed surfaces. Then give Castor Oil (a tablespoonful). 3- Stimulate heart, circulation, and respiration With Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or J4 teaspoonful doses hy - podermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every to 2 hours). May give Picrotoxin hypodermically (1/60 to 1/40 grain dissolved in water. Tincture of digitalis (15 to 30 drops by mouth, or half as much hypodermically every % to 2 hours), or Digitalin 1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using °ne every % to 1 hour if necessary) may be used lor the same purposes. 4- Employ artificial heat (such as hot wate! hotties, or ordinary bottles containing hot water, Or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body) to main- tain bodily temperature. Employ friction. If breathing becomes labored, resort to arti- ficial respiration (rhythmically raise arms from side to up over head and back again, 20 times per minute). If convulsions, give Chloroform cautiously. CONVALLARIA (LILY OF THE VALLEY). HISTORY: The common preparations-the extract and fluid extract-contain the two active principles Con- vallarin and Convallamarin. The former is a pur- gative, while the latter is a heart poison, quite sim- har in action to Digitalin. Symptoms and treatment similar to Digitalis (q. v.). 132 A MANUAL OF TOXICOLOGY. COPPER AND ITS COMPOUNDS: COPPER SULPHATE (BLUE STONE, BLUE VIT- RIOL)-VERDIGRIS (COPPER SUBACE- TATE) - ETC. HISTORY: Copper is taken by accident or for the purpose of abortion, suicide, or murder. Commonest cause of poisoning is the use of copper vessels in cook- ing. Chronic poisoning may result from using copper to give a green color to pickles, preserved peas, and sweets; the use of green wrappers for foods; copper used in the manufacture of artificial flowers; the keeping of drugs in copper vessels; from working in copper or bronze, etc. Fatal dose: death from an ounce of Copper Sul- phate; and also a recovery. Death from also one ounce of Verdigris. Death in 4 hrs. to several days. Copperish or metallic taste in mouth; griping and colicky pains; gastro-enteritis; nausea; bluish liquid vomit; purging with straining, stools con- sisting first of intestinal contents, then mucous or blood; intense salivation and bronchial secretion; incessant expectoration; jaundice; thirst; respira- tion hurried; anesthesia; delirium; epileptiform convulsions; pulse small, rapid; urine diminished, or suppressed, sometimes black; sometimes syn- cope ; coma. SYMPTOMS: TREATMENT: Avoid Vinegar, and Oils. i. Give the chemical antidote, Potassium Ferro- cyanide (Yellow Prussiate of Potash, in 5 to 15 grain doses in water) ; or give albumin and milk, mixed with sugar; or Magnesia. If eggs are not at hand, give a thin paste of flour and water; then 2. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as COPPER AND ITS COMPOUNDS. 133 Zinc Sulphate (20 grains in 2 tablespoonfuls of Water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effec- twe), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 15 minutes until vomiting results), or Apomor- Phine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving an emetic, always give repeatedly plenty of luke-warm water to encourage vomiting and to Wash out the stomach. Follow with cathartic. 3- Give demulcents (egg and milk mixed and sweetened well with sugar is preferable and indi- cated; or give barley, elm or flaxseed tea, gum arabic, starch or flour water) to soothe and protect the irritated and inflamed surfaces. 4- Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, Or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body) to main- tain bodily temperature. 5- Give Opium (Powd. Opium, 1-2 gr. every ^2 to 2 hours; or Laudanum, 20 drops every ^2 to 2 hours by mouth, or teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (j4 grain by mouth or hypodermically every to 2 hours), to relieve pain and nervous irritability. If the breath- mg becomes much labored, employ artificial respi- ration. 6. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every to to 15 minutes, or % teaspoonful doses hypo- dermically as frequently), or with Aromatic Spirit °f Ammonia (a teaspoonful in a little water every to to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 grain hypo- dermically every % to 2 hours), or Tincture of 134 A MANUAL OF TOXICOLOGY. Belladonna (20 drops every to 2 hours). Tinc- ture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically every % to 2 hours), or Digitalin 1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % t° 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee are good. 7. Saturate the system with Potassium Iodide (in 3 to 10 grain doses in water). CORN COCKLE (Crown of the Field). Poisoning from inferior wheat flour containing cockle seeds. It causes vomiting, disturbed vision, dyspnea, diarrhoea, debility, sometimes death. Evacuate and stimulate as in Laburnum (q.v.). CROTON OIL (CROTON TIGLIUM). The oil and also the liniment have each been taken for Castor Oil by mistake. Fatal dose: 20 drops of the Oil. Half a drachm has been recovered from. Death in 4 to 12 hours. HISTORY: Severe abdominal pain; vomiting; purging; fluid stools; pulse small and thready; skin moist; face pinched; prostration ; collapse; death. SYMPTOMS: 3 TREATMENT: i. Evacuate the stomach: If abdominal pain is slight, syphon out the stomach with a stomach-tube, using much water, with % pint milk or Olive Oil, and i or 2 eggs, or may use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water), or Mustard (a tablespoonful in a small cupful of water) ; or Ipecacuanha (Pulverized Ipecacuanha, CROTON OIL. 135 3° grains) or Syrup of Ipecac (a teaspoonful) ; the emetic may be given every io to 15 minutes until vomiting results. If abdominal pain is severe, give Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving an emetic, give plenty of lukewarm water to encourage vomiting. 2- Gum Arabic water and demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, hour and water, or even crushed bananas), to soothe and protect the irritated or inflamed sur- faces. 3- Give Opium (Powd. Opium, 1-2 gr. every to 2 hours; or Laudanum, 20 drops every to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every to 2 hours), to relieve pain and purging. 4- Employ artificial- heat (such as hot water bottles, or ordinary bottles containing hot water, Or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- fain bodily temperature. Apply linseed meal poul- tices to abdomen. 5- Give Spirit of Camphor (5 to 10 drops on sugar or in milk at 10 minute intervals, 4 to 6 times). 6. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful hoses hypodermically as frequently), or with Spirit °f Camphor (5 drops in a little milk every hour or two, if necessary), or with Aromatic Spirit of Am- monia (a teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 grain hypodermically every ^2 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every ^2 to 2 hours), or Tincture of Belladonna (10 to 20 drops in water every to 2 hours). Tincture of 136 A MANUAL OF TOXICOLOGY. Digitalis (15 to 30 drops by mouth, or half as much hypodermically every % to 2 hours), or Digitalin 1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary, may be used for the same purpose. Draughts of strong coffee may also be given. CURARE (WOORARI, SOUTH AMERICAN "INDIAN ARROW POISON") - CUR- ARINE. HISTORY: If Curare swallowed action much less severe, (see 1.) Agitation; the poison wound swollen and pain- ful; voluntary muscles completely paralyzed; tem- perature elevated; heart slowed; respiration gradu- ally diminished ; urine increased and contains sugar. Death by asphyxia. SYMPTOMS • TREATMENT: I. The poison is usually introduced through a wound. If there is a wound ligate above it; incise the part freely and endeavor to suck out the poison; wash the wound with a weak solution of Potassium Permanganate. Give Spirit of Nitrous Ether (i to 2 teaspoonfuls in a wineglassful of water; repeat in io to 20 minutes). Employ artificial respiration as the most efficient antagonist (rhythmically raise extended arms from sides up to over head and back 18 times a minute) until poison is eliminated. The poison usually passes off rapidly. Evacuate the bladder frequently, to prevent reabsorption. 2. Stimulate the heart, circulation, and respira- tion with Brandy or Whisky (2 teaspoonfuls every 10 to 15 minutes, in a little water). Strychnine Sul- phate (1/60 grain hypodermically every to 2 CYANIDE OF MERCURY. 137 hours) has an antagonistic action upon the heart and respiration, and Atropine Sulphate (1/120 to T/6o grain hypodermically every J4 to 2 hours), or tincture of Belladonna (10 to 20 drops in water every 34 to 2 hours) has a similar effect. i 3- Employ artificial heat (such as hot water pottles, or ordinary bottles containing hot water, or hags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature. CYANIDE OF MERCURY (MERCURIC CYANIDE). 10 grains, also 20 grains have destroyed life. Symptoms, chiefly Mercuric; also Cyanic. Treat- paent: Give Ferrous Sulphate and Magnesium Car- bonate (See 1, p. 71). Follow with whites of 3 eggs 111 cupful of water and flour or thick starch water Or milk. Evacuate stomach. Stimulate (See 3, p. ^S). Also see Mercury, p. 174). HISTORY: CYANIDE OF POTASSIUM (POTASSIC ■ CYANIDE). Potassium Cyanide is used in electro silvering and Adding, in photography, to clean lace, and also for Pie purposes of suicide and murder. 2^4 grains are equivalent to one grain of the Anhydrous Prussic Acid. Fatal dose: about 2^2 grains is considered to be 'die fatal dose. Usually 5 grains is a fatal dose,, in about 15 minutes. Recovery after 50 grains. HISTORY: SYMPTOMS : The Acid properties of Hydrocyanic Acid are ^ery feeble, so that it does not have the effect of the aimeral acids on the skin or mucous membrane; out Cyanide of Potassium is very alkaline and has even caustic properties-thus, on an empty stomach has produced a condition similar to that resulting 138 A MANUAL OF TOXICOLOGY. from a moderate quantity of solution of Potash. Salivation; nausea; sometimes vomiting; sense of constriction in throat; then constricting pain in chest; giddiness; confusion of sight; person falls in convulsions resembling epilepsy; convulsions may be general or attack only certain groups of muscles; sometimes true lockjaw; inspiration shorty expiration prolonged and imminence of death in- creases length of interval between them; skin pale, blue or bluish gray; eyes glassy and staring; pupils dilated; mouth covered with foam; breath smells of the poison; pulse first quick and small, then slower, until imperceptible; convulsions pass into paralysis; respiration gradually ceases. Potassic, Cyanide in very strong solution may cause erosion of lips, mouth, throat, gullet, and of much of the duodenum, but rarely. As a rule the local effects are limited to the stomach and duodenum. TREATMENT: Treat as in poisoning by Acid Hydrocyanic (qa.) - also employ demulcents if caustic action has been severe. CYANIDE OF SILVER (SILVER CYANIDE)- The action is similar to that of Hydrocyanic Acid, but weaker. SYMPTOMS: TREATMENT: Give large draughts of Ferrous Sulphate (Greet' Vitriol, to 2 grains in much water). Then treat as for poisoning by Hydrocyanic Acid. DIGITALIS 139 Digitalis (fox glove) - digitalin - STROPHANTHUS (q. v.) - "KOMBE AR- ROW POISON" - STROPHANTHIN (q.v.) CONVALLARIA (q. v.) - CONVALLA- MARIN - SCOPARIUS - SCOPARIN - SPARTEINE - SQUILL - SCILLITIN - SCILLITOXIN - ADONIDIN-ANTIARIN - HELLEBOREIN - OLEANDRIN--ETC. HISTORY: Digitalis has poisoned by being mistaken for other ^rugs or through ignorant use. Has been used for the purpose of murder. Maximum dose: Powdered leaves, single, 4^2 gr.; daily, 15.4 gr. Infusion, single, 480 min.; daily, I>44O min. Extract, single. 3 gr.; daily, 12 gr. Tinc- ture, single, 45 min.; daily, 135 min. Digitalin, single, 1/35 gr.; daily, 1/12 gr. Fatal dose: Tincture of Digitalis, 9 drachms; but 2 oz. have been recovered from. 10 grs. of the pow- dered leaves have been fatal. Death in hours or days. Digitoxin is six to ten times stronger than Digi- talin and 1/16 grain is considered a fatal dose. The fatal dose of Digitalin is considered to be 3/10 of a grain. Of ordinary commercial Digitalin slightly larger doses would be required to produce a fatal result, but 1/16 grain would be very dangerous. Digitalin is a cumulative poison, and like all poi- sons affecting the heart, a dose that once taken is harmless, becomes deadly if frequently repeated. As a rule, double the maximum dose may be con- sidered quite dangerous. (Digitalis is the cardiac type, the others act Quite similarly.) Vomiting of matter of a grass green color, mucous and bile; purging with severe pain; severe head- ache; pupils usually dilated, sometimes contracted; . eyeballs bulging; sclerotic blue colored; vision dis- SYMPTOMS: 140 A MANUAL OF TOXICOLOGY. ordered; vertigo; salivation; pulse small, slow, ir- regular, but rapid and weak upon arising, although heart beats violently; face pale; pain in back and limbs; diarrhoea; suppression of urine; conscious- ness usually maintained; lethargy, followed by de- lirium and convulsions; coma; death suddenly. Death by paralysis of heart. Put in horizontal position during and for some time after symptoms subside, to prevent fatal syncope. Keep patient quiet. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if not effective), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacu- anha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 min- utes until effective). After giving an emetic, al- ways give plenty of luke-warm water to encourage vomiting. While emptying the stomach, give Tan- nic Acid or Gallic Acid (30 grains in a cupful of water, then in 10 minutes again evacuate the stom- ach). If Tannic or Gallic Acid is not convenient, give plenty of strong tea, or a decoction of oak bark (1 ounce to a small cupful of hot water), or give Potassium Iodide (10 grains) and Iodine (1 grain, in half a wineglassful of water). 2. Then give Epsom Salt (1 to 2 tablespoonfuls in a teacupful of water), or Rochelle Salt (2 tea- spoonfuls in a small cupful of water), then plenty of water. 3. Then give Fluid Extract of Quillaja (10 drops in a tablespoonful of water), or Fluid Extract of Senega (10 drops in water). For the effects of TREATMENT: ERGOT. 141 large doses, give Tincture of Aconite (2 to 4 drops m water every / to 2 hours), or Laudanum (15 to 20 drops in water every 1 to 3 hours), as an antag- onist for effects due to the continued use of Digi- talis. May give Atropine, ice or Cocaine for vomiting. 4. Stimulate with Brandy or Whisky (2 to 4 tea- spoonfuls in water every % to I hour), or with Aro- matic Spirit of Ammonia (a teaspoonful every y2 to 3 hrs.) or Amyl Nitrite. Friction. Keep body warm. 5- Resort to artificial respiration if necessary (raise rhythmically arms extended at sides to up over head and back to sides, 18 times a minute). Saponin and Senegin are the most complete phy- siological antagonists, if available. The principal gases produced by the action of ex- plosives are Carbon Dioxide, Carbon Monoxide and Nitrogen. Gunpowder gives CO and H2S; dyna- mite, gun-cotton, nitroglycerine, tonite, roburite, sicherheit, trinitrintoluol, etc., and the smokeless powders each gives off much CO. (See also pp. 67, 116, 149.) EXPLOSION GASES. ERGOT. HISTORY: Given or taken to produce abortion. 15 to 60 grains of Ergot have produced very seri- ous symptoms. SYMPTOMS: Not very definite as a rule. More or less gastric disturbance; vomiting; thirst; diarrhoea; burning pain in feet; tingling in fingers; cramps in extremities; pupils dilated; dizziness; pulse small, feeble > weakness ; coldness of surface; sometimes convulsions; abortion or miscarriage in pregnant women. Cataract, or a necrosis of extremi- ties may be secondary effect. 142 A MANUAL OF TOXICOLOGY. TREATMENT: Recumbent position. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effec- tive), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomor- phine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm water to encourage vomiting. While emptying the stomach, or at first, give, Tannic Acid or Gallic Acid (30 grains in a cupful of water frequently). Then in ten minutes evacu- ate the stomach. If Tannic or Gallic Acid is not convenient, give plenty of strong tea, or a decoction of oak bark (1 ounce to a cupful of hot water), or give Potassium Iodide (to grains) and Iodine (1 grain in wineglassful of water). 2. Give Castor Oil (2 tablespoonfuls), or Epsom Salt (2 tablespoonfuls in p2 cupful of water), or a drop or two of Croton Oil on the back of the tongue. 3. Stimulate with Nitroglycerin Hydrochlorate (1/100 grain hypodermically), or with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aromatic Spirit of Am- monia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 grain hypodermically every J4 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every 14 to 2 hours), or Tincture of Belladonna (20 drops in water every /to2 hours). Tincture of Digitalis (15 to 20 drops by mouth, or half as much hypo-, FORMALDEHYDE. 143 dermically every to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to I hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every to I hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. For convulsions Chloroform or Bromides. 4. Employ friction, and artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to maintain bodily temperature. If abortion is threatened from Ergot, Opium and fest are most important measures. ETHER. (See Anesthetics.) EUPHORBIUM. (See Aloes.) EXALGIN. (See Acetanilid.) FISH BERRIES. (See Cocculus Indicus.) FLY PAPER, POISONOUS. Commonly contains Arsenic (q. v.). FORMALDEHYDE-FORMALIN. Formaldehyde is a powerfully disinfectant gas. It is employed as a disinfectant for clothing, rooms, etc. Formalin is a 40 per cent, solution of gaseous Formaldehyde, and is used as an antiseptic and dis- infectant in solutions ranging from 1 to 2,000 to, I to 200. When swallowed it has a caustic effect. HISTORY : From inhalation: Intense irritation of eyes and nose; dyspnoea; throb- bing pain in head; sense of suffocation. From swallowing a Formaldehyde solution (com- monly a 4, io, or 40 per cent, solution): Pain in stom- ach ; nausea or vomiting; vomit may be bloody; dysp- noea; vertigo; intense anxiety; pulse rapid and SYMPTOMS: 144 A MANUAL OF TOXICOLOGY. small; urine suppressed; may be diarrhoea; coma,' collapse. When inhaled: Fresh air ; gentle stimulation if necessary. When swallowed: 1. Ammonia is considered the best antidote, form- ing a harmless hexamethylene amine. Three vol- umes of Spirit of Mindererus should be administered for every volume of 40 per cent. Formaldehyde solu- . tion which has been swallowed. An alkaline mineral water may then be given, to neutralize the acetic acid resulting from the reaction. In the absence of other । agents, white of egg stirred up in water may be given and the stomach then washed out ox' evacuated by Apomorphine Hydrochlorate (in 1-10 gr. doses). 2. Stimulate with hypodermic injections of Strych- nine, Digitalin, Aromatic Spirit of Ammonia, etc. 3. Give demulcents, as milk, barley water, etc. FOOD, POISONOUS. (See Part IV.) Poisonous Cheese; Poisonous Fish; Poisoned or Poisonous Meat (as putrid meat), Oysters, Milk. All protein poison. Fungi (such as Poisonous Mushrooms, Toad- stools, Truffles, etc.). Also, Muscarine, Sausage Poison, etc. (Also see Ptomains.) , TREATMENT: HISTORY: It is supposed that the symptoms of food-poison- ing are due either to toxins, or to several causes)' combined. Phallin, a toxalbumin from Amanita Phal- loides, breaks up red blood corpuscles. The only anti- dote is transfusing fresh blood or salt solution. Food poisoning is commonest from bacterial products. SYMPTOMS: The symptoms are generally those of a powerful gastro-intestinal irritant. Usually there is a 2 to 6^ hours incubation period. > Usual symptoms: nausea; sudden and severe retch- ing; abdominal pain; dilated pupils; reddened or\ scarlatina-like skin; great thirst; very offensive diar^ rhoeal discharges; elevated or reduced temperature; FOOD, FUNGI. 145 muscular twitchings; prostration, tendency to col- lapse. Coma. In Ptomain, dilated pupils, nearly palsy. Poisonous Cheese usually causes retching, vomit- ing, purging, dyspnoea, dilated pupils, rapid pulse, and depression of temperature. Cheese poisoning is attributed to tyrotoxicon. (See Ptomains.) Poisonous Fish (such as craw-fish, land crab, yel- low-billed sprat, dolphin, gray snapper, conger eel, mussels, smooth bottle-fish, grooper, rock-fish, Por- tuguese man-of-war, king-fish, porgie, fugu, old wife, blower, etc.) causes symptoms of severe irrita- tion of the gastro-intestinal tract, somewhat resem- bling cholera morbus. Some fish always poisonous from gland secretions, etc.; others only in spawning season; may poison from bacterial products. Mus- sels frequently produce very alarming symptoms, due to a leukomain called mytilotoxine, the action of which resembles that of Curarine. When mussels are gathered from the bottom of a ship, in dock, they are apt to be contaminated withCopperfrom the sheathing or with Arsenic from the paint. Pickled Salmon and Herrings sometimes produce poisonous symptoms. In some cases of poisoning by fish the symptoms are those of simple irritation, such as nausea, vomiting, purging, cramps, depression, etc. In other cases there are marked nervous symptoms, while the symptoms of gastro-enteric irritation are slight. The chief nervous symptoms are delirium, weakness, thirst, sense of heat about head and eyes, insensibility, dyspnoea, coma, and convulsions. Sometimes eruption appears resembling nettlerash and associated with asthma. Poisoned Milk or Meat, such as that of birds or animals which have fed upon stramonium, laurel, or other poisonous plants or substances, produce the characteristic symptoms. Putrid or decaying meat produces symptoms of gastro-enteric irritation and also of a typhoid character, or septicaemia. (Spoi Poisoning may be produced: botulism; by meat from sick animal; by germs in food, as typhoid; or specific disease of animal, as tuberculosis, anthrax, etc.; or food infected with parasites or their ova, as trichina. Fungi: various forms of fungi, such as mush- 146 A MANUAL OF TOXICOLOGY. rooms, toadstools, truffles, etc., are directly poison- ous and produce symptoms of severe irritation of the gastro-intestinal tract. Poisonous Mushrooms, mistaken for edible varieties or through ignorance of their poisonous properties, produce such narcotic-irri- tant symptoms as violent vomiting, purging, anxiety, thirst, abdominal pain, delirium, stupor, etc. The symptoms commonly occur within an hour, and death usually within 24 hours. The gills and spores of the mushroom should be sought for in stomach contents. Muscarine-a deadly alkaloid from various mush- rooms, as the Fly Fungus (Fly-Blown Agaric, False Orange). Fly Fungus is used in Kamschatka and Siberia to produce intoxication. Muscarine produces salivation; free perspiration; desire to urinate; vio- lent colic with thirst; slow, weak pulse; contracted pupils, dilating before death; dyspnoea; paralysis. Death from effect upon the heart, usually in 24 hours. May often distinguish poisonous from non-poison- ous mushrooms by the following: Gills of poisonous usually white, cap often warty and stem hollow. Gills of non-poisonous first pink, then brownish-purple; stalk commonly cylindrical and solid. Reject mush- rooms which have white gills or milky juice, or in which the color changes when they are broken or cut. Sausage Poison-It is claimed that in uncured sausage-meat, a ptomaine is sometimes developed by bacterial growths, which causes symptoms of sausage poisoning. Recent discoveries, however, indicate the poison to be allied to the tetanus, diphtheria, and other toxins. Serious illness may be caused by eat- ing sausage infected with trichina spiralis, a minute worm coiled up in an oval cyst. This is the most minute and numerous of the parasites. Its source is raw or imperfectly cooked pork or sausages. While enveloped in its capsule, the parasite is absolutely harmless. After entering the alimentary canal, it leaves its cyst and produces numerous young, which bore through walls to the muscular tissue of the body, where they lodge in the muscular-fibre sheaths. Tri- chinae- Droduce malaise, anorexia, sleeplessness, fever FUNGI 147 severe muscular pains, swelling of joints, sometimes contractions of flexors of extremities, oedema of face and eyelids, diarrhoea. Sometimes typhoid symp- toms appear, and death in unconscious state results. Death usually within 30 days. Chemical and micro- scopical examinations of suspected food or of a portion of the subject's muscle should indicate nature of poi- son (p. 244). Occasionally poisoning, by union of malic acid of fruit juices with metal used in canning. TREATMENT: i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if not effective), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacu- anha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically («i/io grain, repeated every 15 min- utes until effective). After giving an emetic, always give plenty of luke-warm water to encourage vomit- ing. While syphoning or before producing vomit- ing, give, if at hand, Tannic Acid or Gallic Acid (30 grains in 2 tablespoonfuls of water), or liberal draughts of strong tea, or a decoction of oak bark (a teaspoonful to 2 wineglassfuls of hot water). Then evacuate the stomach again, unless vomiting continues. To relieve nausea after stomach has been emptied, give Lime Water and Creosote (put 2 drops of Creosote in a tablespoonful of Lime Water and give a teaspoonful of the mixture frequently). 2. Give Castor Oil (2 tablespoonfuls) and use an enema. In poisoning by Fungi, give Epsom Salt (2 tablespoonfuls in small cupful of water), or Glauber Salt (2 teaspoonfuls in 4 tablespoonfuls of water). After purging give vinegar in water. 3. Stimulate. If depression is very great, sup- port heart with Nitroglycerin (in 1/100 grain 148 A MANUAL OF TOXICOLOGY. doses), or stimulate with Brandy or Whisky (a tea- spoonful dose by mouth every 10 to 15 minutes, or 54 teaspoonful doses hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or 54 tea- spoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every 52 to 2 hours), or Atropine Sulphate (1/120 grain hypodermically every 54 to 2 hours), or Tinc- ture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis (15 to 20 drops by mouth, or half as much hypodermically every 54 to 2 hours), or Digitalin (1/100 grain hypo- dermically every y to 1 hour), or Caffein Citrate (1 to 4 grains every 54 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every 54 to 1 hour if necessary), may be used for the same pur- pose. Draughts of strong coffee may also be given. 4. If body or feet are cold employ artificial heat (such as hot water bottles, or ordinary bottles con- taining hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body). Also apply hot fomentations to the ab- domen. In collapse, use sterilized salt solution (p. 118). 5. Give Opium (Powdered Opium, 1 to 2 graino every y2 to 2 hours), or Laudanum (20 drops every 54 to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (54 grain by mouth or hypodermically every 54 to 2 hours), to relieve pain and nervous irritability. Also give Tincture of Capsicum (15 to 20 drops in 54 cupful of water). Give solution of Ammonium Acetate (in teaspoonful doses every 54 hour) to reduce fever and relieve kidneys. Oil of Eucalyptus Globulus in 5 drop doses, is helpful in ptomain poisoning. In fish poisoning, give Potassium Chlorate freely, or Spirit of Mindererus; also Capsicum. Use Chloro- form, if required. GASEOUS POISONS. 149 In poisoning by the Fungi, give, as early as pos- sible, Atropine Sulphate, hypodermically (1/120 grain every to 2 hours) as a specific antagonist; or after stomach has been emptied, Tincture of Belladonna (20 drops in water every % to 2 hours by mouth) may be given instead of the Atropine. Atropine exactly opposes Muscarine. Antiseptics (such as Thymol, Salol, Naphthalin or Calomel) are recommended in the after treatment. There is no known remedy for trichinae poisoning. GASEOUS POISONS. BROMIDE (q.v.) CARBON DIOXIDE (see Carbonic Acid Gas). CARBON MONOXIDE (q.v.) CHLORINE (q.v.) FORMALDEHYDE (q.v.) muriatic acid fumes. NITROUS acid fumes. HYDROFLUORIC ACID (q. v.) HYDROGEN ANTIMONIDE (STIBIN). (IN GENERAL.) HYDROGEN ARSENIDE (AR- SENIURETTED HYDROGEN). HYDROGEN SULPHIDE (q.v.) NITROGEN MONOXIDE (NIT- ROUS OXIDE). (See Anes- thetics.) PHOSPHINE (PHOSPHORETTED HYDROGEN). (Seep. 100.) SULPHUR DIOXIDE (SULPHUR- OUS OXIDE). MIXED GASES. AIR GAS (Air passed through mixture of hydrocarbons). COMBUSTION, FIRE AND "FURNACE" GASES. ILLUMINATING GAS (active ingredient, Carbon Monoxide) (Coal Gas-distilled from Coal; Water Gas-by steam passed through mixture of hydrocarbons; Acetylene Gas; Rock or Natural Gas), and FUEL GAS. (See p. 116-155.) METHANE (MARSH GAS), FIRE DAMP. OIL GAS, NAPHTHA GAS (are distilled from hydrocarbon oils). SEWER GAS AND CESSPOOL EMANATIONS (q. v.) GENERAL SYMPTOMS: Regarding gaseous poisons it may in a general sense be said, that they cause dizziness, headache, nausea, perhaps sense of suffocation, exhaustion, and collapse. GENERAL TREATMENT: Fresh air, Oxygen and Ammonia inhalations, cold douche to head and chest, saline solution (see 5, page 118), gentle stimulation, heat friction, artificial respiration, rest. 150 A MANUAL OF TOXICOLOGY GASEOUS POISONS IN WARFARE. There are three varieties of gas attack: 1. By Emanation. 2. By Drift Gas, Gas Cloud, or Gas Mist. 3. By Chemical Shells. 1. By Emanation: The emanation process consists in scattering chemicals about the trenches or other places which it is the intention to desert. When such chemicals are dis- turbed or dug up, or brought into contact with moisture, by the new occupants, a poisonous gas is produced. Calcium Arsenide, one of these chemicals, generates Arsene, a gas having faintly the odor of garlic. 2. By Drift Gas, Gas Cloud, or Gas Mist: For this pur- pose, gas is carried up to a front line or trench, compressed in steel cylinders (or tanks) ; the cylinders are dug in at the bottom of the trench and connected with pipes extending out over the parapet. When the valves of the cylinders are opened, the gas often escapes with a hissing sound which can be heard at some distance. The gas mixes with the air and is carried, by a suitable wind blowing toward the adver- sary, over the intervening ground and into his trenches and dug-outs, shelters, craters and hollows, but around eminences, perhaps even into his rear ranks and encampments. Some- times the drifting is aided by blowing or pumping the gas. Usually the gas contains Chlorine as its chief constituent. It is heavier than air and drifts along close to the ground as a dense bank, perhaps seven or eight feet high. A wind blow- ing from four to eight miles per hour best favors its trans- mission. A five-mile wind is the most effective of all. Watercourses and ponds do not obstruct the progress of the gas, and gentle rain'has no apparent effect upon it; but strong rain washes it down. The color of the ordinary drift gas varies: in very dry air it is almost transparent and slightly greenish; in damp weather it has the appearance of a white cloud. It may be mixed with smoke of any color. The gas may be harmless after traveling five rods, or it may prove deadly for a distance of two miles or more from its source. As it advances it gradually becomes thinner, less deadly and ultimately innocuous by dispersion and dilution. It is said^ that gas-attacks have been made with wind velocities vary-' ing from three to twenty miles per hour (1)4 to 10 yards per second) and over a front varying from one to five miles. In a nine-mile wind the gas would reach trenches one hun-, dred yards distant, in twenty seconds. It has sometimes been found necessary for the adversary to wear protective helmets as far back as eight miles from the source of the gas. GASEOUS POISONS IN WARFARE 151 The chief chemicals used in the drift, cloud or mist attacks have been Bromine, Chlorine and Phosgene (Phosgen-i. e., light producing, or light yielding. Composed of Carbonic Acid and Chlorine). 3. By Chemical Shells, and such other gas projectiles as hand grenades, trench mortar-bombs, etc.: The chemical shells commonly contain small quantities (usually about five pounds) of cloud or other gases in a liquid form. Among the poisonous gases used in shells are also Methyl Sulphate (of the Wood Alcohol group), Pelite [i. e., of a Petrol) (Gasoline), Petroleum, or fine mud (Pelos) source or character], also a gas having the odor or character of mustard; etc. The "A" Tear Shells (Lacrimal, or Lachrymal Gas Shells, or "Weepers") of the Germans, contain Bromacetone (Ace- tone-"An inflammable liquid, with a biting taste, obtained by the destructive distillation of Acetates and various organic compounds-used in making Chloroform and as a solvent for fats, Camphor and resins." The "T" Shells of the Germans, contain Xylylbromide. (Xylyl, a radical from Xylene; the latter is a constituent of coal tar and of wood tar). The Lacrimal Gas Shells may have little or no odor. They act directly upon the tear (lacrimal) glands of the eyes, producing a profuse secretion and flow of tears; this is accompanied by an intense smarting of the eyes, with con- sequent temporary blindness and inability to ward off or avoid bayonet, bomb, or other attacks. Strong concentra- tions of such gases also affect the lungs. In gas projectiles, a large part of the possible explosive charge is replaced by a liquid which is converted into gas by the explosion. Usually, a large number of chemical shells are discharged into a small space, and after the ex- plosion the irritant chemicals form a small gas cloud; but some of the poison may sink to the ground and remain active for a long time. Gas shells are used most effectively when the wind is of low velocity or when there is a calm. Clumps of trees, clusters of buildings etc., often retain the discharged gas, in an active state, for some time. When very dilute, Chlorine may be recognized by its pecu- liar, Chloride-of-Lime-like smell, but stronger and more penetrating. Chlorine and Phosgene gases have a strongly corrosive action on metals, so that metal parts of arms must be well greased to protect them. In shell gas, when the contents are released by the explo- sive charge, it expands in about the same ratio as water to steam. As the use of shells is independent of wind direction and they give no cloud-effect warning, but in large numbers are as deadly as clouds, they may be very destructively em- 152 A MANUAL OF TOXICOLOGY ployed against distant ranks and rear artillery, as well as against approximate antagonists. In consequence, their use is becoming more common. Phosgene and certain other gases strongly attack the mucous membrane of the respiratory organs, causing severe coughing. Exposure to such gas when it is highly con- centrated, or long exposure to such when of low concentra- tion, injures the tissues of the lungs, breathing becomes more and more difficult and distressing, until impossible, and death by suffocation ensues. Death may result from only two or three breaths of such gas. When present in suf- ficient quantities, Chlorine and Bromine kill by suffocation. Chlorine will cause paralysis of the glottis or windpipe valve when only one part of it is present in one thousand parts of air; and those affected by it will tear open their throats with their fingers in their frantic efforts to get air. In the much weaker proportion of one part of it in five thousand parts of air, death results from the acute inflammation of the lungs that the poison induces; agonizing death follows a frothy hemorrhage from the lungs after more or less prolonged suffering associated with the acute pulmonary inflammation. In one to fifty thousand parts, death occurs in a few days by gangrene of the lungs. The effects of Bromine are similar to those of Chlorine but more active. Phosgene gas produces no effects immediately apparent. The person exposed to it may feel and act as usual for hours, then suddenly have a fatal collapse, apparently due to heart failure. Phosgene acts through its abstraction of lung moisture, etc. The Anhydrides (chemical compounds derived from acids and other substances by abstracting a molecule of water from them) abstract moisture from the lungs upon enter- ing them and revert, practically, to their former character, forming acids like their bases and act similarly. All of these warfare-gases produce, immediately or re- motely, intense distress in breathing, or a severe irritation of the eyes, or both. Their use is sometimes concealed or other- wise aided by being associated with the use of smoke-clouds or smoke-shells. Prussic Acid gas is not much used; partly because it is too quickly fatal; most of the other gases terrorize by the obvi- ously agonizing distress they cause; and they reduce the num- ber of combatants through the urgent efforts of the victim's companions to afford him immediate relief, in what appears to be a critical, perhaps only temporary disability. Prussic Acid gag is the only gas that will go through the ordinary mask. It has a direct action upon the nervous system. When it is in the dilute form it produces dizziness, headache, GASEOUS POISONS IN WARFARE 153 Pains in the chest and difficult respiration; these may be fol- lowed by coma, convulsions and death. When it is in a concentrated form, inhalation of it is fol- lowed almost immediately by unconsciousness and death. The following are the chief symptoms observed in those affected by the other asphyxiating gases to which reference has been made in the foregoing. (Those most familiar with such poisonings assert that they are essentially and practically Chlorine poisonings in character, effects and treatment) : When a soldier is gassed to the point of collapse, he usually falls to the ground (where gas concentration and duration, of exposure are the worst), gasping for breath and tearing at his throat with his fingers, almost blind and Perhaps vomiting, his eyes smarting, and a burning feeling ln his chest and a sensation as if it were in a vise. Death Way take place immediately. Commonly, those who thus died of suffocation had a greenish-yellow color after death. Even some hours after being gassed, many victims are still choking, coughing up a green slime, making agonizing efforts to breathe, clutching at their throats and tearing open their -clothes. At one moment they prop themselves up to gasp, and in another moment they fall back exhausted by their struggles. There is more or less headache and marked cy- anosis, especially of the lips and ears; in some cases a light- Yellowish frothy discharge escapes from the mouth and Pose. Some, especially the older men, are in a state of almost Uninterrupted collapse, with faces and hands of a leaden hue, and heads fallen forward on their chests; the majority of these do not recover nor rally. Usually all except those dying or collapsed are fully conscious and fighting desperately for life. The typical case is cold, with subnormal temperature, restless, conscious, with slow, full pulse, except in case of Collapse. The face is more or less intensely cyanosed, and there is a strained, anxious expression. The posture is that °f being propped up in bed or on stretcher, with head thrown back and gasping for breath; some lie upon the side with bead over the edge of the bed or stretcher, endeavoring to aid expectoration of a frothy mucus_, and distressed by a choking cough. The respirations are jerky and hurried, and way be forty per minute. With each inspiration the chest expands to its fullest extent. Usually the person who has been gassed, passes through three stages: First, the asphyxial stage (about 36 hours). Second, the quiescent or intermediate stage (about 12 hours). Third, the bronchitic stage. Some die in the third stage, the frothy secretion changing to a thick, greenish, muco-purulent expectoration; there is delirium, and the temperature may go up to 104° F.; the pulse is small and may run as high as 160 beats per minute; the respirations become less choking 154 A MANUAL OF TOXICOLOGY and gasping, but more shallow and a short time before death' as high as 70 per minute. Death occurs from acute con- gestion and edema of the lungs. The treatment in these poisonings, aims to do three things: "First, to expel the excessive secretion. Second, to diminish the secretion. Third, to support the failing heart, and to* oxygenate the blood." If possible the patient should b^ placed in the open air, or in an airy room; heat should b« applied to the feet and body, he should be well wrapped up and given hot drinks. The most serviceable emetic is! salt and water, in ten-ounce doses, followed by warm water given freely. Vomiting may be induced by tickling the back of the throat with a soft brush, or the patient should bd encouraged to use his finger to vomit; usually the vomiting affords great relief, and brings away quantities of yellowy ish, frothy fluid. Very often the soldier, suddenly gassed, fortunate enough to vomit profusely at once; this serves r° clear out the deeper respiratory passages. If the gassed person is vomiting well, no efforts should be employed ta increase the vomiting unless the respiratory passages becorrk' obstructed with the secretion; but if he has not vomited, should be made to do so. The choking and gagging whicl1 occurs when the gassing takes place, accounts for the en- trance of the gas into the stomach. Chlorine poisoning death: are called "dry land drowning" because the deeper respirator' passages become filled up with serous transudation. There fore the Schaefer method of artificial respiration is ver4 beneficial in that and similar poisonings. Ammonium Can bonate in 10 to 15 grain doses, every three hours, and 10 to 15 minims of Wine of Ipecac with the same frequency, act aj' stimulating expectorants. Atropin is of minor value and i* used should be given early. Some have favored promp venesection, to unburden the venous circulation, while other are opposed to it. Opium, best in form of the tincture in 5 to 15 minim dosesl relieves the restlessness and allays the mental strain. Oxyget inhalations are helpful in marked cyanosis and dyspne^i Desiccated Pituitary Body (Substance), (Posterior Lobe), hw podermically in half-grain doses, and Brandy, for failing hear and general circulation is recommended. Some give oxyge; hypodermically. Warmth and much fresh air are of specie importance. Not only is the quiescent period, in those wff have been gassed, usually followed by a severe bronchitis but they are quite apt to develop a gastritis and gastrfl enteritis, characterized by furred tongue, loss of appetif discomfort and burning in the gullet, tenderness over th stomach, recurrent vomiting, even of blood, from the stomacX bilious and bloody stools, diarrhoea and more or less jaundice' the liver may be enlarged, and albuminuria and henrt GASEOUS POISONS IN WARFARE 155 globinuria present Although the majority of those persons Who have been gassed, even severely, recover, usually the recovery is slow and prolonged. Most of those who die, but not at once, succumb within 36 hours. In acute fatal cases, post mortem observations have shown: "An intense conges- tion of the entire respiratory tract, with bloody edema of a large portion of the lung tissue, and intervening small areas of acute emphysema." . The best preventive measures against gassing are the gas masks or helmets and respirators. "When the allied forces were caught in the first gas attacks by the Germans, a few men recognized the chlorine gas." They knew that it has great affinity for moisture, and wet their handkerchiefs, coat sleeves or other pieces of cloth with water, or in the absence of such, even with urine, to breathe through; and they quickly passed the warning an'1 advice along the lines, thus saving thousands of lives. "The P. H. Helmet consists of a double flannelette ba with two eyepieces and a mouthpiece, consisting of a hard tube on the inside, and a flat piece of rubber on the out side," through which the poisonous carbon, Dioxide, etc., of natural respiration may be exhaled; this rubber remains col- lapsed when exhalation is not taking place through it. The flannelette is impregnated with solutions of Phenol, Caustic Soda, Hexamine (Hexamethylenamine) and Glycerine. It is claimed that the Phenol is used to neutralize the Chlorine gas, the Caustic Soda against the possibility of encountering Prussic Acid, and to neutralize the acid-producing gases. The Hexamine is supposed to take out the Phosgene. The Glycerine holds the chemicals in solution. A common French type of anti-gas appliance is a mask. It consists of several layers of gauze, each saturated with chem- icals, and so adapted as to fit under the chin, up the sides of the face, and across the forehead; it is held in place by rub- ber bands. The mask must so fit as to prevent air from en- tering the space in front of the face. Each man must be fitted and use his own mask. The goggles of these masks are made of cellulose, acetate, which will not break or fog from the breath. The Box Respirator consists of a small canvas haversack, called a satchel, of two compartments, one of which contains the metal filter with its Charcoal and Sodium Hyposulphite to absorb and neutralize the gas. The other, the mask, called the face-piece, is made of rubberized material, with mica eyeglasses, a nose clip (nose pincers), a rubber mouthpiece which is held in the teeth and which terminates on the out- side of the face-piece in a flat, rubber exhaling valve, like that on the P. H. Helmet. Connecting the face-piece or mask and the metal filter, is a short length of non-collapsible tubing. 156 A MANUAL OF TOXICOLOGY The mask fits the face closely and is held in place by broad, elastic bands, passing around the head. Slight imperfec- tions in helmets or respirators might easily permit of fatal results in gassing; hence, frequent inspections are made as to their condition. A person in danger of gassing should learn to apply the mask or respirator in from four to six seconds. GELSEMIUM (YELLOW JASMINE) - GEL- SEMINE - AESCULIN. HISTORY: Has been more or less used as a pain-killer and to produce abortion. Has also caused poisoning through taking by mistake. Fatal dose: of the Fluid Extract (which is 4 times stronger than the Tincture) of Gelsemium 1 also 2 drachms. 35 drops of the Tincture have caused death in 134 hours. A concentrated Tincture equiv- alent to 1/6 grain of Gelsemine caused death in 73^ hours. Death by paralysis of the respiratory centres. Pain in brows and eyeballs; vision dim, some- times double; pupils dilated; ptosis; dropping of jaw; sense of langour; drowsiness; great muscular relaxation; staggering; pulse rapid, feeble; skin cold, moist; face anxious; voice lost; pain in chest; respiration slow, labored; sensibility diminished; suffocation; spasm; foaming at mouth; coma. SYMPTOMS: I. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If ' stomach-tube is not at hand, use an emetic, such( as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not ' effective), or Ipecacuanha (Powdered Ipecacu-' anha, 30 grains; or Syrup of Ipecac, a teaspoonful TREATMENT: GELSEMIUM. 157 every io or 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. Keep head up. While syphoning, or before causing patient to vomit, give, if at hand and poison recently taken, Tannic Acid or Gallic Acid (30 grains in 2 table- spoonfuls of water), or liberal draughts of strong . tea, or a decoction of oak Dark (a teaspoonful to 2 wineglassfuls of hot water). Then evacuate the stomach again, unless vomiting continues. 2. Give Castor Oil (2 tablespoonfuls). 3. Stimulate. [Atropine may hasten paralysis. If give: Atropine Sulphate (1/120 to 1/60 grain hypodermically every % to 2 hours), or Tincture .of Belladonna (20 drops in water every % to 2 hours).] Stimulate heart, circulation, and res- piration with Brandy or Whisky (2 teaspoonfuls doses, by mouth every 10 to 15 minutes, or % tea- spoonful doses hypodermically as frequently), or With Aromatic Spirit of Ammonia (a teaspoonful m a little water every 10 to 15 minutes, or % tea- spoonful hypodermically as frequently; also with Strychnine Sulphate (1/60 to 1/20 grain hypo- dermically every J4 to 2 hours). Tincture of Digi- talis (15 to 30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypodermically, every % to I hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to I hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 4. Morphine is considered to be the most com- plete antagonist (give % grain every *4 to 2 hours). 5. Resort to electricity if necessary. Arouse by hot and cold water alternately douched on head and chest 158 A MANUAL OF TOXICOLOGY. 6. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids heated, applied to the feet and sides of the body) to main- tain bodily temperature. Employ friction. 7. If respiration ceases or is labored, resort to artificial respiration (rhythmically raise and lower the extended arms from the sides up to over head and back-again 18 times a minute). GOLD COMPOUNDS Irritant symptoms. It causes a pink stain upon the skin. SYMPTOMS: i. Give Albumin (white of egg) or flour (in water freely, and Sulphate of Iron (in i grain doses) promptly. 2. Evacuate the stomach without delay (either independent of or in conjunction with above) if free vomiting has not already begun. Syphon out the stomach with a stomach-tube, using plenty of water,J If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha,: 30 grains; or Syrup of Ipecac, a teaspoonful every/j 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10; grain, repeated every 15 minutes until effective)- After giving the emetic, give plenty of luke-warm' water to encourage vomiting. While syphoning, or before causing patient to vomit, give, if at hand and poison recently taken.' Tannic Acid or Gallic Acid (30 grains in 2 table d spoonfuls of water), or liberal draughts of strong tea, or a decoction of oak bark (a teaspoonful to TREATMENT: HYDROGEN SULPHIDE. 159 Wineglassfuls of water). Then evacuate the stom- ach again, unless vomiting continues. 3. Stimulate heart, circulation, and respiration Ivith Brandy or Whisky (2 teaspoonful doses by ^nouth every 10 to 15 minutes, or % teaspoonful Joses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little Water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every /. to 2 ^ours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every % to 2 hours), or Tincture of ^elladonna (20 drops in water every ^2 to 2 hours), tincture of Digitalis (15 to 20 drops by mouth, or yalf as much hypodermically, every to 2 hours), $r Digitalin (1/100 grain hypodermically every % W 1 hour), or Caffein Citrate (1 to 4 grains every ^4 to 1 hour), and inhalations of Amyl Nitrite (a 3 ?r 5 minim pearl crushed in a handkerchief and in- 'aled, using one every % to 1 hour if necessary), ^ay be used for the same purposes. Draughts of sTong coffee may also be given. . 4- Employ artificial heat (such as hot water Jotties, or ordinary bottles containing hot water, jr bags of salt, bricks, plates, or stove-lids, heated, Applied to the feet and sides of the body), to main- bodily temperature. ' GROUND GLASS. k Although not a poison, when given in food, kills T irritation-mechanical action. Treat by giving kead or mush freely; emetic; castor oil; demul- Tts; use counter irritation. d'VDROGEN SULPHIDE (SULPHURETTED HYDROGEN). HISTORY: pA very active narcotic poison, but its characteris- offensive rotten-egg-like odor prevents frequent A'cident. May prove instantly fatal if inhaled pure; Ven when diluted, if breathed, causes prompt insea 160 A MANUAL OF TOXICOLOGY. sibility and even death; probably the result of rapi( destruction of the blood corpuscles. Encountered by workmen in drains, sewers and cesspools Usually, when encountered, is combined with othe' gases resulting from putrefaction of animal matter) The dark-brown or black color of the blood is dui to the destruction of the blood corpuscles. Death by asphyxia. Spectroscope shows sulpb meth-hemoglobin. Breathed in a diluted state, it quickly produce unconsciousness and death. Persons remaining long in an atmosphere contaminated with this g^ experience nausea, weakness and giddiness, loss 0' blood from mouth, pupils dilated and fixed, fac1-. livid, convulsions, coma. SYMPTOMS: TREATMENT: I. Take patient into open air; or if possible, pro vide the patient with air containing Chlorine Gas t break up the Hydrogen Sulphide. 2. Employ friction of limbs and trunk. 3. Apply heat to the body (such as hot water bot': ties, or ordinary bottles containing hot water, or bagX of salt, bricks, plates, or stove-lids, heated, applie' to the feet and sides of the body to maintain bodi?; temperature. 4. Stimulate heart, circulation, and respiratio^ with Brandy or Whisky (2 teaspoonful doses eve^, 10 to 15 minutes, or % teaspoonful doses hypoder mically as frequently), or with Aromatic Spirit C Ammonia (a teaspoonful in a little water every 10 i 15 minutes, or % teaspoonful hypodermically as frA quently) ; also with Stryqhnine Sulphate (1/60 grai hypodermically every % to 2 hours) and Atropin* Sulphate (1/120 grain hypodermically every ^2 tc^' hours), or Tincture of Belladonna (20 drops / water every to 2 hours). Tincture of Digital?. (30 drops by mouth, or half as much hypodermically every % to 2 hours), or Digitalin (1/100 grain h) ILLUMINATING GAS. 161 podermically every to i hour), or Caffein Citrate (i to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same pur- poses. Draughts of strong coffee may also be given. 5. For threatened death from embarrassed respi- ration, resort to artificial respiration (rhythmically raising and lowering arms from straight at sides to up over head and back again, 18 to 20 times a min- ute). (Treat as for Belladonna, q. v.). HYOSCYAMUS. ILLUMINATING GAS (COAL GAS, WATER GAS, ACETYLENE GAS), FUEL GAS,! ROCK GAS-ETC. The facts stated regarding Carbonic Oxide apply in the main to Illuminating Gas; but the physiolog- ical effects of the latter are due to its displacing air, thus removing oxygen, and to the combined effect of this gas and heavier hydrocarbons. Poisoning has occurred from leakage of pipes in an adjoin- ing room or from cellar or even a street main, the gas filtering in such case through the soil and per- haps so diluted as to be odorless, yet poisoning. The gas may be diffused through walls and partitions. Water Gas is more dangerous than Coal Gas. HISTORY: Headache; confusion ; dizziness; nausea ; uncer- tain gait; weakness ; loss of memory ; impaired respi- ration ; perhaps convulsions; unconsciousness and death. If unconscious, patient may rouse up for a little while and seem intelligent, and then again be- come unconscious or have convulsions and die. Secondary Asphyxia and death may occur after ap- parently almost complete recovery. The symptoms vary in poisoning by Illuminating Gas, according to whether they are those of true asphyxia (suffocation) or of slow Carbonic Oxide poisoning (by slow absorption). GENERAL SYMPTOMS: 162 A MANUAL OF TOXICOLOGY. Asphyxia, due to an overwhelming quantity of the Gas interrupting respiration and rapidly poison- ing, exhibits such characteristic symptoms as chok- ing, gasping, suffused eyes, congested face, cyanosis, collapse, coma, death. Asphyxia by Illuminating Gas (true suffocation) is very different from a slow absorption-poisoning resulting from prolonged or irregular breathing of the diluted Gas. Headache, dizziness, loss of appetite and malaise from slow poisoning from leaky pipes, etc., by small amounts of Gas, present in the air of rooms. TREATMENT: No true antidote known for poisoning by the Gas. For true poisoning by the Gas, treat as for Car- bon Monoxide (q. vj. For suffocation by the Gas, fresh air inhalations and gentle stimulation. If necessary, artificial res- piration. (See 1 and 4 under Carbon Monoxide). INSECT POWDER, POISONOUS. Treat as in Arsenic Poisoning (q. v.). [For Dalmatian, Persian (Pyrethrum), evacuate; free catharsis.] INSECTS, POISONOUS. (See p. 244.) The bite or sting of bee, hornet, wasp, etc. SYMPTOMS: Usually mainly local irritation. When by taran - tula or scorpion may be serious and consist of: pain; swelling; fever; erysipelas; suppuration; gan- grene; death. TREATMENT: In mild cases apply strong solution of Ammonium Chloride, strong soap-suds, or other alkali, or Tr. Iodine, to affected part. If stinger was left in, ex- tract it. Cold wet cloths, Camphorated Chloral, or Beta Naphthol Ointment (30 gr. to 1 oz.), for pain. Stimulate. In severe cases treat as for snake bite. (q. v.) IODINE AND ITS COMPOUNDS. 163 IODINE AND IODIDES. HISTORY: Iodine is sometimes taken by mistake for harmless mixtures or medicines. Rarely used for suicide or mur- der. 20 grs. caused death. Recovery has occurred after taking drachms. Death from 1 drachm of Tincture. Death usually occurs within 30 hours. SYMPTOMS: Pain in throat and stomach; metallic taste in hiouth; salivation; great thirst; severe gastro- enteritis; vomiting; purging; vomit yellow from iodine, blue if farinaceous articles be present in stomach; face deathly pale; urine entirely sup- pressed; giddiness; faintness; pulse rapid, feeble; >Ugh fever; pain in larynx; eyelids sometimes Swollen ; albuminuria ; cyanosis; great excitement; convulsive movements; collapse. I. Evacuate the stomach: syphon out the stomach With a stomach-tube, using plenty of water contain- 'ng egg and starch paste. If tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 .^blespoonfuls of water, repeated in 10 to 15 minutes 'f vomiting is not produced), or Mustard (a table- . spoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered ipecacuanha, 30 grains; or Syrup of Ipecac, a tea- Toonful, every 10 to 15 minutes until vomiting re- mits), or Apomorphine Hydrochlorate, hypodermi- cally (1/10 grain, every 15 minutes until effective). After giving the emetic, give plenty of luke-warm ^ater to encourage vomiting. T Starch is the antidote to free Iodine forming °dide of Starch. Promptly and freely give large Quantities of starch, wheat flour or arrow-root water P Water made by boiling starch in water or by pour- ing boiling water upon such), or give Sodium Thio- TREATMENT: 164 A MANUAL OF TOXICOLOGY. sulphate (20 grains in 2 tablespoonfuls of water). The stomach must be evacuated soon after giving the antidote, as the compound is not altogether inactive. Sodium Bicarb, is antidotal in 2 dr. doses. 2. Give demulcents (such as white of egg, milk, oil, flaxseed or elm tea, barley water, gum arabic of oatmeal gruel, gelatin, or even crushed bananas);, to soothe and protect the irritated or inflamed sur^ faces. Give Castor Oil. 3. Stimulate heart, circulation, and respiration; with Brandy or Whisky (2 teaspoonful doses b)j mouth every 10 to 15 minutes, or 54 teaspoonfuf doses hypodermically as frequently), or with AroA matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or 54 teaspoonful hypodermically as frequently) ; also with Strych' nine Sulphate (1/60 grain hypodermically every W to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every 54 to 2 hours), or Tine* ture of Belladonna (20 drops in water every 54 to > hours). Tincture of Digitalis (15 to 30 drops b) mouth, or half as much hypodermically, every 5' to 2 hours), or Digitalin (1/100 grain hypodermic ally every % to 1 hour), or Caffein Citrate (1 to 4 grains every 54 to 1 hour), and inhalations of Amy Nitrite (a 3 or 5 minim pearl crushed in a handke( chief and inhaled, using one every 54 to 1 hour 1 necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 4. Employ artificial heat (such as hot wat^ bottles, or ordinary bottles containing hot watej or bags of salt, bricks, plates, or stove-lids, heated applied to the feet and sides of the body), to mai& tain bodily temperature. 5. Give Opium (Powdered Opium, 1 to 2 graiq every 54 to 2 hours), or Laudanum, 10 to 20 dro^ every J4 to 2 hours by mouth, or 54 teaspoonful / gruel by rectum as frequently), or Morphine Sit phate (54 grain by mouth or hypodermically, ever,'! IODOFORM, 165 % to 2 hours), to relieve pain and nervous irrita- bility. IODOFORM-IODOL-ARISTOL. Iodoform taken by mistake or poisoning by ab- sorption from surgical dressings. 4 drachms by mouth has been recovered from, but small doses have caused serious symptoms. ; death from 30 grs. HISTORY: Drowsiness; slight delirium; emaciation; high tem- perature ; rapid pulse; symptoms resemble meningitis. GENERAL SYMPTOMS: i. Wash the wound with the Oil of Eucalyptus. [If the poison was swallowed evacuate the stomach.] 2. Give stimulants if necessary. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 min- utes, or % teaspoonful doses hypodermically as fre- quently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, Or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypo- dermically every % to 2 hours) and Atropine Sul- phate (1/120 to 1/60 grain hypodermically, every y? to 2 hours), or Tincture of Belladonna (20 drops in Water every y to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypo- dermically, every ^2 to 2 hours), or Digitalin (1/100 grain hypodermically, every % to I hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for same purpose. Draughts of strong coffee may also be given. Give Po- tassium Bromide. Potassium Bicarbonate aids elimi- Uation. TREATMENT: IPECACUANHA. SYMPTOMS: Vomiting; hematemesis; hemoptysis. 166 A MANUAL Or TOXICOLOGY. TREATMENT: i. Wash out the stomach if possible. 2. Give vegetable acids, such as vinegar and water (equal parts), Acetic Acid, diluted (a teaspoonful in ^2 pint of water), Citric Acid or Tartaric Acid (% to 2 drachms in a pint of water), or clear lemon juice, or orange juice, freely. 3. Give stimulants if necessary. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses, by mouth every 10 to 15 min-^ utes, or teaspoonful doses hypodermically as fre- quently), or with Aromatic Spirit of Ammonia (a( teaspoonful in a little water every 10 to 15 minutes,' or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypo-, dermically every % t° 2 hours) and Atropine Sul- phate (1/120 to 1/60 grain hypodermically, every ^4 to 2 hours), or Tincture of Belladonna (20 drops in water every Jd to 2 hours). Tincture of Digitalis- (15 to 30 drops by mouth, or half as much hypo- dermically, every % to 2 hours), or Digitalin (1/100 grain hypodermically, every % to 1 hour), or Caffein Citrate (1 to 4 grains every *4 to I hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every t° 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. Give Opium or Morphine for pain. JABORANDI (PILOCARPUS) - PILOCAR> PINE. . I HISTORY: The dangerous dose of Pilocarpine is assumed to' be 2 grains subcutaneously. SYMPTOMS: Profuse sweating; dizziness; salivation; vomit- ing; purging; tearing pain in eyeballs; contracted pupils; myopia. JABORANDI. 167 TREATMENT: I. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small, cupful of water, repeated in 15 minutes if not effective), dr Ipecacuanha (Powdered Ipecacu- anha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. While syphoning, or before causing patient to vomit, give, if at hand and poison recently taken, Tannic Acid or Gallic Acid (30 grains in 2 table- spoonfuls of water), or liberal draughts of strong tea, or a decoction of oak bark (a teaspoonful to 2 wineglassfuls of hot water). Then evacuate the stomach again, unless vomiting continues, 2. Give Atropine Sulphate-(1/100 grain antago- nizes 1/6 grain of Pilocarpine) - (1/120 to 1/60 grain hypodermically every to 2 hours), or Tinc- ture of Belladonna (20 drops in water every y2 to 2 hours by mouth). Very efficacious in arresting the symptoms. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every 20 minutes until pupils are dilated), or Tincture of Belladonna (20 drops in Water every 20 minutes until the pupils are dilated). 168 A MANUAL OF TOXICOLOGY. Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypodermically, every 54 to 1 hour), or Caffein Citrate (1 to 4 grains every 54 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every 54 to ! hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 4. Morphine Sulphate (54 grain every 5^ to 2 hours) to control nausea and vomiting. JALAP. SYMPTOMS: Large, watery stools; tormina; tenesmus. I. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. 2. Give demulcents (such as white of egg, milk, oil, flaxseed or elm tea, barley, gum arabic or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas) to soothe and protect the irritated or inflamed surfaces. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful TREATMENT: LABURNUM. 169 doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a litiie water every io to 15 minutes, or % teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically, every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every p2 to 2 hours), or Digitalin (1/100 grain hypodermically, every % to I hour), or Caffein Citrate (1 to 4 grains every % to I hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and mhaled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. "KNOCK-OUT" DROPS. (Commonly contain Chloral, with perhaps Opium, Hyoscyamus, Bromides or Cannabis Indica). Treatment: Note symptoms as to predominant poison and treat accordingly (see such poison). laburnum (the seeds, wood, bark, LEAVES, FLOWERS, PODS)- CYTISINE-ARNICA. HISTORY: All parts of Laburnum are poisonous, due to the presence of Cytisine, which is also contained in Arnica. Half an ounce of the Laburnum root has caused very serious symptoms. Symptoms usually come on very rapidly; vomit- mg; purging; restlessness ; drowsiness; twitchings; rigidity; convulsions; coma. SYMPTOMS • I. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such TREATMENT : 170 A MANUAL OF TOXICOLOGY. as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small' cupful of water, repeated in 15 minutes if not effec- five), or Ipecacuanha (Powdered Ipecacuanha, 30, grains; or Syrup of Ipecac, a teaspoonful every 10, to 15 minutes until vomiting results), or Apomor- phine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After1 giving emetic, always give plenty of luke-warm^ water to encourage vomiting. Give Tannic Acid or Gallic Acid (30 grains in a cupful of water, then- 10 minutes afterwards again evacuate the stomach).; If Tannic or Gallic Acid not convenient, give plenty7' of strong tea or a decoction of oak bark. 2. Give Epsom Salt (p2 to 1 ounce-1 to 2 table-' spoonfuls-in a teacupful of water), or Rochelle) Salt (2 teaspoonfuls in a small cupful of water). 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aroc matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hy-j podermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every *4 to // hours), and Atropine Sulphate (1/120 grain hypo- dermically every y2 to 2 hours), or Tincture of; Belladonna (20 drops in water every y2 to 2 hours) ( Tincture of Digitalis (15 to 20 drops by mouth, oq half as much hypodermically every y2 to 2 hours)^ or Digitalin (1/100 grain hypodermically every y to 1 hour), and inhalations of Amyl Nitrite (a 3 of. 5 minim pearl crushed in a handkerchief and im! haled, using one every Bi to 1 hour if necessary), may be used for the same purposes. Draughts or strong coffee may also be given (a pint by enema a 4. Employ alternately, hot and cold douches tt the head and chest to arouse the patient. LEAD AND ITS COMPOUNDS 171 LACTUCARIUM. Symptoms somewhat similar to those of Opium, Treat as in Opium poisoning (q.v.). LARKSPUR-STAVESACRE. Symptoms are tetanic-like. Treat as for Nux Vomica poisoning (q. v.). LAUREL: "Broad-Leaf," "Poison," "Moun- tain," "Wood," "Sheep," (etc.) Laurel. It poisons man and animals. Causes nausea, vomiting, dyspnea, dizziness, drowsiness, stupor. Treatment: Evacuate and stimulate, as in Laburnum. LEAD AND ITS COMPOUNDS. Poisoning from Lead is usually by the Acetate ("Sugar of Lead"), sometimes by the Carbonate ("White Lead"), by Red Lead, or by Goulard's Ex- tract. Sugar of Lead has been accidentally mixed with flour, in place of alum. White Lead has been mistaken for chalk, and Goulard's Extract for wine, resulting in poisoning. i% drachms of the basic Acetate has caused ser- ious symptoms; an ounce of Sugar of Lead has been taken without fatal result; Goulard's Extract ^4 pint has been recovered from, also an ounce of White Lead; about 2^4 drachms of the Carbonate of Lead caused the death of a child. Death in fatal cases is usually 3 or 4 days after the patient is prostrated. HISTORY: Throat dry; great thirst; sweet, metallic taste in mouth; breath foetid; colic, relieved by pressure; abdominal muscles very rigid; cramps in legs; par- alysis of extremities ; vomited matters white; stools black (lead sulphide) ; sometimes constipation; rapid, tense, cord-like pulse, becoming weak and relaxed; anxious, pinched, livid face; vertigo ; an- esthesia ; stupor; muscular twitching; convulsions; coma; death. Secondary effects may be atrophy of extensor muscles. SYMPTOMS: 172 A MANUAL OF TOXICOLOGY. TREATMENT: Give soluble sulphate, such as Magnesium or Sodium Sulphate, to form insoluble Lead Sulphate. With Magnesium Sulphate also give white of egg. Treat same as for poisoning by Barium compounds (q. v.). Morphine and Atropine for vomiting and colic; or Alum for colic. Put drachms Powdered Alum in pint boiling milk, separate curd, sweeten with sugar, give wineglassful every 1 or 2 hrs. Elim- inate poison by Potassium Iodide (to to 20 grains in water every 2 to 4 hours), which renders it soluble. Elimination takes place by bile, perspiration and urine. Also employ sulphur baths. Use electricity. Avoid carbonates. LIME. Burning pain in the abdomen; intense thirst; obstinate constipation. SYMPTOMS: TREATMENT: I. Give a vegetable acid: lemon juice or orange juice freely; or Citric Acid (t to 2 drachms to a pint of water), or Tartaric Acid (1 to 2 drachms to a pint of water), or Acetic Acid (a teaspoonful in % pint of water), or Vinegar (in % cupful doses, with water). The soluble sulphates, such as Mag- nesium or Sodium Sulphate (in 1 to 2 tablespoon- ful doses in water). 2. Give demulcents (such as white of 3 or 4 eggs, milk, oil, flaxseed or elm tea, barley water, gum arabic or starch water, oatmeal gruel, or even crushed bananas) to soothe and protect the irri- tated or inflamed surfaces. 3. If pain is severe, give Opium (Powdered Opium, 1 to 2 grains every to 2 hours), or Lau- danum (20 drops every to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth, or hypo- dermically every % to 2 hours.), to relieve pain and nervous irritability. LOBELIA. 173 LOBELIA (LOBELIA INFLATA, INDIAN TOBACCO). HISTORY: A drachm of the powdered leaves is considered a fatal dose. Death in % to 4 days. SYMPTOMS: Violent vomiting'; severe depression and prostra- tion; sometimes violent purging; cold sweat; pale skin; feeble pulse; giddiness ; tremors; sometimes burning pain in fauces and esophagus; convulsions; coma; collapse; death. TREATMENT: Keep in recumbent position, even after acute symptoms are relieved. i. Evacuate the stomach, if free vomiting has not already occurred, i. e., syphon out the stomach with a stomach-tube, using plenty of water. If a stomach- tube isnotat hand, usean emetic, such asZinc Sulphate (20 grains in 2 tablespoonfuls water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective). After giving the emetic, give plenty of lukewarm water to encourage vomiting. While syphoning, or before causing patient to vomit, give, if at hand and poison recently taken, Tannic Acid or Gallic Acid (30 grains in 2 table- spoonfuls of water), or liberal draughts of strong tea, or a decoction of oak bark (a teaspoonful to 2 wine- glassfuls hot water). Then evacuate the stomach again, unless vomiting continues. Caustic alkalies decompose the poison. 2. Give Castor Oil (2 tablespoonfuls). 3. Stimulate heart, circulation, and respiration with Brandy or Whiskey (2 teaspoonful doses, by mouth every 10 to 15 minutes, or % teaspoonful hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine 174 A MANUAL OF TOXICOLOGY. Sulphate (1/60 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every / to 2 hours), or Tincture of Belladonna (20 drops in water every to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to I hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 4. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body) to main- tain bodily temperature. 5. Give Opium (Powdered Opium, 1 to 2 grains every y2 to 2 hours), or Laudanum, 20 drops every % to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate yy grain by mouth, or hypodermically every y2 to 2 hours), to relieve pain and nervous irritability. LOCO (Colorado Itch) LOCO WEED (Crazy Weed) Poisonous, generally; and poison horses, cattle and sheep. Produce mania, erratic, grotesque move- ments, defective vision, progressive emaciation. Treatment: Emetics; cathartics; sedatives or nar- cotics as Chloral, Bromides, Opium, etc., with quiet surroundings; later stimulants, tonic, etc. HISTORY; MALE FERN. Evacuation, stimulation, as in Lobelia. Avoid oil. MERCURY AND ITS COMPOUNDS. Bichloride of Mercury (Corrosive Sublimate)- Red Precipitate (Red Oxide of Mercury)- White Precipitate (Ammoniated Mercury) -Etc. MERCURY AND ITS COMPOUNDS. 175 HISTORY: Corrosive Sublimate has been dispensed for Calo- mel. It is used to kill insects and vermin, to pre- serve specimens, also to prevent dry rot in timber. Death may result from a lotion or ointment of it. Antiseptic solutions used for washing out cavities and as a surgical dressing may poison. Fatal dose: White Precipitate has caused danger- ous symptoms in 30 to 40 grain doses; 10 grains of the Cyanide of Mercury has caused death; Turpeth Mineral has been fatal in doses of 40 grains; 3 grains of Corrosive Sublimate has been fatal; but recovery from an ounce taken on a full stomach, free vomit- ing being promptly induced. The rubbing into the body of a salve of finely divided Mercury for the itch has caused death. Inhalations of Mercury poured on red hot coals has caused death. The fatal result may occur in *4 hour or be delayed to 2 weeks. An alcoholic solution of Corrosive Subli- tnate (80 grs. to ounce) applied to scalp for ring worm killed girl 9 yrs. of age. Death in 3 hours to 12 days. SYMPTOMS: N. B.-The following symptoms refer especially to Corrosive Sublimate, but are in the main also characteristic of the others. Severe gastro-enteritis; acrid, metallic, coppery taste in mouth; sense of constriction in throat; burning heat in esophagus and stomach; colicky pains; mucous, bilious, bloody vomiting; mucous, serous, bloody, straining stools; lips and tongue white and swollen, perhaps shriveled; breath fetid; pulse small, frequent, irregular; face swollen and flushed or anxious and pinched; extremities cold; convulsions; coma; collapse; death. Pain may be absent. Skin eruption (Eczema Mercurial) if symptoms are protracted. Secondary symptoms are coppery taste in mouth; foul breath; swollen, tender, dark-red colored gums; hectic fever; teeth sticky; tongue swollen and thickly furred; breath offensive; salivation. In salivation the saliva may be increased from a pint to i% pints in a day. There may be a mercurial tremor, and anuria. 176 A MANUAL OF TOXICOLOGY. TREATMENT: I. Evacuate the stomach if vomiting has not already occurred; syphon out the stomach with a stomach-tube, using water or albumen-water, (2)* containing Magnesia. May use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha,, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo-^ morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective)/ After giving the emetic, give plenty of luke-warm 4 water to encourage vomiting. *2. Stir up white of egg in water or milk (whites of 4 eggs to 1 quart) and give when begin to wash out stomach. If poisoned by Corrosive Subli- mate, avoid excess of albumin, as the Albuminate of Mercury formed by the white of egg becomes soluble in an excess of the latter, also in the alka- line contents of the intestines, and may be ab- sorbed. Give white of 1 egg for every 4 grains of Corrosive Sublimate taken. If eggs not at hand, give finely chopped raw lean meat, mixed up in milk or water; or wheat flour and milk, or Magnesia. May mix flour in water and give, if eggs, meat or milk not at hand. After giving albumin, milk, or flour, again evacuate stomach, washing out thoroughly if possibles . Give Potassium Iodide (io to 20 grains in 2 table- spoonfuls of water every 2 to 4 hours). { 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by; mouth every 10 to 15 minutes, or % teaspoonfuli hypodermically as frequently), or with Aromatic, Spirit of Ammonia (a teaspoonful in a little watea every 10 to 15 minutes, or % teaspoonful hypo: dermically as frequently) ; also with Strychnine' Sulphate (1/60 to 1/20 grain hypodermically, every' NAPHTHALIN. 177 % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every J4 to 2 hours), or Tincture of Belladonna (5 to 10 drops in water every 2 to 6 hours) lessens the secretion in ptyal- ism. Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every J4 to 2 hours), or Digitalin (1/100 grain hypodermically, < very toi hour), or Caffein Citrate (1 to 4 grains every to 1 hour), and inhalations of Amyl Nitrite (3 or 5 minim pearl crushed in handkerchief and inhaled, using one every X to 1 hour if necessary), may be used as stimulants. Draughts of strong coffee may also be given. Also give demulcents. 4. Employ artificial heat [as in 4 of p. 168]. 5. Give Opium (Powdered Opium, 1 or 2 grains every *4 to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or J4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth, or hypodermically, every *4 to 2 hours), to relieve pain and nervous irritability. 6. Bismuth, Dilute Nitric Acid in water, or Tan- nin as gargles and mouth washes for salivation. The intravenous injection of 7^ grains of Calcium Sulphide in 7^4 ounces of boiled and filtered water has been found beneficial. [Some favor the following treatment, especially in cases seen early, in accordance with the Lambert and Paterson method: Give whites of several eggs, then thorough lavage of stomach; then introduce a pint of milk. If nausea persists repeat the lavage in an hour. When the stomach is quiet, give every other hour one-half pint of a mixture of sugar and Cream of Tartar each one dram, lemon juice one ounce, boiling water one pint. Every alternate hour give one-half pint of milk. Give Potassium Acetate solution, one dram to the pint, by colonic drip enteroclysis, continuously, to induce copious diuresis. Wash out the stomach and irrigate the colon, twice daily, to remove any of the poison being eliminated through these organs. Induce free perspiration by daily use of hot pack. The treatment should be continued until the urine examination, on two successive days, shows the poison is no longer present. For mild cases, a week's treatment may suffice. In cases where a large dose or a series of doses of the poison have been taken, or in which there was a previous kidney, lesion or in which treatment has been delayed for one or more days, it may be necessary to continue it for as long as three weeks. If the treatment is delayed until anuria develops (usually on or by the fourth day), a favorable outcome is quite uncertain although urination be re-established.] N. B.-Corrosive Sublimate is soluble in Alcohol and in Ether. Ether abstracts it from its solution in water. NAPHTHALIN. Depression; cyanosis; twitching; strangury; dark-brown changing to inky-black urine. SYMPTOMS: 178 A MANUAL OF TOXICOLOGY. TREATMENT: I. Evacuate the stomach; syphon out the stom- ach-with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. 2. Give demulcents (such as white of egg, milk, oil, flaxseed or elm tea, barley, gum arabic or starch water, oatmeal gruel, or even crushed bananas), to soothe and protect the irritated or inflamed sur- faces. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or *4 teaspoonful hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every J4 to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. NITROBENZENE-NITROBENZOL. 179 NICOTINE. HISTORY: A liquid alkaloid obtained from tobacco. Has been used for suicide and murder. Is a very deadly poison, death occurring in some instances in a few minutes. The fatal dose of Nicotine for an adult not accus- tomed to tobacco is placed at about i/io of a drop. It is one of the most deadly poisons known, caus- ing death in 3 minutes; but death has been delayed for hours. (See Tobacco). NITROBENZENE (NITROBENZOL, ES- SENCE OF MIRBANE, ARTIFICIAL OIL OF BITTER ALMONDS). A pale yellow oily fluid resembling in odor that of bitter almonds and because of its odor is added sometimes to sweetmeats, liqueurs or pomades. Its fumes, swallowing it, or only applying it to the skin, may poison. Workers in anilin dyes are exposed to danger from handling it. It is the solvent in many liquid shoe blackingsand may poison by being absorbed. It is a powerful narcotic; effects similar to those of Prussic Acid. Death in hours or days. Fatal Dose: 8 to 15 drops is considered a fatal dose ; or merely tasting the fluid. Death from asphyxia. HISTORY: The symptoms vary in character and may be strangely delayed for a day or two. Languor; numb feeling in head; confusion of mind; nausea; anxi- ety ; cyanosis; dark nails, lips, tongue and mouth; dilated pupils ; convulsions. Coma. SYMPTOMS : TREATMENT: When swallowed. I. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If 180 A MANUAL OF TOXICOLOGY. the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (i/io grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. . Then give Ammonium Carbonate (2 to 10 grain doses every 2 to 4 hours in much water), or Spirit of Mindererus (J4 to 1 tablespoonful in water every 2 to 4 hours), or 2. Stimulate heart, circulation and respiration with Aqua Ammonia (^ teaspoonful in a cupful of water), or with Aromatic Spirit of Ammonia (a tea-, spoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently), or with Chloric Ether teaspoonful in water every 15 to 30 minutes), or give these as enema; also with Strych-' nine Sulphate (1/60 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every % to 2 hours), or Tincture of Belladonna (20 drops in water every J/ to 2 hours).' Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every to 2 hours), oil Digitalin (1/100 grain hypodermically, every X I'j hour), or Caffein Citrate (1 to 4 grains every X to i'l hour), and inhalations of Amyl Nitrite (a 3 or 5 minim' pearl crushed in a handkerchief and inhaled, using one every to 1 hour if necessary), or inhalations of Ammonia may be given for the same purposes. Draughts of strong coffee may also be given. Thq transfusion of a normal saline solution (a heaping, teaspoonful of salt to 1 quart of water,used at no° F.}( may prove serviceable. [Blood is thick and brown.]' NITROGLYCERINE. 181 3. Employ alternate hot and cold douche to chest, pouring from a height. Rub body. 4. Employ artificial respiration if necessary (by rhythmically raising arms extended at sides to up over head and back 18 times a minute) until recov- ery results or cardiac pulsation is lost. 5. Give oxygen. Use normal salt solutions per rectum. Chloroform for excitement. 6. Employ interrupted current of electricity over heart region and to chest walls. Flagellate. When inhaled : omit No. 1, NITRIC ACID. (See Acids, Mineral.) NITRITES. (See Amyl Nitrite.) NITROGLYCERINE. Is used as a remedy for neuralgia, angina pectoris, and various cardiac affections; has been taken by mistake for a beverage. Fatal dose : two mouthfuls of crude Nitroglycer- ine caused death; 1/50 m. severe headache. HISTORY: SYMPTOMS : Throbbing headache, increased by motion; "queer" feeling in head; pulsation all over body, even to the ' tips of the fingers; mental confusion; giddiness; sense of constriction in throat; irregular pulse; mus- qcular weakness; precordial pain; dilated pupils; flushed face; anxiety; scanty, pigmented urine; sudden collapse; sometimes nausea and loss of con- sciousness; also symptoms characteristic of the Nitrites. TREATMENT: Emetics and cathartics. Recumbent position. • Apply to head, cloths containing ice or wrung out in ice water. Give Brandy (i to 4 teaspoonful doses). 'Give Strychnine Sulphate (1/60 to 1/20 grain hypo- dermically every to 2 hours) and Atropine Sul- phate (1/120 to 1/60 grain hypodermically, every %, to 2 hours), or Tincture of Belladonna (20 drops in 182 A MANUAL OF TOXICOLOGY water every to 2 hours). As a rule the Bella- donna relieves the headache. Also give Fluid Ex- tract of Ergot (X to 1 teaspoonful in water, re- repeated in 15 to 30 minutes, by mouth, or half as, much, or a grain of Ergotin, hypodermically). Also coffee for headache. NITROUS OXIDE. OILS, VOLATILE. (See Anesthetics). (See p. 222). NUX VOMICA (STRYCHNOS NUX VOM- ICA, POISON NUT, QUAKER BUTTONS, RAT'S BANE) - STRYCHNOS IGNATII - STRYCHNINE - BRUCINE. HISTORY: Poisoning may result from swallowing a vermin killer containing meal or flour with strychnine, and! perhaps arsenic also. Game killed with Strychnine may poison. The drug is used for both suicide and murder. It has been taken by mistake for Santo-, nine, for Salicin, etc. Brucine may be physiologic- ally considered a dilute Strychnine. Fatal dose: Powdered Nux Vomica, 30 grains. (One seed weighs about 30 grains-sufficient quan-- tity to cause death). Extract of Nux Vomica, 3 grains. Death may occur from Nux Vomica in> from 15 minutes to 12 hours. Three grains of" Strychnine are usually fatal, and 1/6 of a grain'has) caused death; 1/16 of a grain hypodermically has' produced alarming symptoms. It is probable that/ 7/10 of a grain hypodermically would produce death; 1/16 of a grain by mouth killed a child 2 years old in 4 hours; a recovery in an adult from 20 grains' after prompt emetic; Dr. Warner died in 20 minutes from % grain (likely to kill), taken by mistake. Death or recovery is usually speedy. There is hope of recovery if the patient lives over 5 or 6 hours. Fatal results have occurred in 5 minutes. NUX VOMICA. 183 There was death after 6 hours in a case where 6 grains of Strychnine were given with some Morphine. Average fatal dose Strychnine about 1% gr. Death in hrs. from W gram. Recovery from 40 grs. Death, from suffocation or exhaustion, usually in about 1 or 2 hours from beginning of symptoms. The taste of Strychnine is intensely bitter and a dilution of 1 part in 100,000 may still be recognized by its bitter taste.' A sense of suffocation and difficulty in breathing; sudden muscular rigidity; stiffness about the neck; uneasy startings and sense of impending death, fol- lowed by tetanic convulsions, which come on in par- oxysms varying in intervals from 3 to 30 minutes; lasting from 1 to 5 minutes or longer; opisthotonos; limbs rigid, head bent back, body stiffened and arched, resting on head and heels, with everted feet, during paroxysm-sometimes the arching is forward and sometimes it is sideways; convulsions produced by a slight touch, breath of air, or noise; between convulsions a complete relaxation; face dusky from difficulty in breathing; eyeballs promi- nent and pupils dilated during paroxysm; lips livid; a peculiar grin (risus sardonicus), corners of mouth drawn back; eyes fixed, widely opened; great thirst but inability to drink from spasms of jaws; respira- tion suspended during convulsion, patient quite con- scious ; often great anxiety; sometimes convulsive screams; cramp-like muscular contractions; pulse feeble and very rapid during paroxysm; involuntary defecation and urination; lock-jaw late in poison- ing; death. (Distinguish from idiopathic or trau- matic tetanus). SYMPTOMS: TREATMENT: N. B. - Put patient in horizontal position in a dark room, free from all noise. i. Give animal charcoal (ad libitum), or Tannic Acid (30 grains in a small wineglassful of water), 184 A MANUAL OF TOXICOLOGY. which forms a very insoluble tannate; or Iodine (i to 2 grains) and Potassium Iodide (5 to 10 grains) in water (a small wineglassful), or strong tea, or a decoction of oak bark ounce to a gill of water) ; or, Tr. Iodine, % dr. doses; follow by syphonage, the stomach-pump, or an emetic if spasms have not set in. Potassium Permanganate (in 10 grain doses in a pint of water and repeated in 2 hours) is said to be a good antidote. Also Iodide of Starch. 2. Evacuate the stomach QUICKLY: Syphon out the stomach repeatedly with warm water, using a stomach-tube and gag. If tube is not at hand, use the stomach-pump, or give an emetic, such as Zinc Sulphate 20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not pro- duced), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective). After giving emetic, always give plenty lukewarm water to encourage vomiting. After tetanic symp- toms have begun, avoid using stomach-tube or an emetic until the paroxysms have been con- trolled. 3. Give Spirit of Nitrous Ether (a teaspoonful). Catheterize frequently to prevent reabsorption. 4. Give inhalations of Chloroform or Ether to control the spasms; or give Chloral (20 to 30 grains in water by mouth or twice as much by rectum, every % to 2 hours), or Potassium Bromide (1 to 2 drachms in water every to 1 hour by mouth, or 1% to 2 drachms by rectum), not both Chloral and Bromide. Keep patient gently narcotized during sev- eral hours if necessary. Give Atropine Sulphate (1/120 to 1/60 grain hypodermically every to 2 hours), or Tr. Belladonna in 20 drop doses every to 2 hours. Inhalations of Amyl Nitrite (3 or 5 minim pearl crushed OPIUM, LAUDANUM, ETC. 185 m handkerchief and inhaled, using one every io to 15 minutes if necessary), Curare (in 1/20 to 1/6 grain doses hypodermically), Calabar Bean (in form of Phy- sostigmine Sulphate, 1 /100 to 1/50 grain every to 2 hours), Paraldehyde (^ to 1 teaspoonful in sweetened Water every to 2 hours) and Urethane (in 5 to 30 grain doses in water every % to 1 hour) also highly recommended. Strong tea relieves thirst. Important! For threatened death from em- barrassed respiration, should promptly resort to artificial respiration (rhythmically raise and lower arms from extended position at sides to up over head and back again, 20 times a minute), if possible. OPIUM - LAUDANUM - CODEINE-MOR- PHINE, HEROIN -NARCEINE -POP- PY-LACTUCARIUM-DIONIN-ETC. Poisoning has resulted from an infusion or decoc- hon of seeds, capsules or leaves of the poppy, also the blossoms and fruit of the red poppy, also from the official and other preparations of Opium. Poison- mg has resulted from enemata, lotions, poultices, .and suppositories containing Opium or its prepara- tions. Children are very susceptible to Opium and ■ its preparations. "Godfrey's Cordial," "Dalby's Carminative," "Battley's Solution" and "Black Drop" may be classed under Opium and its prepa- rations. Opium is quite often employed for the commission of suicide, also of murder. Fatal dose: 4 grains is the smallest fatal dose of Opium recorded, but 360 grains have been recov- ered from; Laudanum, 1 drachm ; Extract of Opium, grains (equal to 5 grains of Opium) ; Morphine Mrom 1 to 4 grains. Fatal results from 1/6 to % of a grain of Morphine subcutaneously. Recovery from even 4 or 5 ounces of Laudanum; also from 2 drachms of Morphine. Infants have died from such small doses as 1/90, 1/15 and % of a grain of Opium, or 2 or 3 drops of Laudanum; 1 drop equiv- HISTORY: 186 A MANUAL OF TOXICOLOGY. alent to about 1/12 grain of Opium, killed an infant 7 days old; 2 grains of Morphine Acetate subcutane- ously injected in a man with rabies produced buk little effect. Tetanus, Strychnine, convulsions, great pain, or Opium habit, make nervous system very toler^ ant of Opium. De Quincey used 9 ounces of Laudanum daily (equal to 360 grains of solid Opium). Death has occurred from Morphine applied to an abraded surface* In Opium poisoning, death usually occurs in from 7 to 12 hours. Shortest period recorded is J4 of anf hour; the longest 4 days. If patient survives 12' hours, chances of recovery are good. Patient corju sidered comparatively safe when respirations stay! above 10 per minute. The symptoms of Morphine poisoning appear ink from % to 1 hour, and a fatal result may occur ini 24 of an hour, but as a rule not until 6 to 24 hours- after the poison was taken. Opium makes whites and Chinese sleepy; said t<| cause homicidal mania in Japanese and Malays. Mental excitement; increased heart action; head,, ache; weariness; weight in limbs; drowsiness; di' minished sensibility, then deep sleep; contracted pupils (perhaps to a pin point) ; then face becomes reddened, suffused, or bluish; consciousness en- tirely lost; at first difficult, later impossible, to arouse patient; reflexes lost; jaw falls; cyanosis ' respiration stertorous and puffing, shallow, slow, difficult, irregular; muscular relaxation; cold clammy sweat; pulse rapid, weak, compressible J coma; death. Early vomiting and free perspiration are favorable symptoms. Prognosis is less favorable, the more strongly the pupils are contracted. A small fatal dose usually produces narcosis, but ?. very large one often causes severe convulsions. [In conjunction with the preceding symptoms in-, vestigate the history of the case; notice the odor of the breath and of the vomited matter, and ex- amine the urine for Morphine. Remember Alco-. hoi and Opium in some form frequently are taken' SYMPTOMS: OPIUM, LAUDANUM, ETC. 187 together. See if pupils are normal or. dilated and conjunctiva congested as occurs in alcoholism, or if the pupils are contracted and insensible to light as occurs in Opium poisoning, or unequal as in apo- plexy. In apoplexy, paralysis of facial muscles or limbs and the cardiac and vascular condition aids m the diagnosis. In Chloroform or Ether poison- mg the vomited matter or breath usually reveals the poison by the odor; and in poisoning by drinking Chloroform is death-like aspect of face and widely dilated pupils. In uraemic poisoning, the history of the case, examination of the urine and equal pu- pils (dilated or normal, with puffy eyelids), indicate the poisoning. In diabetic coma, the characteristic apple or pear odor may be detected on the breath, and sugar found in the urine.] Differentiate from hemorrhage into pons with contracted pupils. TREATMENT: Immediately resort to artificial respiration and stimulation in the most urgent cases. (See p. 89.) 1. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains, or Syrup of Ipecac, a teaspoonful, every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, every 15 minutes until effective), if narcosis has not set in. After emetic, give water to en- courage vomiting. Thoroughly wash out stomach (Morphine given hypodermically, enters stomach) While syphoning the stomach, or when giving emetic, or even before, give Potassium Perman- ganate (10 grains in a pint of water, repeated in % hour; or as much as of Morphine taken, and re- peat every % hour 3 or 4 times), to oxidize the poi- 188 A MANUAL OF TOXICOLOGY. son. This drug has seemingly proved effective even when Morphine had teen taken hypodermically. It is said that 6 grains of the Permanganate will neu- tralize an ounce of Laudanum. It has been pro- posed to add 2 teaspoonfuls of Dilute Acetic Acid or of White Vinegar to the antidote to change the Mor- phine into a soluble salt. Irrigate colon, high up. The hypodermic injection of Potassium Per- manganate solution is believed to have proved bene- ficial in some cases. (Inject 15 minims of a grain to the ounce solution every 15 minutes.) When Potassium Permanganate has been intro- ' duced into the stomach in treatment, it should after- wards be removed by syphon or emetic. If Potas- sium Permanganate is not at hand, give Tannic ' Acid (30 grains in a wineglassful of water), or Gal- lic Acid (the same amount), or copious draughts of strong tea, to make all the alkaloids insoluble. Ani- mal Charcoal (a tablespoonful or more, preferably dry) may be given to precipitate or absorb the alka- loids. When the stomach has been evacuated well in- troduce a pint of hot, strong coffee and leave it there.. 2. Administer Atropine Sulphate, hypodermic- ' ally (1/120 to 1/90 grain every 15 minutes, 3 times, or until respirations number 8 per minute), or Tincture of Belladonna by mouth or hypodermically (10 to- 20 drops in water every 15 to 30 minutes, 2 or 3 times). It is said that 1/20 grain of Atropine will , antagonize 1 grain of Morphine, and 2 to 3 drachms of Laudanum. Atropine or Belladonna should be^ given very cautiously in this kind of poisoning^ and not until the pupils dilate (therefore not de-( pending upon such effect as a guide), lest poison- ing by either result.-guide is better respirations., 3. Arouse patient with inhalations of Ammonia? Water or smelling salts cautiously employed. 4. The patient should be further aroused and' kept awake by means of shaking, pinching, slapping! with a wet towel, dashing cold water on face and chest, or alternate hot and cold, over his head from a height, frequently repeated, drying patient in the OPIUM, LAUDANUM, ETC. 189 intervals. Avoid applying so much cold water as to cause collapse. Alternately hot water and ice tc the nape of the neck helps. Walking between attendants often helps to arouse and stimulates lagging circula- tion, but avoid walking patient so much as to use up vitality. Arouses to flagellate soles of feet. Tincture of Capsicum (i to 2 tablespoonfuls in Water) by rectal injection sometimes almost instantly relieves the stupor. Lemon or Orange Juice, or Cream of Tartar in water, every 10 minutes, antag- onizes the narcotism. Avoid vinegar and Acetic Acid. 5- Oxygen inhalations are frequently of great Value; also faradization of chest muscles (anode placed over root of phrenic nerve, cathode 3 inches below ensiform cartilage), or of the extremities. 6. Stimulate heart, circulation, and respiration with Strychnine Sulphate (1/60 to 1/20 grain hypo- dermically every X t0 2 hours), or Tincture of Digi- talis (15 to 30 drops by mouth, or half as much hypo- dermically, every % to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour). Caffein Citrate (1 to 4 grains every to 1 hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every to 1 hour if necessary), are highly recom- mended for the same purposes. Plenty of strong Coffee may well be given frequently by mouth, but enema of a pint, introduced hot, is often very beneficial. (Although Brandy,Whisky, Ether or Cam- i phor hypodermically are sometimes resorted to for failing circulation and respiration, as a rule it is bet- ter to avoid their use, owing to their effects upon Jhe brain, etc.) May use Cocaine(% gr. hypoderm.) 7- Give Sweet Spirit of Nitre (1 teaspoonful in a . ^ineglassful of water every hour) to aid elimina- / ion of the poison by the kidneys. Evacuate the * Madder frequently to prevent reabsorption of the poison. Pilocarpine aids elimination. 8. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, bags of salt, bricks, plates, or stove-lids, heated 190 A MANUAL OF TOXICOLOGY. applied to feet and sides of body), to maintain bodily temperature. Employ: friction, heart massage. 9. Resort to artificial respiration (raise extended arms from sides to up over the head and back again 18 times a minute) if breathing stops or becomes very labored. Should be kept up for 2 hours if in doubt. Normal salt solution, may help. (See p. 118.) PARALDEHYDE. Has been recommended as a substitute for Chloral. Odor of drug in breath and urine. Fatal dose: I drachm has produced serious symp- toms. Recovery from 3)4 ounces. Unconscious- ness may last for more than 30 hours. Death by paralysis of respiratory centres. HISTORY: SYMPTOMS: Slight stimulation; excited; incoherent; muscular relaxation ; rapid pulse; pupils contracted and in- sensible to light; insensibility; collapse. TREATMENT: i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha. 30 grains, or Syrup of Ipecac, a teaspoonful, every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. 2. Give Atropine (1/120 grain hypodermically every % to 1 hour, 2 or 3 times), or Tincture of PETROLEUM-ROCK OIL, ETC. 191 belladonna (10 to 15 drops every to I hour, for 2 or 3 doses), or Strychnine Sulphate (1/60 to 1/20 grain doses hypodermically every *4 to 2 hours). Employ electric battery if necessary. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body). 4- Oxygen. If required, artificial respiration. PETROLEUM (CRUDE MINERAL OIL OR ROCK OIL) - PARAFFIN OILS - KERO- * SENE (MINERAL OIL, COAL OIL)- GASOLINE (PET RO L - BEN Z INE) - NAPHTHA-RHIGOLENE-ETC. Petroleum or the products of its distillation have peen drunk accidentally for ginger beer and other beverages with serious results. 3 ounces of Naph- ta (the kind usually burned in lamps) killed a boy 12 years of age. Recovery after swallowing a pint Petroleum and ^2 pint of Kerosene. Poisoning Easily recognized from smell of breath and vomited Matters. The prognosis is good. [The inhaling of Gasoline fumes or gases of its com- bustion, particularly in an enclosed space such as a garage, has proved very dangerous and sometimes sud- denly fatal, through the production, it is claimed, of carbon Monoxide, Methane, acetylene, etc. The free ^se of Gasoline as a wash may cause dysphagia, head- ache, cyanosis, coma, perhaps death; mania may occur 'luring a recovery. Treat these forms of Gasoline Poisoning as in poisoning by Carbon Monoxide, but "timulate cautiously.] HISTORY: SYMPTOMS: Severe burning in mouth and stomach; vomiting; •-mols covered with oily layer; cold skin; feeble Pulse; sighing respiration; pale, anxious face; great durst and restlessness at night; unconsciousness. *i. Evacuate the stomach; syphon out the stom- 6^h with a stomach-tube, using plenty of water. If TREATMENT: 192 A MANUAL OF TOXICOLOGY. a stomach-tube is not at hand, give an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if nobf effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains, or Syrup of Ipecac, a teaspoonful, every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10' grain, repeated every 15 minutes until effective)., After giving the emetic, give plenty of luke-warm water to encourage vomiting. 2. Stimulate heart, circulation, and respiration1 with Brandy or Whisky (2 teaspoonful doses by> mouth every 10 to 15 minutes, or J4 teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little^ water every 10 to 15 minutes, or % teaspoonful hy' podermically as frequently) ; also with Strychnin^. Sulphate (1/60 grain hypodermically every *4 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every ^2 to 2 hours), or Tincture of Belladonna (20 drops in water every *4 to 2 hours W Tincture of Digitalis (15 to 30 drops by mouth, oh half as much hypodermically, every )4 to 2 hours)/ or Digitalin (1/100 grain hypodermically every to 1 hour), or Caffein Citrate (1 to 4 grains ever/ % to 1 hour), and inhalations of Amyl Nitrite (a 3 O^ 5 minim pearl crushed in a handkerchief and inhaled using one every % to 1 hour if necessary), may b/; used for the same purposes. Draughts of strong coffee may also be given, and friction of the skiy resorted to. 3. Employ artificial heat (such as hot wate1 bottles, or ordinary bottles containing hot waters or bags of salt, bricks, plates, or stove-lids, heatelp applied to the feet and sides of the body), to main' tain bodily temperature. 4. Resort to artificial respiration (raise extended}, arms from sides to up over head and back agair# PHOSPHORUS-"RATSBANE," ETC. 193 18 times a minute), if breathing stops or becomes very labored. Should be kept up for 2 hours if in doubt. 5. If pain is severe, give Opium (Powdered Opium, 1 or 2 grains every *4 to 2 hours; or Lau- danum, 20 drops every J4 to 2 hours by mouth, or j4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth, or hypoder- mically, every *4 to 2 hours), to relieve pain and nervous irritability. PHENACETIN. (See Acetanilid). PHENOLS. (Acid Carbolic, etc.) PHOSPHORUS-"RATSBANE"-"RAT POISON"-MATCHES. HISTORY: Yellow (common) Phosphorus is poisonous, lum- inous, and evolves a strong odor. Red Phosphorus is not poisonous, not luminous, and almost odorless. The former is used in rat-poison and both kinds for the ends of matches. Old style matches are tipped frith Yellow (waxy) Phosphorus mixed with Potassium Chlorate, sand, and glue. "Safety" matches are tipped only with Potassium Chlorate and Antimony Sulphide; Red Phosphorus and sizing on the contain- ing box, for lighting. The ordinary Phosphorus rat- paste consists of Phosphorus, fat and sugar; some also contain Prussian blue as a coloring matter; others contain Arsenic as well as Phosphorus, and a common rat-paste is said to have ground glass for one of its constituents. Some vermin killers con- tain Strychnine. Fatal dose: grains of Phosphorus; 1/9 grain has caused death. The chewing of two matches killed a child. Recovery after suck- ing 300 matches. 1/50 grain of Phosphorus killed a child; ij4 grains killed a man, and % grain, a woman, inside of 12 hours. A child recovered after swallowing a drachm of rat-poison. Death occurs in from % hour to 12 days; usually between the 194 A MANUAL OF TOXICOLOGY. third and seventh days. Recovery is rare. Death results from failure of circulation and respiration. Death frequently takes place suddenly. Phospho- rus is more likely to cause death if finely divided or in solution than if taken in solid form. SYMPTOMS: The symptoms may appear in an hour or not until 3 or 4 days after the poison has been taken. Breath smells of Phosphorus-is garlicky; Phos- phorus or garlic taste in mouth; eructation of Phos- phorus vapors and may be Phosphorus odor in breath; burning pain in esophagus, stomach and ab- domen ; inflammation of stomach and intestines; mucus, bile and blood vomited and are luminous in the dark; there may be purging or constipation; may be bloody, coffee-grounds vomit with suppres- sion of bile; jaundice, perhaps with nettle-rash; pain in region of and liver enlarged; pupils usually dilated; temperature low; abdomen distended; twitchings; headache; vertigo; delirium; tendency to hemorrhage; albuminous, scanty urine; convul- sions; coma; pseudo-menstrual discharge, abortion or miscarriage in women. The general symptoms are similar to yellow atrophy of the liver. (De- generation of liver and kidneys may finally result and ultimately cause death.) TREATMENT: Avoid oils and fats and substances containing them, such as milk, as they increase solution and absorption of the Phosphorus. There is no known chemical antidote. i. Evacuate the stomach by syphoning it out with ' a stomach-tube, using also, if possible, water, into - which a teaspoonful of old Oil of Turpentine has been put. Wash thoroughly. If a stomach-tube ist, not at hand, may use a stomach-pump or give anil emetic of Copper Sulphate (3 or 5 grains in 2 table- । spoonfuls of water every 5 to 10 minutes until vom- - iting results). Then continue the Copper Sulphate in 1 xJHOSPHORUS-"RATSBANE," ETC. 195 1 grain doses every 15 minutes for 2 or 3 more doses. Copper Sulphate is the best emetic, inasmuch as it is believed to have some antidotal action by forming a less soluble phosphide; it is supposed to coat the particles of Phosphorus, primarily with a layer of Copper Phosphide, secondarily with Copper itself, thus preventing the solution of the Phosphorus par- ticles in the stomach fluids. If Sulphate of Copper is not at hand, use Zinc Sulphate (20 grains in 2 tablespoonfuls of water), '°r Mustard (a tablespoonful to 2 of water), may be ^ven. [Recto-colonic irrigation later on.] 2. Give without delay old, resinified Oil of Tur- pentine, or better still, French Oil of Turpentine teaspoonful or more, floated on hot water or in [apsules, and repeat 3 or 4 times, at 15 to 30 minute intervals. Avoid oil, soup, milk, white of egg or hher albuminous substances; also avoid mucilagi- Jous or alcoholic drinks. If it cannot be determined ■hat quantity of Phosphorus has been taken, the old brench Oil of Turpentine may be given in 4 doses * % teaspoonful at 15 minute intervals. If the > Cunach will not retain the Turpentine, it has been ^commended that it be injected into the rectum, AOmized into the lungs, the air of the room satur- Hed with its fumes, or that it be rubbed into the skin b the form of a liniment. The French Oil of Tur- ^ntine is quite soluble in Ether and Alcohol. Tur- Witine (old) forms with Phosphorus an almost insolu- mass, the so-called Turpentine-phosphoric Acid. V°o times as much Turpentine should be given as < Pere was Phosphorus taken.) It should be given h°t water or alone (floated on the water or in cap- ^Jes) immediately after the Phosphorus has been ?iken or as soon thereafter as possible. It is con- Pa 'red valueless if not given within 12 hours after. 'T/otassium Permanganate recommended (4 gr. . J an ounce of water, frequently, or several pints of . .T same strength used to wash out stomach). Orito 1 V. Hydrogen Peroxide solution may be used instead. 196 A MANUAL OF TOXICOLOGY. Lime Water freely, or Charcoal (a teaspoonful mixed in a small cupful of water) may be given W prevent action upon the tissues. If nothing else i* at hand, some recommend giving Gum Arabic o5 Tragacanth in water to protect the stomach. 3. If the Turpentine given does not freely purge give Magnesium Sulphate (Epsom Salt, 2 tablespoon- fuls in water or Infusion of Senna, Sweet Spirit oi Nitre (a teaspoonful in water) or more old Turpen tine (in % drachm doses in mucilage every % hr.), If the bladder is inactive use a catheter frequently 4. Give Opium to counteract the pain and tb'p cardiac and systemic depression. Powdered Opium (1 to 2 grains every ^2 to 2 hours), or Laudanuq' (10 to 20 drops every ^2 to 2 hours by mouth, or teaspoonful in gruel by rectum as frequently), o Morphine Sulphate (% grain by mouth or hypodeC mically every to 2 hours). 5. Transfusion may be necessary to repair t^ blood. Inhalations of highly diluted Turpentin vapor are beneficial; also of pure oxygen. HydrC gen Peroxide, given in solution or injected subct taneously, has been highly recommended. 6. Magnesia, Milk of Magnesia, Chalk, or Li rd suspended in gruel have been recommended. Aftc acute symptoms over, give Sodium Carbonate freely f< acid intoxication. Apply heat to feet and body. PHYTOLACCA (POKE: "Berry," "Root," a J "Weed." Garget; Pigeon. Berry; Crow Berd Cancer Root; Red Weed; Red Ink Plant, etc L ■ Nausea; vomiting; slowing of heart and respirf tion; depression; dyspnea; palpitation. TREATMENT: i. Vomiting and purging are frequently pr duced by the poison, but syphoning out the stom- ach with stomach-tube and much water is desii SYMPTOMS: PHYTOLACCA. 197 able. If evacuation does not occur, give Apomor- phine Hydrochlorate, hypodermically (i/io grain every io or 15 minutes until effective), or Mustard (a tablespoonful in a small cupful of water). 2. Stimulate. Give Brandy or Whisky (2 tea- spoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or Aromatic Spirit of Ammonia (a teaspoonful in Water every 10 to 15 minutes), or Compound Spirit of Ether (% to 2 drachm doses in water every 10 to 20 minutes). Support heart with Tincture of Digi- talis (10 to 20 drops in water every *4 to 2 hours), pr Digitalin (1/100 to 1/50 grain doses hypoderm- ically every to 2 hours). 3- Give Opium (Powdered Opium, 1 to 2 grains every y2 to 2 hours), or Laudanum (20 drops every % to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every % to 2 hours), to relieve pain and nervous irritability. PICROTOXIN. (See Coccultis Indicus). PILOCARPINE. (See Jaborandi). PINK ROOT. (See Spigelia). (See Phytolacca). POKE. POISON OAK OR POISON VINE. (See Rhus). POPPY. POTASSIUM,-CAUSTIC POTASH. (See Opium). (See Alkalies). 198 A MANUAL OF TOXICOLOGY. POTASSIUM CHLORATE-Chlorates- Nitrates. Fatal dose: from y2 ounce upward, in% to 12 day4 HISTORY: SYMPTOMS: Poisonous doses interfere with the oxygenation of the blood corpuscles and produce toxic haema-f globinuria. Evidences of severe irritation of the! alimentary canal and of the nervous system; severd dyspnoea; cyanosis; the skin usually jaundiced^ delirium; coma. Acute tubal nephritis is pro;/ duced; the excretion increased, but its chemical; reaction unchanged. TREATMENT: I. Evacuate the stomach: syphon out the stom.y ach with a stomach-tube, using plenty of water If a stomach-tube is not at hand, use an emetic' such as Zinc Sulphate (20 grains in 2 tablespoon- fuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a, small cupful of water, repeated in 15 minutes it not effective), or Ipecacuanha (Powdered Ipecacu-'* anha, 30 grains; or Syrup of Ipecac, a teaspoonfulj every 10 to 15 minutes until vomiting results), op Apomorphine Hydrochlorate, hypodermically (1/1O- grain, repeated every 15 minutes until effective)-. After emetic, give plenty of lukewarm water. Pilo^ carpine cautiously, favors salivary excretion. 2. Give demulcents (such as white of egg, millA oil, gum arabic, flaxseed or elm tea, gelatin, flou/' and water, barley or starch water, oatmeal gruel,i or even crushed bananas) to soothe and protect the irritated and inflamed surfaces. * r} 3. Employ artificial heat (such as hot wate^ bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body) to main- tain bodily temperature. PTOMAINES. 199 4. Give Opium (Powdered Opium, I to 2 grains every % to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate ()4 grain by mouth, or hypodermically every % to 2 hours), to relieve pain and nervous irritability. Employ inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to I hour if necessary). Avoid stimulants, or anything likely to increase the congestion of the kidneys, if severe. PRECIPITATE, RED OR WHITE. (See Mercury). PTOMAINS (PUTREFACTIVE, CADAVERIC OR ANIMAL ALKALOIDS). HISTORY: Ptomains are alkaloidal or basic products of the putrid decomposition of animal or vegetable matter. Many of the Ptomains respond to most of the ordi- nary reactions of the vegetable alkaloids, thus lead- ing to confusion or error in toxicological investiga- tions. Not all Ptomains are poisonous, and quite often that which is called Ptomain-poisoning is really due to a mixture of substances containing no recognized causative Ptomain. Such poisoning should be considered as a food poisoning (q. v.). The reactions of certain Ptomains duplicate the actions of the following alkaloids: Atropine, Colchi- cine, Coniine, Delphinine, Digitalin, Nicotine, Strychnine and Veratrine. The substances which produce symptoms very much like those of Atropine are called Ptomatro- pines. They have been found in corned beef, poi- sonous sausage, decaying fish, and putrid game. SYMPTOMS: 200 A MANUAL OF TOXICOLOGY. They cause dryness of the mouth, great thirst, red and swollen gums, dilated pupils, drooping eyelids; occasionally loss of voice, great weakness; there may be chills, vomiting, diarrhoea, offensive, dark- colored stools, temperature 101 to 104, convulsions and even death from paralysis of the heart. Post mortem examinations may show congestion of brain, lungs and kidneys, etc. Oily, alkaline, volatile substances resembling Coniine in their reactions have been discovered in decomposing animal tissues. The reactions and physiological effects of certain ptomains from corn meal are somewhat similar to those of Strychnine. Digitalin-like substances have been discovered in liver sausage. A substance giving most of the reactions of Col- chicine has been found in beer. Poisons formed during putrefaction. Tyrotoxicon is said by some to be a poisonous proteid allied to the tetanus and diphtheria toxins; by others a ptomain, and found at times in stale milk, cheese, ice-cream and certain milk products. Tyrotoxicon produces vomiting, purging, rapid pulse, dilated pupils, hurried breathing, depression of temperature, prostration, and death. Typhotoxine-a substance produced by the Eb- erth bacillus of typhoid fever, kills mice and guinea pigs in a day or two. Mydaleine, found in decaying cadaveric liver, spleen, etc., causes increase in temperature when hy- podermically administered. Neurine, found in decomposing animal tissue, acts similar to Curare. Cancroin is believed to be similar to Neurine and the active agent in producing cancer. Susotoxine, Choline, Methylguanidine, Isoamylamine, Patoa- mine, Trimethylenediamine, Ethylidenediamine, etc., also cause more or less serious symptoms or death. Treat as in Food, Poisonous (q. v.). TREATMENT: PULSATILLA. 201 PULSATILLA. HISTORY: Death by paralysis of heart. Reduced heart action, respiration, and tempera- ture; pupils dilated; motion and sensation para- . lyzed. SYMPTOMS: I. Evacuate the stomach : syphon out the stomach With a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of Water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not ■effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every T° to 15 minutes until vomiting results), or Apo- niorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm Water to encourage vomiting. Give Tannic Acid (in 10 to 20 grain doses). 2. Stimulate. Give Brandy or Whisky (2 tea- - spoonful doses by mouth every 10 to 15 minutes, or 34 teaspoonful doses hypodermically as frequently), and Tincture of Digitalis (15 to 20 drops by mouth, pr half as much hypodermically, every % to 2 aours), or Digitalin (1/100 grain hypodermically .every % to 1 hour). 3- Give Opium (Powdered Opium, 1 to 2 grains ।every to 2 hours), or Laudanum, 20 drops every 34 to 2 hours by mouth, or y2 teaspoonful in gruel ay rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically, every % to 2 flours), to relieve pain and tenesmus. TREATMENT: RAT PASTE-"ROUGH ON RATS"; ETC. (See Arsenic; also Barium and Phosphorus). 202 A MANUAL OF TOXICOLOGY. RESORCIN. HISTORY: Is used as an anti-pyretic and antiseptic. Very few cases of poisoning. Fatal dose: 2 drachms have nearly caused death. Death by para'lysis of respiratory centres. Dizziness;tingling sensation-"pins and needles''; severe perspiration; lips blanched; dry tongue; low temperature; normal pupils; black urine; clenched ■ teeth; unconsciousness. SYMPTOMS: TREATMENT: I. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If a' stomach-tube is not at hand, use an emetic, such, as Zinc Sulphate (20 grains in 2 tablespoonfuls of water every 10 to 15 minutes if vomiting is not pro- duced), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective); or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 min-^ utes until vomiting results), or Apomorphine Hy-, drochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). While syphon*; ing, or after giving the emetic, give plenty of luke- warm water containing Soda or Saccharated Limei 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful dose hypodermically as frequently), [Red Wine, used freely, is considered an excellent antidote], ov with Aromatic Spirit of Ammonia (a teaspoonful D a little water every 10 to 15 minutes, or % teaspoon®' ful hypodermically as frequently) ; also with Strych- nine Sulphate (1/60 to 1/20 grain hypodermically every % t° 2 hours) and Atropine Sulphate (1/120' to 1/60 grain hypodermically every to 2 hours), or Tincture of Belladonna (20 drops in water every J4 to 2 hours). Tincture of Digitalis (15 to 3c' RHUS-RHUS RHADICANS, ETC. 203 drops by mouth, or half as much hypodermically, every % to 2 hours), or Digitalin (1/100 grain hypo- dermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to I hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same pur- poses. Draughts of strong coffee may also be given. 3. Give demulcents (such as white of egg, milk, oil, flaxseed or elm tea, barley, gum arabic or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and protect the irritated or inflamed surfaces. 4. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature. Maintain recumbent posi- tion. Also employ friction and use an interrupted elec- tric current if necessary. RHUS-RHUS RADICANS, RHUS TOXICO- DENDRON (POISON VINE, POISON OAK, POISON IVY, POISON CREEPER, MER- CURY)- RHUS VENENATA (SWAMP- SUMACH, POISON-SUMACH)- POISON DOGWOOD (POISON ELDER) - SNOW ON THE MOUNTAIN-ETC. Rhus often mistaken for the Virginia Creeper; but leaves of Creeper divided into 5 leaflets, leaves of Poison Ivy into three. Poison Ivy is a green vine climbing over walls and fences and hanging over rocks; sometimes is erect. In May and June has greenish-white flowers in loose clusters at junction of leaves and vine. Fruit: small, smooth, waxy, changed to reds, browns and yellows. Fruit of Poison Sumach is yellowish. Satinwood-dust poisons. HISTORY: SYMPTOMS: Itching; swelling; vesicular eruptions ; throat may- be involved, causing cough; thirst; vomiting; col- 204 A MANUAL OF TOXICOLOGY. icky pains, with fever and delirium. (Rhus poison- ing due to active principle, a non-volatile oil called toxicodendrol, contained in the pollen, hairs, etc.). 1. Wash well with hot soap suds, then apply a dilute-alcohol solution of Lead Acetate. A lotion of Grindelia Robusta (Fluid Extract of Grindelia Ro- busta 1 part, water 10 to 48 parts, mix), or of Sodium Hyposulphite often relieves. For burning pain, etc., use a 5 per cent, aqueous solution of Cocaine, or of Phenol or weak Ammonia Water, or a Sal Ammoniac solution (1 ounce to 1 pint of water) or iced, satu- rated solution of Sodium Bicarbonate, or the same of Boric Acid, or promptly sponge the part with Ben- zene, Chloroform or Gasoline. After blisters rupture, apply Lime Water. Infusion of Lobelia (1 ounce to pint), also Corrosive Sublimate or Potass. Permang. solution, or Alum, good applications: also Aristol dusted on or Ichthyol applied. Give simple diet. 2. Give Magnesium Sulphate (a tablespoonful in a small cupful of water). Also cooling drinks. 3. Give Opium (Powdered Opium, 1 to 2 grains every y2 to 2 hours), or Laudanum, 20 drops every % to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% gr. every % to 2 hrs. by mouth or hypodermically). Avoid fats and oils, as they spread the poison. TREATMENT: SALIVA OF RABID ANIMALS-RABIES (HYDROPHOBIA.) (Infection by bite.) HISTORY: Hydrophobia may result from bite of dog, cat, wolf, fox or other carnivorous animal. The disease is, as a rule, fatal; death in from 2 to 5 days; short- est period on record 24 hours. Longest, 9 days. Symptoms do not as a rule come on inside of 3 weeks after the bite (usually between the 20th and 120th day), and may not occur until after years, the wound being long since healed. Symptoms are: pain and uneasiness in the part bitten; restlessness; ma- laise; dyspnoea; difficult swallowing; fear of water; pain in the stomach, with bilious vomiting; severe con- SYMPTOMS: SANGUINARIA. 205 vulsions; swollen, often protruding, tongue; free flow of viscid saliva; distorted face. If the dog has an appetite after the fourth day, or dies without paralysis, rabies did not exist. Preserve for observation the dog or other hydro- phobic animal known or suspected. A positive diag- nosis can thus be made in a few days, and prolonged, determinative, experimental-inoculations for diag- nosis, avoided. (Early injection of antirabic serum ad- visable in all suspected cases, and practically harmless). Preventive treatment when bitten: Immedi- ately ligate above wound and apply Tincture of Iodine in and about it; wash with hot water and suck wound to remove virus ; apply Carbolic Acid to or cauterize (not with Silver Nitrate) or excise bitten part. Ammonia Water applied benefits. Inoculate with Pasteur's hydrophobia emulsion. TREATMENT: TREATMENT FOR HYDROPHOBIA: Give Chloroform (5 to 30 drops) in sugar and water. Give Morphine hypodermically grain every 1 to 3 hours) until under influence. Rectal injections of Chloral or Potassium Bromide may be given. Spray throat with 4 per cent solution of Cocaine. Feed per rectum with nutritive enemas and sup- positories. Put patient in a dark room and keep quiet and warm. Exclude all draughts. Inoculate with Pasteur's hydrophobia emulsion. SANGUINARIA (BLOOD-ROOT). Death by paralysis of cardiac and respiratory centers. HISTORY: Severe salivation; violent vomiting; severe purg- ing; faintness; vertigo; coldness; dilated pupils; re- duced temperature; slow pulse; great prostration; intense thirst; convulsions; collapse. SYMPTOMS : i. Evacuate the stomach: syphon out thestomach TREATMENT: 206 A MANUAL OF TOXICOLOGY. with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective, or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of lukewarm water to encourage vomiting. Tannic Acid (in 20 gr. doses) is recommended. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every to 2 hours), or Tinc- ture of Belladonna (20 drops in water every to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every JZ to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every y to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 3. Give Opium (Powdered Opium, 1 to 2 grains every y2 to 2 hours), or Laudanum (20 drops every y2 to 2 hours by mouth or hypodermically every y^ to 2 hours), to relieve local irritant action. SANTONIN. 207 SANTONIN. HISTORY: About 2 grains of Santonin killed a boy 5^2 years of ag'e in 15 hours; flower heads equal to 30 grains of Santonin killed a girl 10 years old; i7/10 grains has caused death of a child 5 years old in 15 hours., The maximum dose for children may be said to be 1 to 2 grains, and for adults about twice as much. Death by asphyxia. SYMPTOMS: Color vision is disturbed, objects first assuming a violet or bluish, then yellow tinge; ringing in ears ; headache; dizziness; dilated pupils; sweating; weak pulse; abdominal pain; convulsions; stupor. Santonin is excreted by the kidneys, coloring acid urine greenish-yellow, alkaline urine cherry-red or crimson. i. Evacuate the stomach: syphon out the stomach With a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not pro- duced), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective). After giv- mg emetic, give plenty of luke-warm water to en- courage vomiting. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or *4 teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a litt'rc Water every 10 to 15 minutes, or ^4 teaspoonful hy- TREATMENT: 208 A MANUAL of toxicology. podermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every % to 2 hours), or Tinc- ture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every ^4 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary) J may be used for the same purpose. Draughts of strong coffee may also be given. Chloroform, or Chloral per rectum, for convulsions. SAVINE. The poison is recognized by its odor. There is no reliable chemical test. Usually poisoning by decoctions or infusion of Savine Leaves. Oil or Tincture of Savine may poi- son. Oil of Savine is present in the leaves to the1 amount of about 2 per cent.; 10 per cent, in the fruit. Death from Savine may occur within 12 hours or be delayed for 2 or 3 days. Death by collapse. HISTORY: SYMPTOMS: Pain in abdomen; vomiting; straining and bloody/ stools; difficult respiration ; convulsions; coma; cob' lapse. Sometimes severe irritation of urinary organs/, such as strangury and bloody urine; odor of drug in urine; may be vomiting of blood anesthesia, uter- ine hemorrhage, and abortion. I. If patient has not vomited freely, repeatedly syphon out the stomach with warm water, or give Apomorphine Hydrochlorate, hypodermicallv (i/W TREATMENT: SAVINE. 209 grain, repeated every 15 minutes until effective). Or if the throat is not much inflamed, may give an emetic of Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated every 10 to 15 minutes until it pro- duces vomiting), or Ipecacuanha (Powdered Ipecac- uanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until it acts). 2. A dose of Castor Oil (an ounce, i. e., 2 table- spoonfuls), or of Magnesium Sulphate (an ounce, i. e., 2 tablespoonfuls), should be given unless bowels have freely moved. Apply poultice, for abdominal pain. 3. Give demulcents (such as white of egg, milk, arrowroot, oil, gum arabic, flaxseed or elm tea, bar- ley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and pro- tect the irritated and inflamed surfaces. 4. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypoder- mically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 to I/20 grain hypodermically every to2 hours) and Atropine Sulphate (1/120 grain hypodermically every % to 2 hours), or Tincture of Belladonna (20 drops in water every to 2 hours), or Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour) and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. Artificial respiration if required. 5. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or 210 A MANUAL OF TOXICOLOGY. bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature. Sometimes cold to head. 6. Give Opium (Powdered Opium, I to 2 grains) or Laudanum (20 drops by mouth, or JG teaspoonful by rectum in gruel), or Morphine Sulphate (% grain by mouth or hypodermically) every % to 2 hours), or Chloroform, Chloral, or Bromides, to relieve pain, nervous irritability, etc. SCHEELE'S GREEN. (See Arsenic). SCOPARIUS. (See Digitalis). SCORPION, ETC. (See Insects). SEWER GAS (CESSPOOL AND PRIVY EMANATIONS). As a rule the sewer gas and privy emanations consist of a mixture of Sulphuretted Hydrogen, Am- monium Sulphide and Nitrogen, but sometimes only of deoxidized air, with an excess of Carbonic Acid Gas. The poisonous vapors of cesspools consist of Car- bonic Acid, Sulphuretted Hydrogen and Nitrogen. Entrance of Sewer Gas into bed-rooms, or the ex- posure to the emanations of cesspools in cleaning them out, have produced fatal result. Emanations from open street gratings sometimes produce serious symptoms. Sewers, cesspools, privies, etc., should be well stirred to permit the escape of the contained gas before cleaning them out. It is well also to dis- infect them. HISTORY: When the poison is concentrated, death may occur at once. If not concentrated, a few moments expos- ure may produce the following symptoms: Uncon- sciousness. which resists all attempts to relieve; lips SYMPTOMS: SILVER COMPOUNDS. 211 livid; pupils dilated and not sensitive to light; eyes fixed and turned upwards; conjunctiva injected; countenance pallid, pink or purple; may be froth issuing from the mouth. No true antidote is known. If there is time to do anything, fresh air, stimula- tion with Ammonia to the nostrils, and Aromatic Spirit of Ammonia by mouth (% to I teaspoonful in water every io to 20 minutes), and Brandy or Whisky (in teaspoonful doses by mouth, or half as much hypodermically, every 10 to 20 minutes), and Strychnine Sulphate (1/60 to 1/20 grain hypoder- mically every % to 2 hours) will help. Rest is bene- ficial. Transfusion of blood and the introducing of a normal salt solution into the veins have proven advantageous. Chlorine water or Dilute Hydro- chloric Acid and Potassium Chlorate internally, are recommended. Give Oxygen inhalations. Artificial respiration. TREATMENT: SILVER COMPOUNDS (SILVER NITRATE, LUNAR CAUSTIC) - ETC. HISTORY: Nitrate of Silver turns black when contaminated with organic matters. It acts principally as a corro- sive poison when taken internally. Prolonged admin- istration of the Silver compounds produces a blue or gray-black indelible discoloration of the skin, begin- ning first around the nails and fingers. Acute poison- ing is rare; usually from accidentally swallowing a piece of Nitrate of Silver stick. 30 grs. has killed. Death commonly results from asphyxia. SYMPTOMS: Pain; vomiting of a white cheesy matter, which in sunlight rapidly turns black; purging; cramps; diz- ziness; cardiac depression; respiratory disturbance; convulsions; paralysis; coma; collapse. Chronic poisoning by Silver lodid or Nitrate shown by blue skin. 212 A MANUAL OF TOXICOLOGY. TREATMENT: I. Give Sodium Chloride-common salt-(a table- spoonful of salt to the pint of water or even milk) freely, as the chemical antidote. It forms Sodium Nitrate, precipitates the Silver as the insoluble and harmless Chloride, and acts as an emetic. Ammonium Chloride may be used instead. 2. Evacuate the stomach, syphoning it out with water containing a tablespoonful of salt to the pint. If the syphon is not at hand, give Mustard (a table- spoonful in 2 tablespoonfuls of water, repeated in io to 15 minutes if vomiting has not resulted), Quassia tea or other bitter infusion, or greasy water (is best to avoid Zinc Sulphate after salt), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipe- cac, a teaspoonful every 15 minutes until it vomits), with much water. Follow with some more salt water. Salt is the best antidote, but white of egg and copious draughts of milk may be given with benefit, having some antidotal effect and serving as food until the stomach has recovered. 3. Give demulcents (as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oat- meal, gelatin, flour and water, or even crushed bana- nas), to soothe and protect the irritated or inflamed surfaces. Give Tannin, also give alkalies. 4. Give Opium (Powdered Opium, 1 to 2 grains every % to 2 hours), or Laudanum (20 drops every % to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every to 2 hours), to relieve pain and nervous irritability. 5. If necessary, stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or %■ teaspoonful hy- podermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours), SNAKE VENOM 213 and Atropine Sulphate (1/120 grain hypodermically every to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis 15 to 30 drops by mouth, or half as much hypodermically, every % to 2 hours), or Digitalin (x/ioo grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every | to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every | to 1 hour if necessary) may be used for same pur- poses. Draughts of strong coffee may also be given. SNAKE VENOM-SNAKE BITE. (The Bite of Various Poisonous Serpents.) (See pp. 237-8.) HISTORY: The venom of the viper contains albumin, albu- moses and globulin, all poisonous. The venom of the cobra contains albumin, globulin and syntonin, all poisonous. One four-millionth of the body weight of cobra venom causes death. It is believed snake venom disintegrates human blood corpuscles. Death by paralysis of cardiac and respiratory centres usually inside of 12 hours. If death occurs in a few minutes, due to thrombosis; if, under 24 hours, by par- alysis of cardiac and respiratory centres; if after 24 hours, by exhaustion or sepsis. In fatal cases the blood deteriorates and will not coagulate. Poisonous snakes are thicker than harmless ones, and the tail is shorter. They also appear rough, owing to the dorsal scales being keeled. The head is also tri- angular; they have a peculiar pit or depression in the upper jaw between the eye and the nose, and they have elliptical pupils. The poison is secreted by glands corresponding to the parotids in man; it is a thin yellowish fluid, varying in quantity from one drop to a drachm, according to the variety and size of the snake. SYMPTOMS: Symptoms more or less severe. Intense thirst, skin clammy. Chief symptoms are: Intense shock; severe pain 214 A MANUAL OF TOXICOLOGY. in part bitten; area of pain rapidly increases; local partial paralysis; intense swelling of portion of body injured, which later becomes livid and gangrenous; fainting; vomiting, small, frequent, irregular pulse; hemorrhages; bloody stools and urine; lethargy; dif- ficult respiration ; convulsions ; death. It is thought the peptones in the venom deter- mine the amount of local edema, the convulsions and also the paralysis of respiration: the globulins are sup- posed to disorganize the blood and produce hemor- rhage. TREATMENT: i. Thoroughly suck or cup the wound ; ligate above it, between the wound and the heart, using piece of rope, or even pocket-handkerchief; cut out the bitten part or cauterize it thoroughly with caustic, red hot iron or live coal, or apply strong Nitric Acid or a solu- tion of Potassium Permanganate, or even put on Gun- powder and set fire to it. Subcutaneous injection, if possible, around wound, or in orifice made by fangs or application of Potassium Permanganate (5 to 10 gr. to pint, or even 1%) solution, has been highly recommended. Also the injection about the wound, of 10 minims or more of a 10 per cent, solution of Calcium Hypochlorite, or a solution of Aurum Chloride. Elimination may be aided by inducing free perspiration or salivation by Pilocarpine Hydro- chlorate (i/iooto 1/60 grain hypodermically). The free application of Ammonia Water has proved effi- cacious. Washing wound thoroughly and then apply- ing 25 per cent. Carbolic Acid solution has been recommended. Application of Tincture of Iodine advised. Also Galium Circaezans internally. Bleeding patient on bitten limb and transfus- ing blood by other limb is recommended when severely poisoned by cobra. The administration, or hypodermic injection in 15 to 20 c.c. doses for adult, children half as much, of a horse serum (one is called Antivenene) has saved lives of many persons bitten by the cobra, or other snake. Inject into abdominal cellular tissue within 2 hrs. after bite; and inject into and around bite 8 c.c. of SPIGELIA. 215 1:6o solution of Calcium Hypochlorite. Bile, or the water soluble portion of it, is said to be beneficial. 2. Encourage heart action and circulation by Weak interrupted galvanic currents applied to chest near the heart. Rub patient and give coffee. 3. Give Ammonia inhalations and stimulate with Brandy or Whisky very freely (2 to 8 teaspoonful doses or more every 10 to 15 minutes, or % teaspoon- ful doses hypodermically as frequently), and with Aromatic Spirit of Ammonia (a teaspoonful in a lit- tle water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently, which, if possible, should be injected into radial vein, with equal vol- ume of water). Strychnine Sulphate (1/60 to 1/20 grain hypodermically every 10 to 20 minutes if nec- essary, for several doses). Some advise carry whisky to point of narcosis. If respiration is seriously interfered with, resort to artificial respiration and maintain for several hours. Keep patient warm, quiet and provide fresh air freely. Transfusion of healthy blood or intravenous injection of normal salt solution may be required. In rattlesnake bite, Olive Oil freely, both external- ly and internally, is by some considered a specific. It is believed snake-charmers render themselves im- mune to venom by taking small doses by the mouth. SNEEZE WEED (Stagger Weed). Causes sneezing, staggering, dyspnea, convul- sions, death. If swallowed, emetics, cathartics. However poisoned, employ rest, fresh air, oxygen, external heat, and sedatives or stimulants as indicated. SPIGELIA (PINK ROOT). SYMPTOMS: Vertigo; dimness of vision; dilated pupils; dry throat; convulsions; delirium. TREATMENT I. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such 216 A MANUAL OF TOXICOLOGY. as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not pro- duced), or Mustard (a teaspoonful in a small cupful of water, repeated in 15 minutes if not effective), or Syrup of Ipecac, a teaspoonful every 10 to 15 min- utes until vomiting results), or Apomorphine Hy- drochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of lukewarm water to encourage vomiting. 2. Stimulate heart, circulation, and respiration as described under Savine on Page 208. SPURGE By mouth, seed or juice produces violent vomit- ing, diarrhoea, debility, sometimes death. Ex-' ternally, burning, itching, blistering, raw surface. When swallowed, treat as for Belladonna; when ex- ternal, use applications as for Rhus (q.v.). STROPHANTHUS (KOMBE ARROW POI- SON)--STROPHANTHIN-OUABAIN. Fatal dose: Strophanthin is three times as poison ous at Atropine, ten times as poisonous as Strych nine, and twelve times as poisonous as absolute Hy drocyanic Acid. Death by paralysis of the heart (in systole). HISTORY: SYMPTOMS : Pulse weak; urine increased; muscular rigidity spasms. TREATMENT: Recumbent position. i. Evacuate the stomach if just taken; syphon out the stomach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 table- spoonfuls of water, repeated in 15 minutes if vomits ing is not produced), or Mustard ( a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecac- STROPHANTHUS. 217 uanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke- warm water to encourage vomiting. Give Tannic Acid or Gallic Acid (30 grains in a little water). 2. Stimulate, by the mouth, or if vomiting per- sists, by the bowel. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoon- ful doses every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently) or with Aro- matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hy- podermically as frequently), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handker- chief and inhaled, using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. 3. Give a saline cathartic, such as Epsom Salt, with much water. 4. Give inhalations of Chloroform or Ether, to secure muscular relaxation. Give Chloral as the best antagonist (30 grains in water by mouth, or twice as much by rectum) as soon as possible; then in 20 grain doses hourly while convulsive tendency continues. Potassium Bromide (a drachm in water every to 1 hour by mouth, or V2 to 2 drachms by rectum) may be given, but its action is rather slow. May give both Chloral and Bromide, keeping pa- tient gently narcotized during several hours if neces- sary. Inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every Ci to 1 hour if necessary), may be used for the same purposes. Curare (1/20 to 1/6 grain hvpodermically) and Calabar Bean (Physostigmine Sulphate, 1/100 grain 218 A MANUAL OF TOXICOLOGY. hypodermically) and Potassium Permanganate are recommended. Also ice to spine, and a tobacco enema. For threatened death from embarrassed respira- tion, resort to artificial respiration (rhythmically raising and lowering arms from straight at sides to up over head and back again, 18 or 20 times a min- ute). SULFONAL-TRIONAL-TETRONA*L- VER- ONAL-AMMONAL-ETC. HISTORY: Death in 40 hours from two 15-grain doses Sulfo- nal taken in 1% hrs. Also death on fourth day from taking over an ounce. Recovery from 3 ozs. SYMPTOMS : Giddiness; confusion; weakness; tumbling and walking about unsteadily; cyanosis; suppressed urine; ptosis; may be pain in stomach, vomiting and papular skin eruption ; collapse; coma. I. Evacuate the stomach if poison was taken only a short time before; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach- tube is not at hand, use an emetic, such as Zinc Sul- phate (20 grains in 2 tablespoonfuls of water, re- peated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 min- utes until vomiting results), or Apomorphine Hy- drochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm water to encourage vomiting. Keep patient horizontal. 2. Give Spirit of Nitrous Ether (1 to 2 teaspoon- fuls in water every to 2 hours) and Magnesium Sulphate-Epsom Salt-(2 tablespoonfuls in a cup- TREATMENT: TIN COMPOUNDS. 219 ful of water). Give Sodium Bicarbonate (a tea- spoonful in a gobletful of water). Heat to body. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every io to 15 minutes, or % teaspoonful doses hypoder- mically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to ^5 minutes, or % teaspoonful hypodermically as fre- quently). Strychnine Sulphate (1/60 grain hypo- dermically, repeated in 10 to 30 minutes if neces- sary)- Draughts of hot strong coffee or Caffein Citrate (2 or 3 grain doses) are also good. Artificial respiration if required. SULPHURIC ACID. (See Acids Mineral). TANSY (TANACETUM VULGARE). Fatal dose: As a rule ounce of the oil causes death; i drachm of it has caused death. The dose of the oil is i minim. - Death by paralysis of heart. HISTORY: SYMPTOMS: Characteristic tansy odor of breath; convulsions; unconsciousness ; dilated pupils ; hurried, stertorous breathing; full, gradually weakening pulse. TREATMENT: Treat same as in poisoning by Savine. tarantula. (See Insects). TARTAR EMETIC. (See Antimony). TIN COMPOUNDS. Metallic taste in mouth'; vomiting; diarrhoea; pain; diminished heart action. SYMPTOMS: 220 A MANUAL OF TOXICOLOGY. TREATMENT: 1. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not pro- duced), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains, or Syrup of Ipecac, a teaspoonful every 10 to 15 min- utes until vomiting results), or Apomorphine Hy- drochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm water to encourage vomiting. 2. Give milk or white of egg freely. Ammoniun^ Carbonate (in 5 grain doses in a small cupful o( water), also Sodium Bicarbonate, have been highly recommended for poisoning by the Chloride. Magnesia mixed in water should be freely give! and followed by mucilaginous and albuminous drinks, such as flaxseed tea, elm bark water, gruel gum arabic or gum tragacanth water, or white ot egg in water. 3. Give Opium for pain (Powdered Opium, 1 to ' grains every to 2 hours), or Laudanum (20 dropy every to 2 hours by mouth, or teaspoonful ir gruel by rectum as frequently), or Morphine Suh phate (% grain by mouth or hypoderm, every t< 2 hrs.) to relieve pain and nervous irritability. 4. Stimulate as in Antimony. TOBACCO-NICOTINE. Pure Nicotine is a colorless oily liquid, and is rapidl) fatal. Havana tobacco contains 2^. Kentucky, Ten nessee and Virginia tobaccos, 6% or 7^. Poisoning ha^ resulted from mistaking infusion for coffee; from to< bacco chewing and smoking; from giving for worm> or to induce abortion; from children using old tobacc - HISTORY: TOBACCO-NICOTINE. 221 Pipes to blow soap bubbles; from local applications of tobacco, etc. Death from enema of drahm of the leaves. Boys have died as result of smoking to- , bacco. Fatal dose Nicotine, Miii-60 in %, 2 or 3 hrs. Death by paralysis of respiration or of heart. SYMPTOMS: Severe depression ; giddiness; feeling of wretched- ness and weakness; nausea; vomiting; weak, rapid pulse; cold, clammy skin; pupils at first contracted, then dilated ; dyspnoea; muscular tremblings; there may be convulsions ; coma. TREATMENT: Put patient in a horizontal position. I. If free vomiting does not occur, evacuate the stomach; syphon out the stomacn with a stomach- tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in P5 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated ln 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipe- cac, a teaspoonful every 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypo- dermically (1/10 grain, repeated every 15 minutes •Until effective). After giving emetic, always give plenty of water to encourage vomiting. Before be- ginning or completing syphonage, or before vomit- lng occurs or ceases, give Tannic Acid or Gallic Acid • 3° grains in a small wineglassful of water), or in deu may give Iodine (1 to 2 grains) and Potassium Iodide (5 to 10 grains) in water (1 to 2 tablespoon- fuls), or in absence of these, copious draughts of strong tea or a decoction of oak bark ounce to a small cupful of water). 2. Give Spirit of Nitrous Ether (1 to 2 teaspoon- ^nls in much water). 3- Give Strychnine Sulphate as the true physio- logical antidote (1/60 to 1/20 grain hypodermically 222 A MANUAL OF TOXICOLOGY. every 5^ to 2 hours), or Tincture of Nux Vomica* (30 minims in 2 tablespoonfuls of water by mouth), as an antagonist. Also stimulate with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypodermically as fre- quently), or give Chloroform (20 to 30 drops inf) water every % to 2 hours). Apply cold to the head. 4. Employ artificial heat (such as hot water/ bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated,' applied to feet and sides of body). Artificial respira- tion and oxygen if required. Note.-Is claimed, in cigarette habit and tobacco smoking, craving 4 lost or lessened by rinsing mouth with Silver Nitrate solution (54 to t grain to water 1 ounce) just before smoking. Should also avoid stimtii lating foods and beverages. ,1 TRIONAL. (See Sulfonal). TRUFFLES. (See Fungi). TURPENTINE-OIL OF TURPENTINE- (SPIRIT OF TURPENTINE). HISTORY: Usually given by mistake, or overdose when use'; to expel worms. A child died in 15 hours from ounce of the oil; a teaspoonful killed a 5 months ol'4 infant; recovery in child under 2 years old aftei taking a tablespoonful. Death of adult from 6 ozs. । Death by paralysis of respiration. SYMPTOMS: A Turpentine odor in the breath. Usually then is giddiness and a kind of intoxication, followed U gastro-enteritis; there is strangury, bloody, scant/ urine, with odor of violets; there may be purging/ cyanosis; dilated pupils; stertorous breathing; d 'w moist skin ; feeble, rapid pulse; coma; collapse. Somewhat resembles poisoning by Opium. TREATMENT: I. Evacuate the stomach if seen promptly; sy phon out the stomach thoroughly with a stomachy URETHAN. 223 tube, using plenty of water. May give emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not pro- duced), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective). After giv- ing emetic, always give plenty of luke-warm water to encourage vomiting. Give Magnesium Sulphate Epsom Salt-(1 to 4 tablespoonfuls in a cupful of water) during syphoning or before emetic effect is over. 2. If bowels have not moved freely, give enema, also Magnesium Sulphate (1 to 2 tablespoonfuls in 1 water). Apply hot fomentations to loins. 3. Give much water and demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatine, flour and water, or even crushed bananas). 4- Give stimulants; as in Sa vine (q. v.). 5* Give Opium (Powdered Opium, 1 to 2 grains Savery y2 to 2 hours), or Laudanum (20 drops every I % to 2 hours by mouth, or y teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% hgrain by mouth or hypodermically every to 2 |hours), to relieve pain and nervous irritability. TYROTOXICON. (See Fish-Poison and Ptomains). URETHAN. Death by asphyxia. HISTORY: SYMPTOMS: Vomiting; reduced temperature and heart action; Muscular weakness; general anesthesia. 224 A MANUAL OF TOXICOLOGY. TREATMENT: i. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to 10 minutes until it acts), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective). After giv- ing emetic, always give plenty of luke-warm water to encourage vomiting. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every,/ 10 to 15 minutes, or teaspoonful doses hypo-1 dermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (i/6oz to 1/20 grain hypodermically every % to 2 hours)/ and Atropine Sulphate (1/120 to 1/60 grain hypo-A dermically every to 2 hours), or Tincture of Bella-/! donna (20 drops in water every to 2 hours). Tinc- ture of Digitalis (30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin) (1/100 grain hypodermically every % to I hour), or Caffein Citrate (1 to 4 grains every % to I hour)'/ and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using' one every % to 1 hour if necessary), may be usedc for the same purposes. Draughts of strong coffee may also be given. VASELIN OR PETROLATUM. 225 VASELIN OR PETROLATUM. Vaselin or Petrolatum is sometimes taken or given to children for colds or various lung affec- tions. Large doses of the latter may produce un- favorable symptoms. SYMPTOMS: If unfavorable symptoms occur, may be cramps in lower extremities; severe, persistent vomiting; collapse. TREATMENT: i. Evacuate the stomach if vomiting is not free; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), Mustard (a tablespoon- Ad in a small cupful of water, repeated in 15 min- utes if not effective), or Ipecacuanha (Powdered -Ipecacuanha, 30 grains; or Syrup of Ipecac, a tea- spoonful every 10 to 15 minutes until vomiting re- sults), or Apomorphine Hydrochlorate, hypoderm- ically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm water to encourage vomiting. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every IO to 15 minutes, or % teaspoonful hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 min- utes, or % teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours), and Atropine Sulphate (1/120 grain hypodermically every to 2 hours), or Tincture of Belladonna (20 drops in water every pi to 2 hours). Tincture of digitalis (30 drops by mouth, or half as much hy- podermically, every pi to 2 hours), or Digitalin 226 A MANUAL OF TOXICOLOGY. (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. VERATRUM-VERATRUM ALBUM (WHITE VERATRUM, WHITE HELLEBORE)- VERATRUM VIRIDE (GREEN HELLE- BORE)-VERATRINE-SABADILLA. Usually taken by mistake. Veratrine sometimes used to commit murder. 1/16 grain Veratrine has caused dangerous symptoms. Death in 1 to 5 hrs. or several days. Recovery from 4 grs. Veratria. Death by paralysis of respiratory centres. HISTORY: Burning and pain in alimentary canal; great mus- cular relaxation; fear; inability to swallow; nausea; vomiting; diarrhoea; palpitation of heart; pulse slow, thready; respiration labored; pupils, usually dilated; intense itching; may be convulsions. SYMPTOMS: TREATMENT: Keep patient in horizontal position, with head lowest, and provide plenty of fresh air. i. Evacuate the stomach unless vomiting has been free, from action of drug itself; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 table- spoonfuls of water, repeated in 15 minutes if vomit- ing is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipe-? cacuanha, 30 grains; or Syrup of Ipecac, a teaspoon- VERATRUM, ETC. 227 ful every io to 15 minutes until vomiting results), °r Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effec- tive). After giving emetic, always give plenty of luke-warm water to encourage vomiting. Give in 'syphoning fluid or before vomiting ensues, Tannic Acid (30 grains in 2 tablespoonfuls of water), or iodine (1 to 2 grains) and Potassium Iodide (5 to to grains) in water (2 tablespoonfuls), or give plenty of strong tea, or a decoction of oak bark (% ounce to a small cupful of water). 2. Stimulate with hypodermic injections of Sul- phuric Ether (10 to 15 minims), or with Brandy or Whisky (2 teaspoonfuls every 10 to 15 minutes, or '4 teaspoonful hypodermically as frequently). Give Aromatic Spirit of Ammonia (a teaspoonful in water every 10 to 15 minutes, 3 or 4 times, to stimulate and prevent the alkaloids forming soluble chlorides. Strychnine Sulphate (1/60 to 1/20 grain hypo- dermically every % to 2 hours), Atropine Sulphate (1/120 grain hypodermically every ^2 to 2 hours), Or rincture of Belladonna (20 drops in water every A to 2 hours). Or to support: Tincture of Digitalis (30 drops by mouth, or half as much hypodermic- ally, every ^2 to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to I hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl Crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given by mouth or rectum. 3- Employ artificial heat (such as hot water hotties, or ordinary bottles containing hot water, Qr bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- . tain bodily temperature. I 4- Give Opium (Powdered Opium, 1 to 2 grains every *4 to 2 hours), or Laudanum (20 drops every 4/2 to 2 hours, or % teaspoonful in gruel by rectum 228 A MANUAL OF TOXICOLOGY. as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every % to 2 hours), to relieve pain and nervous irritability. 5. Apply electricity over the heart, and resort to artificial respiration if death is threatened from em- barrassed respiration (rhythmically raising and lowering arms from straight at sides to up over head and back again, 18 times a minute). VERMIN KILLERS. (See Arsenic, Phosphorus, Strychnine.) VOLATILE OILS: OIL OF CEDAR, ETC. (Treat as in Savine poisoning.) WOORARA. (See Curare). WHITE PRECIPITATE (See Mercury Compounds). WOUNDS, POISONOUS (POST MORTEM, DISSECTING, ETC.). 7 Pain; swelling; inflammation, perhaps fever. SYMPTOMS: TREATMENT: Wash under stream of water, suck out the poison/, cauterize and apply antiseptic solution. May paint over and around wound with Tincture of Iodine.^ Dress antiseptically with Boric Acid, Carbolic Acid^i Bichloride of Mercury or similar solution. ZINC COMPOUNDS: ZINC CHLORIDE-ZINC SULPHATE (WHITE VITRIOL)-ETC. The Chloride used in embalming, as disinfectant and by tinsmiths, is corrosive, and the commonest cause of dangerous symptoms. ■ Fatal dose: abt. i dr. of Chloride; % to i oz. of* Sulphate. Fatal results from the Chloride in 4 hr^' Infrequency of fatal result from Zinc Sulphate HISTORY: ZINC COMPOUNDS. 229 due to its usually being expelled by vomiting. Death in 4 hrs. to 4 months. SYMPTOMS]: Corrosion of lips and mouth; pain or burning in throat, stomach and bowels; nausea; incessant vom- iting and vomit blood stained; pulse and respiration increased ; dyspnoea ; pupils dilated; convulsions; paralysis; coma; death. [N. B. Only Chloride cor- rodes.] TREATMENT: Antidotes: Albumin, soap, alkaline carbonates, and mucilage. i. Evacuate the stomach, if free vomiting has not already occurred: syphon out the stomach with a stomach-tube, using plenty of water. If a stomach- tube is not at hand, tickle throat with finger or feather and give tepid water freely; may cautiously use an emetic, such as Ipecacuanha (Powdered Ipe- cacuanha, 15 to 30 grains; or Syrup of Ipecac, a tea- spoonful every 15 minutes until vomiting results), Or Apomorphine Hydrochlorate, hypodermically fl/io grain, repeated every 15 to 30 minutes until effective). In severe corrosion or marked tendency to vomit, avoid emetics. Syphonage and medicated water ser- viceable. For persistent vomiting give ice or cau- tiously small doses of Cocaine. N. B.-Put Sodium or Potassium Carbonate or Bi- carbonate (% ounce) in water used in syphoning to form the insoluble Zinc Carbonate, or give it in Water after emetic to assist emetic action, etc. 2. Give freely white of egg in water or milk. Give Tannic Acid or Gallic Acid (30 grains in 2 tablespoonfuls of water), or give strong tea, or a de- coction of oak bark (^ oz. to a cupful of water). 3. Apply linseed meal poultices to the abdomen, and if much pain, give an enema of starch or gruel and water. Give mucilaginous drinks, such as gum arabic or gum tragacanth water or flaxseed tea. 4. Give Opium (As directed under Veratrum). 5- Give Stimulants for collapse. 230 A MANUAL OF TOXICOLOGY Key to Principal Poisonous Plants, Etc. A.-Aconite (Aconitum Napellus) Monkshood; Wolfsbane. I. Stem (flowering). 2. Pistil. 3. Stamens. 4. The two recurved nectaries. B.-Belladonna (Atropa Belladonna) Deadly Nightshade: Death's Herb; Poison Black Cherry. 1. Stamens. 2. Style. 3. Stigma. 4. Berry and seeds. 5. Berry. 6. Stem. C.-Hyoscyamus (Hyoscyamus Niger); Henbane; Poison Tobacco; Insane Root. I. Flowering stem. 2. Corolla. D.-Stramonium (Datura Stramonium) Thorn, Devil's, or Mad Apple; Jamestown Weed. 1. Fruit shown in section. 2. Stem. E.-Sanguinaria <Sanguinaria Canadensis) Bloodroot; Indian Red Paint. Puccoon. P.-Physostigma (Physostigma Venenosum); Calabar Bean ; Ordeal Bean. 1. A flowering branch. 2. Pistil (half of calyx removed). 3. Terminal part of style and') appendage. 4. Appendage (trans, sec.). 5. A pod. 6, 7. Seeds. 8. Dry seed (trans, sec.). 9. Base of cotyledon, showing plumule and radicle. G.-Cannabis (Cannabis Sativa); Hemp; ^Var. American Hemp (Cannabis); Indian Hemp (Cannabis). 1. Pistillate inflorescence. 2. Staminate. 3. Flower. H.-Castor Oil Plant (Ricinus Communis) ; Palma Christi. I. Stamens. 2. Anther. 3. Stigmas. 4. Capsule (transverse section). 5. Seed. 6. Embryo. I. -Cherry Laurel (Prunus Laurocerasus). Branch, fruit and flowers. J.-Coca (Erythroxylon Coca). Flowering branch. K.-Colchicum (Colchicum Autumnale); Meadow Saffron. 1. Capsule (closed). 2. Capsule (open). 3. Styles. 4. Capsule (transverse section). 5. Seed. L.-Conium (Conium Maculatum); Hemlock ; Poison Hemlock ; Beaver Poison; Water Parsley.-Cicuta. 1. Fruit (vertical section)) 2. Fruit (transverse section). 3. Fruit. 4. Flower. 5. Stem (flowering). H. Digitalis (Digitalis Purpurea) ; Purple or American Foxglove ; Lion's Mouth; Fairy Fingers ; Dead Men's Bells. N.-Gelsemium (Gelsemium Sempervirens); Yellow Jasmine; Woodbine; Even- ing Trumpet Flower. 1. Branch (flowering). 2. Calyx and Pistil. 3. Corolla and Stamens. 4. Fruit. 5. Branch (fruiting). J O.-Lobelia (Lobelia Inflata); Wild or Indian Tobacco; Emetic Weed; Asthma Weed. 1. Branch (flowering). 2. Flower. 3. Capsule. P.-Common Mushroom (Agaricus Campester) ; Edible Mushroom ; Meadow Mushroom. 1. Three young plants. In one, veil just separated Pom margin. 2 and 3. Caps partly expanded, gills still pink (later black). 4.' Mature plant, cap fully ex- panded, gills blackish brown. 5. Vertical section of cap and up; H paH of stem oi ' immature plant. 6. Same, of mature plant. 7. Four spores x 200+ . Fig. 8. Variety: Hortensis-immature plant. 9. Mature. 10. Four spores x 2oo-i-. Q.-Poison Amanita, Death Cup (1 to 4. Amanita Phalloides). I. Plant with ' whitish cap partly expanded. 2. Fully expanded. 3. Mature plant (ve.'t. sec.). (5 to 7. Amanita Verna.) Vernal Amanita. 4. Young plant just emerging f-(m wrapper. 5. Immature plant with cap partly expanded. 6. Same, fully expanded. 7. Four spores x 200+; (poisonous). R.-Fly Amanita (Amanita Muscaria); Fly Mushroom; (poisonous). I. Young plant just breaking from its wrapper. 2. Plant with red cap partly expanded. 3. Ma- ture plant, cap fully expanded and faded to yellow on striated margin. 4. Vertical section of part of cap and upper part of stem. 5. Four spores x 200+. S.-Nux Vomica (Strychnos Nux Vomica); Vomit or Poison Nut ; Dog Poison; Ratsbane; Ordeal Root. 1. Branch (flowering). 2. Corolla (opened). 3. Calyx and Pistil. 4 and 5. Ovary. 6. Fruit. 7. Fruit (cross section). 8-10. Seed. T.-Poke (Phytolacca Decandra);. Poke Weed, etc. 1. Branch. 2. Fruit (single - showing carpels). U.-Poppy, Opium Poppy (Papaver Somniferuml; Thebaica. 1. Ovary (with some stamens remaining). 2. Ripe Capsule. 3-4. Seeds. 5. Branch. 6. Capsule open. y Rhus Rhus Radicans, 1 Poison Ivy; Poison Oak.- (Rhus Ver- | Var.: Rhus Toxicodendron J nix, Poison Sumach.) W.-Tobacco (Nicotiana Tabacum). 1. Plant in flower. 2. Capsule. 3. Ripe capsule opening at top. 4. Capsule (transverse section). X.-Veratrum Viride (Veratrum Viride); American Hellebore; Devil's Bite; In- dian Poke; Itch Weed; Bugbane. 1. Root. 2. Flower. V. Spigelia (Spigelia Marilandica); Pink Root. 1 Flowering stem. 2. Corolla (opened). 3. Ovary with part of style. 4. Fruit and calyx. 5. Same (one cell ; opened). 6. Ovary (trans, sec.). 7. Root stock and stem. Z.-Strophanthus (Strophanthus Hispidus). Illustration : seed with comose awn. PRINCIPAL POISONOUS PLANTS, ETC. Referred to in foregoing. (See page 224.) (.Unaccompanied by names, as identification test). A B 232 A MANUAL OF TOXICOLOGY 2 c 1 1 D 2 PRINCIPAL POISONOUS PLANTS, ETC. 233 E 7 6 1 s 3 9 4 8 F 3 234 A MANUAL OF TOXICOLOGY. 3 1 G £ 1 3 4 2 5 6 H PRINCIPAL POISONOUS GRANTS, ETC. 235 I J 236 A MANUAL OF TOXICOLOGY. a 1 4 3 * K 1 3 2, L 4 5 PRINCIPAL POISONOUS PLANTS, ETC. 237 M 5 41 3 3 N 1 238 A MANUAL OF TOXICOLOGY. [ 2 1 3 3 6 p 8 PRINCIPAL POISONOUS PLANTS, ETC. 239 a 3* 1 7 y c 4 Q * * 6 R 240 A MANUAL OF TOXICOLOGY. % s' 3 19 9 s 1 7 T 1 2 PRINCIPAL POISONOUS PLANTS, ETC. 241 1 6 2. 4 3 u 2 1 J V I w * 242 A MANUAL OF TOXICOLOGY. 2 1 X ,7 3 % t z 4 I PRINCIPAL POISONOUS PLANTS, ETC. 243 COBRA DE CAPELLO FER DE-LANCE 244 A MANUAL OF TOXICOLOGY. 12 3 4 5 HEAD OF RATTLESNAKE | Now 2 Pit . 3 BY® 4 Poison 5 Fa*$ ^land j RATTLESNAKE RATTLE OF RATTLESNAKE (SNAKE I yrs old) TARANTULA SCORPION & I SPANISH FLIES i.TRICHINA ^.TRICHINA, ENCYSTED A MANUAL OF TOXICOLOGY 245 KEY TO CONSTITUENTS of Various Patent, Proprietary and General Preparations [Note! The KEY is indicative of the reported, reputed probable or proved, present or previous, active or otherwise important, ingredient or ingredients of the respective prep- aration, as shown in the parenthesis following its name. It should be noted, that proprietors of some preparations have been in the habit of varying certain of their formulas; also that not very long before or shortly after the passage of the Harrison Narcotic Law, or other restrictive measures, the proprietors of certain preparations quite materially modified some of their formulas. However, a poisoning might occur from a preparation secured before such change in formula and kept for a long time before being used.] The analytical findings conducted for, or under the aus- pices of the American Medical Association, The Druggists Circular, American Druggist, The Western Druggist, The National Druggist, Medical World, The Medical Record, American Journal of Pharmacy, The New Idea, etc.,and other sources of information have been carefully consulted in this compilation. The Key is intended to serve as a guide to procedure in real or fancied emergency: e. g.--When a small child has swallowed a large quantity of a presumed potent liniment or other preparation it is helpful to have information regard- 'ng the ingredients; etc. Anesthetics (Local).-They commonly contain or consist °f one or more of the following': Cocain, novocain; eucain; carbolic acid with camphor and alcohol; or similar agents. Asthma, Hay Fever, Catarrh, etc.; "Cures," Specifics," etc. Commonly one or more of: Opium, cocain, stramonium, hyos- cyamus, Indian hemp, belladonna, etc. Ascatco (Opium-arsenic preparation, etc.) Brodie's Liniment for Asthma (oils of stillingia, cajeput, lobelia, alcohol). Haye's Asthma Cure [7 remedies] ("No. 781": oils of tur- pentine, peppermint, etc.) ; ("T. T. Q.".: lodids). Himrod's Asthma Cure (Lobelia, stramonium, saltpeter, tea). Stello's Asthma Cure (Indian hemp, potassium iodid). Tucker's Asthma Specific (Cocain, potassium nitrate). (Varied-another, later analysis: Atropin sulphate, sodium nitrate.) ["As Cure" (Cocain).] Cancer "Remedies," "Cures," etc.-Some "cures" have been found to contain one or more of: Cocain, opium, strychnin, cresol, phenol, potassium iodid, methyl salicylate, acetanilid, thymol, hyoscyamus, etc. Some have proved to be pure deceptions, the ingredients being inert. Cancerine (alcohol, etc.) Cancerol (opium, alcohol). Miller's Cancer Cure (acetanilid). .Mixer's Cancer and Scrofula Syrup [In 7 packages] ("Syrup," potassium iodid, methyl salicylate, alcohol, etc.), ("Cancer Paste," camphoracous oils, hyoscyamus-like or helladonna-like substances). <( Curry Cancer Cure [14 preparations]. (Among them, a 'White Solution"-4% cocain; a "White Powder"-25% Acetanilid: "Liquid/Poppy"-opium; "Wash" & "Tonic(s)"- »% to 20% alcohol) 246 A MANUAL OF TOXICOLOGY Cancer Pastes.- (Commonly-Arsenic with or without zinc sulphate or chloride; or Chromic acid; or antimony chloride). Cough "Cures," Consumption "Cures," ete. Allen's Lung Balsam (opium, lobelia, blood root, etc.). Ayer's Cherry Pectoral (approximately: morphin^ acetate, wines of antimony and ipecac; etc.-P.M.&S.J.) Dr. Seth Arnold's Cough Killer (morphin). Boschee's German Syrup (opium or morphin). Brown's Bronchial Troches (conium, cubebs, acacia, licor- ice, sugar). Bull's Cough Syrup (morphin sulphate, gr. in one ounce.) Cherry Balsam (a "consumption cure" labeled "harmless." Analysis showed opium, alcohol, bitter almond oil). Crosby's Balsamic Cough Elixir (an analysis showed chloroform, sulphuric acid, acetic acid, etc.) Dr. Drake's German Croup Remedy (opium). Gowan's Pneumonia Cure (camphor, opium, carbolic acid, turpentine, quinine). Keating's Cough Lozenges (morphin; or ipecac, lactucari- um, squill, ext. licorice, sugar, mucilage of tragacanth). Hoff's Consumption Cure (morphin, potassium, arsenic). "Adjunct Cough Mixture Used in Conjunction with Prof. Hoff's Cure for Consumption" (codein, chloroform, alcohol). Jackson's Cough Syrup (morphin). Jayne's Expectorant (opium 1 1-5 gr., alcohol 15% in each oz. (1908); or opium, digitalis, camphor, ipecac, squill, tartar, emetic, etc). One Day Cough Cure (morphin, Indian hemp). Piso's Cure for Consumption (morphin, tartar emetic, chloroform, Indian hemp, lobelia). Stoke's Expectorant (paregoric). Victor Lung Syrup (opium). Wistar's Balsam of Wild Cherry (opium, ipecac, squill, tartar emetic). White Pine compounds for coughs and colds (commonly morphin, chloroform, etc. Sometimes contain as many as 15 ingredients). [Consumption "Cures".-Commonly one or more of: Mor- phine, chloroform, belladonna, hyoscyamus, peppermint, gin- ger, muriatic acid. Sometimes strychnin, creosote, guaiacol or similar agents; oil of wintergreen, sulphuric acid, potas- sium iodid, potassium bromid, capsicum, caustic soda, or, etc. Some are of very simple or practically worthless or inert substances as regards this disease, such as corn starch, bis- muth, sugar, pancreatin, sugar of milk, soap, etc.-perhaps in conjunction with aromatic oils, etc. In one instance sugar was thus sold at $8 per pound. Nauseous combinations may impair the ability to digest suitable food, thus vitiating the victim's chief avenue of hope for recovery. Pretension to cure, "by means of sugar plus various incidentals," etc.- an exploitation frequently by conscienceless laymen or "by men who are as lacking in professional training as they are in moral responsibility" (A.M.A.). The attendant upon a case of suspected poisoning by a "consumption cure" must carefully determine if there be a true poisoning or an above indicated gastro-enteric disturbance only.] Headache Preparations, ete.-Headache powders common- ly contain: acetanilid or antipyrin, or phenacetin, or aspirin or some other analgesic, perhaps cocain; and such is fre- quently associated with caffein or camphor monobromate, and bicarbonate of soda, or sodium salicylate. Ammonal (acetanilid 50 naffs. sodium bicarbonate, am- monium carbonate [analy. 1905].) A MANUAL OF TOXICOLOGY 247 Antikamnia (acetanilid 68 parts, citric acid, caffein, sodi- um bicarbonate-analy. 1905). (Later-phenacetin in place of the acetanilid.) Bromo Seltzer (potassium bromid 10.53 parts, acetanilid 4.58 parts, caffein 1.20 parts-in 100 parts: in 1 teaspoonful about 7 gr. pot. brom.,>Jj gr. acetanilid and 4/5 gr. caffein. Eames Tonic Headache Wafers (acetanilid). Hick's Capudine Cure (antipyrin and caffein.-19 grains, and salicylates equivalent to about 14 grains of salicylic acid, to each fluid ounce of the preparation, alcohol 8%-- AM.a.) [Exploiters claimed: "Hick's Capudine is not a 'dope' "does not contain . . . poisonous drugs," etc.] . Kephalgine (antipyrin, roasted coffee, caffein, sodium sal- 'cylate). Koehler's Headache Powder (acetanilid 76 parts, caffein 22 parts-analy. 1905). Midol [tablets], Nurito [powders] (pyramidon-" a pro- prietary preparation derived from and having the antipy- retic and anodyne properties of antipyrin"-1912). Nyal's Headache Wafers (acetanilid 4 grains, caffein 1 grain in each wafer). O. K. Headache Cure (acetanilid, alcohol). Orangeine (acetanilid 43 parts, caffein 10 parts, sodium bi- carb. 18 parts-1905). Phenalgin (acetanilid 57 parts, sodium bicarbonate 29 Parts, ammonium carbonate 10 parts). Salacetin (actanilid 43 parts, sodium bicarbonate 21 parts, sodium salicylate 20 parts-analy. 1905). "Shac" [Stearn's Headache Cure] (stated to contain 4 grains acetanlid in each wafer-1907). Allen's World's Hair Restorer (lead acetate, sulphur). Sherman's Headache Cure (acetanilid). Stanley's Instant Headache Cure (acetanilid). Mrs. Summer's Harmless Headache Remedy (acetanilid, caffein, camphor, sodium salicylate). Hair Dyes, etc. Various kinds of hair restoratives con- tain lead. Ayer's Hair Vigor (lead acetate, sulphur). Hall's Hair Renewer (lead acetate, sulphur). Bordet's Hair Tonic (carbolic acid, tincture nux vomica). "Captol" (chloral hydrate, tannic acid or tartaric acid or both-analy. 1910). Eau Sublime (similar to "Mrs. Potter's Walnut Stain," etc.) Farr's Gray Hair Restorer (ammoniacal sol. silvercrabout * gr. silver nitrate to 3% ounces). La Tosca Hair Tonic (98.5% wood alcohol). Mrs. Potter's Walnut Juice Hair Stain [later-"Hair Tint"] (active principle of the dye a phenolic compound-con- formed to tests for paraphenylene diamin-a poisonous and dangerous chemical). Well's Hair Balsam (lead acetate, sulphur, glycerine). Skinner's Dandruff Mixture (chloral). Liniments, etc.-Liniments commonly contain: ammonia or lodin or camphor; etc. Some also contain one or more of the following: belladonna, aconite, opium, arnica, lobelia, soap, carbolic acid, oils of amber, cinnamon, sassafras, pen- nyroyal, peppermint, wintergreen, wormwood, juniper, hem- lock, thyme, turpentine, cloves, cedar, spike or origanum; acetic acid, crude petroleum, kerosene, menthol, chloroform, capsicum, cantharides, mustard, and an oil as olive, linseed, goose, snake, skunk, woodchuck, fish, whale, seal or por- poise, etc. Brodie's Liniment (sulphuric acid, turpentine, olive oil). California Liniment (ether, chloroform, oil of lobelia). Centur Liniment (turpentine, caustic soda, oils, soap). 248 A MANUAL OF TOXICOLOGY Fluid Lightning (aconite); (another of the reputed form- ulae: oils of mustard, cajeput, cloves and sassafras each 2 fluid drams, ether 1 fluid ounce, landanum 1% fluid ounces, alcohol 20 fluid ounces). Gunn's Rheumatic Liniment (oils of cedar and amber.' tur- pentine, laudanum, camphor). ' Hinkley's Bone Liniment (oils of wormwood, hemlock, thyme and turpentine with capsicum). St. John's Liniment (camphor, ammonia, turpentine, opium, oils of origanum, hemlock, juniper and amber. "Magnetic Liniments, Rheumatic Oils of "Joy"; "Gladness," etc. (commonly contain several or many of the following: capsicum, camphor, ammonia, opium, turpentine, sassafras, contharides. ether, chloroform, oils of hemlock, rosemary, amber, origanum, peppermint, horsemint, marjoram, cedar, etc.) Thomas's Electric Oil (chloroform, camphor, catechu, opium, oils of hemlock, wintergreen, origanum, sassafras and turpentine; alcohol). Tobias Venetian Liniment (ammonia, camphor, capsicum, alcohol, water). Wilson's Lightning Liniment (capsicum, ammonia, cam- phor, turpentine, chloroform, opium, alcohol, oils of cedar and sassafras). Chlorodyne or Chloranodyne (an old formula: Chloroform 1 dram, morphin 5 grains, ether % dram, oil of peppermint 4 drops, hydrocyanic acid dilute 1 dram, tincture capsicum 1 dram, extract licorice 15 grains, molasses 10 drams. Mix. More modern formulae are: Morphin sulphate 24 grains, tincture cannabis Indica 6 drams, chloroform 6 drops, tinc- ture capsicum 12 drops, oil peppermint 12 drops, hydrocyanic acid dilute 72 drops, alcohol 3 1-5 ounces, glycerine 3 1-5 ounces. Mix. Or: Morphin hydrochlorate 32 grains, alcohol 3 fluid ounces) tincture Indian cannabis 1 fluid ounce, tincture cap- sicum % fluid dram, oil peppermint 12 minims, chlorofom 1 fluid ounce, dilute hydrocyanic acid 2 fluid drams, glycerine enough to make 8 fluid ounces. Mix. Fosgate's Anodyne Cordial (paregoric, ginger, rhatany, rhubarb). Lindsey's Pain Cure (capsicum, camphor, chloral, chloro- form, ether, oils of hemlock, cinnamon, sassafras, cloves, cedar, origanum, wintergreen. Pain Base (acetanilid). Perry Davis's Pain Killer (opium, camphor, capsicum): or (Spt. camphor, tr. capsicu-H^tr. guaiac, tr. myrrJvalcohol). Pope's Cure for Neuralgia (conium( potassium iodid). Radway's Ready Relief (ammonia, capsicum). Pain Preparations. Brown's Male-Fern Vermifuge (Fl. ext. male fern, oil wintergreen). Fahnestock's Vermifufte (reputed ingredients: oils of wormseed, anise and turpentine, tincture of myrrK,and cas- tor oil). Freeman's Vermifuge Oil (pink root, oils of wormseed and turpentine; hydrastin, c^tor oil, syrup of peppermint). Kennedy's Worm Syrup (santonin). Kennkle's Vegetable Worm Syrup (santonin, pink root). Proctor's Vermifuge (santonin, pink root). Vermifuges. Battle's Vermin Killer (23% strychnin, Prussian blue, sugar, and flour). Butler's Vermin Killer (strychnin 5%, soot and flour). Glbson's*(% grain strychnin in each package). Vermin Killers. A MANUAL OF TOXICOLOGY 249 Simpson's (arsenous acid 40%, mixed with malt and starchQ,ySome are of phosphorous arsenic and ground glass. Ayer's Moth and Freckle Lotion (corrosive sublimate). Ayer's Vita Nuova (cocain, alcohol). "Break-Up-The-Grip" Tablets (acetanilid). Bull's Blood Syrup (red iodide of mercury, potassium io- did, poke root). Bromida (One should bear in mind that the essential drug' is not the bromid. Given formula: Chloral hydrate 15 grains, potassium bromid 15 grains, extract cannabis Indica % grain, extract hyoscyamus % grain). Burnett's Disinfecting Fluid (corrosivecof zinc chlorid, 220 grs. to oz., etc). Coke Extract [a soft drink] (cocain). Chloralose (chloral, glucose). Cures for Drunkenness, Drug Habits, etc., under various names, commonly found to contain an opiate, or cocain, or bromides or both; etc.(e. g., Habitina, advertised as "a pos- itive cure" of the "morphin and other drug habits" and formerly called "Morphina-Cura"-% oz. bottle of the liquid, upon test, found to contain 8 grains morphin sulphate and 4 grains.heroin hydrochloride-"enough morphin to kill 7 or 8 people^ Such preparations frequently found to contain either belladonna, hyoscyartnus, hyoscin, camphor, cannabis Indica, caffein, strychnin, tartar emetic, pilocarpin, carbolic acid, spartein, etc. either alone or combined with one or more of the drugs herein mentioned. Cuticura Resolvent (potassium iodid, whisky). Crayons, Colored Crayons, Jfrench Chalk [some crayons mistaken for candies by children, and are likely to contain chromium. The cheaper varieties of artists' crayons and colors commonly contain arsenic. Crayons frequently con- tain white lead and coated. Some are Dutch pink mixed with Prussian blue]. Dr. Don's Kola [a flavoring extract for soft drinks] (co- cain, caffein, phosphoric acid). Dr. Elder's Celebrated Tobacco Specific ["cures smoking, chewing, cigarette and Snuff Dipping Habits in 3 to 5 days"] (analysis showed contained cocaine, strychnin, etc.) Firwein (bromin. iodin. phosphorus). Haarlem Oil (oils of amber, turpentine, flaxseed, Barba- does, tar, balsam of sulphur). . Hamlin's Wizard Oil (camphor, cloves, chloroform, turpen- tine. ammonia, sassafras, alcohol). Hunter's Red Drops (corrosive sublimate, muriatic acid). Injection Brou (similar formula said to contain: lead acet- ate, zinc sulphate, tincture catechu, cocain. Another formula gives opium instead of cocain). Jaynes Alterative (similar formula said to contain: tartar emetic, digitalis, camphor, opium, lobelia). Kickapoo Indian Oil (camphor; oils of turpentine, pepper- mint, wintergreen; tincture capsicum: alcohol). King's New Discovery (morphin, chloroform). Kline's Nerve Restorer (bromides of ammonium and po- tassium). Kopp's Baby's Friend (analysis showed 1-3 grs. morphin in 1 fluid ounce of the preparation). Methylene or Bichloride of Methylene (anesthetic of chlor- oform, and methylic alcohol 20%). Pierce's Favorite Prescription (opium, digitalis, savin). Pierce's Golden Medical Discovery (opium, podophyllin, guaiac). Pimple Lotion (carbolic acid, tannic acid). Platt's Chlorides (approximately: chlorides of aluminum, magnesium, potassium, sodium, zinc). Miscellaneous. 250 A MANUAL OF TOXICOLOGY Radway's Renovating- Resolvent (potassium iodid). Ree's Cholera Mixture (opium, chloroform, cloves). Roche's Embrocation (oils of cloves, lemon, amber, olives); (also: "asafetida, olive oil, oils of caraway, turpentine and wintergreen"). Madam Ruppert's Flesh Bleach (corrosive sublimate, tinct. benzoin). Seven Seals (ether, chloroform, camphor, capsicum, pep- permint). St. Jacob's Oil (chloral, chloroform, ether, opium, cam- phor, oils of origanum and sassafras) ; or, (ether, turpentine, carbolic acid, capsicum, aconite, origanum, alcohol). Scotch Oats Essence (morphine 2 gr. to bottle; 35% alcohol). Swift's Syphilitic Specific (copper sulphate, sumacs roots, etc). Thieleman's Cholera Mixture (opium, chloroform, ether, ipecac, peppermint, alcohol). Thompson's Eye Water (copper and zinc sulphates, spirit camphor, tincture saffron). Trafton's Balm of Life (potassium iodid, opium). Vapo Cresolene (appears to be "essentially cresol and cor- responds in every respect to cresol of the U. S. P."-A.M.A. 1908). White's Elixir (tartar emetic, camphor, opium). Mrs. Winslow's Soothing Syrup (morphin, essence of anise, syrup of balsom of tolu). "Winslow's Soothing Syrup" ("For years contained mor- phin" and still found in preparations in U. S. market in 1912). (Finally, in Great Britain, potassium bromid substi- tuted for the opiate, but alcohol was still present.) Embalming Fluids (one or more of the following: zinc chlorid, arsenic, formaldehyde, carbolic acid, camphor or tannin; etc. (Sometimes contain thymol, potassium bichro- mate, carbonate, nitrate of sulphate). Syrup of Figs (Purging action due to senna and not to figs. Found to be 25% an elixir of senna and 6% of alcohol. ImlU. S. had to add to the title of "Syrup of Figs" also the words "and Elixir of Senna," because of the American Food and Drugs Act.) Santogen ("Casein makes up about 95% of the prepara- tion." Casein is commonly known as the curd, in milk, or as cottage cheese.) Beechaaa-nis Pills (aloes, ginger and soap). Castoria (Reported as approximately: "Senna 4 dr.. Ro- chelle salt 1 oz., Manna 1 oz., fennel (bruised) 1% dr., sugar 8 oz., boiling water 8 fl. oz., oil of wintergreen, sufficient.") Carter's Little Liver Pills (approximately: "Podophyllin gr., aloes (socotrine) 3% gr., mucilage of acacia, suffici- ent, mix, divide into 12 pills; coat with sugar.") Brandreth's Pills ("Ext. colocynth, aloes, soap, oils of pep- permint and cinna^anon, gum arabic and alcohol.") Pink Pills (iron sulphate, sodium carbonate, licorice). Ayer's Sarsaparilla ("Fl. exts. sarsaparilla, stillingia, yel- low dock, May apple; potassium iodid 3.4 grains per fluid ounce; iron iodid, glycerine or sugar"). Cuticura Ointment ("carbolic acid (2%), petroleum jelly, oil of bergamot"). Cuticura Resolvent ("aloes, rhubarb, potassium iodid, whisky"). Wilson's Compound Sarsaparilla (5.1% alcohol; molasses). [Journal Amer. Medical Ass'n, (May, 1912): "It is extremely improbable that there is any therapeutic value in sarsapar- illa.'□ A MANUAL OF. TOXICOLOGY 251 Cosmetics (S. N. and S.) Complexion Powder (bismuth, subcarbonate). Flake White (lead carbonate). Pearl White (bismuth subnitrate). Riker's Face Powder (calcium, zinc carbonate). Saunder's Face Powder (zinc oxid). Bradford's Enameline (zinc oxide). . Circassian Cream (corrosive sublimate). Eugenie's Favorite (lead carbonate). French's Grease Paint (calcium and zinc oxide). Gouraud's Oriental Cream (calomel). Hagan's Magnolia Balm (zinc oxide). Kalydor (potash, mercuric chlorid). Lac Virginis (benzoin). Laird's Bloom of Youth (calcium, zinc oxid). Milk of Roses (mercuric chlorid). Snow White Enamel (lead carbonate). Snow White Oriental Cream (lead carbonate). Children's Comfort (morphin). Dr. Moffett's Teethina; Teething Powders (opium). Hooper's Anodyne, The Infant's Friend (morphin). Dr. Fahrney's Teething Syrup (morphin). Dr. James' Soothing Syrup (heroin). Pierce's Smart Weed (opium). Crossman's Specific Mixture (opium). Watkin's Anoyne (heroin). Wright's Instant Relief (opium). Tousley's Sneezeless Snuff (morphin). Shiloh's Cure (heroin). Petit's Eye Salve (morphin). Mexican Oil (opium). Godfrey's Cordial (opium). Colwell's Egyptian Oil (opium). Agnew's Powder (cocain). Anglo-American Catarrh Powder (cocain). Coco-Bola (cocain). Captol (chloral)., . Peruna (as original such, later called Ka-tar-no). Form- erly Peruna: whisky. In 1906 notified to put some medicine in the preparation, or could be sold only where liquor license was carried. A laxative was added; but that ap- pears to have materially injured its sale. Therefore later announced;"old Peruna (now called Ka-tar-no) and sold as an alcoholic beverage*' Hood's Compound Extract of Sarsaparilla (4 4/10 grains potassium iodid per fluid ounce; 18% ol alcohol). Poslam (zinc oxid, sulphur, acid salicylic, oil of tar, men- thol. corn starch, and probably petrolatum). Sanitol (An analysis showed salol, menthol, alcohol, for- maldehyd; perhaps common plantain present). Tiz (From analysis apparently approximately: alum, starch, salicylic acid, talcum, tannic acid). Sal Hepatica (sodium sulphate 26.27 parts, sodium phos- phate 29.80 parts, sodium bicarbonate 18 parts, lithium phos- phate 4/100 part, salt 13.05 parts, citric and tarartic acids sufficient to make 100 parts.), "A. C. E. Mixture" (alcohoyl, chloroform 2. ether 3, parts). Laudanum (Brit.) (Strength 1 gr. in 15 min.) Paregoric (Paregoric Elixir,.British); (1 gr. in % oz.) Scotch Paregoric (ammoniated tincture of opium) (5 grs. in 1 oz.) Extractbf Opium (about twice as strong as powdered opium) Liquid Extract of Opium (% gr. morphin in 100 min.) (15^ Liniment of Opium (tincture of opium and soap liniment equal parts) 252 A MANUAL OF TOXICOLOGY Syrup of Poppies (British); (originally a preparation from poppy capsules; now usually a variable mixture of laudanum and syrup). Black Drop (4 times as strong as laudanum) Battley's Solution (50% stronger than laudanum). Dalby's Carminative (2% minims of laudanum to the ounce). Godfrey's Cordial (% to 1% grains of opium to the ounce, and said to contain molasses and sassafras). Nepenthe (of about same strength as laudanum, and said to contain glucose and sherry wine). Teething Powders (usually contain calomel 1 grain, Dov- er's powder 2 grains, milk sugar 3 grains). Veronal Tablets (should be dissolved before being admin- istered). pt Mother's Friend (opium). ^Fatal effects from as little as 15 grains of the drug. Hostetter's Bitters (Diluted alcohol 4 gals.; Peruvian Bark, gentian, columbo and calamus roots, orange peel, rhu- barb, cinnamon, cloves and sugar totalling about 26 ozs.; also reported 44.3 alcohol). Walker's Vinegar Bitters (golden seal 1 oz., cape aloes % oz.. water 16 oz.; also, reported 61% alcohol). Warner's Safe Cure. Van Buskirk's Sozodont (soap, red sanders, oil winter- green, water, alcohol). Drake's Plantation Bitters (St. Croix rum, was 33.2% alcohol). Swift's Syphilitic Specific (cupric sulphate, roots of the fringe tree, prickly ash, white sumac, red sumac and sarsa- parilla). Bateman's Pectoral Drops (tinctures of opium, opium ben- zoated and Canada castor with ground cochineal). Schenck's Pulmonic Syrup (wormwood, catnip, tansy, hoarhound, hops, hyssop, chamomile, comfrey, elecampane, sfeiega). Sage's Catarrh Remedy (golden seal, borax, salt). Heave's Embrocation (olive oil, aqua ammonia, oil origan- um, Goulard's lead extract). Radway's Ready Relief (tincture capsicum, ammonia water, soap liniment, alcohol). Hop Bitters (reported 12% alcohol). Lydia Pinkham's Vegetable Compound (said to closely re- semble infusion or decoction of "life everlasting'' plant). KEY TO TREATMENT. (A digest arranged from the preceding pages of Part II.) POISON. TREATMENT. Chemical and Mechanical. Physiological. acetanilid. anilin. antipyrine. exalgin. phenacetin. Evacuate the stomach. Recumbent position. Artificial respiration. Caffeine Citrate. Digitalis. Strychnine. Oxygen. Heat. acid- acetic. -Mineral Acids- HYDROCHLORIC. PHOSPHORIC. NITRIC. SULPHURIC. Magnesia. Albumin. Lime-Water. Soap, Demulcents. Avoid emetics and stom- ach pump if acid concen- trated. Stimulants. Opium. External heat. ^CID- CARBOLIC. CREOSOTE. GUAIACOL. ETC. (PHENOLS.) Alcohol. Evacuate stomach. Sodium or Magnesium Sulphate. Lime-Water or Syrup of Lime. Soap. Albumin. Demulcents. (Avoid Oil and Glycerine) Atropine. Opium. Stimulants. External heat. Artificial respiration. ACID- CARBONIC. Fresh air. Friction, and heat to extremities. Artificial respiration. ACID- HYDROCYANIC (also the CYANIDES). A mixture of Ferrous and Ferric Sulphates with Sodium or Potas- sium Hydroxide or Car- bonate or Magnesia. Evacuate stomach if time. Pot. Permanganate or Hydrogen Peroxide. Demulcents if required. Cold douches. Ammonia or Chloride of Lime inhalations. Artificial respiration. Stimulants. Artificial heat. ACID- OXALIC. Lime in any form. Magnesia. Demulcents. Stimulants. Opium. External heat. aconite. Tannic Acid (10-30 grs.). or Animal Charcoal (1 tablespoonful). Syphon out stomach. (Avoid emetics.) Horizontal position. Artificial respiration. Digitalis. Artificial heat. Stimulants. N. B.-By STIMULANTS is meant not only. Alcohol, but alsothe varioMt cardiac and respiratory stimulants, such as Ammonia, Digitalis, Caffeine, Strycl> nine. Nitroglycerine, Atropine, etc. 248 A MANUAL OF TOXICOLOGY. POISON. TREATMENT, Physiological. 6 C fl SIA 1C £L 1 • ALCOHOL. ETHYL. Evacuate stomach. Cold to head; heat to extremities. Ammonia inhalations. Ammonium Chloride. Atropine. Digitalis. Electricity. Artificial respiration. ALCOHOL, METHYL. Evacuate stomach. Pilocarpine Hydrochlor* ate. Treat as for Ethyl Alco» hoi. ALKALIES- AMMONIA, CAUSTIC POTASH, CAUSTIC SODA, LIME, etc. Dilute Acids, especially Vegetable Acids, as Cit- ric or Tartaric, Lemon, Orange juice, Vinegar. Milk, Oil. Stimulants. Artificial heat. Opium. For Ammonia; Aconite, Digitalis, cold air. ALKALOIDS. Tannic Acid. Charcoal. Iodine. Albumin. Evacuate stomach. Maintain circulation and respiration. ANESTHETICS- CHLOROFORM, ETHER, NITROUS OXIDE. When Swallowed : Evacuate stomach if pos- sible, and give water containing Sodium Carb, or Bicarb. Also demul- cents if necessary. Remove cause. Place head low. Artificial respiration. Fresh _ air, Oxygen. Atropine. Stimulants Artificial heat. ANTIMONY and its COMPOUNDS. If necessary evacuate stomach. Tannic Acid. Demulcents. Stimulants. Opium. Artificial heat. ARSENIC- ARSENOUS ACID. FOWLER'S SOLUTION, PARIS GREEN. "ROUGH ON RATS,'' etc. Evacuate stomach. The Hydrated Oxide of Iron with Magnesia; or, the Hydrated Sesquiox- ide of Iron; or Dialyzed Iron. Demulcents. Cas- tor Oil. Stimulants. Opiurn if necessary. Artificial heat. Spt. Nitrous Ether BARIUM and its COMPOUNDS. Evacuate stomach. Mag- nesium or Sodium Sul- phate. Demulcents. Stimulants. Opium if necessary. Artificial heat. BELLADONNA. HYOSCYAMUS. STRAMONIUM. Tannic Acid. Evacuate stomach. Opium. Pilocarpine Ni- trate. Muscarine. Arti- ficial respiration. Alter- nate hot and cold douches. External heat. Stimu- lants. CANNABIS- AMERICAN or INDIAN HEMP. Tannic Acid. Evacuate stomach. Stimulants. External heat. KEY TO TREATMENT. 249 POISON. TREATMENT. Chemical and . Mechanical. Physiological. CHLORAL. CHLORALAMID. Evacuate stomach. (Is well to siphon out stomach with tea or coffee.) Liquor Potassse ( 3 K-z in water Jviii.) Artificial respiration. Cold to head. Ammo- nia and Oxygen inhala- tions. External heat. Picrotoxin. Strychnine. Atropine. Stimulants COCAINE. If swallowed: Give Tannic Acid and evacu- ate stomach if possible. Horizontal position. Fresh air-. Amyl Nitrite. Mor- phine. Atropine. Art. resp. Stimulants. Oxygen. Heat. Electricity. Ether, etc. CONIUM. Tannic Acid. Evacuate stomach. Demulcents. Place head low. Stimu- lants. Artificiai heat. Artificial respiration if necessary. COPPER and its COMPOUNDS. Potassium Ferrocyanide. Albumin or milk. Evacuate stomach. Demulcents. Magnesia. Artificial heat. Stimulants. Opium. CROTON OIL. Evacuate stomach. Demulcents. Artificial heat. Opium. Stimulants. Digitalis. Tannic Acid. Evacuate stomach. Magnesium Sulphate. Horizontal position. Aconite. Saponin. Al- coholic stimulants. Arti- ficial respiration. Heat. food, POISONOUS. Tannic Acid. Evacuate stomach. Castor Oil. Antiseptics if required. Stimulants. Atropine for poisoning by Muscarine. Artificial heat. gaseous POISONS. Fresh air. Oxygen. Artificial respiration. Rest. Stimulants. gelsemium. Tannic Acid. Evacuate stomach. Castor Oil. Morphine. Atropine. Stimulants. Artificial respiration. Hot and cold douches alternated. Artificial heat. Electricity. IODINE and its COMPOUNDS. Starch or flour with water. Evacuate stom- ach. Demulcents. Stimulants. Artificial heat. Morphine. Lead and its COMPOUNDS. Magnesium or Sodium Sulphate. Alum. Evacu- ate stomach.Demulcents. Stimulants. Opium if necessary. Artificial heat. Lobelia. Tannic Acid. Evacuate stomach. Castor Oil. Stimulants. Artificial heat. Opium. 250 A MANUAL OF TOXICOLOGY. POISON. TREATMENT, Chemical and . Mechanical. Physiological. MERCURY and its COMPOUNDS. Albumin (White of one Egg for 4 grs. Corrosive Sublimate). Evacuate stomach if vomiting has not occurred; also after Albumin. Stimulants. Artificial heat. Opium. NITROGLYCERINE. Emetics and Cathartics. Horizontal position. Cold to head. Atropine. Ergot. Strychnine. NUX VOMICA-. STRYCHNINE, BRUCINE, etc. Charcoal, Tannic Acid, or Potassium Permanga- nate. Evacuate stomach quickly before convul- sions. Tube, or Apo- morphine hypodermic. Horizontal position in dark, quiet room. Arti- ficial respiration. Chloro- form for convulsions. At- ropine. Bromides. Chlo- ral. Opium. Urethane. OPIUM- LAUDANUM. PAREGORIC. MORPHINE. CODEINE. HEROINE, etc. Potassium Permangan- ate, or Tannic Acid. Evacuate stomach. Keep patient awake by flagellation, walking, elec-' tricity, etc. Amyl Nitrite. Atropine. Strychnine. Di- gitalin. Coffee, Cocaine, Tine. Capsicum, orange or lemon juice. External heat. Artific. respiration. PHOSPHORUS. Copper Sulph. Old Oil of Turpentine, Pot. Per- mang. or Hydrog. Perox. early. Evacuate stom- ach. Magnesium Sul- phate. (No fats or oils.) Opium. Oxygen inhalations. Artificial heat. RHUS (POISON IVY, POISON OAK, POI- SON SUMACH). Apply : Grindelia Rob. Alum. Ale. Sol. of Lead Acetate. (Avoid oils and fats.) Give Mag. Sulph. Opium to quiet. SILVER COMPOUNDS. Sodium Chloride. Evacu- ate stomach. Demulcents of albumin, milk, etc. Opium. Stimulants if necessary. STROPHANTHUS. Tannic Acid. Evacuate stomach. Saline cathartic. Chloroform or Ether in-. halations, Chloral or Bro-' mide. Artif. respiration. SULFONAL. TRIONAL. Evacuate stomach. Magnesium Sulphate. Stimulants. TOBACCO. Tannic Acid. Evacuate stomach. Horizontal position. Cold to head. Strychnine. Artificial heat. VERATRUM. Tannic Acid. Evacuate stomach. Horizontal position. Fresh air. Stimulants. Artif. heat. Opium. Electricity. ZINC COMPOUNDS. Tannic Acid. Evacuate stomach. Bicarb. Soda. Albumin. Lime-Water. Soap. Mucilage. Milk. Morphine. Hot fomentations. INDICATIONS OF VARIOUS SYMPTOMS. 253 PART III. the indications of various SYMPTOMS IN POISONING. (an aid to diagnosis of the poison)* Suspect: Wood Alcohol, Barium, Digitalis, Qui- nine, Nicotine, etc. BLINDNESS. BREATH (Specific Odor of Breath). Suspect: Acid Hydrocyanic, Alcohol, all ethereal °ils, Ammonia, Amyl Nitrite, Amylene-hydrate, Bromine, Bromoform, Chloroform, Creosote, Ether, Brominated Ether, Iodine, Iodoform, Nitro-ben- zene, Opium, Paraldehyde, Pental, Phosphorus, salts of Tellurium, Camphor, Tobacco, Formalde- hyde, etc. BREATH (Phosphorescence of Breath). Suspect: Phosphorus. (Also Garlic-like odor.) COLLAPSE. Suspect: Concentrated corrosive acids or alka- nes, Antimonial preparations, Arsenic, Colchicine, Aconite, Nicotine. COMA, PROFOUND. Suspect: Alcohol, Aniline Oil, Belladonna, Car- bon Monoxide, Chloral and its analogues, Chloro- form and its analogues, Coal Gas, Opium or Mor- phine, Oxybutyric Acid, Sulfonal, Trional. *See also pages 329-336. 254 A MANUAL OF TOXICOLOGY. CONVULSIONS, SEVERE; OR TETANUS. Suspect: Aconitin, Ammonia salts, Cocaine, Condurangin, Corydalin, Cicutoxin, Cornutin, Cy- tisin, Digitaliresin, Filicic Acid, Gelsemine, Guani- din, Picrotoxin, Ptomaines, Strychnine, Tetanus bacillus toxin, Thebaine, Antimony, Arsenic, etc. COUGH, BARKING, AND APHONIA. Suspect: Allantotoxin, Atropine, Hyoscyamine, Scopolamin, etc. Suspect: _ Anilin, Acetanilid, Benzocoll, Exalgin, Nitrobenzene, Phenacetin, Toluidin. CYANOSIS. DEAFNESS AND BLINDNESS (More or Less Complete). Suspect: Aconite, Belladonna, Cocaine,- Conium. Suspect: Acid Hydrocyanic, Acid Carbolic, Car- bon Dioxide, Creosote, Potassium Cyanide or other cyanides. Strong Ammonia, Oxalic Acid. DEATH, QUICK AND SUDDEN. DELAYED SYMPTOMS. (First symptoms of poisoning 12 to 24 hours after eating). Suspect: Arsenic (not in solution), Mushrooms containing Phallin, Virus of rabid animals. DEPRESSION, MENTAL. Suspect: Alcoholism, Cocaine habit, Morphine habit, Maydism, Mercurialism Ergotism, Ether- ism, Saturnism, Carbon Disulphide, Iodoform. DIARRHCEA WITH VOMITING. Suspect: Antimony and substances containing it, Arsenic and substances containing it, Colchicine, INDICATIONS OF VARIOUS 'SYMPTOMS. 255 Colocynths, corrosive poisons, Croton Oil, sub- stances of the Digitalin group, Emetin, Muscarin, Ricotine, Pilocarpine, etc. DISCOLORATION (Black and Blue Peripheral Parts of Body). Suspect: Gangrenous Ergotism. DISCOLORATION (Skin Dark and Muddy). Suspect: (If not Blue) Poisoning by Arsenic (Arsenical-melanosis), Copper, Lead, Mercury. (Blue or Argyria) Silver preparations. DISCOLORATION (Discolored Tongue and Mu- cous Membrane of Mouth). White: Carbolic Acid, corrosive acids, corrosive alkalies, corrosive metallic salts. Brown: Bromine, Iodine. Yellow: Nitric Acid, Picric Acid. [chromates. Reddish-Yellow: Salts of Chromic Acid and Bi- Greenish-Blue: Paris Green, salts of Copper. discoloration (icteric, or Pseudo-Icteric, Yellowish-Brown Discoloration of the Conjunc- tiva or of the Skin). Suspect: Amyl Nitrite, Arsine, Helvellaic Acid, Phosphorus, Phallin, Potassium Chlorate, Pyro- gallol, Saponin substances, Sodium Nitrate, Solanin. Emaciation: From prolonged poisoning by Ar- Senic, Lead or Mercury, secondary effects of cor- rosives. ERUPTION (Acne) Suspect: Bromides, compounds of or substances Which contain Antimony, arsenicals, Emetine, 'odides. Boric Acid (papular). 256 A MANUAL OF TOXICOLOGY. ERUPTION (Clear Vesicles on Skin or in Mouth). Suspect: Preparations of Cantharides, Crowfoot, etc. ERUPTION (Eczematous). Suspect: Anilin (externally), Carbolic Acid- Cardol, Cinchona (dust of the bark), Croton Oil, Curcas Oil, Sulphonal, Tar, Vanilla (poor quality)- ERUPTION (Nettle, Scarlatinal or Measles-like Rash). Suspect: Antipyrine, Atropine, Belladonna, Bal- sam of Copaiba, Chloral, Cubebs, Hyoscyamine, Iodine, Morphine, Quinine, Antimony, Arsenic, Food. Suspect: Bismuth, Copper (green), Lead (blue), Mercury (bluish), Silver. Boric Acid (gray). GUMS (Dark Line or Border on Gums). Suspect: (Impaired or Lost) Barium, Bromism^ Cinchonism, Salicylism. (Intensified) Strychnine. (Buzzing) Salicylic Acid. (Ringing) Quinine. HEARING ILLUSIONS, VISIONS, ETC. Suspect: Absinthe, Opium and Morphine, Co- caine, etc. MANIA OR DELIRIUM (Raving Mania, Rag- ing Delirium, or Mental Excitation). Suspect: Alcoholism (chronic), Atropine, Cam- phor, Cannabinon, Cocaine, Physostigmine, Vera- trine, Hyoscyamus, Stramonium, Cannabis. MISCARRIAGE OR ABORTION. May be due to: Cotton Root Bark, Cornutin Pennyroyal, Phosphorus, Rue, Savine, Tansy, etc INDICATIONS OF VARIOUS SYMPTOMS. 257 CEDEMA (of Glottis). Suspect: All the corrosive poisons. CEDEMA (Pulmonary). Suspect: Ammonia, Morphine, Muscarine, Pilo- carpine. PAIN. Colic: Arsenic, Colocynth, Copper, Lead Cramp: Antimony, Arsenic, Lead. Neuritic: Chronic arsenical poisoning. PARALYSIS (As a rule, ascending). Suspect: Aconite, Arsenic, Colchicine, Coniine, Curare, Ergotinic Acid, Gelsemium, Guachamaca- Poison, Lead. PERSPIRATION (PROFUSE). .Suspect: Aconite, Acetanilid, Antipyrine, ExaL Sm, Phenacetin, Sulfonal, etc. Suspect: Cantharidin, etc. PRIAPISM. Suspect: Atropine, Hyoscyamine, Scopolamine, etc. PULSE (Greatly Accelerated). PULSE (Particularly Slow). Suspect: All narcotics, Baryta, Lead, Morphine, Muscarine, Nicotine (later rapid and. irregular), Mpium, Physostigmine, Pilocarpine (later rapid and irregular), substances of the Digitalin group (later rapid pulse). PULSE, WIRY. Suspect: Baryta, Lead, substances of the Digi- tabn group. 258 A MANUAL OF TOXICOLOGY. PUPILS, CONTRACTED. Suspect: Codeine, Morphine (Opium), Musca1 rine, Nicotine, Physostigmine, Pilocarpine. PUPILS, DILATED. Suspect: Aconitine, Alcohol, Atropine, Chloroform (swallowed), Cocaine (subsequently contracted), Coniine, Cytisin, Eppedrin, Gelsemine, Homatropine, Hyoscyamine, Opium (last stage), Scopolamin (Hyo- scin), Stramonium. SALIVATION. Suspect: Ammonia, Antimony, Arsenic, Can- tharidin, Cytisin, Mercury, Muscarine, Nicotine, Physostigmine, Pilocarpine, Saponin substances, etc. SKIN, MOUTH AND PHARYNX, VERY DRY Suspect: Atropine, certain parts of Belladonna, Hyoscyamus, Thorn-apple, Allantotoxin (from de- caying fish), Hyoscin, Hyoscyamine, Scopolamin. ■ SKIN, MOIST. Suspect: Aconitine, Antimony, Lobelin, Moi''' phine, Muscarine, Nicotine, Opium, Physostigmine, Pilocarpine, Alcohol. SKIN, YELLOW. SKIN, BLUE Suspect: Picric Acid and its salts. Silver Salts Suspect: (Garrulous) Opium or its alkaloids (Thick) Alcohol. SPEECH. TASTE, FOUL. Suspect: Arsenic, Copper, Lead, Mercury, Po- tassium Iodide, Tartar Emetic. INDICATIONS OF VARIOUS SYMPTOMS. 259 TEMPERATURE, MARKED ELEVA- TION OF. Suspect: Cocaine, enzymes, Phosphorus, strong convulsants (under certain conditions). tingling or numbness in lips or TONGUE. Suspect: Aconite. URINE (Having' Coloring Matter of Blood in Solution). Suspect: Cyclamin, Solanin and other Saponin substances, Helvellaic Acid, Phallin. Red: Antipyrin, Fuchsin. Claret Colored: Sulfonal, Trional. Becoming Scarlet in Air: Santonin. Reddish Yellow: Picric Acid and salts. Becoming Dark Green in Air: Phenol. Greenish: Methylene blue. Brownish or Greenish Brown: Phos- phorus, Lead, Mercury. urine URINE, ACID' (Containing Colorless Crystals). Suspect: Oxalic Acid and its Salts URINE, ICTERIC. Suspect: Cephalanthin, Phallin, Phosphorus, 'Toluene, Diamin. URINE (Containing Methaemoglobin With or Without Haematin). Suspect: Amyl Nitrite, Arsine, all corrosive poi- |°ns, Chrysarobin, Potassium Chlorate, Pyrogallol, Sodium Nitrite. URINE (That Reduces Fehling's Solution). Suspect: Benzaldehyde (Bitter Almond) Oil, Carbon Monoxide, Chloral, Chloroform, Formic ^cid, Oxalic Acid and its salts, Phloridcin, Pyro- gallol, Uranium salts. 260 A MANUAL OF TOXICOLOGY. URINE (Very Odorous). Suspect: Ammonia, Asparagus, Tellurium, Tur- pentine Oil (violets), and other ethereal oils. URINE (Unnatural Scantiness or Suppression). Suspect: Cantharidin, Corrosive Sublimate and other mercurial preparations, Oxalic Acid, Oxa- minic Acid, Oxamid, Potassium Oxalate VISION Suspect: (Double) Belladonna, Conium, Gelse- mium, Ptomain-poisoning, etc. (Yellow or Green) Santonin. (Red) Duboisin. (Loss of) In Barium, Lead paralysis, Trichinosis, etc. (Rough) Belladonna. VOICE Aconite, Ammonia (stringy saliva, perhaps blood), Antimony (mucus, white, stringy, perhaps bloody), Arsenic (brown, with blood), Colchicum, Colocynth, Digitalis (grass-green vomit), Phosphorus (vomit luminous in dark), Antimony, Zinc (incessant). VOMITING. Suspect: Antimony and substances containing it, Arsenic and substances containing it, Colchicin, Colocynths, corrosive poisons, Croton Oil, sub- stances of the Digitalin group, Emetin, Muscarine, Nicotine, Pilocarpine, etc. VOMITING AND PURGING. VOMITING, WITHOUT DIARRHCEA. Suspect: Apomorphine, Cytisin, Lobelin, Nar- cissus poison, etc. Poisons Commonly Resorted to by Suicides: Carbolic Acid, Oxalic Acid, Paris Green, Arsenic/ rat paste. Chloral, Opium and its preparations, Prus- sic Acid, Strychnine, Sugar of Lead, illuminating gas, charcoal fumes, etc.; of late, in N. Y., Lysol, Carbolic Acid, illuminating gas, Paris green. (See p. 366.) SIMULATION OF POISONING BY DISEASE 261 PART IV. SIMULATION OF POISONING BY DISEASE, AUTO-INTOXICATION AND DISEASE, ACTION AND ELIMINATION OF POISONS. (ALSO SEE PAGES 18-27, IOO AND 329; ALSO PART X.) It is well to remember that poisoning is simulated by the sudden onset of such affections or diseases as angina pectoris, aneurism, embolism, apoplexy, epilepsy, acute pneumonia, cholera morbus, uremia, cerebral conges- tion, etc. Among the diseases simulating poisoning by cor- rosives and irritants are acute gastritis (does not occur strictly idiopathically), gastro-enteritis, peritonitis, Asiatic and English cholera, and all of the acute inflam- nrations of the alimentary canal, such as dysentery, also rieus, strangulated hernia, rupture of abdominal vis- cera, etc. Sudden death simulating the action of a pow- erful poison may result from a draught of very cold water when the body is much heated. Aneurism, rup- ture of the stomach due to efforts to vomit, rupture of the intestines, biliary ducts, uterus, Fallopian tubes, etc., also ovarian apoplexy, have each been mistaken for poisoning. Pain, vomiting, collapse, and death within 24 hours, characterized the symptoms of each; symp- toms common also to irritant poisoning. The various distinctive differential features are to be borne in mind 111 making a diagnosis : Purging is an earlier symptom in cholera than it Is in poisoning. While pain and constriction in the throat and bloody vomit are unusual in cholera, they are quite common in irritant poisoning. In ileus and strangulated hernia there is usually constipation instead of diarrhoea, and the vomited matters are fecal. 262 A MANUAL OF TOXICOLOGY Diseases which simulate poisoning by narcotics, etc., are uremia, epilepsy, certain fevered states, apoplexy, the effects of blows on the head, hydrocephalus, and various diseases of the nervous centers characterized by coma and insensibility, etc. In diseases simulating poisoning by narcotics there are, as a rule, premonitory symptoms, and persons of a certain age or condition are affected; but in poisoning by narcotics such are absent, and persons of any age may be affected. Apo- plexy usually attacks the old, or prematurely old, and while in such poisoning as opium it is possible to arouse the patient, in apoplexy such is commonly impossible. In epilepsy the diagnosis is, as a rule, assisted by the history, the chronic character of the affection, the peculiar character and duration of the paroxysms. Idiopathic tetanus, although uncommon, may be mistaken for the tetanus of strychnine. But in idio- pathic tetanus the symptoms gradually develop and be- gin with difficulty in swallowing. Locked-jaw is the earliest and most prominent symptom in this form of tetanus, and is followed by stiffness of the trunk and extremities. In strychnine tetanus the symptoms de- velop rapidly, reaching their height in a few minutes. Locked-jaw is imperfect and may even be absent. Opisthotonos is very early and severe, whereas in idio- pathic tetanus it is much less severe and its appearance is delayed for hours or days. In the latter affection deglutition is slow, difficult or impossible; in strychnine tetanus it is perfect in effect, but peculiarly gulping. The tetanoid convulsions of epilepsy and hysteria are differentiated from poisoning by the general history of the case, the peculiar nature and order of the spasms, and rapid alternation of relaxation and contraction. In all sudden sickness characterized by severe symp- toms the physician or other observer should not over- look the possibility of poisoning, and should make the following observations suggested by Dr. Luff: i. The time at which the symptoms commenced, and the nature of the symptoms. 2. The time at which the symptoms commenced after the last ingestion of food, AUTO-INTOXICATION AND DISEASE 263 3. The occurrence of any recent previous illness from which the patient may have suffered. 4. If the patient has vomited, the vomit should be collected, or, if necessary, scraped up from the floor or from the dress, bedding, or carpet; if necessary, a portion of the dress, bed- ding or carpet containing the vomit should be cut out and preserved. 5. The nature of the food recently taken by the patient should be ascertained; and if suspicion attaches to any articles of food, these should be secured by the medical man and preserved under seal. If the death of the patient occur, in addition to attending to the points above mentioned, note should be taken of the following: 1. The exact time at which death occurred. 2. The position of the body with regard to surrounding objectspits attitude, and the condition of the dress. 3- All surrounding objects should be carefully observed, and any bottles, packets, or weapons in the room should be col- lected and preserved. 4- The condition of the body as to lividity or pallor should be noted, and also whether the countenance presents a dis- tressed or calm appearance. Not only should any bottle, box, packet or vessel and contents be carefully observed, but also all clothing, cloths, furniture or furnishings which may afford a clue to the cause or condition. Important articles should be carefully secured if possible. Appearance, manner, etc., of persons present should also be noted. Apparently many of the general disorders which seem to be related to alimentary irritation, and most of the intestinal disorders themselves, result from putrefactive disturbances in the alimentary canal, particularly in its lower porton. An auto-intoxication or toxaemia, dis- abling the blood and seriously interfering with general nutrition, may result from putrefactive disturbances in the alimentary canal and the absorption of the resultant toxins. The auto-intoxication may produce such symp- toms as to simulate various grave diseases. Further- more it is supposed that bacterial toxins are of the na- ture of ferments which bring about chemical changes in other matter and thus are capable of producing disease, as arteriosclerosis, etc. Toxins may produce gastric and intestinal irritation, causing severe enteritis, etc. In studying the bacteriology of the intestine, we ob- 264 A MANUAL OF TOXICOLOGY serve that what Tissier calls the "superadded flora" pro- duce chiefly harmful effects in the intestinal canal. These organisms are anaerobic and tend to produce pu- trefactive changes in the intestinal contents. The hydro- chloric acid of the chyme, and the action of the di- gestive secretions of the first part of the small intestine retard the action of the putrefactive organisms. The putrefactive products are formed from the protein. The decomposition of protein is prevented and the num- ber of putrefactive germs lessened by the production of acids from the carbo-hydrates. Vegetable sugar fer- mentation produces an acid reaction in the intestinal canal, destroying the anaerobic organisms; but it may create other disturbances. When digestion is active there is a prompt absorption of the digestive products? leaving but little material in the intestinal canal for tM production of putrefaction by action of the anaerobes. [Some investigators claim that the contents of the small intestine are more poisonous than those of the large in- testine. They assert that when the pancreatic juice mixes with the intestinal juice, particularly that of the duodenum, it becomes poisonous. Also that the gastric- contents become poisonous when they enter the intestine-, and are acted upon by the intestinal juice. It is sup- posed that various cases called "auto-intoxication at- tacks" are not suffering from the effects of bacterial, action, but from the decomposition effects produced by the intestinal juices on proteins of no value to the sys^ tern; the protein molecule is probably irregularly split up, by which poisonous products result, which ary absorbed as such or induce other changes resulting if a toxaemia.] , Tissier divides the intestinal bacteria into: the fun- damental flora,-Bacillus bifidus, Bacillus coli and the, enterococcus; the subsidiary flora,-organisms whicl\ accompany various articles of food, influencing the pro-1 duction of acid, and therefore serve to support th? fundamental flora in their salutary action; the super added flora, composed of a number of pathogens organisms whose effects in the intestinal canal are AUTO-INTOXICATION AND DISEASE 265 largely harmful,-Bacillus serogenes capsulatus, etc. The foul-smelling gases NHs, H2S and NH4HS are produced during putrefaction. Antiseptics (as salol) check putrefaction by destruction of the germs con- cerned in its production. Herter gives three varieties of disorder referable to bacterial infection and intoxications of intestinal origin, viz.: the saccharo-butyric, the indolic, and the indolico-saccharo-butyric disturbances. The strict veg- etarian who is over-indulgent in eating, induces the first variety of alimentary disturbance. He overtaxes and overburdens his digestive apparatus with such an ex- cess of vegetable proteid as to cause severe flatulence, etc. The Bacillus serogenes capsulatus and the Bacillus enteritidis sporogenes are rarely found in the feces in this variety of disturbance, but are present in large numbers in the indolic variety. [The ordinary feces consist largely of the unabsorbed chyle remnants, un- digested food, and remnants of intestinal and hepatic excretion, all extensively permeated by a vast multitude of bacteria. It has been estimated that, when easily digested food has been taken, about one-third of the solids of the feces consists of bacteria.] Great nutrition does not necessarily result from ex- cessive ingestion of food. On the contrary, normal nutrition is apt to be lessened through the tax placed upon the digestive and other functions. Appropriation of food is dependent upon the character of the food, ease of conversion into absorbable material, and the Perfection with which systemic distribution is made. Age, habits, heredity, rest, exercise and idiosyncrasy all play an important part in the determination of one's assimilative power, and the bodily condition as to fleshi- ness, etc. Overabundant ingestion of food results in an excessive production of uric acid or other harmful end- products. A toxic condition may result from a disturb- ance of the relationship between producton and elimi- nation, as well as from overproducton or deficient elimination. Functional disturbances may in time be- come structural ones. Toxic matter may be thrown into 266 A MANUAL OF TOXICOLOGY the circulation by a functional disturbance, injuriously affecting the parenchyma cells of organs distant from the seat of original disturbance, producing degenerative changes in such organs. There seems to be an affinity on the part of certain toxins for certain tissue cells. In acute disorders of digestion, and in many other affections, nature endeavors to protect the body against the effects of injurious substances by developing a leucocytosis. Under certain conditions she also de- velops anti-bodies for protective purposes. To co- operate, we produce soluble toxins in such suitable media as broth, etc., from the organisms of tetanus, botulism, diphtheria, etc., and with them develop spe- cific antidotes, which we call antitoxins, to counteract the effects of the organisms and their products. In cases of decomposition effects apparently caused by the decomposing action of the intestinal juices on valueless proteins; also where, in intestinal lesion or general disease, a condition of so-called auto-intoxica- tion results dependent upon putrefactive changes in the intestinal canal caused by bacterial action, it is import- ant that the protein diet-such as eggs and meat-be reduced. By such reduction, less material is provided for protein decomposition or for the putrefactive organisms to live upon and produce their putrefactive products. [Strictly fresh eggs contain little or no toxin, but meat altho quite fresh, usually contains toxins; the less fresh, the more toxins, and heating does not destroy them.] Putrefactive bacillary processes occur chiefly in the colon, from which they may extend up into the small intestine and even into the stomach. Their effects are more toxic than mechanical in character, affecting chiefly the blood and nervous system. As previously indicated, carbohydrates should be eaten, in order that they may serve as food for acid-forming organisms and thereby diminish the putrefactive processes. Further- more, the direct destruction of the putrefactive organ- isms may be attempted by means of direct intestinal disinfection, through the use of intestinal antiseptics. But if these are used in sufficient strength and quantity INTESTINAL PUTREFACTION 267 to be effective, they are liable to disturb digestion and also to injure the mucous membrane; or they may be absorbed before they can act; or they may be rendered inactive by proteids in the intestinal canal. The lactic acid bacillus, which is not a putrefactive organism, has the power to arrest putrefactive proc- esses in the intestinal canal. This effect is claimed for both the Bulgaricus and the Hueppe varieties. Prof. Elie Metchnikoff of the Institut Pasteur, Paris, carefully prepared cultures of the bacillus Bulgaricus, which cultures he named Lactobacilline. This prep- aration, in the form of either tablets, liquid, or powder, containing the live bacilli, he has recommended as a bacillary treatment of microbial and fermentative affec- tions of the alimentary canal. The tablets may be swal- lowed, or one of the preparations may be employed to sour milk to be used for both protective and nutritive purposes. When the preparation is used, the bacilli in it multiply and act upon the carbohydrates they encounter, producing lactic acid. The lactic acid appears to have an antiseptic action in the alimentary canal, arresting the production of putrefactive organisms and their toxic products. When Lactobacilline is used to sour milk (preferably pasteurised milk) the bacilli multiply, lactic acid is produced by the action of the bacilli upon the milk sugar, and the casein is made very soluble. Klotz, Leon and many others recommend sour milk thus prepared. [The ordinary "souring of milk" produces a natural curdling, the curd consisting mainly of casein, the result of the precipitation of caseinogen, the chief proteid of milk.]. There are several preparations on the market quite similar to Lactobacilline. The use of but- termilk in place of sour milk has also been recom- mended. Buttermilk tablets, called Lactone, pure cul- tures of the Hueppe lactic acid bacilli, are used to pro- duce a variety of buttermilk said to retain all the food elements of fresh milk, etc. Lactic acid itself may be given for its corrective influence in cases of intestinal putrefaction instead of taking or using the Lactobacil- line, etc.; but the acid is quite liable to cause gastric 268 A MANUAL OF TOXICOLOGY and renal irritation and it is also probable that it will be decomposed before reaching the large intestine. Acid intoxication, a form of auto-intoxication, re- sults from loading the blood and tissues with such acids as lactic, sarcolactic, sulphuric, phosphoric, uric or fatty acids, due to proteid decomposition or imperfect oxida- tion. They manifest their presence by various nervous disturbances-sometimes mental dulness or coma-and particularly by a free elimination of their compounds in the urine. Bodily fatigue has been assumed to be caused by an analogous auto-intoxication. The normal alkalinity of the blood is reduced in chloroform absorption, and in acute alcoholic intoxica- tion through the production of volatile fatty acids, pro- ducing more or less marked systemic disturbance. Per- haps the benign effects resulting from the administra- tion of ammonia in cases of acute alcoholic intoxication may be accounted for to some extent by an acid- neutralizing effect upon the blood. It appears that at times or under certain conditions the stomach acts as an excreting organ in the effort to remove some special poison from the system. In vari- ous cases of hysterical and nervous crises, accompanied by severe headache and altered vision, the stomach con- tents were observed to be decidedly toxic. No poison had been taken and the toxic condition was not caused by food remnants or food decomposition. The stomach appears to have been acting as an excretory organ, re- moving toxic material from the circulatory system. Apparently, the mental state is of very great import- ance, from a toxicological standpoint.. An auto-intoxication dependent upon the produc- tion of putrefactive changes in the intestine, frequently causes great prostration, rapid emaciation, distressing pain in the head, disturbance of vision and various alarming nervous phenomena. The absorbed toxins may produce a degree of toxaemia seemingly imminently fatal in its effects. The treatment for the relief of an attack consists of a thorough cleansing of the ali- mentary canal, employment of heat, careful stimula- ACTION OF POISONS IN DISEASE 269 tion; anodynes, etc. To prevent recurrent attacks there should be a thorough investigation of the patient's con- dition; an examination of the feces, and also of the urine to determine if the trouble is referable to the phenol, indol or skatol group. The comparative num- ber of given bacteria found should be noted and serve as a guide in conducting the treatment. Careful dieting, sometimes the bacillary treatment, and colonic irri- gation observance of the laws of hygiene, mental Quietude, and gentle tonic treatment favor recovery. Regarding the action of poisons in disease, as stated elsewhere, certain poisons are less active in certain diseases. On the other hand, the action of certain Poisons is more severe in certain diseases. The absorption of such poisonous substances as $hloral, opium, digitalis, belladonna, etc., may be greatly interfered with in alcoholism. This results from the blood and tissues being heavily charged with alcohol. Hence in delirium tremens these substances may be given in more frequent and larger doses than in the formal state. However, death may result from the repeated administration of large doses of such agents as opium, chloral, etc., to intoxicated persons; the fatal result being due to the action of such poison after the elimination of the alcohol from the system. Saliva- tion readily results when small doses of mercury are given in renal disease. Therefore, the effects of a poison are greatly dependent upon the condition of the system. j The general action of poisons, in the absence of or independent of disease, is very clearly and concisely stated by Kobert as follows: .Some of the agents, such as the salts of the heavy metals, }vill readily combine with the protein substance, thereby caus- 'h? their destruction, viz., necrosis of the tissues involved; others, such as concentrated acids and caustic alkalies, act also as powerful irritants and cause a reactive inflammation; ~P11 others, as strychnin, morphin, curare, muscarin, cause an ^citation and enfeebling of the nerves, muscles, or glands of 1-he affected parts, without any marked apparent changes. 270 A MANUAL OF TOXICOLOGY. The remote effect is produced by the absorption of* the poison into the lymphatics and into the blood, causing general symptoms and diseases of other organs-e. g., of the kidneys, following the administration of cantharidin; of the brain, after taking opium; of the intestine, after quillaic acid. Prac- tically, the remote action is really a local one produced by the poisoned blood circulating everywhere. The poison, as it circulates in the blood, may be either' decomposed, or it may enter into the combination with the blood constituents and thus change the composition of the blood, or it may reach the various organs in its original con- dition. Physiology teaches us that various endosmotic changes take place in these organs, depending upon their functions, upon the formation of their constituent elements, and upon the number and arrangement of the capillaries passing through them. The chemical constitution and physical properties of the poison will determine, to a varying degree, the role it' plays in these changes by participating in the interaction of the vessels of the tissues. The presence of this foreign sub' stance sooner or later disturbs, to a greater or less degree, the healthy condition and function of the organs particularly affected; and, again, this cannot take place without a reaction upon the whole body. The animal organism, however, pos- sesses four means of rendering partly or entirely harmless poisons which have entered the system: i. Rapid Elimination-Under this head, naturally, we first mention vomiting which, fortunately, occurs so promptly following the introduction of most poisons into the stomach' that it generally saves the life of a patient, or at least has, already materially lessened the danger to life before the phy' sician puts in an appearance. We should call this vomiting, which takes place before the absorption of the poison, pri- mary vomiting, in contradistinction to a secondary emesis, which takes place following absorption, and which latter i# either exclusively a sign of disturbed cerebral activity or is caused by the excretion of the poison from the blood into thf stomach. In an analogous manner we must differentiate be*' tween a primary diarrhoea, which carries off the poison before absorption, and a secondary purging, which is a sign of dis-' turbed intestinal innervation, or is caused by the excretion, of the poison from the blood into the lumen of the gut. Some poisons are not removed by vomiting or purging, but appear in the urine in a remarkably short time. Thus, for example'1 it is impossible to produce complete curarization by the ad' ministration of moderate, though oft-repeated, doses of curare because the excretion of the poison through the kidneys tak^ place as rapidly as does absorption. The liver, pancreas, gaC, trie mucous membrane (for morphin), intestinal mucous mem' brane (for mercury), salivary glands, mammary glands, am transformed into an increase of alkalescency, since even the lungs and other channels are effective in assisting the excre' ACTION AND ELIMINATION OF POISONS. 271 tion of various substances from the blood. Not nearly enough attention was formerly given to the excretion through the glands of the mucous membrane of the stomach. Finally, elimination takes place through the structure of the skin, es- pecially through the sweat-glands. 2. The organism deposits and fixes poisons, in a manner not yet sufficiently understood, in several organs, especially in the liver, which certainly must be regarded as a filter for poisons, so far, at least, as enzymes (e.g., emulsin), metals (e.g., iron), metalloids (e.g., arsenic), and alkaloids (e.g., strychnin) are concerned. It is probable that, in the case of some substances, the biliary acids play an important part in the matter. We can hardly imagine that this disposition is accom- plished in any other way than in the transformation of the readily soluble poisons into saline combinations, not freely soluble (bile-acid-alkaloids) or into albumen derivatives (metalbuminates). But, since these combinations are in no case entirely soluble, the beneficial action of the liver consists only in the fact that it gives the acute poisoning a more pro- tracted, and consequently a milder, form. 3- The organism renders the poisons innocuous by phago cytosis. This destructive crusade carried on in the interests of rhe body by phagocytes, which has not yet been sufficiently mquired into pharmacologically, is applicable for certain toxalbumins (toxopeptone, enzymes), as well as for heavy metals. . 4- The organism transforms the poison into a compara- tively harmless, though readily soluble combination. Such a transformation may consist of neutralization, oxidation, reduc- tion, coupling, splitting, and peculiar changing of the chemical constitution, (i) As an example of poisons rendered inert by neutralization, we must mention the acids, which are trans- formed, as far as possible, by the organism into the corre- sponding alkaline salts of less poisonous, or absolutely non- Poisonous, properties. So far as the stomach is concerned, the organism attempts to balance any excess of alkali by the acids of the gastric juice and does the same thing in the blood by the decomposition of an immense number of blood-corpuscles, whereby glycero-phosphoric acid is formed from lecithin. Caustic lime is combined with carbamic acid and then ex- creted. (2) The best-known example of inertia produced by oxidation is that of phosphorus, which is transformed into Phosphates. In an analogous manner the extremely poisonous sulphids are converted into sulphates which are relatively non- Poisonous. The organic acids and their salts are oxidized to the ultimate degree, producing carbonates, and it is a promi- nent and important fact that in the latter case the dangerous diminution of the alkalescency bv means of these acids ?c bicarbonates are of alkaline reaction. (3) Examples of pro- ducing inertia by means of reduction are offered in the case of iodates, chlorates and perchlorates, which are excreted in the 272 A MANUAL OF TOXICOLOGY. markedly less poisonous form of chlorids and iodids. (4) In- ertia produced by coupling is one of the most remarkable facts in physiological chemistry. An intimate knowledge of this phenomenon is as imperative for the physician at the bedside as for the chemist intrusted with the chemical analysis of the remains. A poison can unite by coupling: (a) with sulphuric acid (e. g., phenol and cresol; (b) with glycuronic acid (e. g. camphor, borneol, menthol) ; (c) with glycocoll-(e. g., benzoic acid, anisic acid, a part of salicylic acid). (5) Inertia produced by splitting occurs with tannic acid of nutgalls, and with some glucosids (e. g., salicin). (6) Examples of changes peculiar to themselves, as productive of inertia, are offered by the salts of ammonia, which are transformed into urea. The liver is the most important organ in producing changes in poisons peculiar to themselves. Coupling occurs partly in the liver and partly in the kidney. Splitting processes take place mainly in the intestinal canal, although the liver must also be considered in this connection. For a time it seemed that we were justified in supposing that organic substances could be divided into two well-defined classes, according to their respective actions exhibited within the animal body; the substances of the fatty series were sup- posed to be destroyed, while those of the aromatic series were not. To-day we know that this does not hold good for all substances; not even oxamid, belonging to the fatty series, a trace of which is oxidized; and tyrosin, a member of the aro- matic series, which can be completely transformed into urea, carbon dioxid and water. This observation, therefore, can at the present time be stated only in the following form: Organic substances con- taining annular linkage within the molecule are frequently not oxidized to form carbon dioxid, water, and urea. It is imma- terial whether or not they belong to the aromatic series proper. Substances not containing annular linkage, which are oxidized with difficulty or not at all, are mainly certain amids. One of the foremost tasks of scientific pharmacology is to explain the relation between the chemical structure of a sub- stance and its pharmacological action. Unfortunately, it can only be said at present that uniform laws, which would be of great service to the physician, have not yet been discovered. As regards irregularity in elementary function: It may encourage certain intestinal bacteria to pro- duce an excess fermentation of sugars and starches, or an excessive breaking-down of proteids; such breaking-down and absorption of the products, re- sult in the so-called intestinal intoxication. Strictly, this condition should not be called auto-intoxica- tion, but the latter term limited to disease caused by some functional digestive disturbance. ACID CARBOLIC. 273 PART V. table of identification tests FOR POISONS. (an epitome op bomb op the principal tests) Carbolic acid added either to albumin or collodion causes such to coagulate. An aqueous solution of carbolic acid treated with one drop of ferric chloride solution gives a permanent violet blue color (the reaction may be interfered with by the presence in excess of hydrochloric or acetic acid or alcohol); the color produced by creosote with ferric chloride solution is at first violet blue, but changes rapidly to greenish and brown, with forma- tion usually of a brown precipitate. With bromine water, carbolic acid forms a white flocculent precipitate of tribrom-phenol. Under the microscope it appears as acicular crystals. Carbolic acid mixed with ammonia water and a little chlorinated soda solution, and warmed, develops a blue color. To a few drops of carbolic acid solution on a white porcelain surface add three or four drops of a solution of one part of molybdic acid in ten or fifteen parts of concentrated sulphuric acid; a yellowish- brown coloration results, which is soon followed by a beautiful purple color. When carbolic acid is in the urine, it is in combina- tion with the sulphates, so that neither the sulphuric nor the phenol radical will respond to the usual tests; but the natural quantities of sulphates again appear if the urine be boiled with hydrochloric acid. The pre- ceding tests may then be employed. In making post-mortem investigations, the odor of ACID CARBOLIC (PHENOL). 274 A MANUAL OF TOXICOLOGY. carbolic acid is, as a rule, observable upon opening the body. The stomach contents are to be acidified and distilled, and the various tests applied to the dis- tillate. ACID HYDROCHLORIC. Hint.-All acids turn blue litmus red. If a glass rod be dipped in ammonia water and then held over hydrochloric acid, dense white fumes are pro- duced. Hydrochloric acid, even in diluted solutions, treated with silver nitrate, gives a curdy white precipitate which is dissolved upon adding ammonia water, and reprecip- itated by nitric acid. ACID HYDROCYANIC. A characteristic test is its odor: it has the odor of bitter almonds or peach kernels. A glass rod moistened with silver nitrate becomes milky in the vapor of hydrocyanic acid. By silver nitrate, the acid is precipitated as silver cyanide, a white, curdy precipitate, not soluble in cold or weak nitric acid, but entirely soluble in boiling con- centrated nitric acid. To the suspected liquid add a little solution of potash and then a mixture of ferrous and ferric sulphates; a dirty greenish-blue precipitate results, which, should hydrocyanic acid be present, becomes clear Prussian blue on acidifying with pure hydrochloric acid. Liebig's test (characteristic in the absence of me- conic acid) :- Treat a solution of hydrocyanic acid with ammonium sulphide, and gently heat; a white sulphocyanide of ammonium is produced; by touching this with a drop of persulphate or perchloride of iron, a blood-red sul- phocyanate of iron results. Make suspected fluid slightly alkaline with potash; add cupric sulphate solution and a greenish-white pre- ACID NITRIC. 275 cipitate will be obtained; add a few drops of hydro- chloric acid, and it turns white. If, in post-mortem investigations, the jar in which the liver, brain, stomach and contents, and other or- gans, is received, is gently warmed, and a glass rod or Watch glass moistened with silver nitrate solution held over its mouth, the vapor which rises from the contents of the jar will, if hydrocyanic acid is present, form white, crystalline silver cyanid, on the rod or watch glass. This may be proved to be silver cyanid and not silver chlorid by its turning blue, upon adding hydrochloric acid and a mixture of ferrous and ferric sulphate. Extended chemical analysis is carried out as indicated in Part V of this book. As a rule, hydrocyanic acid may be found in the body for about three weeks after death. But in case of body decomposition the sulphuretted hydrogen gen- erated may convert the acid into the thiocyanate. In such case the thiocyanate should be dissolved out by alcohol, and this followed by filtration and evaporation. -The residue should then be dissolved in water and tested by a ferric salt. Thiocyanate has been found ln the body as long a time after death as four months. The fact that thiocyanates are found in the saliva and the latter may have been mixed with the material under investigation, should not be overlooked. ACID NITRIC. Concentrated nitric acid is known by its orange colored, irritating fumes. Poured on copper filings it effervesces, gives off red acrid vapor and, a blue liquid remains. Nitric acid mixed with hydrochloric acid dissolves gold. A trace of nitric acid with sulphuric acid gives a blood-red color with narcotine. The strong acid gives a deep red color with brucine. Nitric acid stains all albuminoid substances yellow; gives a yellow stain on skin or piece of quill; reddens Inorphine and its salts; blackens green iron sulphate *n the presence of sulphuric acid. 276 A MANUAL OF TOXICOLOGY. ACID OXALIC. The crystals are oblique, flattened, octahedral prisms, colorless, odorless, permanent in the air, and very acid; thus distinguished from crystals of magnesium sul- phate, and zinc sulphate. When the crystals are heated they melt, dissipate without charring and leave no residue. Cupric sulphate added to solution of oxalic acid gives a light-blue precipitate of cupric oxalate not re- dissolved by a few drops of hydrochloric acid. Adding lime water forms calcium oxalate, which is insoluble in excess of lime water but soluble in nitric acid or hydrochloric acid, but not in any vegetable acid. To a solution of oxalic acid add silver nitrate and a white precipitate of oxalate of silver is produced, soluble in nitric acid; when dried and heated on plati- num foil it detonates and evolves a white vapor. In post-mortem analyses, acidify the material to be tested (kidneys, stomach and contents, etc.) with hy- drochloric acid and digest the whole for several hours with dilute alcohol, stirring frequently. After filtra- tion ammonium hydroxid should be added to the fil- trate until the latter is alkaline; acetic acid should then be added until a slight excess results; then add cal- cium chlorid; after thorough stirring stand the mix- ture aside. If a precipitate results, it is from the combination of oxalic acid with calcium. Under the, microscope the characteristic octahedral crystals may be identified. The salt turns gray upon being heated. Dissolve some of the precipitate in water, acidify with dilute sulphuric acid; upon adding a few drops of potassium permanganate solution, decolorization of the permanganate occurs. The acid looks oily and is heavy. It feels soapy in the fingers. Concentrated sulphuric acid is usually white, or if impure, a brownish colored liquid, and chars wood or other organic matter. ACID SULPHURIC. ALKALIES. 277 Upon mixing it with water, heat is evolved. It forms sulphurous acid gas when boiled with mercury. Add a small portion of veratrine to some of the diluted acid, carefully evaporate to dryness, and a crim- son-purple color is obtained. Sulphuric acid gives a white precipitate with barium chloride. ALKALIES (SOLUTIONS OF AMMONIA, POTASSA, SODA). The alkalies turn red litmus blue. They feel soapy in the fingers. They are not precipitated by adding solution of potassium carbonate as the solution of alkaline earths are. They neutralize acids, and saponify fats. The presence of one of the caustic alkalies, in vom- ited matters or stomach contents, may be suspected, when in addition to alkaline reaction and soapy feeling in the fingers, the suspected materials become frothy when shaken, and produce but slight effervescence upon adding an acid. Potash, or soda, would be indi- cated if, when the suspected materials are warmed, ammoniacal odor is absent, and the holding over them of a glass rod, dipped in hydrochloric acid, produces no cloudy effect upon the surface of the rod. If some of the suspected material be filtered, the filtrate evap- orated to dryness, then heated to a dull red heat until all organic matter is destroyed, and then cooled, upon adding a small quantity of dilute hydrochloric acid a solution is obtained with which to determine whether the alkali is potash or soda. Upon testing this solution with a platinum wire held in the colorless flame of a Bunsen burner, a lavender color imparted to the flame indicates potassium, a yellow one sodium. Wormley's test directs to treat the suspected sub- stance, in solution, with an alcoholic solution of picric acid, and if alkaloids are present a yellow precipitate will be obtained. ALKALOIDS. 278 A MANUAL OF TOXICOLOGY. Mayer's reagent gives a white precipitate with alka- loids. Wagner's reagent gives with alkaloids a brown pre- cipitate soluble in alcohol. A powder of either brucine, delphine, morphine, im- pure strychnine, or physostigmine with nitric acid, gives a red color; if by adding stannic chloride it be- comes violet, it is brucine; if it becomes black, it is del- phine ; if it is soluble, giving off free iodine when iodic acid is added, it is morphine; if not soluble and will not decompose iodic acid, it is strychnine; if the powder became green when nitric acid was added, it is so- lanine; if- the powder is insoluble in ether and does not redden nitric acid, it is emetine; if it is soluble in ether, does not redden nitric acid, and is volatilized, it is atropine; if it is soluble in ether, does not redden nitric acid, and is not volatilized, it is veratrine. ACONITINE, COCAINE, CONIINE, DATURINE, NICOTINE, ETC., AND GLUCOSIDE SOLANIN. Aconitine. Pure Aconitine crystals are colorless and transpar- ent. If a solution of aconitine be applied to the skin it produces a sensation of heat and numbness. It is said that so small a quantity as one one-hundredth part of a grain, dissolved in spirit and rubbed into the skin, will cause a loss of feeling which will con- tinue for quite a while. For toxicological analysis a modification of Stas' process is employed. (See text-books). Stas' Method.-In this method the organic mat- ters are extracted by strong alcohol, tartaric acid being added. Then the filtered solution is carefully neutralized with soda, shaken up with ether, and a pipette used to separate the ethereal solution. Some analysts have recommended that chloroform be used in place of the ether, and that amyl alcohol also be used; also that acetic, hydrochloric, and sulphuric be substituted for tartaric acid. Otto proposed a modification of Stas' method, and such modification ALKALOIDS. 279 is considered by very many chemists to be a decided improvement over the original method of Stas, pragendorff's method is quite frequently employed m the isolation and identification of alkaloids. (See books on organic analysis). Cocaine. In aqueous solution, cocaine^is best identified by means of the crystalline precipitates which platinum chloride, gold chloride and picric acid produce. In very dilute solution iodine in potassium iodide Produces a rose-colored precipitate; and a non- crystalline brown one in stronger solutions. If a small portion of cocaine is covered with fum- mg nitric acid and dried on a water bath, then When cold, moistened with a drop of solution of po- tassium hydroxid in absolute alchohol, a distmct $dor of citronella or peppermint may be observed. Coniine. The leaves of parsley may readily be mistaken for those of conium. In suspected poisoning by conium, the contents of stomach and intestines should be carefully examined for the remains °f hemlock seeds or leaves. Suspicious leaves should be carefully rubbed up in a mortar with potassa to bring out the peculiarly mousy smell of conium leaves. Employ Stas' process in analysis. Coniine is found chiefly in the conium seeds, and is exceedingly powerful and fatal. If a drop of coniine is put in a watch-glass, over "which another watch glass be placed, on the under surface of which has been put a drop of pure hydro- chloric acid, dense, white fumes will quickly fill the enclosed space, and the coniine be changed into a Quantity of beautiful, delicate, crystalline needles. These do not deliquesce upon exposure to air. Stramonium seeds are kidney shaped, wrinkled, black or brown in color, and larger than the seeds of Daturine. 280 A MANUAL OF TOXICOLOGY. belladonna or hyoscyamus. Daturine may be de- tected in the stomach and other organs by the same analytical processes as employed for Atropine. Nicotine. Upon adding a solution of iodine in ether to an ethereal solution of nicotine, after some time long needle-like crystals form. Platinum chloride causes a yellow precipitate to form which is soluble in hydrochloric acid, and appears crystalline under the microscope. Picric acid produces a yellow, amorphous precipi- tate, which under the microscope appears as a crys- talline tuft. For organic analysis Stas' process is advantageously employed. The Glucoside Solanin. In the pure state solanin appears as delicate, acicular crystals, soluble in ethyl and amyl alco- hol, slightly soluble in ether, almost insoluble in water and altogether insoluble in chloroform. A hot amylic alcohol solution of solanin gelatinizes upon cooling, even though but little solanin be present. Sulphuric acid turns solanin to an orange-yellow color, after which it dissolves it and such solution turns brown. When solanin is present in an organic mixture a modification of Stas' process is employed for its determination. ANESTHETICS. Such organic mixtures as the contents of the stom- ach usually retain the odor of chloroform for some time. After distilling such mixtures on a water bath, the distillate should be redistilled with calcium chlorid, and then the proper tests for odor, solubil- ity, etc., applied. When heated with an alcoholic, solution of caustic potash and a few drops of anilin,' chloroform gives off an unpleasant odor, similar to that of witch hazel. After chloroform has been Chloroform and Chloral. ANTIMONY. 281 attracted from the stomach by distillation, it may be tested by passing the vapor through a flame, whereby decomposition into carbon, chlorine, and hydro- chloric acid will occur. The carbon is easily rec- ognized by its black deposit; the hydrochloric acid by its turning blue litums red; the chlorine by its effect upon starch paper which has been dipped in a solution, of potassium iodide, the iodine being set free by the decomposition of the potassium iodide, the starch turns blue. Chloral.-In testing for chloral, the chloral should be converted into chloroform by mixing with an alkali. After the solid matters have been properly divided they should be diluted with distilled water, sodium bydroxid added to alkalinity, then after heating in a flask, conduct the remainder of the examination as m chloroform analysis. ANTIMONY. Tartar emetic is the principal medicinal salt of anti- mony. Tartar emetic is soluble in water, but not in alcohol. If a portion of tartar emetic is heated to redness, it chars, emits an odor of burning sugar, and leaves a black residue, having an alkaline reaction. If this is mixed with charcoal and heated in a small glass tube, a dark mirror-like ring of metallic antimony will form m the cooler portion of the tube. A solution of tartar emetic treated with tincture of nutgall or solution of tannic acid gives a whitish-yel- low precipitate of tannate of antimony. , Sulphuretted hydrogen gives an orange colored pre- cipitate with antimony solution. (See also Marsh's and Reinsch's Tests, described under arsenic.) ANTIPYRINE. Antipyrine gives a red color with ferric chloride; the color disappears upon adding a few drops of sul- phuric acid. 282 A MANUAL OF TOXICOLOGY. Antipyrine gives a green color with nitric acid. To a solution add 12 drops of sulphuric acid, 2.5 grammes of sodium metaphosphate, filter and add a few drops of solution of sodium nitrate, and a green color is obtained. ARSENIC. Gives garlic-like odor when sublimed on charcoal or red-hot iron. When heated in glass tube it sub- limes, forming small octahedral crystals on the sides of the tube. Sulphuretted hydrogen gives a yellow precipitate with arsenic. Ammoniated solution of cupric sulphate gives a green precipitate. Marsh's Test: Introduce some pieces of zinc, free from arsenic and antimony, into a bottle holding about 150 c.c.; then pour over them sulphuric acid, diluted with 4 parts of distilled water; close the flask with a cork containing a funnel tube, which reaches nearly to the bottom of the bottle and a delivery tube, drawn to a fine point, into which a bulb containing a pledget of cotton has been introduced. After allowing the gen- eration of hydrogen to go on for about half an hour, to expel the air from the upper part of the flask, light the gas at the open end of the delivery tube and hold a cold porcelain surface down upon the flame. If the zinc and sulphuric acid used contain no arsenic or antimony, no black stain will be produced on the por- celain. It thus being evident that the apparatus and materials are free from arsenic, put out the flame and pour the suspected fluid through the funnel tube so as to admit little or no air with it into the flask. Then ignite the gas and test the flame again with the cold porcelain surface. If a brilliant black or brown stain, soluble in a solution of chlorinated soda is obtained it is probably arsenic. If you moisten one of these spots with nitric acid it should disappear, then evap- orate the acid over a lamp, moisten the spot with water, and hold the dish over a vessel containing sulphuretted hydrogen, prepared by the action of sulphuric or hy- drochloric acid upon sodium or potassium sulphide. ARSENIC. 283 If the stain was due to arsenic, the spot will turn lemon-yellow. The antimony mirror is insoluble in chlorinated soda (Labarraque's Solution), and after treatment as above, gives an orange stain. Now soften the glass, bend the delivery tube downward, and let it dip into a solution of silver nitrate; after an hour pour some very weak solution of ammonium hydroxide upon the surface of the silver nitrate solution. A yel- low precipitate at the line of separation of the two liquids shows the presence of arsenic. If the sub- stance to be tested is a solid, a small portion of it may be thrown upon glowing charcoal, when if arsenic be present, it will give a garlic-like odor. [Various modifications of Marsh's test have been proposed by different writers; one, in which, instead of the use of porcelain, the arsenic is deposited in a drawn-out narrow tube, as advised by Otto and others.] Reinsch's Test may also be employed as follows: Boil the liquid suspected of containing arsenic, with one-sixth of its bulk of pure hydrochloric acid. Then, or before boiling, introduce a bright slip of copper when, if grsenic be present, it will coat the copper with an iron-gray deposit. Remove the copper, wash it with distilled water and dry it between folds of blotting paper. Then cut it into slips, introduce it into a reduction tube and apply heat, when, if arsenic be present, arsenous acid will be sublimed and de- posited on the sides of the tube in minute octahedral crystals. These may be dissolved in water and tested by the various reagents. Antimony deposits nearer the copper than arsenic does, and it produces a blue or violet tinted deposit on the copper foil. The interference encountered by the presence of organic matter in the suspected mixture may be overcome by separating the arsenic by dialysis. The copper and hydrochloric acid used in the above process should have been previously tested as to purity by boiling the copper with a mixture of the acid and distilled water 284 A MANUAL OF TOXICOLOGY. When arsenic is supposed to be present in organic matters, a distillation process may advantageously be resorted to as follows: Dry the suspected matters on a water bath, not using too great heat. Then introduce them into a flask fitted with a long bent tube; add a quantity of strong hydrochloric acid (previously proved free from arsenic), sufficient to drench the ma- terial. Digest the whole for several hours. Then apply heat to the flask by means of a sand-bath and a receiver, containing a little water, fitted to the bent tube. Both receiver and tube should be kept cool. By this distillation process arsenic passes over in the form of arsenous chloride and is collected in the receiver. An additional portion of hydrochloric acid may be used to remove any traces of arsenic in the organic material. The arsenic may be obtained from the chloride by boiling with pure polished copper, as de- scribed above in Reinsch's process. A few drops of sulphuric acid dropped in the sus- pected fluid gives a white precipitate, insoluble in nitric acid. [If the barium is in a colored menstrum, it should be bleached with chlorine; then drive off the chlorine by heat before applying the test.] Burnt on platinum wire barium salts give a greenish flame. BARIUM SALTS. BELLADONNA AND ATROPINE. Treat the suspected substance with a few drops of concentrated sulphuric acid and warm. If atropine be present an odor resembling a mixture of roses and orange flowers develops; on now gradually adding a few minute fragments of potassium dichromate, the odor will change to that of bitter almonds; the color will be green. Atropine dilates the pupils when a drop of a very weak solution is introduced into the eye. In suspected poisoning by Belladonna, the vomit BRUCINE. 285 stools and stomach contents should be thoroughly ex- amined for seeds, berries, or the remains of leaves or root. The stomach and its contents should be thoroughly comminuted, then acidified with warm alcohol and acetic acid. The mixture should then be filtered and the filtrate treated with sulphuretted hydrogen and lead subacetate, thus precipitating lead sulphide. The clear filtrate should then be evaporated to dryness, acidified, saturated with solution of potash in excess, and aftei' the addition of alcohol suitable identification tests may be applied to the extract. Nitric acid dissolves it and colors it blood-red. By then adding solution of protochloride of tin, color changes to deep violet. BRUCINE. CANTHARIDES. If the cantharides be undissolved, there are shining green pieces of the drug. Water gives a white precipitate when added to the alcoholic solution, the precipitate being afterwards soluble in an excess of water. By exhausting the suspected material with ether, cantharidin may be separated out of it. The ethereal solution may then be evaporated until nearly dry, and spread on oiled silk. If upon applying it to the skin, it blisters, cantharidin is present. CARBONIC ACID GAS. When the gas is present in the proportion of 12 to J5 per cent, it extinguishes a candle. Agitating solution of lime or solution of subacetate of lead in this gas produces a white precipitate in the solution. Agitating a litmus-blued solution of chloride of lime in the gas drives off the color, which is evidence that it ls not nitrogen. 286 A MANUAL OF TOXICOLOGY. COPPER SALTS. Whether in solution or not, all cupric salts are blue and green. The reaction of the solution is usually acid. To a suspected solution add solution of ammonia, a bluish-white precipitate is produced, soluble in excess of the ammonia, producing a violet-blue solution when copper is present. Potassium ferrocyanate gives a chocolate-brown pre- cipitate or reddish-brown color, if copper is present, although only in small quantities. Sulphuretted hydrogen gives a deep brownish-black precipitate when added to a solution of a copper salt. If polished steel is suspended in a copper solution, it speedily becomes coated with copper. Pour the suspected solution on a platinum plate, acidulate with nitric acid, then touch the platinum passing through the solution, with a slip of zinc, and if copper is present, it will deposit upon the platinum. In examining such organs as the kidneys, liver, etc., for the presence of copper, the organ or organs under examination should be incinerated, the resulting ash treated with dilute hydrochloric or sulphuric acid and the various tests for copper applied. In examining vomited matter or stomach contents, they should be diluted, if necessary, stirred and allowed to stand in a conical vessel for several hours. To the clear fluid which separates the various tests for copper may be applied as above given. CREOSOTE. Creosote has a peculiar smoky odor, and instantly coagulates albumen. With Ferric Chloride creosote gives a violet colored solution, rapidly changing to green, then brown and forming a brown precipitate. Phenol gives a purple- colored solution. Creosote is not soluble in glycerine; phenol is, Creosote does not coagulate collodion; phenol does. FORMALDEHYDE. 287 FORMALDEHYDE. Dissolve a decigram of morphine in 1 c.c. of sul- phuric acid; gently add, without mixing, an equal vol- ume of the suspected liquid; if there be any formalde- hyde present the liquid will soon assume a red violet color. ILLUMINATING GAS. Blood charged with illuminating gas does not coagu- late. When shaken a distinct froth forms. The blood is of a bright cherry color, which is per- sistent. If to the blood which has taken up illuminating gas a 5 per cent, solution of caustic soda be added, the bright red color of the blood will be maintained or in- tensified ; whereas in normal blood the color will change from red to green and later a dark brown. Hemoglobin in combination with carbon monoxide is not changed by adding reducing agents. The oxy- hemoglobin of ordinary blood is changed. Both kinds of blood show two absorption bands when examined through the spectroscope, but they vary slightly in position. Upon adding a reducing agent to ordinary blood, the two bands disappear and a broad band of reduced hemoglobin appears in their place. This does not occur with the blood which is saturated with the gas if more than 27 per cent, of the hemoglobin be saturated with carbon monoxide. Rubner's test for carbon monoxide in blood, is: Shake the blood with 4 or 5 volumes of lead acetate in solution; if the blood contains carbon monoxide, it will retain its bright color; if not, it becomes a choco- late-brown. IODINE. Free iodine turns gelatinized starch blue. Acetate of lead gives a yellow precipitate of lead iodide. By sublimation a violet or purple vapor is produced. 288 A MANUAL OF TOXICOLOGY. To a solution of an iodide add nitrate of silver so- lution, a pale yellow precipitate results, insoluble in nitric acid or ammonia water. Potassic iodide gives a scarlet precipitate with a solution of bichloride of mercury. Iodides mixed with starchy solutions and treated with chlorine gas or nitrous acid give a blue color. When iodine is combined as in the form of an iodide or iodoform, it must be set free in order to test it. The urine or stomach contents suspected to contain such should first be digested with distilled water, then filtered. If upon adding first some chlorine water and then a few drops of starch paste to a little of this fil- trate, a blue color is obtained, the presence of iodine in the above combined form, in the original solution, is indicated. Free iodine would be indicated by a blue color obtained in the same way, but omitting the chlor- ine water. LEAD. Solution of potassic sulphate will give a white pre- cipitate. Sulphuretted hydrogen gives a black precipi- tate. Potassic chromate produces a yellow precipi- tate. Dissolve in acetic acid, add potassic iodide, which gives a yellow plumbic iodide precipitate. MERCURY SALTS. Salts of mercury are either mercuric or mercurous. The most important salt of mercury, from a toxico- logical standpoint, is corrosive sublimate (mercuric chloride). This and other mercuric salts are identi- fied by the following tests : With potassium iodide solution, a scarlet precipitate is formed, which dissolves upon adding excess of the potassium iodide solution. With solutions of soda or potash, a yellow pre- cipitate is formed. Heated with sodium carbonate in a tube, globules oi metallic mercury are formed. NITROBENZOL. 289 Upon a bright gold surface drop some of a solu- tion of the suspected poison, when, if corrosive sub- limate be present, it will form an amalgam when the gold surface is touched by the point of a knife through the fluid. Mercurous salts, such as mercurous nitrate, calo- mel, etc., are identified by giving a black precipitate with alkaline hydroxides, a greenish-yellow precipitate with potassium iodide. If a solution of stannous chloride be added to a suspected mercury salt solution, a white and gray pre- cipitate consisting of metallic mercury and calomel is produced. In the examination of suspected urine it should be evaporated to dryness by gentle heat on a water bath. The residue should then be dissolved in distilled water with a few drops of hydrochloric acid boiled and fil- tered, when the various tests for mercury salts may be employed. NITROBENZOL. When nitrobenzol is mixed with organic matter, it may be separated by distillation, after having added sulphuric acid. NUX VOMICA AND STRYCHNINE. Adding nitric acid to an aqueous infusion of nux vomica gives a bright red color. Adding ferric chloride to aqueous infusion of nux vomica gives a green color. No change occurs upon dissolving strychnine in sul- phuric acid; however, if we add an oxidizing agent, such as potassium bichromate, manganese dioxide, lead peroxide, etc., a play of colors from deep blue to Purple, violet, rapidly changing to red or crimson, and orange-yellow, results. Quebrachine is the only alka- loid substance which produces the same colors in the same order, but it differs from those of strychnine in the intensity and duration of the color play ; and que- 290 A MANUAL OF TOXICOLOGY. brachine dissipates on heating on a water-bath, strych nine does not. After being absorbed, strychnine is deposited in the various organs like mineral poisons. It is usually found in the liver and kidneys, but has been discovered in the blood, spleen, brain, heart, etc. To detect it, it is necessary to finely subdivide the suspected tissues and digest them, in alcohol acidulated with sulphuric acid. The mixture is then cooled, filtered and con- centrated, the residue washed with acidulated alcohol, and evaporated. Chloroform is then employed the same way, and after evaporation the residue is purified and suitable identification tests applied. OPIUM AND MORPHINE. Ferric chloride gives a deep red color with an aque- ous solution of opium. Also apply tests for morphine. In making a toxicological examination for the detec- tion of opium in the stomach, vomit or tissues, the stomach contents should first be examined for particles of undissolved opium, and an effort made to discover the odor of opium or one of its preparations. In examining vomited matter, or the stomach con- tents, such should be finely divided, if in a solid state, distilled water added until a thin paste is secured, the mixture acidulated with tartaric or acetic acid, and then digested over a. water-bath for about an hour. It should then be filtered and the filtrate evaporated. Two or three volumes of 95 per cent, alcohol should then be added to precipitate the organic matter and the mixture should be well stirred. The insoluble material should then be separated by filtration, and the filtrate evaporated, thus removing the alcohol. The residue should then be dissolved in water acidulated with tar- taric or acetic acid, to still further separate extraneous organic matter, after which it should again be filtered. A slight excess of lead acetate should now be added to the filtrate until there is no further precipitation. The OPIUM AND MORPHINE. 291 precipitate produced is insoluble lead meconate and contains the meconic acid, if such were present in the materials under examination. After allowing the pre- cipitate to stand, it should be placed on a filter and washed with distilled water. The substance on the filter should now be analyzed for meconic acid; the filtrate should be analyzed for morphine, it being pres- ent in that solution as an acetate. • Process A. Separation of the meconic acid: Slightly wash the material on the filter with dis- tilled water, to dissolve out any soluble portions. Then wash the precipitate from the filter into a beaker; after which pass sulphuretted hydrogen through the con- tents of the beaker, thus precipitating the black insolu- ble lead sulphide, leaving the meconic acid in solution. Then filter the mixture to remove the lead sulphide. The filtrate contains the meconic acid and should be concentrated by evaporation, after which it may be tested by adding a little ferric chloride to a portion of Jt to determine the presence of meconic acid. With ferric chloride, a red color would be produced, which Would not be destroyed by strong mineral acids. If another portion of the filtrate be taken and concen- trated by evaporation, the meconic acid may crystallize out if present in sufficient quantity. Process B. Separation of the morphine: The filtered liquid which contains the morphine ace- tate together with the lead acetate in excess, should be taken and treated with sulphuretted hydrogen, by pass- ing the latter through it to saturation, thus removing the excess of lead acetate, the lead being converted mto the insoluble sulphide. In order that the sulphide luay settle, the mixture should be allowed to stand in a Warm place for a number of hours. The sulphide may then be separated by filtration. It may then be evap- orated by a gentle heat, placed in a test tube, a slight excess of ammonia added, then a double volume of arnyl alcohol, the mixture thoroughly shaken and allowed to stand. In a short time the amyl alcohol hull rise to the top of the tube and may be removed by 292 A MANUAL OF TOXICOLOGY. using a pipette. Then another portion of amyl alco- hol is used to repeat the operation, the two portions mixed, and a gentle heat employed to evaporate this mixture. A microscope should then be used to exam- ine the residue for morphine. Before applying the characteristic tests for mor- phine, all impurities and foreign matter should be separated from the residue; this is done by dissolving the residue in a little dilute acetic acid and then filter- ing the mixture. The morphine may then be left un- affected and all impurities taken up, by making the remaining fluid alkaline with potassium carbonate, and shaking the mixture with hot amyl alcohol added in double volume. The various tests for morphine may then be applied. Regarding the detection of morphine in the organs and tissues, the organ to be examined should be finely subdivided and subjected to the same course of pro- cedure as detailed above for the examination of vom- ited matter or stomach contents. To powder supposed to be morphine, or to strong cold solution supposed to contain morphine, add strong nitric acid in excess and an orange-red color will be produced, which slowly fades to yellow and is not changed to purple upon adding stannous chloride, as occurs with brucine. Solution of ferric chloride neutralized by potash gives an inky-blue color when applied to a cold and not very acid solution. (As phenol, gallic acid, tannic and salicylic acids give a similar color, care should b? Laken to insure their absence.) Iodic acid mixed with starch produces a purplish or deep purple color when added to a cold and not very acid solution. (Husemann's Delicate Morphine Test) : Heat the suspected liquid to 1500 F. for a few minutes with concentrated sulphuric acid; let it cool and add a trace of potassium chlorate or chlorin^ water; a blue to violet-red color, changing to blood' red and finallv disappearing, is produced. PHOSPHORUS. 293 PHOSPHORUS. Mitscherlich's process is usually employed for de- tecting phosphorus. The organic matters supposed to contain phos- phorus are made fluid by diluting them with distil- led water, and then acidified with sulphuric acid. They are then placed in a flask and put upon a sand-bath and the flask connected with a Liebig's condenser and placed in absolute darkness. When the flask is heated, the phosporus present is volatilized, and upon its condensing in the tube a luminous ring is formed, which is evidence of the presence of phosphorus. If alcohol, ether or oil of turpentine are present the luminosity of the phos- phorus will be destroyed. Hence this process would iu such case be useless. SILVER NITRATE. An aqueous solution of silver nitrate gives with hydrochloric acid awhite precipitate of silverchloride, soluble in ammonia. All the chlorides precipitate a solution of silver nitrate in the form of a white powder, which blackens by light. Potassium chromate gives a dull rec| precipitate, soluble in acids. TIN. Tin compounds give a white precipitate, becoming gray and black, with mercuric chloride. They give a dark-brown precipitate with H2S, soluble in alkaline sulphides, in potassium hydroxide, and also in hot water. They also give a white precipitate, with ammonium hydroxide, which turns olive-brown when the fluid is boiled. 294 A MANUAL OF TOXICOLOGY. TYROTOXICON. Tyrotoxicon forms crystals with potassium hydrate. When treated with a mixture of carbolic and sul- phuric acids, a green color is produced. In whey, tyrotoxicon varies in color from yellow to orange-red. ZINC. Zinc Sulphate : Potassic chromate precipitates yellow zinc chro- mate. Ammonium sulphide in the presence of ammonium hydroxide gives a white precipitate. Potassium ferrocyanide gives a gelatinous white precipitate. CRYSTALS. (Under the Microscope.) Strychnine (Ale. sol.). Morphine (Ale. sol.). Atropine (+KHO) Oxalic Acid (Ale. sol.). Carbolic Acid, from dilute and cone, solutions. (From analysis of organs, etc., in a case of fatal poisoning by Carbolic Acid.) 295 'I'his and the following chart, by Thompson of England, are worthy of the analyst's consideration: "A CONDENSED CHART FOR THE DETECTION OF METALS IN SOLUTION." Group I. 1 Group II. 1 Group III. Group IV. ' Group V Add HCL Lead. Mercurous| Salt. J White] Silver. ppt. ' Bismuth or Antimony as oxychlo- rates. Add excess HCL ppt. 1 Bismuth dissolves •< or Anti- if ( mony. If precipitate does not dissolve, boil; if dissolved, Lead is indicated. If un- changed add ammo- nia. Precipitate dissolves =Silver. Turns black = Mer- cury. Pass H2S into solution. ( Mercuric Salt. Black J Copper, ppt. | Bismuth. ( Lead. Add Sol. Pot. lodid. to same. If it turns Red = Mercury. Green = Bismuth. Yellow = Lead. Brown = Copper. Yellow f . Arsenic. PP / > Cadmium. h's ^Stannic Salt. Add to same Ammon. Sulphyd. Arsen ic=dissolves. Tin=dissolves. Cadmium = insoluble. If ppt. is dissolved add HCL. Arsenic is precipitated, Tin is not. Brown ppt. with HaS=Stan- nous Salt. Orange ppt. with H2S=Anti- mony. Add AmCL AmHO (till it smells when shaken). AmHS (a little). Black J Lr0"-lf •< Cobalt. ppt- ( Nickel. To original solution add RgFe2Cy]2* Blue ppt. = Iron. Plum color ppt.= Cobalt. Yellowish ppt. or none = Nickel. White j Alum, ppt. | Zinc. To original solution add K4FeCyfi. White ppt.=Zinc. No ppt."Alum. Green ppt. = Chro- mium. The AmHS and Am HO must give a green ppt. for Cr. If white with Am HO, Al or Fe is indicated. Flesh color ppt. = Manganese. Add to last solution Am2CO3. ( Barium. Wh*te-^ Strontium. ppU (Calcium. Dissolve the ppt. in Acetic Acid and add K2CrO4. Yellow ppt. = Ba- rium. If no ppt. add H2 SO4. Dilute = White ppt. on stand- ing or shaking = Strontium. No ppt. add Am2 C2O4. White ppt. = Cal- cium. Add to original solu- tion Na2HPO4. White ppt. =:Mag- nesium. If no ppt. is obtained in either group, Potassium, Sodium or Ammonia are indicated. Potassium. Yellow ppt. with Pt CI4. White ppt. with strong solution of Acid. Tart. Sodium. No ppt. with above and yellow flame. Ammonia. Heat with KHO, gas evolved. (Nessler's test.) 296 " CHART FOR THE DETECTION OF ACIDULOUS RADICALS OF SALTS IN SOLUTION," (THOMPSON.) Group I. H2SO4. Decomposes. Group II. BaClj. Precipitates. Group III. CaCl2 Precipitates. Group IV. AgNOg. Precipitates. Group V. Fe2Cl6. Precipitates. Group VI. H2S04-|-FeSO4. Forms a black colouration. Sulphites. Sulphides. Carbonates. Cyanides. Acetates. Oxalates, White. Tartrates " Citrates " Sulphates " Phosphates " Oxalates, White. Tartrates " Citrates " Phosphates " Chlorides, White. Tartrates " Bromides, Yellowish White. Iodides, Yellow. Phosphates " Chromates, l\ed. Arseniates, Chocolates. Arsenites, Yellow. Ferrocyanides, Blue. Borates, Yellowish. Nitrates. DISSOLVE THE SALT IN WATER, AND RENDER IT NEUTRAL, IF NECESSARY. Should the precipitates produced by this reagent be insoluble in HNO3, a sulphate is indicated. Should the precipitate be soluble, pass on to Group III. Should the precipitate produced by this reagent be insoluble in acetic acid, blit soluble in HC1, the presence of an oxalate is indicated. Confirm. Tartrate of calcium is also insoluble in acetic acid, an acid tartrate of calcium being formed, which may be distinguished from the amorphous oxalate of calcium by its crystalline character. Confirm. Should the precipitate be soluble in acetic acid, test for citrates. The colour of the precipitates by this reagent is very characteristic. If the precipitate is white and insoluble in HNO3, but soluble in dilute solution of ammonia, the presence of a chloride is indicated. Confirm. Should the previous reagents give no precipitate, add a crystal of sulphate of iron and a few drops o£ w.rong sulphuric acid. The formation of a black colour indicates a nitrate. Confirm. Apply heat, and notice any' odour which may' be evolved. Sulphides give off H2S (sulphuretted hydrogen). Confirm. Sulphites give off SO2 (sulphurous acid gas). Confirm. Carbonates effervesce and give off CO2 (carbonic acid gas). Confirm. Cyanides give off the odour of HCy (hydrocyanic acid). Confirm. Acetates give off the odour of acetic acid. Confirm. A yellowish precipitate indicates a borate. Confirm. Group IV. AgNO3 Group VI. H2SO4 Group I. H2SO4 Group II. BaCl2 Group III. CaCla Group V. Fe2Clg OUTLINE OF PROCEDURE. 297 PART VI. OUTLINE OF PROCEDURE IN SEARCH- ING FOR POISONS. Those portions of the body which are to be sub- jected to chemical or microscopical examinations, should be carefully placed at the time of the autopsy, by the person performing it, in new, or thoroughly clean glass jars, having air-tight glass covers. Where Prompt analysis is to be made, neither alcohol nor any pther preservative fluid should be added. When such ls added, it should be distilled alcohol and known to be pure; and a carefully sealed and labeled portion of it should be preserved for the chemist to test for im- purities The jars should be sealed, numbered and labeled, and the sealer should affix his initials. The portions of the body to be preserved for the chemist's examinations, are, as a rule, the stomach and contents, a portion of or the whole intestinal canal, the liver, both kidneys, the spleen, the brain, the urine found io the bladder, and upon occasion, the heart, lungs, a Portion of or the entire spinal cord, and a portion of muscle taken from the leg. When it is desirable, but impossible to obtain the whole of an organ, the pro- portion which the part obtained bears to the whole °rgan should be ascertained. Careful inspection should be made of all organs, sometimes also by a Pathologist and a bacteriologist, to exclude other cause of death than by poisoning. In removing the stomach and its contents from a body for examination, a double ligature should be Passed around the esophagus just above the cardiac prifice, and another about the duodenum three or four inches below the pylorus, and the organ removed with its contents thus intact. It is frequently advisable to Place each organ intended for analysis in a separate glass jar or other container. It is rarely necessary to analyze the whole body. As 3 rule the following are the organs to be examined, 298 A MANUAL OF TOXICOLOGY. and in this order: the stomach and contents, the liver, spleen, kidneys, heart, lungs and brain; it may, how- ever, be necessary to also examine the spinal cord,1 uterus, portions of intestines, the blood, etc. When the material to be analyzed consists of either solids, or solids and liquids to be analyzed together, the solids should be reduced to a finely divided mass, and any liquid portion so mixed with it as to make/ the whole a uniform mixture. If there be an insuf-, ficient quantity of liquid present, it may be necessary to add some distilled water in order to secure a uni- form mixture. The mixture should now be weighed and about one-twelfth or one-fifteenth (not over one- tenth) weighed out and employed for preliminary tests. Is proper in systematic analysis to search first for vol- atile poisons, then alkaloids, then inorganic poisons. In testing vomited matters, a clear liquid, service- able for preliminary tests, may usually be obtained by placing them in a cone-shaped glass vessel, and setting them aside for 12 to 24 hrs. In absence of much fluid a small quantity of distilled water may be added and well mixed with these matters before setting them aside. In making chemical analyses, dialysis is often re- sorted to, to separate the poison (especially any crys- tallizable salt) from the complex matters associated with it; either alcohol or water, accordingto their abilz' ity to dissolve the poison, is used as the outer liquid. During life all the body tissues are alkaline except those of the stomach and the urinary apparatus. For a short period after death all the tissues become more or less acid, but soon change to alkaline, owing to the production of ammonia through the process by which the proteids are changed into waste matter and cast out. The tissues which contain sulphur ultimately change into hydric sulphide, precipitating the sul- phides of mercury, lead, arsenic, etc. The hemoglobin of the blood becomes converted into sulphuret-hemo- globin, and ultimately into ferrous sulphate. These two compounds give the body a greenish color in the earlier periods of decomposition. CVTLINES of procedure. 299 The analyst, upon receiving the samples or materi- als for analysis, should note accurately the manner in which they have been packed, that the container was well closed and tightly sealed, and that the seals have not been disturbed; also, whether the container or wrappings were likely to contaminate the samples, the character and wording of the labels, if there be such, and the date and agent of receipt. Careful observation should then be made of the appearance, smell, color, weight of each solid, the volume of liquid, and the reaction of the samples. Opium, hydrocyanic acid, or alcohol may be sug- gested by the smell. The salts of copper, portions of insects, or certain arsenical preparations, or other col- oring matter may be suggested by the color. Spots which are characteristic of the sulphides of mercury, lead, arsenic, etc., may occasionally be found long after interment, on or in various organs of the body. In making his chemical analysis the investigator must insure the purity of the atmosphere of the room in which the investigation is made, the security of the samples in such room, it being accessible only to the analyst, and the perfect freedom of his apparatus from contamination. He must also determine the absolute purity and reliability of his test solutions, by testing them. He should make notes of his work. A careful hand magnifying-glass and microscopical examination of the suspected organs and their con- tents is often advisable; the identification and sub- sequent exhibition of characteristic substances and forms is thus provided for. Before a suspected organ is destroyed in process of investigation, it is often Well to photograph it. The nature cf the food last eaten and its bearing on the case is frequently a matter of the utmost impor- tance. Washings of samples and containers should be included in the investigation. It is as a rule advisable to examine only one portion of the vomited matter, stomach contents, or intestinal 300 A MANUAL OF TOXICOLOGY. contents, at one time. The other portions should be reserved for subsequent experiments. Inasmuch as the poison may be present in only a very small quan- tity, the portion of fluid under examination should be concentrated, by evaporation at a gentle heat, to secure the best responses to the various tests. Sepa- ration of materials under examination may require re- sort to dialysis-as in the separation of colloid sub- stances from crystalloids-or to distillation-as in such volatile substances as alcohol, chloroform, prussic acid, phosphorus, chloral, etc.-as well as to such processes as filtration, etc. In the search for an inorganic, poison (as antimony, arsenic, etc.) in the presence of or- ganic matter, Fresenius' process is commonly resorted to for the destruction of the organic matter. By this process, the material to be tested, is, after being finely divided, boiled with about one-eighth of its bulk of pure hydrochloric acid, occasionally adding crystals of potassium chlorate, allowing sufficient time each time for the chlorate to decompose, until the materials under investigation are oxidized to a straw-colored fluid; then hydrogen sodium sulphite is added until the mixture gives off an unmistakable odor of sul- phurous acid. Most of the metallic poisons are then precipitated in the form of a sulphide by passing sul- phuretted hydrogen through the mixture for several hours. By collecting such precipitate, the various tests for identification may be applied. Poisonous alkaloids are advantageously separated from complex mixtures, by means of either Stas' Roger and Girdwoods, or Uslar and Erdmann's method. Stas uses ether as a solvent. Uslar and Erdmann resort to alcohol. In Stas' process for separating alkaloids, the fol- lowing course is pursued: The stomach or intestinal contents, or the solid organs to be tested are digested with acidulated alcohol or water, until such are in a state of solution. Then the whole is filtered and ether added to the filtrate. The ether removes the oily mat- OUTLINE OF PROCEDURE. 301 ters, and is itself then removed and the watery solution neutralized by adding potash or soda. The alkaloid is ultimately separated by ether, when it may be expected to remain behind in suitable condition for the employ- ment of further tests. Some analyzers prefer to modify Stas' process. One of these modifications con- sists in acidulating the suspected material with hydro- chloric acid, then heating it for an hour or more over a water-bath, and filtering the mixture. This proc- ess is continued until a pure product is obtained. -This product is neutralized by adding hydrogen so- dium carbonate, and the freed alkaloid is taken up by shaking the mixture with chloroform or ether. If the mixture then be put in a tall, tightly corked test tube mid allowed to stand, the chloroform or ether may be separated by means of a pipette, and upon evap- -oration the alkaloid will be found ready for additional purification or testing. . The toxicologist resorts to a variety of methods in his efforts to detect traces of poison in suspected sub- stances. Herold very tersely says: "Combinations are formed With other elements, revealing the poison in the form °f solids, liquids or gases. Others are arrayed in varied colors, in crystalline shapes, or volatilized in 'flame and viewed by the achromatic or apochromatic tenses of the microscope, or their incandescent vapors through the prisms of the spectroscope. For example, the existence of metals is indicated by brilliantly tinted and sharply defined lines, as they are presented in front °f the narrow slit of the spectroscope, even infinitesimal traces being accurately noted." "The great advances made in electricity have con- tributed the mysterious power of this fluid in toxi- cological analyses, as is exemplified in the production °f ozone for the purple-color reaction for strychnine, pr in evolving hydrogen from distilled water for the Marsh test.' (Doremus.)" 302 A MANUAL OF TOXICOLOGY. A SHORT ANALYTICAL PLAN. A systematic analysis for the detection of poisoi may be resolved into two principal procedures: i. Afi? alysis for volatile and inorganic poisons. 2. Analysis for non-volatile organic poisons. Having reduced the materials to be examined to f uniform mixture by means of thorough division, and if necessary, also by dilution, a small and carefull} weighed portion may be taken for the application 0 simple preliminary tests. Then the remaining portic- may be divided into either three or four parts: on* part for the first procedure, one for the second pro- cedure, one part for control tests, and, if deemed ad- visable, one in reserve for use in case of accident. Ead part should be carefully marked. The part pro1 vided for the first procedure, the analysis for volatile and inorganic poisons, is now acidified with tar- taric or acetic acid and put into a distilling flask. Th^ delivery tube is connected with a glass condenser, and the mixture distilled over a water-bath for about halt an hour. The products of condensation should be re' ceived in a flask in which a little water has been placed If, upon observing the reaction of the distillate it is found to be neutral, it may contain amyl, ethyl, or me- thyl alcohol, or anilin, amyl nitrite, carbon bisulphide,, chloroform, chloral, coniin, carbolic acid, hydrogen sw phide, lobeline, nicotine, nitro-benzole, or phosphorus- If the distillate is found to be acid, hydrobromic, hydro- chloric, or hydrocyanic acid may be present, and they may be identified by the ordinary tests. The organic matter present in the residue left in the distilling flask should next be destroyed as follows- This residue should be placed in a good sized flask and dilute hydrochloric acid which is known to be fre£ from arsenic, should now be added in sufficient quan- tity to cover the material, and the whole heated on a water-bath. Crystals of chlorate of potash, in smal^ portions, at intervals sufficient to permit of the de-, composition of the chlorate of potash are now intro- duced; this should be continued until the contend OUTLINE OF PROCEDURE. 303 of the flask present a clear straw-colored appearance. The object in introducing the chlorate of potash is two- fold : first, to oxidize the organic matter; second, to prevent the loss of arsenic through the vaporization of arsenous chlorid. The fluid in the flask is then to be cooled, and air should be drawn through the mixture with an aspirator, until all free chlorine has been ex- pelled ; the contents of the flask are then ready for testing for inorganic bases by the ordinary methods. The portion reserved for the second procedure, i. e., analysis for non-volatile organic poisons, is now treated as follows: It is put into a distilling flask and about three vol- umes of absolute alcohol which has been acidified with tartaric or acetic acid is added. Connection should then be made with a return condenser and water-bath heat applied for half an hour or more. The mixture should then be cooled, filtered, the residue washed with absolute alcohol, the washings added to the filtrate and the alcohol distilled off. Then add an equal quantity of water, mix well, filter, and place the filtrate in a cy- lindrical glass-stoppered jar. This filtrate contains the poison sought, and may be marked F. Next, .after having added an equal volume of ether, and shaken up the resulting mixture, permit it to sepa- rate and then remove the ethereal layer. After re- peating this operation two or three times, put the ex- tracts together and evaporate them to dryness on the Water-bath. Acetanilid, antipyrine, caffeine, cantharidin, colchi- cin, digitalin, phenacetin, picric acid, picrotoxin, piper- fin, salicylic acid, salol or santonin, may be contained in this extract, and by applying suitable tests to small portions of it, such may readily be identified. The ethereal layer having been separated from the acid filtrate F., extract with chloroform in the same way as was done with the ether. The resulting ex- tract may contain digitalin, helleborin, narcein or papa- verin, for which suitable tests should be employed. If the foregoing extractions have been fruitless, all chloroform should be expelled from filtrate F. by 304 A MANUAL OF TOXICOLOGY. warming the latter on the water-bath; it should then be placed in the glass-stoppered cylindrical glass jar, ammonia added to alkalinity, and extraction made by means of petroleum ether. Aconitin, apomorphine, atropine, brucin, cocaine, codeine, narcotine, pilocar- pine, quinine, strychnine or veratrine may be contained in this extract. Suitable tests should then be em- ployed for their identification. If, howev-e^, this also results in nothing being ob- tained, amyl alcohol should be used to extract the alka- line liquid. This extract may contain morphine, and suitable tests should be applied for the identification of that alkaloid. In searching for poisons, the general method of procedure of W. Autenrieth, according to Blyth, divides poisonous substances, for the purposes of separation and detection, into three classes: "I. Poisons capable of distillation from an acid aqueous solution. II. Organic substances which are not capable of distillation from acid solutions. III. Metallic poisons. Where possible, the fluid or solids submitted to the research are divided into four equal parts, one of the parts to be kept in reserve in case of accident or as a control; one of the remaining three parts to be distilled; a second to be investigated for organic substances; and a third for metals. After the ex- traction of organic substances from part No. II, the residue may be added to No. Ill for the purpose of search after metals; and, if the total quantity is small, the whole of the process may be conducted without division. AUTENRIETH'S METHOD. I. SUBSTANCES SEPARATED BY DISTILLATION. The substances are placed in a capacious flask, diluted if necessary with water to the consistence of OUTLINE OF PROCEDURE. 305 a thin soup, and tartaric acid added to distinct acid reaction, and distilled. In this way phosphorus, prussic acid, carbolic acid, chloroform, chloralhy- drate, nitrobenzol, aniline (aniline is a weak base, so that, although a solution be acid, some of the aniline distills over on heating), and alcohol may be separated and identified by characteristic reac- tions. II. ORGANIC POISONS NOT VOLATILE IN ACID SOLUTION. Part No. II is mixed with double its volume of absolute alcohol, tartaric acid added to distinct acid reaction, and placed in a flask connected with an inverted Leibig's condenser; it is then warmed for 15 to 20 minutes on the water-bath. After cooling, the mixture is filtered, the residue well washed with alcohol and evaporated to a thin syrup in a porce- lain dish over the water-bath. The dish is then allowed to cool and digested with 100 c.c. of water; fat and resinous matters separate, the watery solu- tion is filtered through Swedish paper previously moistened. If the fluid filtrate is clear, it may be at once shaken up with ether, but if not clear, and especially if it is more or less slimy, it is evaporated again on the water-bath to the consistence of an extract: the extract treated with 60 to 80 c.c. of ab- solute alcohol (which precipitates mucus and dex- trin-like substances), the alcohol evaporated off and the residue taken up with from 60 to 80 c.c. of dis- tilled water; it is then shaken up with ether, as in Dragendorff's process, and such substances as digi- talin, picric acid, salicylic acid, antipyrin and others separated in this way and identified. . After this treatment with ether, and the separa- tion of the ether extract, the watery solution is strongly alkalized with caustic soda and shaken up 306 A MANUAL OF TOXICOLOGY. again with ether, which dissolves almost every al- kaloid save morphine and apomorphine; the etheieal extract is separated and any alkaloid left is identi- fied by suitable tests. The aqueous solution, now deprived of substances soluble in ether both from acid and from solutions made alkaline by soda, is now investigated for mor- phine and apomorphine; the apomorphine being separated by first acidifying a portion of the alka- line solution with hydrochloric acid, then alkalizing with ammonia and shaking out with ether. The morphine is separated from the same solution by shaking out with warm chloroform (but hot amyl alcohol would be better). III. METALS. The substances are placed in a porcelain dish and diluted with a sufficient quantity of water to form a thin soup and 20 to 30 c.c. of pure hydrochloric acid added; the dish is placed on the water-bath and 2 grammes of potassic chlorate added. The con- tents are stirred from time to time, and successive quantities of potassic chlorate are again added, until the contents are colored yellow. The heating is continued, with, if necessary, the addition of more acid, until all smell of chlorine has ceased. If there is considerable excess of acid, this is to be evapo- rated away by diluting with a little water and con- tinuing to heat on the water-bath. The dish with its contents is cooled, a little water added, and the fluid is then filtered. The metals remaining on the filter are: silver chloride, lead sulphate, barium sul- phate. In the filtrate will be all the other metals. The filtrate is put in a flask and heated to from 60 to 80 degrees and submitted to a slow stream of hydric sulphide gas; when the fluid is saturated with the gas, the flask is securely corked and al- lowed to rest for twelve hours; at the end of that time the fluid is filtered and' the filter washed with water, saturated with hydric sulphide. OUTLINE OF PROCEDURE. 307 The still moist sulphides remaining on the filter are treated with yellow ammonium sulphide con- taining some free ammonia and washed with sul- phide of ammonium water. Now remaining on the filter, if present at all, will be: mercury sulphide, lead sulphide, copper sulphide, cadmium sulphide. In the filtrate may be arsenic sulphide, antimony sulphide, tin sulphide; and there may also be a small portion of copper sulphide, because the latter is somewhat soluble in a considerable quantity of ammonium sulphide. The filtrate from the original hydric sulphide pre- cipitate will contain, if present, the sulphides of zinc and chromium in solution. INVESTIGATION OF THE SULPHIDES SOLUBLE IN AMMONIUM SULPHIDE, VIZ., ARSENIC, ANTIMONY, TIN. The ammonium sulphide solution is evaporated to dryness in a porcelain dish, strong nitric acid added and again dried. To this residue a little strong caustic soda solution is added, and then it is inti- niately mixed with three times its weight of a mix- ture composed of 2 of potassic nitrate to 1 of dry sodium hydrate. This is now cast, bit by bit, into red-hot porcelain crucible. The whole is heated Until it has melted into a colorless fluid. Presuming the original mass contained arsenic, antimony, and tin, the melt contains sodic arseniate, sodic pyro-antimonate, sodic stannate, and tin ox- 1(ie; it may also contain a trace of copper oxide. The melt is cooled, dissolved in a little water, and sodium bicarbonate added so as to change any caus- ae soda remaining into carbonate, and to decompose the small amount of sodic stannate; the liquid is then filtered. The filtrate will contain the arsenic as sodic ar- senate, while on the filter there will be pyro-anti- uionate of soda, tin oxide, and, possibly, a little Topper oxide. 308 A MANUAL OF TOXICOLOGY. The recognition of these substances now (by) chemical methods) is not difficult. INVESTIGATION OF THE SULPHIDES INSOLUBLE IT^ SULPHIDE OF AMMONIUM, VIZ., MERCURY, LEAD, COPPER, CADMIUM. If the precipitate is contaminated with organic matter, it is treated with hydrochloric acid and po-/ tassic chlorate in the manner already described. Afterwards it is once more saturated with hydric" sulphide, the precipitate is collected on a filter, well washed, and the sulphides treated with moderately concentrated nitric acid (i vol. nitric acid, 2 vols.j water). The sulphides are best treated with this' solvent on the filter; all the sulphides mentioned, save mercury sulphide, dissolve and pass into the filtrate. This mercury sulphide may be dissolved by nitro-muriatic acid, the solution evaporated to dry- ness, the residue dissolved in water acidified with hydrochloric acid and tested for mercury. The filtrate containing, it may be, nitrates of lead, copper and cadmium, is evaporated nearly to dry- ness and taken up in a very little water. The lead is separated as sulphate by the addition of dilute sulphuric acid. The filtered solution, freed from lead, is treated' with ammonia to alkaline reaction; if copper be present, a blue color is produced, and this may be confirmed by other tests. To detect cadmium in the presence of copper, potassic cyanide is added to the blue liquid until complete decolorization, and the liquid treated with hydrogen sulphide; if cad- mium is present, it is thrown down as a yellow suk phide, while potassic cupro-cyanide remains in solu- tion. SEARCH FOR ZINC AND CHROMIUM. The filtrate from the hydric sulphide precipitate is divided into two parts-the one half is used in the search for zinc, the other half is used for chromium; OUTLINE OF PROCEDURE. 309 Search for Zinc.-The liquid is alkalized with ammonia, and then ammonium sulphide is added. There will always be a precipitate of a dark color; the precipitate will contain earthy phosphates, iron, and in some cases, manganese. The liquid with the precipitate is treated with acetic acid to strong acid reaction and allowed to stand for several hours. The portion of the precipitate remaining undissolved is collected on a filter, washed, dried and heated to red- ness in a porcelain crucible. The residue thus heated is cooled and dissolved in a little dilute sul- phuric acid. To the acid solution ammonia is added, and any precipitate formed is treated with acetic acid; should the precipitate not completely dissolve, phosphate of iron is present; this is filtered off, and if hydrogen sulphide be added to the filtrate, white zinc sulphide will come down. Search for Chromium. - The second part of the hydrogen sulphide filtrate is evaporated to a thin extract, mixed with double its weight of sodic ni- trate, dried and cast, little by little, into a red-hot Porcelain crucible. When the whole is fully melted, the crucible is removed from the flame, cooled, and the mass dissolved in water and filtered. Any chro- mium present will now be in solution in the easily recognized form of potassic chromate. investigation of the residue after the treat- ment OF THE ORIGINAL SUBSTANCE WITH HY- DROCHLORIC ACID AND POTASSIC CHLORATE FOR PRESENCE OF SILVER CHLORIDE, LEAD AND BAR- IUM SULPHATES. The residue is dried and intimately mixed with three times its weight of a mixture containing 2 Parts of sodic nitrate and 1 part of sodium hydrate, his is added, little by little, into a red-hot porcelain crucible. The melted mass is cooled, dissolved in 310 A MANUAL OF TOXICOLOGY. a little water, a current of carbon dioxide passed through the solution to convert any caustic soda into carbonate, and the solution boiled. The result will be an insoluble portion consisting of carbonates of lead and baryta, and of metallic silver. The mix- ture is filtered, the insoluble residue on the filter is warmed for some time with dilute nitric acid; the solution, of nitrates of silver, lead and barium are concentrated on the water-bath nearly to dryness so as to get rid of any excess of acid, and the nitrates dissolved in water. Then the silver is precipi- tated by hydrochloric acid the lead by hydrogen sulphide, and the barium by sulphuric acid." THE CORPUS DELICTI. The "corpus delicti" may be defined as: The injuri- ous substance; the appreciable cause of injury or death. It is the poison, presented in stable condition. It is not only desirable to so present it, but the law, in some countries, directs that for all cases of forensic chemical research, the poison must be pre- sented to the judge and jury in a permanently stable condition, capable of impressing the senses. This is forensically called the corpus delicti. The following serve to illustrate such: the plati- num double-salts of ammonia and alkaloids. Prus- sian blue from hydrocyanic acid, mercury in the form of red mercuric iodide, oxalic acid in the form of calcium oxalate, spots and mirrors of arsenic and antimony, phosphorus in its natural state, the seeds of various plants such as stramonium, hemlock, and hyoscyamus, the hulls of berries such as belladonna, leaves fragments such as those from digitalis, hyos- cyamus, lobelia, root fragments from aconite, the shining, green particles from cantharides, etc. Questions commonly asked the analyst are: Is the poison combined or free? How was it obtained? Could it exist naturally? How much was found, its strength, and the quantity fatal ? If there is no poison, is anything detrimental to health present ? THE SIGNS OF DEATH. 311 PART VII. THE SIGNS OF DEATH. I. Absence of respiratory murmur. 2. Absence of cardiac pulsation. 3. Insensibility and inability to move. 4. Changes in the eyes. 5. Body pallor. 6. Loss of animal heat. 7- Venous coagulation. 8. Rigor mortis. 9. Cadaveric lividity. 10. Putrefaction. 11. Saponification. 12. Mummification. TESTS. I. A feather lightly suspended near the mouth °r nose remaining unmoved indicates death has oc- curred. 2. Hold a bright mirror over the mouth and nose °f the subject and any respiratory moisture promptly appears upon the glass. 3- The eyes are insensible to light after death, neither dilating nor contracting; but some poisons and some brain affections have similar effects. (Test may be made with candle or lamp). 4- Insensibility of the cornea to touch indicates Cieath, although certain injuries of the brain, etc., produce the same condition. 5- The conjunctivae exhibit gray, cloudy discol- orations, rapidly changing to black, upon their sur- faces, due to formation of films of mucus or to ca- daveric imbition from decomposition changes. 6. After death, any external pressure on the eye- 312 A MANUAL OF TOXICOLOGY. ball permanently alters the circular shape of the pupil. 7. Examine cardiac and pulmonary regions care- ■ fully, the former with a stethoscope. 8. Apply a ligature to a finger or limb and note if part beyond the constriction becomes a deep-red or purple color-evidence of life. 9. As a rule, scarifying the surface of the body and then applying a cupping glass causes no blood 1 to flow if death has occurred. 4 10. Open a vein and see if coagulation of the blood has ensued. If no blister forms when red-hot iron is applied to skin, death is indicated. / 11. Inject ammonia solution subcutaneously; if living, a port-wine congestion will appear in the surrounding parts; if dead, it does not appear. u 12. Thrust a clean, bright needle into the biceps muscle and leave it there for a time; it will rapidly rust and tarnish (oxidize) if life is not extinct; if it is, no such change results. Rigor mortis or cadaveric rigidity-the stiffening of the muscles of the body throughout its entire ex- tent, and probably due to the coagulation of the myosin in the muscles-usually takes place inside of six hours after death. Its duration is from 16 to.< 24 hours-until putrefaction sets in. Heat shortens and cold prolongs rigor mortis. In sudden acci- dental death while in health, appearance of rigor mortis is delayed, whereas in death from exhausting disease, as phthisis, it promptly appears. Rigor mortis begins in muscles of the eye, then affects muscles of lower jaw and neck, then chest and upper extremities, and lastly muscles of abdomen and lower extremities. If body is only slightly cold and jaws show signs of rigidity, with glazed eyes and shrunken eye-balls,'- death has probably occurred within to 4 hours. If the whole body is perfectly cold and rigid, death has occurred within 12 hours to 4 days. If, cadaveric lividity be present, death has probably oc- curred in from 1 to 4 days. THE MODES OF DEATH. 313 PART VIII. SUDDEN DEATH. Sudden death may result from: i. The action of such poisons as aconite, alcohol, carbolic acid, hydrocyanic acid, oxalic acid, anes- thetics, cocaine, mercuric cyanide, potassic cyanide, silver cyanide, irrespirable gases, nitrobenzene, nitroglycerine, nicotine, phosphorus, snake venom, strychnine, etc. 2. Violence: such as a blow upon head, or large bood-vessel, over heart or plexus of nerves, etc. 3. Hemorrhage: cerebral, gastric, aortic, etc. Hemorrhage into pancreas; into peritoneal cavity from ectopic gestation, or ruptured uterus, etc. 4- Rupture <ff Internal organs: as heart, spleen, distended bladder, pregnant uterus, or other organ m the abdominal cavity. Rupture of ulcer in some part of alimentary canal. Rupture of vessel, var- icose vein or aneurysm, etc. 5. Such cardiac affections as angina pectoris, aortic regurgitation and other valvular diseases when associated with deficient compensation, car- diac degeneration, the exhaustive effects upon the heart of diphtheria and other poisonous diseases, etc. 6. Thrombosis, embolism, bronzed-skin disease, diabetes, uraemia, epilepsy, intense emotion, etc. 7. Such affections of the respiratory system as: asthma, whooping cough, pneumothorax, hemotho- rax, pleuritic effusion, acute pneumonia, tumors, foreign bodies in pharynx, larynx, or trachea, mem- branous deposits, spasm or cedema of glottis or larynx, etc. CAUSES OF DEATH. MODES OF DEATH. (Partly adapted from Bichat and Herold). The actual or immediate cause of sudden death is obviously dependent upon one or other of the three 314 A MANUAL OF TOXICOLOGY. great centres of life, the heart, the lungs, or the brain. When one of these centres ceases to work, the actions of the others are promptly embarrassed, as the maintenance of life is dependent upon the in- tegrity and activity of each. (Together, these three centers constitute life's "tripod.") The'modes of death have been classified into:-- i-Death beginning at brain, coma. (See p. 328.) 2-Death beginning at heart, syncope. (See p. 328.) 3-Death beginning at lungs, asphyxia or apnoea. The immediate cause of death should be sought in the brain, heart or lungs, no matter what the remote cause of the death may be. COMA. Coma may be defined as a state of profound in- sensibility. It is a condition usually dependent upon changed brain conditions. Causes: May be due to increased amount of blood in blood vessels of brain, to blood or other fluid or solid outside those vessels, or to brain in- jury. Hence: Compression of the brain; apoplexy; fractures of the bones of the head or other injury to the skull; hydrocephalus; concussion of the brain; the action of narcotics, arsenic, coal gas, or other poisons; various discharges and hemorrhages; cer- tain diseases of the kidneys, such as uraemic poison- ing ; or of the liver, such as acute yellow atrophy; etc. Symptoms: Stupor; patient insensible to exter- nal impressions; unconsciousness; slow, irregular, stertorous breathing; loss of voluntary control over respiration-as the medulla begins to be affected there is increasingly feeble respiration; pulmonary circulation and aeration of blood ceases; the pulsa- tions of the heart, and lung movements are arrested; the pupils are sluggish and dilation frequently occurs. Post-Mortem Appearances: More or less blood in the cavities of the heart, but not such an engorge- ment as when death has resulted from asphyxia. Usually the brain is congested and there is more or less oedema. THE MODES OF DEATH. 315 SYNCOPE. Syncope may be considered to be suspended ani- mation, due to failure in heart action. Causes: Heart action may have been arrested by either (i) Anaemia or (2) Asthenia. 1-Anaemia, or less blood than normal: due to sudden loss of blood from ruptured aneurism, uter- ine or pulmonary hemorrhage, and from cardiac or vascular injury; also suppurations which act indi- rectly as severe drains upon the blood. 2-Asthenia, or insufficient heart power: due to paralysis of its muscular walls. This may be the result of fatty degeneration or other cardiac dis- eases, of starvation, of cancer, cholera, typhoid fever, phthisis, diabetes, dysentery, or other ex- hausting disease; certain poisons, such as digitalis, prussic acid, veratrum viride, etc.; certain injuries, such as blows over the stomach, concussions of the spine, etc.; also severe cerebral lesions; shock. Symptoms: 1-Anaemia: face pale or dusky; lips livid; skin covered with a cold perspiration; sight dimmed; tinnitus aurium; vertigo; pulse ir- regular and weak; pupils dilated; gradual insensi- bility. May be nausea, vomiting, irregular respira- tion, jactitation, photophobia, convulsions; may be hiccough. The nervous symptoms result from the insufficient supply of blood to the brain. 2-Asthenia-- arrest of circulation in the extrem- ities, producing lividity of the fingers, lips, nose and ears; surface of body and extremities cold; weak, frequent pulse; although great muscular weakness, the senses and intellect are unimpaired. Post-Mortem Appearances : 1-Anaemia : heart empty and contracted; if death was delayed, may be a heart clot; organs and tissues usually pale. 2-Asthenia : heart may contain some blood, but its cavity is more or less dilated or flabby from stop- page of blood in the circulation; the blood is in the large arteries and veins; neither the brain nor lungs sre engorged. 316 A MANUAL OF TOXICOLOGY. ASPHYXIA (Apnoea). Asphyxia is a condition of more or less complete suspension of respiration. Asphyxia from inhalation of poisonous gases may be due to damaging of red blood-corpuscles, so their oxygen carrying power is almost destroyed by the conversion of their hhemo- globin into methsemoglobin, (an internal asphyxia). Causes: Arrest of respiration resulting from : i-Mechanical obstruction to the entrance of air into the lungs, as the pressing of foreign bodies in the air passages; a tetanic spasm of the lespiratory muscles, produced by strychnine poisoning, tetanus, etc.; pressure of the thorax; muscular exhaustion from cold or debility; paralysis of the pneumogas- tric or phrenic nerves; submersion; suffocation; hanging; strangulation; absence of air, as in very high altitudes; the effects of sulphuretted hydrogen gas, chlorine gas and other irritant gases. 2-Dis- eases, such as bronchitis, pneumonia and other lung diseases; spasm or oedema of the glottis; embolism of the pulmonary artery; pharyngeal abscess, and serum blood or pus accumulated in the pleural cavities. Symptoms : Sense of suffocation, with vigorous effort to breathe; face livid ; unconsciousness; vertigo; sphincter muscles relaxed; general convulsions. Post-Mortem Appearances: The skin and mucous membranes are livid. The lungs may be engorged with dark blood; the bronchi being red- dened by both venous engorgement and ecchymoses; they may contain either froth or blood; the pulmo- nary artery, right cavities of the heart and the venm cavae are engorged, and usually the viscera; the left side of the heart, the aorta and the pulmonary veins are comparatively empty; sometimes, however, the cavities of the right side of the heart are empty. Usually the blood is fluid and dark and may con- tain a few clots. The veins of the brain are engorged. Punctate ecchymoses (small dark hemorrhagic points) may be found here and there over surface of brain, lungs or other organs, especially if asphyxia were rapid and were violent attempts at respiration. PHARMACOLOGICAL TOXICOLOGY. 317 PART IX. PHARMACOLOGICAL TOXICOLOGY, ETC. The study of the physiological or ultra-physiological reasons, etc., for the various symptoms which are produced by sub- stances in toxic doses, i.e., the basic modus operandi, etc., of the drug, is a most important part of toxicology. It should be noted that the character and degree of influ- ences exerted by various toxic substances, in relatively pro- portionate doses, upon man, and upon various animals with similar organs and functions, often differ more or less widely. Nevertheless, in very many instances, such a degree of paral- lelism and close relationship exists between the human and animal phenomena produced by various poisonous substances as to command our interest, careful observation and investiga- tion. Furthermore, experience demonstrates that the measures which are successful in neutralizing and combating poisons 5nd their effects in the animal are, as a rule, absolutely identi- cal with those which relieve man. Hence a careful study of the effects of various poisons upon pertain animals, and the measures which are most successful ln their treatment, may well furnish information of the highest value in saving human life. All investigations should, however, unquestionably be carried out with no lack of humane con- secrations. The animals most suitable for the study and demonstration °f the poisonous effects and the proper treatment to be em- ployed in poisoning by various poisons are chiefly the follow- ing : Dogs, cats, rabbits, guinea pigs, rats, white rats, mice, monkeys, fowls, pigeons, frogs, turtles and toads. The first lour and frogs are most used; as a rule, the best results being obtained by using medium-size dogs. Some poisons have nearly, if not quite, opposite effects upon cats from those which they produce upon dogs; the effects upon dogs being analogous to those upon man. There are other notable differ- ences in animal phenomena, calling for an intimate knowledge °f both animal peculiarities and the methods of operation of Poisons in such. Where individuals, or the members of a laboratory group, administer a poison, note the phenomena resulting, and apply suitable remedial measures, the following facts should be care- mlly recorded: The date, name of the observer or observers, the place, the kind of animal, its color, markings, condition, sox, apparent age, weight, etc. The preliminary measures em- ployed (such as anesthesia, etc.). The name, condition and ,orm of the poison to be employed (its purity; if a solid, liquid or gaseous substance, etc.). The quantity and time of administration of the first and subsequent doses. The effects °f each as regards vomiiins and excretions, stupor or delirium 318 A MANUAL OF TOXICOLOGY or excitement, etc. The position taken by the animal, and if maintained. The muscular action (twitchings and other motions), their regularity or the reverse, frequency, severity,* duration, etc. The respirations, their frequency, regularity force, depth, etc. The pulse, temperature, condition of eyes and mental condition. Additional facts. Some of the physiological causes of toxic phenomena in man, and the doses to be employed in laboratory demonstration?, and investigations upon animals, are given below. Experience teaches that there is a marked individuality regarding the poW' ers of resistance of an animal of a given kind to the effects of a certain poison, as compared with another animal of thy same kind which has been given a proportionate dose of the same poison. Allowances for such must be made in comput- ing dosage and in anticipating effects. Acetanilid. Paralysis of motor and sensory nerves. De- pression of heart and vasomotor mechanism, producing imi mediate fall of arterial blood pressure. Depression of res piratory center, diminished oxygen-carrying power of thf blood, and paralysis of peripheral motor nerves. Formation o' methemoglobin. Hemolysis may occur. There is loss of he^ through vaso-dilatation from the central action. On frogs it seems to paralyze motor nerve endings. Whe^ convulsions occur in animals, such are sometimes of spina* and sometimes of cerebral origin. Doses (toxic). Dog: 0.7 to 0.8 gm. x kilogram by mouth. Rabbit: 0.2 to 0.4 gm. kg. by mouth. Anilin. On frog: 2 drops in mouth producing convulsion?' cardiac paralysis and death. Phenacetin. On dog: 0.3 to 0.5 gm. x kg. by mouth toxic and fatal. Acid, Carbolic. Depression of cerebrum and heart; heat,' stops in diastole. Arterial tension reduced. Stimulation q' center and periphery of vagi. Depression followed by paralys}5 of respiration from depression of centers. Carbolic acid 15 absorbed from the stomach particularly when associated wiD alcohol; and it readily diffuses into the blood, where it probably exists as an alkaline carbolate. Although it is eliminated b} all the secretions, such occurs mainly through the lungs ana kidneys. In the urine it appears as salts of sulphocarbolic an® glycuronic acids, etc., but considerable of the phenol is eliny inated without being changed. There is diminished heat pr< duction and increased heat dissipation. Fall in blood pressuF through paralysis of vasomotor center. In collapse frotf phenol all the medullary centers and the cardiac muscle aC involved, and consequently the collapse cannot be removed by- artificial respiration. However, in collapse from drugs of the al- coholic series, the opposite maintains. Dose. Dog: 0.2 to 0.3 gq1- x kg. hypoderm., toxic and fatal. Cat: 0.1 to 0.2 gm. x kg. (P solution) hypoderm., toxic and fatal. Rabbit: 0.1 to 0.2 g# PHARMACOLOGICAL TOXICOLOGY 319 x kg. hypoderm., toxic; 0.5 to 0.7 gm. x kg. hpoderm., toxic and fatal. Guinea Pig: 0.4 to 0.6 gm. x kg. hypoderm., toxic and fatal. Frog: 1 to 8 mg. (in 5 per cent, solution) hypo- derm., toxic and fatal. Anesthetized dog: 50 mg. x kg. in vein, toxic; by stomach 1 to 2 cc. x kg., dilute or concentrated, toxic and fatal. Acid, Hydrocyanic. There is a primary involvement of the medullary centers, followed by that of other nervous centers. First a stimulation of the respiratory center producing fuller and more rapid respiratory movements. Then convulsive respiratory movements develop, accompanied by dyspncea, with ultimate paralysis of respiration; falling blood pressure, medul- lary and cardiac paralysis. Oxygen absorption is prevented, and the failure to reduce the oxyhemoglobin causes the venous blood to retain its bright red color. Dose: 5 to 15 cc. of a 2 per cent, solution is toxic and fatal by mouth. Rabbit, 5 to 10 cc. of the same solution. Acid, Mineral. By chemical combination with the proto- plasm, the tissue is dissolved, i. e., corroded. By coagulation of the myosin, muscular rigidity is produced. In combining with the protoplasm mineral acids neutralize the alkalies and form mineral salts. They combine with the albumin, forming acid albumin. Therefore, their local action is more or less caustic. Dose: hydrochloric acid, toxic and fatal effects. Rabbit, 1 per cent, solution by mouth 1 gm. x kg. Heart ac- tion and respiration slowed, paralysis and convulsions followed by death. Guinea pig, 5 to 30 cc. Acid, Oxalic. Affects central nervous system, especially the medullary centers. The mental functions and reflexes are first stimulated and then paralyzed. Death may be due to either cardiac or respiratory paralysis. Dose: Rabbit, 2 to 4 gm. by mouth, toxic and fatal. Guinea pig, 0.1 gm. hypodermically, toxic and fatal. Frog, 0.05 to 0.1 gm. hypodermically, toxic, may be fatal. Aconitine. The vasomotor center successively stimulated and depressed, and a very variable blood pressure occurs. The effects upon the heart are the result of direct action upon the heart muscle and also due to a stimulation and depression of the vagus and the accelerator mechanisms. There is increase m the rate of the heart action for a time. The heart becomes very arhythmic. Finally the medullary centers are paralyzed. Blood pressure is lowered by direct depression of the heart °r its motor ganglia. Ultimately the heart is arrested in diastole. Clonic convulsions may result through interference with the cerebral circulation. The sensory neurons of the spinal cord and the sensory filaments of the peripheral nerves are depressed. As aconitine has a sedative effect upon the stomach, toxic doses may not vomit. Dose: Aconitine, rabbity !-5 mg. x kg. hypodermically. Guinea pig, 2 mg. x kg. Pigeon, 06 mg. x kg. Frog, 0.2 mg. x kg. hypodermicallv. 320 A MANUAL OF TOXICOLOGY Apomorphine. On central nervous system, first stimulant then paralyzant in its action. The cardiac muscle may be ' paralyzed, also the respiratory center. Dose: Dog, 2 to 4 mg.^ x kg. hypoderm, causes emesis by action on medullary center. Rabbit, same dose acts as a cerebral stimulant, causing excite- ment, but does not vomit. Grain to applied to frog's heart diminishes action and causes paralysis. Arsenic. There is a fall in blood pressure, chiefly the result of the following: A peripheral vascular paralysis (capillary). Depression of the vasomotor center and diminished cardiac^ action. A great amount of blood is drawn from the general circulation by the distention of the splanchnic area, thus re- ' acting upon other organs, and a paralysis of tbe central nervous system may result. There is increased permeability of the capillary walls. In the intestine there is marked exudation into the connective tissue. Dose. Liquor Potasse Arsenitis (U. S. P.) : Dog, 1 cc. x kg./ by mouth, toxic and fatal. Rabbit, 1 cc. by mouth, fatal as a i rule. Belladonna (Atropine). Stimulation followed by paralysis of various parts of the central nervous system, particularly of the medullary and cerebral centers. A primary paralysis of certain peripheral nerve endings, as those governing secre- tion, accommodation, and the action of cardiac and intestinal muscle. Primarily stimulation, subsequently paralysis of smooth and cardiac muscle. Dose. Atropine Sulphate: Dog, 20 mg. to 0.4 x kg. hypo- derm. produces paralysis of vagi and proves fatal as a rule. Cat, 0.05 to 0.08 gm. x kg., paralysis of vagi. Rabbit, 1 to 2 gm. x kg. hypoderm., toxic. Dog (anesthetized), 1 mg. x kg. hypoderm., vagi paralyzed. Rabbit (anesthetized), 10 to 15 mg. x kg. hypoderm., prompt paralysis of vagi. Guinea pig, 0.5 ' to 0.8 gm. hypoderm., fatal. Frog, 0.1 gm., fatal dose. Solu- tion 1/6 to 1/10 per cent, applied to frog's heart causes arrest of mucous secretion and paralysis of vagus. Chloral. Depression of cortical cells of brain and of spinal cord. Respiratory center depressed, and its function may en- tirely cease from paralysis. There is an increased destruction of proteids. Chloral produces a destructive influence upon the blood and the blood vessels. Muscular metabolism is diminished through a lessened muscular activity. There is lessened oxidation in the cells of the body, and an increased heat dissipation owing to dilatation of the cutaneous vessels; a diminished heat production and reduction of bodily tempera- ture. Dose: Dog (anesthetized), 0.5 to 2 gm. x kg. in vein, toxic. Cat, 0.15 gm. x kg. by mouth, toxic and fatal. Frog, 0.1 gm., toxic and fatal. Chloretone. In true narcotic doses chloretone is more dangerous than chloral, but is useful as an anesthetic for lab- PHARMACOLOGICAL TOXICOLOGY 321 oratory animals, because of not requiring attention even in protracted operations. But when recovery of the animal is de- sired, as when no post-mortem changes are to be observed, it should not be used. The dog is given 20 mg. x kg. of mor- phine, and when vomiting has occurred, 0.2 gm. of chloretone Per kilogram of animal is introduced into the animal's stomach by means of the stomach tube; the chloretone is previously dissolved in the smallest quantity of alcohol which will dissolve Jt. Anesthesia occurs in 15 to 30 minutes, and usually con- tinues for several hours. In dogs there is a slow fall of blood pressure from chloretone. In rabbits the fall is rapid. Among the toxic effects of choloretone are a lowered blood pressure through a depression of the heart and vasomotor center, central vasomotor paralysis and cardiac depression. A great lowering of temperature and diminished consumption of oxygen from the effects produced upon metabolism. .Dose: Rabbit, ounce x kg. of a saturated aqueous solution given per rectum usually is toxic and fatal. 0.2 to 0.3 gm. x kg. dissolved in alcohol and given per rectum, toxic and fatal. Chloroform. Depression of motor and sensory neurons of spinal cord. Medullary depression resulting in slowed res- pirations and fall of blood pressure. Vasomotor and cardiac Paralysis, and diminished heat production. Probably there is a lessened irritability of the heat-regulating centers. Dose: Dog, cat, etc., 1 to 2 drachms hypodermically into femoral vein has toxic effect and produces rigor. Frog, 0.45 cc. hypodermi- cally, toxic and fatal. Cocaine. Depression of spinal cord and peripheral nerves, Particularly of the sensory nerve filaments and of the sensory columns. Vasomotor paralysis and depression of cardio-in- hibitory centers. Marked reduction in arterial pressure. Paralysis of the respiratory center. Dose: Dog, 15 to 30 mg. x kg. hypoderm., commonly fatal. Babbit, 60 to 70 mg. x kg. by mouth, toxic; 100 to 500 mg. * kg. hypoderm., usually fatal. Guinea pig, 60 to 70 mg. x kg. hypoderm., toxic and fatal. Frog, 3 mg. fatal. 1 per cent, solution applied to vascular surface causes vaso-constriction and temporary paralysis of nerve trunks. Conium (Coniine). Paralyses of both ganglia and motor endings. Action is therefore half-way between that of curare and of nicotine. The central nervous system, particularly the medullary centers, depressed, and the symptoms which occur are referable chiefly to the motor system. An ascending Paralysis ensues; it is probably due to a reduced conductivity of the cord to impulses coming from the brain. The first in- terference being a blocking of the path, to those impulses which have the greatest distance to travel. The ascending Paralysis gradually proceeds from the lower extremities to the. tongue; thus speech may be lost while the brain is still active and the mind clear. The historic symptoms of Socrates, 322 A MANUAL OF TOXICOLOGY after drinking the fatal cup of hemlock, well exemplify the leading features of an ascending paralysis thus induced. Dose: Dog, 0.2 to 0.4 gm. x kg. hypoderm., toxic. Cat, 0.05 to 0.4 gm. hypoderm., toxic and fatal. Rabbit, 80 to 100 mg. x kg., toxic and fatal. Guinea pig, 0.5 x kg. hypoderm., toxic and fatal. Frog, 0.06 gm. x gm. hypoderm., toxic and fatal. Convallaria. Action similar to that of Digitalis. Dose: Guinea pig, 0.04 to 0.1 gm. x kg. hypoderm., toxic and fatal. Frog, 0.26 to 0.30 mg. x gm., toxic and fatal. Curare. Paralysis of ends of motor nerves distributed to respiratory muscles. Central paralysis may result. End plates of motor nerves of striated muscles are paralyzed, the respira- tory and smaller muscles being affected first. Unstriped muscle terminations and sensory nerves are unaffected. There is a paralysis of the peripheral ganglia sympathetic. There is a re- duction in blood pressure and a diminished general metabolism. Although in warm-blooded animals death results from a paralysis of the respiratory muscles, nevertheless, if the dose has been barely large enough to produce a respiratory paraly- sis, recovery may occur if artificial respiration be maintained. In cold-blooded animals where the respiratory exchange oc- curs chiefly through the skin, respiratory movements not being necessary, elimination of the poison gradually takes place if the animal be kept in a moist atmosphere so as to favor such action. Direct application of curare to the spinal cord causes the typical convulsions of strychnine poisoning; as ordinarily administered such effects are masked by the paralysis of the nerve endings. Sometimes, however, typical strychnine con- vulsions appear before the development of the typical curare action. Dose: Frog, % to 3 cc. of a 1 per cent, solution of curare, introduced into dorsal lymph sac of frog, toxic, paralyzant. Digitalis (Digitalin. Digitoxin). Vagus center partially paralyzed, or may be intense irritability of cardiac muscle, re- sulting in delirium cordis. An arhythmia; inefficient cardiac contractions and cardiac exhaustion with relaxation in diastole. The blood pressure is irregular and ultimately it is greatly lowered. Inasmuch as absorption of digitalis occurs more rapidly than its elimination, it has an accumulative effect when given at about the limit dosage or over a protracted period in large doses. Dose: Dog (anesthetized), 1 to 5 mg. x kg. hypoderm., toxic. Frog, 3 to 5 mg. hypoderm., toxic and fatal. Ether. Over-stimulation and paralysis of respiratory cen- ter. Great reduction in temperature from depression of cir- culation and respiration, and rapid evaporation of the ether, by which body and lungs are chilled. The nervous mechanism governing the heat centers appears not to participate in this effect. Dose: Dog (anesthetized), 8 to 15 cc. hypoderm., toxic. Frog, 6 to 8 cc. hypoderm., toxic and fatal. Formaldehyde. Large doses injected into the blood cause PHARMACOLOGICAL TOXICOLOGY 323 coagulation, producing methemoglobin and hematin. Dose: Rabbit, 0.25 to 0.5 gm. x kg. hypoderm., toxic and fatal. Gelsemium (Gelsemine). Depression of heart and of spinal cord, especially of its motor neurons. The peripheral filaments °f the cranial nerves are paralyzed, also gradually the respira- tory center. Its mydriatic action appears to be due to a ^Paralysis of the motor oculi nerve. Dose: Guinea pig, 2 to 6 "gm. x kg. hypoderm., toxic and fatal. Frog, 7 to 15 mg. x gm. hypoderm., toxic and fatal. Local application to heart of 2 Per cent, solution causes paralysis. Hyoscyamus (Hyoscyamine). Action similar to Bella- donna. Dose: Guinea pig, 10 gm. x kg. hypoderm., toxic and rntal. Frog, 10 to 15 mg. x gm., toxic and fatal. Hyoscyamine: Lat, 0.03 to 0.06 mg. hypoderm, causes paralysis of vagi. Frog, 5 to 10 mg. hypoderm., toxic and fatal. Iodine (Iodides). Employed internally, rapid absorption Recurs in the form of iodides, and promptly appears in all of me body secretions. Most of it is removed in the urine in the torm of iodides. Iodides in the blood are supposed to be con- certed into sodium iodide without affecting the composi- jon of the blood. It is supposed that they form a loose combination with proteids. It is asserted that potassium ipdide dilates the blood vessels, thus increasing the secre- 'on of glands. Dose: Dog (anesthetized), tincture of iodine 4 cc. hypoderm., toxic. Rabbit (anesthetized), 0.1 to 1.0 gm. x *g. hypoderm., toxic and fatal. Ipecac (Emetine). Reduction of temperature by poisonous °ses. In dogs very large doses produce cardiac paralysis, es- pecially if injected into the jugular vein. Dose: Dog, emetine, to 2 mg. x kg. hypoderm., emetic. Dog, cat, rabbit, 0.1 to 0.2 ?m- x kg. hypoderm, or 0.02 to 0.05 gm. x kg. injected into femoral vein is promptly toxic; fatal. Frog, 5 to 10 mg. hypo- ^m., toxic, paralysis, fatal. Mercury (Corrosive Sublimate). The soluble salts of mer- Cl'ry to some extent inhibit the digestive properties. The in- soluble salts are somewhat irritating and produce increased Peristalsis and secretions. They act but slightly upon the digestive ferments. Leukocytosis, etc., may be produced by arge doses. Dose: Dog corrosive sublimate, 1 to 2 ounces of one per cent, solution by mouth toxic, producing more or ess corrosion of alimentary canal. In rabbit same dosage atul, with alimentary canal corrosion. Methylene Blue. There is a strong affinity between the axis cylinders of nerves and methylene blue. Dose: Dog (anes- hetized), 0.1 to 0.2 gm. in solution into femoral vein, toxic fatal. Muscarine. Stimulates the cardiac endings, which are para- lyzed by atropine. Contractility of skeletal muscles is dimin- ished. Fall of blood pressure. Vasomotor paralysis. Dose: / to 3 mg., toxic; 1 mg. hypoderm, produces toxic ef- 324 A MANUAL OF TOXICOLOGY fects; 3 to 12 mg., toxic and fatal effects. Frog, 5 to 7 mg..' hypoderm, paralyzes vagi and fatal. Opium (Morphine). Stimulates vagi both centrally and! peripherally and slightly stimulates the heart or the ganglial which it contains. Paralysis of vagi and heart with resultant rapid, feeble pulse finally occurs. It is supposed that opium' depresses both the cerebral perceptive centers and the afferent . paths in the spinal cord. Morphine locally employed directly depresses the sensory nerve filaments. It is a powerful res-' piratory depressant even to the point of paralysis. Peristalsisri is stimulated in toxic doses, the inhibitory nerves beings paralyzed. The pupils are contracted through stimulation oh the motor oculi centers. Dryness of mouth and thirst result from the checking of the secretions of the salivary glands by it. All of the bodily secretions, except that of perspiration, are lessened. Over-stimulation, and consequent exhaustion of the', vasomotor center and vagi, produces a rapid and weak pulsey Lactic acid forms in the blood through defective oxidation.. Dose. Morphine sulphate: Dog, 5 to 7 mg. x kg. hypodermic produces vomiting; 0.3 to 1.0 gm. injected into femoral vein of medium-sized dog is toxic. Cat, 40 mg. x kg. produces ex-J citement. Rabbit, 0.15 to 0.3 gm. x kg. hypodermic is toxic' and fatal; 0.5 to 1.0 gm. x kg. by mouth is narcotic, toxic and fatal, as a rule. Guinea pig, 0.5 to 0.7 gm. x kg., toxic and fatal. Frog, 0.05 to 0.08 gm. in posterior lymph sac, toxic, may be tetanus, and fatal. (Thebaine, one of the alkaloids of opium, belongs to the strychnine group of motor excitants, acting largely upon the spinal cord, causing an increase in the activity of its reflex functions.) Nux Vomica (Strychnine). Augmented susceptibility tc?; external stimulation, the slightest external stimulus produc- ing a greatly exaggerated reflex. Spasmodic and distressing.! muscular contraction, chiefly affecting the extensors. Opis- ' thotonos. Toxic doses of strychnine ultimately produce I paralysis of the motor apparatus, with loss of voluntary move- ment, the result of over-stimulation of the reflex centers in the spinal cord, causing exhaustion of the same. The pulse is' slowed and weakened, due to an over-stimulation of the motor mechanism and of the heart muscle itself. Blood pressure is increased and the visceral vessels constricted. Asphyxia may occur through interruption of breathing from the tetanic cony tractions of the respiratory muscles; these muscles finally be- come exhausted and death occurs from the excessive tetanic contraction and asphyxiated condition or from paralysis of the respiratory center. Respiration may cease some time before the heart stops. Dose. Strychnine Sulphate: Dog, cat, 0.75 to 1.0 mg. x kg. hypodermic, toxic and fatal. Dog, 2 to 4 mg- x kg. by mouth, toxic and fatal. Rabbit, 4 to 5 mg. x kg. by mouth, toxic, may be fatal; 0.58 to 0.6 mg. x kg. hypoderm., toxic and fatal. Guinea pig, 4.5 to 5.0 mg. x kg., toxic an4. PHARMACOLOGICAL TOXICOLOGY 325 fatal. Tetanus convulsions may be produced by much smaller doses. Note, in convulsions in frog legs are extended and arms flexed. Is possible to hold frog in horizontal position by the feet. Convulsions commonly intermit, frog paralyzed between spasms. Spasms start with cry. Paraldehyd. Cardiac exhaustion and lowered arterial pres- sure. Depression of respiratory center and finally paralysis. Dose: Dog, etc., I to 2 gm. x kg. anesthetic. Rabbit, 3 to 5 gm. x kg. by mouth paralyzes vasomotors. Phosphorus. Cardiac depression. Kidney epithelium irri- tated. Fatty degeneration of retinal capillaries. It is believed that a portion of the phosphorus is oxidized in the stomach. Then the phosphoric acid which is formed combines with the alkalies and enters the blood in the form of phosphates. Some of the phosphorus appears to be dissolved in the oils and fats which are contained in the stomach and probably passes into the circulation in the form of elementary phosphorus. Dose: Dog, 20 to 30 mg. x kg. by mouth (in oil or mucilage), toxic and usually fatal. Produces transitory leucocytosis. Physostigma (Physostigmine). Powerful stimulation of intestinal contractions. Depression of medulla and spinal cord. Abolished spinal reflexes, finally paralyses of medullary centers. It causes fibrillary twitchings from its- action upon muscle sub- stance. The fibrillary twitchings of aconite poisoning are due to its action on motor endings. Dose. Physostigmine Sali- cylate : Dog, 4 to 6 mg. x kg. hypoderm., toxic and fatal. Cat apd rabbit, 2 to 4 mg. x kg. hypoderm., toxic and fatal. Guinea P'g, 4 to 6 mg. x kg. hypoderm., toxic and fatal. Frog, 0.5 to °-8 mg. hypodermic, toxic and fatal. Dog (anesthetized), °-5 to 3 mg. x kg. hypoderm, removes effect of curare. . Picrotoxin. Acts chiefly on medulla. Clonic convulsions, increased respirations. Slowed heart and pulse, rise in arterial Pressure. Increased reflex irritability of spinal cord. Vaso- motor center stimulated. Depression of cardiac muscle, binally all stimulant action gives way to paralysis. Medullary centers paralyzed. In the frog spasms of the laryngeal muscles result in distention of the body with air and a characteristic cry quite like that frequently heard in poisoning of a frog with strychnine. The convulsions are cyclic and occur, as a rule, only after a period of depression. Between the con- yulsive periods the frog often appears to be paralyzed. Smce ln convulsions the action may be located in the sensory nerve endings, in the brain, the medulla, the spinal cord, the motor endings, or even the muscle fibers, it is interesting to locate s.Uch action in using the various convulsants. Motor stimula- tion may be central or peripheral. When central it is abolished by progressive destruction of the central nervous system, and 'ts exact location thus noted. In poisoning of a frog by picrotoxin it is seen to be located in the medulla; by strych- mne in the spinal cord; by atropine and cocaine in the cere- 326 A MANUAL OF TOXICOLOGY brum itself. Peripheral motor stimulation, not abolished by nerve section upon test, but abolished by curare, hence in the motor endings, as by aconitine and nicotine poisoning; not abolished by nerve section or by curare, hence in the muscle fi- bers, as in poisoning by caffeine, physostigmine, and veratrine. In picrotoxin, emprosthotonos and may be "bucking." Convul- sive action chiefly on flexor muscles. Dose: Dog, io to 15 mg. x kg- hypoderm., toxic; convulsions, paralysis, death; 0.06 to 0.1 gm. x kg. by mouth, toxic and fatal. Cat, 1 to 2 mg. x kg. hypoderm., toxic. Guinea pig, 5 to 10 mg. x kg. hypoderm., toxic; 10 to t5*mg. x kg. hypoderm., fatal. Frog, 5 to 8 mg. hypoderm., convulsant; 10 to 15 mg. hypoderm., fatal. Pilocarpine. Primary stimulation is followed by depression of the nerve endings, the ganglia and cells. There is depres- sion of the respiratory center, and vasomotor paralysis. Motor centers, especially of the cord, are paralyzed (atropine is a physiologic antidote). Finally a marked paralysis of various parts of the central nervous system. Late there is a paralysis of the motor oculi endings. When pilocarpine is applied to the heart of a frog it produces stimulation, then paralysis. It appears to be a direct paralysis of the heart muscle. Dose. Pilocarpine Hydrochloride: Dog, rabbit, etc., 5 to 8 mg. x kg. hypoderm, causes free salivation. Rabbit, 0.4 to 0.5 gm. hypoderm, x kg., toxic. Guinea pig, 0.04 to 0.05 gm. x kg., toxic and fatal. Frog, 0.05 to 0.1 gm., toxic and fatal. Potassium Permanganate. Gives up a part of its oxygen when it comes in contact with organic matter. Silver Nitrate. Precipitates the albumin of the cells with which it comes in contact, and contracts the blood vessels. In its concentrated state a caustic, coating the parts affected with a silver albuminate; but its corrosive effects are superficial, owing to the impenetrable character of the coagulum, promptly formed. Therefore its astringent action is exerted mainly upon the gastric mucous membrane, when it is swallowed. Only a very small proportion of that swallowed enters the circula- tion. Dose: Characteristic effects may be obtained with 10 to 20 per cent, solutions, under anesthesia, or by weaker, other- wise. Strophanthus. Much resembles digitalis in its action, but differs in some respects. In concentrated form it acts as a muscle-poison, producing paralysis and a tonic contraction of the fibers. It is eliminated about as rapidly as it is absorbed, consequently has little or no cumulative effects. Dose: Rabbit, 0.1 to 0.2 gm. hypoderm., toxic and fatal. Guinea pig, 7 to 10 mg. x kg., toxic and fatal. Frog, 0.01 to 0.03 mg. x gm., toxic and fatal. Dog (anesthetized), 0.05 to 0.15 gm. x kg., toxic, fatal. Tobacco (Nicotine). The peripheral effects of nicotine are quite similar to those of pilocarpine, except that the action is confined to the ganglia, and paralysis promptly follows stim- PHARMACOLOGICAL TOXICOLOGY 327 ulation. The nicotine effects may be removed by atropine or thuscarine. Nicotine convulsions are not entirely located in the spinal cord, but also in the medulla and hind brain. Stim- ulation of the central and ganglionic vagus slows the heart, hut subsequent paralysis of the vagus ganglia suddenly greatly Quickens it. Increasing depression of the vasomotor ganglia dilates the blood vessel and reduces the blood pressure. Fi- nally reduced coronary pressure wears out the heart muscle. After short stimulation effect, nicotine paralyzes the ganglia In relation to unstriped muscle. (Curare acts chiefly upon end plates, nicotine upon ganglia.) Upon frogs nicotine causes, ■\n toxic doses, first an extension of the forearms, finally also °f the hind legs. Dose: Dog and rabbit, a few drops of the a*kaloid dropped upon the tongue of the animal usually causes convulsions. Dog, 0.05 to 0.2 gm. hypoderm., toxic and fatal, as a rule. Rabbit, 20 to 30 mg. x kg., toxic and usually fatal, guinea pig, 30 to 50 mg. x kg. hypoderm., toxic and fatal, hrog, 2 to 4 mg. hypoderm., toxic and usually fatal. Dog or cat (anesthetized), 2 to 12 mg. x kg. hypoderm., toxic effects; vagus stimulated, then paralysis, paralysis ganglia. - Veratrine. Causes striated muscles to respond intensely to stimuli and there is a great prolongation of the period of con- l(action. Ultimately the muscles become paralyzed. Depres- S1pn of medullary centers and heart. Convulsions result from stimulation of spinal cord centers. In many respects veratrine acts like aconite. It finally depresses the central nervous sys- ^em more or less generally. In rabbits one of its common $xic effects is to make the animal "buck." It is corrosive. requently causes dizziness and blindness from its superior central action. Dose. Veratrine Sulphate: Rabbit, 2 to 3 mg. * kg. hypoderm, causes convulsions; I cc. of I per cent, solu- ^'on by mouth causes corrosion of stomach. Rabbit (anes- g>etized), 8 to 10 mg. hypoderm, paralyzes heart. Frog, 1 mg. uypoderm., toxic and fatal, as a rule; per cent, solution aPplied to frog's heart stops it in systole. the production of anti-toxines from MINERAL AND VEGETABLE POISONS. It is possible that the common mineral and vegetable poisons, such as arsenic, lead, mercury, atropine, morphine, etc., may cause the formation of antitoxines, as do the organisms of diph- heria, tetanus, etc., when administered for such purpose, tiirschlaff claims to have been successful in producing an anti- toxic serum capable of counteracting poisoning by morphine. He lnjected gradually increasing doses of morphine into rabbits and then administered, to other rabbits, some of the thus prepared serum, along with fatal doses of morphine. He claims to have found that much larger doses of morphine could be administered 328 PHARMACOLOGICAL TOXICOLOGY without fatal effects, when associated with such serum than with- out the latter. Also that the same serum was similarly protective to mice. He furthermore claims to have demonstrated that th*i antitoxic-rabbit's-serum is beneficial in acute morphine poisoning of the human ; and that in cases of the morphine habit, it enables- the victim to promptly discontinue the drug without experiencing the distressing nervous symptoms commonly encountered. HoW-[ ever, this and other sera of similar character, such as an alco- holic-serum, etc., have as yet not been so satisfactorily demon-; strated as to be accepted by the scientific world. Furthep demonstration is necessary for acceptance. THE FATAL DOSE, AND CAUSES OF DEATH It is very difficult to declare positively the exact fatal dose of any particular poison. Age of person} condition of stomach as regards food, early and frep vomiting, tolerance of that particular poison from habit or otherwise, etc., all more or less influence the, effect and result. Even in some authenticated cases, the exact quail' tity is unknown, and in others the strength of th^i preparation used is not stated. Some poisons are exceedingly active or deadly iP very small doses. Among these are Aconitine g-'( i/io; Digitaline gr. % ; Hydrocyanic Acid gr. li Strychnine gr. % ; etc., also some animal poison^ such as the venom of certain snakes, the bite of thy tarantula, etc. Some of the toxines are exceedingly poisonous. The toxin of diphtheria is so poisonoti5 that, it is said, so small a quantity of it as one four' millionth of the body-weight will produce death. < Poisons may cause death: by producing great r£' duction in body temperature; by hemorrhage due td corrosive perforation of blood vessels; by seveff pain, protracted vomiting or convulsions producing exhaustion; by cerebral or cardiac paralysis; by swelling of the glottis or epiglottis; by pulmonary edema; etc. The poison may be chemically discovered in the living body, in its blood or urine, or even in the serum of a blister. In the corpse the poison may 1/ found in the blood, in the viscera or other tissue or in the secretions. PECULIAR EFFECTS. 329 PECULIAR FOOD AND DRUG EFFECTS (Produced by the ingestion of them) SUBSTANCES EXCRETED IN MOTHER'S MILK When certain substances are taken by a nursing toother, commonly they are excreted in her milk. ,-Such are Ammonia and various aromatic and vola- tile oils (such as the oils of Anise, Cumin, Dill, b/ormwood, etc.) ; also Garlic, Turpentine, and Co- paiba; the purgative principles of Rhubarb, Senna, Castor Oil, and Scammony, etc.; also Opium, Iodine, odides, Antimony, Arsenic, Bromides, Quinine, Sul- nur, Hexamethylenamin, Bismuth, Iron, Lead, Mercury, and Zinc. Therefore, the actions of certain drugs administered to the mother may be observed ln and may even poison her child; among such are Opium, Arsenic, Potassium lodid, Mercury, etc.; Senna, Castor Oil and some other purgatives may *ct as drastic cathartics, influencing the action of other drugs or of irritant or other foods. SUBSTANCES CAUSING SKIN ERUPTION OR ITCHING Antimony, Antipyrine, certain sera-antitoxins, vaccines, glandular extracts, etc. Arsenic, Arsenicals, belladonna, Boric Acid, Bromides, Cantharides, Cin- chona, Chloral, Copaiba, Croton Oil, Crowfoot, Cu- °eb, Emetin, Ergot, Iodine and Iodides, certain es- sential oils and aromatic substances, such as Cloves, Pennyroyal, Peppermint, etc.; also Hexamethylena- ^in, Hyoscyamus, Morphine, Opium, Mustard, * °henol, Quinin, Salol, Salicylic Acid, Sulphonal, Tar, shell fish, currants, red berries, tomatoes, pickles, Cheese, etc. 330 MANUAL OF TOXICOLOGY. SUBSTANCES ALTERING COLOR OF URINE Dark green, or brown-Phenol. Bluish green-Methylene Blue. Brown or greenish-brown-Phosphorus, Phenol, Lead, Mercury, etc. Yellow or yellowish-Phallin, Phosphorus, Diamin,^ Rhubarb, Santonin. (If urine acid. ) Salol, To-1 luene, Senna, etc. (If urine alkaline.) Purple-Santonin. (If urine alkaline.) Red or reddish-Santoni .. (On exposure to air.) Senna. (If urine acid.) Solanin, Sulfonal, Phallin, * Antipyrine, Fuchsin, Trional, etc. Very dark, black or smoky-Sulfonal, Phenol, Creo-- sote, and various kidney irritating drugs. A light color-produced by drugs which increase the amount of the urine, (as, Potassium Salts, Digitalis, etc.). SUBSTANCES PRODUCING ODOROUS URINE Acid Hydrocyanic (odor of bitter almonds), vaj rious ethereal (essential, volatile) oils, and theii vegetable sources, Turpentine, Cubeb, Asparagus, Gin, etc. SUBSTANCES ALTERING COLOR OF FECESH Deeper color-Purgatives. Black or dark gray-Bismuth salts, Iron, Lead, Manganese, etc. Green or greenish-Colchicum, Mercury (as Calo- mel, etc.), etc. ' " e SUSPICIOUS SYMPTOMS. 331 SUSPICIOUS SYMPTOMS OF POISONING. (GENERAL HINTS) When a person apparently in good health suddenly becomes sick, vomiting or purging or both, or showing symptoms of great vasomotor disturbance, or marked cerebral symptoms, one should suspect the invasion of some acute disease, the presence of a severe gastro-intestinal irritant, or the action of some active poison, in the absence of a history of shock. If several persons are affected in the same way a food poisoning should be suspected. Convulsions, if present, might be due to acute disease, some gastro-intestinal irritant, or such poison as one of the alkalies, or strychnine, etc. Vomiting and purging might be due to disease or to such poison as ptomains, salts of the metals, aconite, alkalies, arsenic, or corrosive sublimate, etc. As a rule, when vomiting and purging occur they are nature's methods of removing that which is a menace to the individual and they should be judiciously encouraged. Great disturbance of heart action or of respiration, marked change in the color or appearance of the skin, a quick, feeble Pulse, hyperasthesia, anesthesia, prickling sensations, pupillary, speech, and temperature changes, stupor and coma, are phe- nomena which may point to acute disease or to a powerful irritant narcotic or depressant poison. Inquire as to the patient's recent experiences, such as history of fall, exposure to elements or contagion, etc.; also regarding medicines, food and drink taken, and observe source and any remnants of them. Test them, if necessary. Care- fully inspect the vomit and excretions, noting color, odor, re- action and presence of foreign substances, such as undis- solved poison, parts of poisonous plants, etc. A peach-like or bitter almond odor of breath or vomit would cause one to suspect hydrocyanic acid poisoning; the peculiar odors of alcohol, ether, formaldehyde, opium, lysol, phenol, etc., are characteristic of the respective poison and should guide to confirmation by other evidences than odor. Observation of the urine as to its appearance and color may reveal the red color of antipyrine or fuchsine, or the greenish of methylin blue, phenol or mercury, etc. Often in suspicious cases it is wise to remove and subject to prompt chemical and micro- scopical tests not only vomited matters and the first stomach washings, but also medicine and food remnants. As it is very humiliating to a physician to have others dis- cover that what he had taken for disease was a plain case of poisoning, it behooves him to be on his guard and painstak- ingly observant. (See also pages 251, 324.) 332 TRANSFUSION TRANSFUSION The term transfusion is somewhat indefinite, inasmuch as it may mean the transferring of blood from one person to another, the introduction into an individual of blood taken from the blood ves- sels of another person, or the introduction of a saline solution or other substance into the blood vessels or some cavity of an individual. The term direct transfusion, or the transferring of blood from one person to another without expos- ing the blood to the air, is more definite, and the process has certain decided advantages over that of indirect transfusion, which is the transferring of blood from a cup or other container to a blood vessel. Normal or physiologic salt solution (see page 118), or some modification of it, by intravenous in- jection, or otherwise, is useful after profuse hemor- rhage, severe diarrhoea, etc.; but it does not con- tain the red blood cells which may be requisite to replace those damaged in gas poisoning, etc., and it lacks fibrin ferment and fibrinogen, which are so essential in hemophilia; likewise, it lacks the ele- ments necessary for the nutrition of brain cells which have been damaged by shock. Blood transfusion is a central nervous and a cardiac stimulant. It supplies deficiencies and meets conditions for which saline transfusion is inadequate. Blood transfusion is especially serviceable in car- bon monoxide and other gas poisonings; in poison- ing by the saponins; in the poisonings by substances which produce methemoglobinemia, such as potas- sium chlorate, anilin and various other coal tar de- rivitives, picric acid, carbon disulphide, amyl and sodium nitrite, nitroglycerin, nitrobenzene, bromin, hydrogen cyanid, chromic acid and poisonous mush- rooms ; in the profound toxic conditions produced by the proteins of various foods and other agents; in the after effects of severe hemorrhage unasso- ciated with hemolysis; also in certain other condi- TRANSFUSION-Continued tions in which there is destruction of or serious damage to red blood corpuscles or other material change in the character of the blood. Secondary anemia from such intoxications as those of arsenic, lead, mercury and other inorganic poisons, from such organic poisons as the toxins of various fevers, and from certain autogenous poisons produced by such chronic affections as jaundice, nephritis, etc., may be materially improved by direct transfusion. Severe anemia, the result of a prolonged hemor- rhage in hemophilia, is best relieved by a certain form of blood transfusion, i.e., by the introduction of blood through a needle inserted through the skin directly into a vein; the ordinary direct transfusion methods are unsafe in this condition, owing to the danger of fatal hemorrhage from the requisite in- cision. In all of the transfusion methods a perfect asepsis should be maintained. The matter of the source of the blood in blood transfusion is important: the donor, the person giving the blood, shuld not be stout, nor over forty years of age, and free from disease. The Wassermann, hemolytic and agglutina- tion tests should be employed upon both donor and donee, unless the case is urgent. In both, the blood pressure, the blood count, the hemogiobin and the coagulation tests should be applied, the urine should be carefully analyzed and the pulse rate and the cardiac condition determined, all previous to the transfusion; the findings in these will influence the acceptance or the rejection of a prospective donor and serve as a guide in meeting the various needs of the donee. Fatal introduction of clot or of air into the blood sometimes occurs in blood transfu- sions, the result of faulty technic. The transfusion- valve method devised by Dr. George I. Miller, of Brooklyn, N. Y., seems to eliminate the probability if not the possibility of such occurrences; it is claimed that this method "will enable one to per- form transfusion, after a little practice, with ease, accuracy and safety." */ per®°n is unconscious, raise eyelid and touch white of eye. patienc will 717177m I t . °b^ state and position of patient's body. Place patient on back, head to one side, so that tongue or vomited ^s^an^sto^Ur^ If be pale'keep head low; if flushed, elevate it. Loosen clothing about nick, chest and to lilht and toucl If nu^™dlf Place a?ay £k°1?1 ob^cts °f injury. Test eyes for condition of pupils, squinting, response minds tA Jh P t 77 y contracted probably poisoned by opium; if unequally contracted, probably injury to brain; if 7! u ,17 to touch probably no injury to brain. If face drawn to one side, probably apoplexy or compression"of brain- if tongue and frothin' c7ay detect °dor of alcohol or opium on breath. Examine mouth and tongue; bite'on sholk nl into7*7a^ I' surface of body; very cold skin indicates fainting, collapse, freezing, severe 7 • skm Vacates g^at fever or sunstroke. Observe breathing; if slow, indicates shock or other depression; 7X 7? „ s,'ndtcates opium poisoning or brain affection. Observe the pulse; if rapid, indicates sunstroke or fever; if slow, brain falUUfJkcci,1:77y T"1 ra.pld.' indicates shock or some depressing effect. Raise successively each extremity and allow to drop: if and extremfe If patlent in convulsion, suspect hysterical, uraemic, epileptic or such convulsions. Examine body PART X.- UNCONSCIO^ COMA.-Its Interpretation and Treatment. KIND OF COMA. 1 ETIOLOGY. DEVELOPMENT. CHARACTER. CONVULSIONS. PARALYSIS RESPIRATION. TEMPERATURE. jj PUPILS. PULSE. SKIN. STOMACH AND 1 BOWELS. 1 DOR OF BREATH, ETC. URINE. TREATMENT. Alcohol. Alcoholism. Delirium. Coma lasts for hours; gradually lessens. Aroused by ammonia or shaking, but is incoherent. No convulsions. No paralysis. "Steamboat." Stertorous. ' leavy. Low. Falls progres- sively from 1° to 6° beloW normal. ^Wed as a rule; Ea may be nor- i insensible to inb conjunctiva Jested, lull and trong; later 1 eeble. Is a trong in Can- 1 tabis Indica. first moist nd warm, hen cold. J /omiting, |g usually 3reath alcoholic. But Icohol may have aused ruptured cere- nal blood vessels in ither coma. By analysis alco- hol. Urine re- tained. Apomorphine hypodermically. Empty stomach. Cold to head. Heat to extremities. Strych- nine to support heart. Belladonna. Belladonna, etc. Dryness of mouth and throat. Delirium precedes coma. Slow and deep. Frequently elevated. ^ated. • Much in- . . creased. dot and dry. Urine retained. Emetics or wash out stom- ach; inject Pilocarpine and stimulants subcutaneously. Douches; Opium. Chloral. Chloral, etc. Profound coma. Can- not be aroused. Diminished, sigh- ing or stertorous; then shanow and feeble. As low as 94° F. or even 91° F. iracted. Di- 4. -1 when awake, nv. Slow, or very weak and quick. Later lost. Very cold. Fi- nally urticaria. Emetic or pump; arouse; hot applications; coffee, strych. nine; artificial respiration. Hydrocyanic Acid. Hydrocyanic acid, etc. Profound coma. Convulsions common. Short inspiration. Prolonged expira- tion. Gasping, panting. wated- Not re- 1tlng to light. Imperceptible. Cold, covered with clammy perspiration. Odor of bitter al- monds. Stimulants; Ammonia in- ha'ations. 1-50 grain Atropine hypodermically. Artificial respiration. Battery. Opium. Opium, etc. Developed gradually. Aroused by noise, not by shaking. When aroused is coherent. No paralysis. First 8 to 10 per min., but deep; then 4 to 5 and long pauses. Shal- low. infracted. Insen- T light. As ft , I11 approaches, Strong. Slow and lull till .ate in poison- -ng. First dry, per- haps warm ; later cold, clammy sweat. Opium in breath. Opium. Wash stomach; one pint strong coffee into rectum; Battery; keep moving; Atro- pine subcutaneously; artifi- cial respiration. Pot. Permang. Asphyxia. Exposure to gas or foul air. Cannot be aroused. May end in convulsions fol- lowing distress- ed breathing. Difficult owing to oedema of lungs. Low. 1 Small. Rapid. Weak. Surface dry and hot. - Much CO or CO2 in breath. Fresh air; inhalation of oxy- gen; artificial respiration. If by CO transfuse blood. Syncope (Cerebral Anaemia). Shock, etc. Coma develops sud- denly, but is tran- sient. Weak but unem- barrassed. Sighing. Absent at vrist. Cold and per- spiring. Lower head; stimulants; smelling salts; cold water to face. Heat to body. Congestive.-■ Insolation. Thermic fever. Sunstroke. Exposure to heat or sun's rays. Develops gradually. Coma yields readily to treatment. No true paral. No coma. Col- lapse in heat exhaustion. Shallow. May be noisy. High. In heat ex- laustion no fever. ■graded or di- Rapid. In leat exhaust'n, soft, feeble. Congested. In heat exhaustion moist, cool, pale. Involuntary diarrhoeal discharges. Passed involun- tarily. In heat stroke, cold to entire body, as by bath; cold ene meta; stimulants. Insnnstroke cold to head, heat to body. Apoplectic (Sine trauma.) Apoplexy (as a rule the left side and old and fat peo- ple). Suddenly developed. Profound stupor from beginning. No signs of injury. No oozing from nose or ears. One side toss- ed, other side motionless. Hemiplegia. Slow; stertorous. Elevated particularly on side paralyzed. or un 1 m Contracted < ; th Rons Varolii Small. Slow. Weak. In head injury suspect cranial fracture. Body emaci- ated. Faeces retained. Breath sweet or may smell of alcohol, as acute alcoholism may have ruptured certain blood vessels. Urine abundant; passed involun- tarily; smells sweet. Keep head elevated; reduce pressure in arteries; venesec- tion if necessary; ice-bag to head; heat to extremities; purge; then alteratives. Epileptic. Epilepsy. Cannot _ be aroused. Attack is short. Follows con- vulsions. N atural. High. p 11 Nearly normal. Odorless. Protect body from cold or heat. Patiently wait for con- sciousness, protecis&g pa- tient from bruises. Diabetic. Diabetes. Develops slowly with sleepiness and great oppression. Patient can- not be aroused. Coma gradually deepens. No convulsions. No true pa- ralysis. Rapid. May be noisy. Usually normal. May go down to 90°. Rapid. W eak. Breath smells sweet, like pear or apple, 01 chloroform. Chemical exam- ination shows sug- ar. Large amount passed involuntar- ily- Give inhalations of oxygen; intravenous injection of sa- line solution; opium if con- vulsions appear. Uraemic. Uraemia. Begins with delirium or convulsions; coma complete. Repeated con- vulsions, per- haps from first. Deep; quick; stertorous. Without convulsion is low, 91°-95°. With convulsion,high; may reach 108°. size nor' 'EL or dilated eyelids. Full, hard and strong, but not fast. Often only 40 to 50. General cedema of body. Urine odor about patient. Albumen and casts; urine scanty and re- tained. Uraemic coma not neces sarily fatal. Pilocarpine hy- podermically; Croton oil gtt. j. If plethoric venesec- tion; chloroform inhalation; support heart. Remarkable recoveries. Traumatic. (Cerebral. Meningeal- Hemorrhage). History of an injury. Patient may recover and relapse. Signs of head injury. May be bloody or se- rous discharge. Is grad- ually increasing stupor. Both sides may show paralysis, or one tossed. Slow; stertorous. Tips inflated on one side on ex- piration. Usually high. M^^ils unequal Apt to be strong and slow. Hot or dry. Early operation for removal of blood clot, and if neces- sary ligation of artery. Hysterical. Trance. (2) Hypnotic. (3) Hysteria. (Fe- males mostly.) Consciousness suddenly lost. Hypnotized. Developed suddenly. Coma alternates with hysterical delirium. No stertor; may be weak. I Usually lowered. ! ilMght1.- Sensitiv Feeble, and frequent. Flushed anc hot. (2) Skir cold. (3) Limb remain as placed. No vomiting. □ J No diarrhoea. No odor- Incontinence. Cold applications. Give Arom. Spt. Ammon. (2) Watch; nourish. (3) Interrupt. 338 MANUAL OF TOXICOLOGY, HINTS ON BRAIN AND HEART POISONS BRAIN. There are three principal groups of poisons affecting the brain: A. The Opium group, the predominant feature of which is the production of sleep. B. The Belladonna group, which produces illusions and de lirium. C. The Alcohol group, which produces excitation and exhila- ration, followed by delirium, and incoordination or sleep. The Opium group causes dizziness, disturbed vision, ringing in the ears, contracted pupils (perhaps to a pin point and but slightly affected by light), headache, mental confusion, stupor. Post Mortem find effusion of serum beneath membranes ancH into ventricles. Brain sinuses and veins filled with blood. The Belladonna group causes indistinct vision, color-illu- sions and form-illusions, excitement, delirium, thirst and dry- ness of mouth, dilated pupils, perhaps convulsions, paralysis, coma. Among these are Belladonna, Stramonium, Hyoscin, Scopolamin, etc. The Alcohol group causes rapid and forceful heart action, mental excitement and confusion, then diminished muscular action, disturbed coordination, hallucinations, weak pulse 1 double vision, stupor, coma. In chronic alcoholism commonly there is delirium tremens. Post Mortem find brain and its membranes congested, and frequently indications of inflammation. The blood is unusually fluid and rigor mortis is persistent. HEART. Poisons acting on the heart cause death by producing more or less sudden shock, or depression, associated with faintness and collapse. To this group belong Oxalic Acid and the Oxa- lates, Aconite, certain coal-tar products, Hydrocyanic Acid, the cyanides of Potassium and Mercury, Digitalis, Cocain, etc. GUIDE TO POST-MORTEM PROCEDURE. 339 PART XI. GUIDE TO POST-MORTEM PRO- CEDURE. (In Suspected Poisoning.) In cases of suspected poisoning, the following practical di- rections are given by Professor Reese, to be observed by those who have charge of post-mortem examinations:- I. Ascertain whether the individual has labored under any previous illness; and how long a time had elapsed between the first suspicious symptoms and his death; also, the time that had elapsed after death before the inspection is made. 2. Note all the circumstances leading to a suspicion of mur- der or suicide-such as the position and general appearance of the body, and the presence of bottles or papers containing poi- son about his person, or in the room. 3- Collect any vomited matters, especially those first ejected, and preserve them in a clean glass jar, carefully stoppered and labelled. The vessel in which the vomited matters have been contained should be carefully inspected for any solid (min- eral) matters which may have sunk to the bottom, or adhered to the sides. If no vomited matters be procurable, and vom- Rmg has taken place on the dress, bed-clothes, furniture, etc., then portions of these must be carefully preserved for future examination. 4- Before removing the stomach, apply tzvo ligatures beyond each extremity, dividing between each pair, so as to prevent the loss of any of the contents. 5- If the stomach be opened for inspection, this should be performed in a perfectly clean dish, and the contents collected carefully in a graduated vessel, so as to properly estimate their Quantity. [Note here, also, the presence of blood, mucus, bile, °r undigested food.] These contents should be preserved in a perfectly clean glass jar, securely stoppered, covered over with 340 A MANUAL OF TOXICOLOGY. bladder and sealed. The contents of the duodenum should be collected and preserved separately. 6. Carefully inspect the state of the throat, (esophagus, and wind-pipe for the presence of foreign substances, and for marks of inflammation or corrosion. 7. Observe the condition of the large intestine-especially the rectum; the presence of hardened faeces would indicate that purging had not very recently taken place. 8. Note any morbid changes in the lungs, as congestion, inflammation or effusion; in the heart, as contraction, flaccidity, presence of a clot; and the condition of the contained blood. 9. Examine the state of the brain and spinalmarrow, and, in the female, the condition of the uterus, ovaries, and genital organs. (Poisons have sometimes been introduced into the vagina.) 10. Along with the contents of the stomach and duodenum, the viscera that are to be reserved for chemical analysis are the stomach and duodenum (to be kept separate from the others), the liver and gall-bladder, spleen, kidney, rectum, and urinary bladder with its contents. Sometimes, also, a portion of the blood may be required for the examination. 11. As the legal authorities will rigorously insist upon the proof of the identity of the matters alleged to be poisonous, it is of the greatest importance to preserve such matters from all possible contamination by incautious contact with calico or paper for wrapping up the specimens. When once the sus- pected articles are deposited in the hands of a medical man, he must preserve them strictly under lock and key, and confide them only to a trusty agent for transportation. Many cases are on record where the chemical evidence failed simply from a want of power clearly to establish the identity of the mat- ters analyzed. Actual testing for poisons in cases of suspected criminality ought to be undertaken only by those whose chemical knowl- edge and skill are considerable. A post mortem examination should be made in regu- lar and generally established routine, that it may be orderly, etc. The presence of other medical men and of an assistant to make notes may be of subsequent importance. The report on the autopsy should be clear, accurate, concise, and without expression of personal opinion. The report on the analysis should be comprehensive and as far as possible conclusive. POST-MORTEM EXAMINATIONS. 341 directions for making post-mor- tem EXAMINATIONS. The following suggestions and directions, by Dr. Witherstine, for making post-mortem examinations, are worthy of consideration : In conducting post-mortem examinations, with a view either to pathological study or medico-legal investigation, order and method are of great importance. The three great cavities-the head, the chest, and the abdomen-should always be examined, whether suspicion of disease in them exists or not. First, however (the autopsy being made from twelve to thirty-six hours after death), we should note the external appearance of the body-its size, Weight, conformation, color of the skin, etc. (In cases of suspected violence, even abrasion should be minutely de- scribed.) To examine the head, an incision should be made through the scalp, across the top of the head, from ear to ear; the two flaps thus formed should be reflected, the one over the fore- head, the other over the occiput. The nature of the attach- ment of the occipito-frontalis muscle to the bone beneath is such as to allow, very easily, the loosening of the scalp. The cranium (calvaria) is now to be removed by means of a small saw. For the purpose of holding the head firmly during the use °f the saw, Dr. T. A. Demme has furnished, as a substitute for the craniotome of Mr. Lund, of London, a cranium-holder, which enables the operator to make a section of the skull in any direction. It consists simply of a bar of iron, curved like the letter U, at each extremity of which two drill-screws are placed, which, when forced down upon the bone, holds the bar firmly in situ, and enables the examiner to control the head. The legs of the instrument, for use, are placed upon the lateral Portions of the skull over the squamous portions of the tem- poral bones. The section of the cranium with the saw should be made through its outer table completely around the head-from before backward, from below the frontal protuberances to the squamous portion of the temporal bone, and from behind for- ward, from the occipital protuberance to the squamous portion of the temporal bone, meeting the line just described. The shape of the piece thus cut out enables it to be maintained in its proper position when the parts are readjusted. It is re- 342 A MANUAL OF TOXICOLOGY, moved by the aid of an elevator, or chisel and hammer, fraC' turing the inner table of the skull by strokes so applied as not to pierce the brain. The dura-mater is next to be cut through, on each side of the superior longitudinal sinus; after which dividing the falx cerebri, the brain may be raised carefully with the hand placed under its anterior portion. The internal carotid artery and cranial nerves, etc., are now to be severed by the knife, and finally the vertebral arteries and spinal chord. The brain itself may then be taken out and inspected, by slicing it from the upper part downward, in successive horizontal layers. To examine the spinal column, an incision should be made from the occipital protuberance to the extremity of the os occygis. The deep muscles of the back should then be loosened from their attachments so as to expose the laminae and spinous processes of all the vertebrae. With the chisel and mallet, or saw, we must cut through the arches of the verte- brae on each side, close to their articular processes. After thus opening the spinal canal, the cord is to be exposed by dividing the dura-mater through its whole length. To examine the neck, an incision should be made through the skin, extending from above the hyoid bone to the upper part of the sternum. Avoiding penetration of the large veins of the neck, the parts to be examined may be carefully dis- sected, and, if desirable, removed from the body. The thyroid gland, larynx, and its appendages, tongue, pharynx, oesopha- gus, blood-vessels, and nerves of the neck, may be thus viewed. To examine the chest, two incisions are desirable; the one from the root of the neck, in front, to the extremity of the ensiform cartilage; the other at right angles to this, across the middle of the thorax. The cartilages of the ribs are to be cut through at the lines of junction with the ribs. The ensiform cartilage, being drawn outward, is to be detached from the soft parts, the knife being held close to the sternum. The sterno-clavicular articulation may now be opened, and the sternum with the costal cartilages raised from its position, a cautious use of the knife being made to remove the adherent soft parts. The thoracic viscera are now exposed, and may be drawn out with care and inspected in detail. To examine the abdomen, make a crucial incision; the one branch extending from the sternum to the pubes, passing to the left of the umbilicus; the other transversely across the POST-MORTEM EXAMINATIONS. 343 middle of the abdomen. Care must be taken, in making these incisions, not to injure the subjacent viscera. Before removing the stomach or any portion of the intes- tines, ligatures should be placed above and below the part that is to be separated. When-as is always desirable, if possible-both of the large cavities of the trunk are to be opened, a single incision, ex- tending from the top of the sternum to the symphysis pubis, may be made. In every case incisions through the skin should be made, as far as practicable, only in those parts which are usually cov- ered by the clothes of the deceased. It is generally advisable, when the abdomen or thorax has been opened, to fill the cav- ities with bran or sawdust. After the examination has been completed, the edges of the divided integument should be brought together, and retained in apposition by the common continued suture. The following are said to be the average weights and measurements of the viscera in health. Some allowance must, of course, be made for extremes (either way) of height and weight. The measure- Wents are in inches: ■Heart-Adult, Male 11 oz. Heart-Adult, Female 9 oz. WEIGHTS AND MEASURES OF VISCERA. Usually about the size of the closed fist(i. e., 5 x 3% x 2^ in.). Brain -Adult Male 49X oz. Brain-Adult Female 44 oz. Spinal Cord... 1 oz. to 1% oz. Liver ;..5O oz. to 60 oz. Pancreas 2^ oz. to 3^ oz. Spleen. 5 oz. to 7 oz. Lungs-Ad., Male (together) 45 oz. Lungs-Ad., Female " 32 oz. Stomach 4% to 7 oz. (Moderately full, 12 in. horiz. x 4 in. vert. Holds 3 pints.) thyroid body 1 oz. to 2 oz. Thymus at birth % oz. Kidneys, together 9 to 10 oz. (Size, 4 x 2 x 1 in. each.) Suprarenal capsules. ... 2 drachms. Prostate gland ... 6 drachms. Testicles, together....% oz. to 1 oz. Lnimpregnated uterus.7 to 12 drachms. (Size, 3 x 2 x 1 in. or a little more.) 1 line (written ") is 1-12 of an inch (written ')• Cuvier, 64 oz. Byron, 58 oz. (18 in. long,) (12 x 7 x 3 in.) 344 HEIGHT, WEIGHT, ETC. (AVERAGES). HEIGHT, WEIGHT, GIRTH OF CHEST (Averages) lbs. Weight at birth 6.8 Weight at one month 7.4 Weight at two months 8.4 Weight at three months .... 9.6 Weight at four months .... 10.8 Weight at five months 11.8 Weight at six months 12.4 (From Report of Brit. Anthropom. Com., 1883.) (Adapted from Wellcome.) lbs. Weight at seven months ... 13.4 Weight at eight months' .... 14.4 Weight at nine months .... 15.8 Weight at ten months 16.8 Weight at eleven months ... 17.8 Weight at twelve months .. 18.8 Males Females Age. yr. Height ft. in. Weight lbs. Age yr- Height ft. in. W eight lbs. I 2 si i8| 14 4 "1 92 2 a 8| 322 15 5 21 loaf 3 2 II 34 x6 5 41 119 4 3 1 37 17 5 6j 131 5 3 4 40 18 5 7 137} 6 3 7 44i 19 5 7i !395 7 3 10 49s 20 5 72 I43i 8 3 11 55 21 5 72 145 9 4 if 6o| 22 5 72 147 IO 4 34 M 23 5 72 J47i II 4 52 72 24 5 7s 148 12 4 7 76J 25-30 5 7f 152I 13 4 9 825 31-35 5 « 160 Age y- Height ft. in. W eight lbs. Age y- Height ft. in. Weight lbs. I 2 3 s 18 14 4 "3 963 2 2 7 2 51 15 5 ' io6j 3 2 IO 3'5 16 5 '3 "3, 4 3 0 36 17 5 2^ "5* 5 3 3 39 18 5 2| 121 6 3 6 4'1 19 s 2| 124 r 7 3 8 475 20 5 3 I23J 8 3 '°5 52 21 5 3 122 V 123M 9 4 4 555 22 5 3 IO 4 3 62 23 5 3 123 11 4 S 68 24 5 2J 121 *1 12 4 75 7^4 25-30 5 2 120 | 13 4 91 87 31-35 5 » 121 Height ft. in. Weight lbs. Chest Girth in. 5 o 112 5 i n6 34 5 2 126 35 5 3 133 35 5 4 1.39 36 5 5 142 37 5 6 145 37J COMPARISONS IN ADULT MALE Height Weight Chest Girth ft. in. lbs. in. 5 7 148 38 5 8 155 38! 5 9 162 39 S io 169 392 5 ii 174 4° 6 o 178 4°z 6 i 182 41 COMPARISONS IN ADULT FEMALE Height ft. in. Weight lbs. 4 io 98 4 11 102 5 o 105 5 i IIO Height Weight ft. in. lbs. 5 2 114 5 3 121 5 4 128 5 5 135 Height ft. in. Weight lbs. 5 6 i39 5 7 148 5 8 158 Note.-Growth is most rapid during the first five years of life, the rate of growth being about the same in both sexes, girls being a little shorter and lighter than boys. From 5 to 10, boys grow more rapidly than girls. From 10 to 15, girls grow more rapidly than boys, and at 11^ to 14^4 they are actually taller, and from 12J4 to 15*4 actually heavier than boys. From 15 to 20,_ boys begin again to increase more rapidly than girls, and complete their growth at about 23. After 15, girls grow more slowly, and practically reach their full height and weight at 20. During childhood increase in weight is more marked in the winter, and increase in height in the summer. In old age, weight greater in winter. Average weight of woman's clothing is about 1/20 of her body-weight; man's about 1/25 of his body-weight. POST MORTEM APPEARANCES IN POISONING. THE MINERAL ACIDS (IN GENERAL). The presence or absence of rigor mortis may be of considerable importance in determining probable time of death in a case of poisoning. Bichat declares he never found rigor mortis in death from charcoal as- phyxiation. Brouardel declares he always found it. It may be said in a general way that rigor mortis first makes its appearance from the third to the sixth hour after death. But after poisoning by a large dose of strychnine, rigor mortis immediately succeeds the muscular contraction, if such exists at time of death. Appearance of body may be healthy. As a rule there are stains about the mouth, fingers and other places with which the acid has come in contact. Mouth cavity and esophagus are usually white and corroded at first but become dark brown and shriveled; mucous membrane detachable. Epi- glottis and glottis swollen. The stomach is some- times contracted, sometimes distended with gas; contains a thick, dark-brown fluid. Outer surface of stomach and intestines is very vascular and that of the stomach may be corroded or perforated. Inner surface of stomach may appear charred and the mucous membrane between the rugae present a scarlet hue. In poisoning by the acids the lining membrane of the esophagus is usually wrinkled or furrowed longitudinally and the mucous membrane of the stomach raised in discolored ridges. The py- lorus is usually contracted. The appearance of the inner surface of the small intestines is similar to that of the stomach, if the patient has lived long enough, but is less in degree. Perforation, if it oc- curs, usually takes place posteriorly if before or after death the person lay on the back, and the edges of the rent are found to be softened. The perito- neum may be greatly inflamed from the escape of the stomach contents through the perforation into, 346 A MANUAL OF TOXICOLOGY. the abdominal cavity. The bodies of persons dead from poisoning by mineral acid seem, for some time, to resist putrefaction. MINERAL ACIDS. (In detail). ACID HYDROCHLORIC. No stains on lips or face. Usually mucous mem- brane of mouth, esophagus, etc., are white or whitish- brown, blackened or charred. Ridges on inside of stomach. Glottis and larynx may be injected and corroded. Hydrochloric Acid poisoning has not been found to result in perforation. ACID NITRIC. Discoloration of lips, tongue and inside of the mouth. Mouth and spots on skin where acid has been in contact appear yellow, which is intensified by a solution of caustic potash which would dis- charge Bromine or Iodine stains. Mucous mem- brane of digestive tract eroded and softened, but stomach rarely perforated although softened; it may be shreddy. The color appearance of the stomach varies-it may be yellow, due to the action of the acid upon the mucous membrane; black from action of acid on the blood; green or brown from action of acid on the bile. Bladder usually is empty. Blood dark and thick. Lining membrane of esophagus may be divided into minute squares by longitudinal and transverse furrows. Seldom that action of acid is well marked beyo '1 the duodenum. Post mortem appearances differ in stomach and internal organs according to whether death is rapid or slow, whether the patient dies from acute poison- ing, or lives some time and dies from ulceration and ACID SULPHURIC. VEGETABLE ACIDS. 347 contraction of some part of the alimentary canal. Usual appearances are: larynx, trachea and lungs softened and blackened; esophagus grayish or black- ish, softened, and mucous membrane may be sepa- rated and peel off. Stomach usually is greatly in- flamed in patches or generally, crossed by black lines, and softened or perforated; often contracted •^nd collapsed; black corrugated mucous membrane Which may be partly stripped off with underneath surface intensely red; contents may be blackish, Pulpy and tar-like, from altered blood; contents of blood vessels black and hard; if there has been per- foration, the edges of the opening appear dark and ragged, and the adjoining viscera is blackened and .softened. If death was not immediate, may be evi- dences of inflammation of intestines, peritoneum, etc. In rapid cases extensive coagulation of epi- thelium in the convoluted and straight urinary tubes; the kidney parenchyma is destroyed but there is absence of inflammation. If acid entered the air passages they will present evidences of corrosive action. Skin of face or surrounding parts touched by acid will generally be corroded and as if covered With white paint, browned or blackened. (But if the poison was taken from a spoon or the neck of a bottle, the mouth may show no signs.) VEGETABLE ACIDS, CARBOLIC ACID, ETC. ACID ACETIC. The mucous membrane of the stomach is not cor- roded nor softened but is blackish near the pylorus. Coagulated blood in submucous areolar tissue of stomach, interspersed with black elevations. Tongue and esophagus a dirty brown color. ACID CARBOLIC. The odor of the acid can be perceived in the body Tter death. When Carbolic Acid is introduced by 348 A MANUAL OF TOXICOLOGY. subcutaneous injection or by outward application there are no characteristic post mortem appear- ances; but when by mouth, grayish white, or when dry, brownish, leathery, wrinkled spots may be found on the cheeks or lips; the mouth, throat, esophagus and stomach often are whitened and sodden and their mucous membrane may be readily detached. If the acid was concentrated, the surface may be eroded. There is reddening (inflammation) between the folds of the stomach. Sometimes the stomach is thickened, contracted and blanched; often greatly congested, and the mucous membrane detached or destroyed. Stomach eschars usually longitudinal, white or gray, involving crests of the folds. Wall of stomach has leathery feel. The duodenum, further portions of intestines, liver and spleen may be affected. Respiratory passages often inflamed and lungs usually filled with blood. Left ventricle of the heart is contracted; right ventricle is dis- tended. The blood is fluid and dark colored. Usually, bladder is empty. The brain sometimes is congested, fluid being found in the ventricles. Blood vessels of liver, kidneys and spleen are gorged with blood. Death resulting from sudden nervous shock, caused by taking a large quantity of the acid, would of course present different post mortem ap- pearances from the foregoing. ACID HYDROCYANIC. There are no constant or characteristic lesions. The stomach may be normal or congested. A gen- eral venous congestion is the most common sign. It may be said in a general way that with the ex- ception of the changes which may be found in the stomach after doses of Potassium Cyanide the pathological changes produced by Hydrocyanic Acid and Potassium Cyanide are very similar to those produced by suffocation. The most notice- able fact about the body is the presence of bright- red spots or patches on the surface of it, due to the ACID OXALIC. 349 formation of cyanmethae-moglobin. The lungs and right heart are full of blood and the pulmonic block produces a backward engorgement. If death be rapid, the left side of the heart is usually empty and strongly contracted; but if death be slow, left side is full of either black and fluid or of coagulated blood. The arterial system is empty. The liver and kidneys, vessels of head and veins of the neck usually are congested. The lungs are gorged and frequently portions of them are oedmatous and there is a bloody foam in the mucous membrane of the bronchial tubes. The pleura and other serous membranes are ecchymotic. As a rule an odor of Hydrocyanic Acid exists everywhere, unless concealed by putrefac- tion, by tobacco, onions, or a strong smelling ethereal pil. The odor of Hydrocyanic Acid may be noticed m the stomach or other parts of the body in some pases, or it may be absent in the stomach and present in other parts of the body. Sometimes the bile is found to be of a deep blue color and the blood black, fluid, or coagulated, and the odoi' of Hydrocyanic Acid easily recognized. There may be turgescence of the vessels of the brain and an effusion into the ven- tricles. Casper and Blyth recommend that the head be first opened and examined to perceive the odor in the brain, where, if present, it may longer be detected than in the abdominal and chest cavities, owing to the earlier putrefactive changes in the latter. No mflammatory change in the stomach mucous mem- brane would be expected in poisoning by Bitter Al- tnonds, yet eroded, inflamed patch found in one case. Cherry Laurel Water. The stomach is very red. One case showed in- t?use congestion everywhere. ACID OXALIC. The mucous membrane of the mouth, pharynx and esophagus is usually soft or brittle, white, shriv- 350 A MANUAL OF TOXICOLOGY. eled and easily removed. The surface of the eso- phagus may appear brown and raised in longi-. tudinal folds. The stomach is frequently con- tracted, containing a highly acid, brown, jelly-like liquid, mainly consisting of altered blood; if death be rapid, the mucous membrane may be soft and pale, but if delayed is usually black in some parts of it and in other parts greatly congested, in rugae,' with some portions peeling off in patches and the underneath coats gangrenous. Actual corrosion and perforation is however rare, although the stom- ach may be too softened to remove entire. The in- testines are usually much congested and contracted more or less throughout their whole extent if death was not prompt. The blood is fluid in all parts of/ the body, except the esophagus and stomach. As a rule the lungs are congested. Occasionally the brain is found to be congested. The kidneys are usually dark and full of blood; may show a fine striping corresponding to the canaliculi; the whole boundary layer may be colored white, due to a depo- sition of Calcium Oxalate. The urine is albumin-j ous and contains hyaline casts and deposits of oxa- lates. Sometimes there are no abnormal post mortem appearances. ACID OXALATE OF POTASH. The pathological changes by the Acid Oxalate of Potash are identical with those of Oxalic Acid in both the esophagus and stomach. These parts are almost always more or less inflamed or corroded, and the inflammation may have extended into the intestines. As a rule the stomach while not actu- ally eroded is unnaturally transparent. ACID TARTARIC. Intense inflammation of the stomach and intes- tines. ACONITE AND ACONITINE. 351 ACONITE AND ACONITINE. No characteristic lesions. May be more or less congestion of lungs and liver and general venous congestion. The brain and its membranes frequently are injected and the stomach and intestines reddened; there is more or less dark and fluid blood in the right side of the heart. The blood is as a rule fluid. There is a fullness of the large veins. Sometimes the body is of a marble-like paleness. Remarkably good preservation and persistent rigidity of the body, as a rule. The mucous mem- brane of the stomach may be fiery red with patches °f a deeper hue; it may be bright red, dark red, brown °r pale, but often it is deeply congested and has the °dor of alcohol; gastric vessels injected and may pre- sent form of a tree with branches-an arbor mortis. Lungs, brain, cerebral vessels and membranes, right side of heart, and the great veins of the neck are more °r less congested. The pia full of blood, engorgement °f sinuses and plexus. Serum is often found in the ventricles. The blood usually is dark and fluid. The great veins of the abdomen are full of blood and in Prolonged coma the bladder is distended with urine. Sometimes there are burn-like blebs on the extremi- ties. As a rule the pupils are dilated. The right side of the heart is empty. ALCOHOL. ANTIMONY -TARTAR EMETIC. Usually signs of inflammation of mucous mem- brane of stomach and intestines, sometimes extend- ^ng to esophagus and throat. Ulcers and pustules have been found upon the mucous membrane of the uiouth. Stomach and intestines usually coated with rnucus and signs of inflammation may be absent. J-he blood is thinner than usual. The brain is, as a rule, congested, and the viscera may be engorged With blood. Lungs generally exhibit signs of em- physema and there may be effusions into the pleura. 352 A MANUAL OF TOXICOLOGY. ARSENIC. As a rule the body is remarkably well preserved, putrefaction being most delayed in those organs which contain Arsenic. The antiseptic properties of Arsenic permit of the recognition of the inflam- matory changes several months after death. But putrefactive changes may produce quite similar red- ness in a healthy stomach. In acute Arsenic poisoning with diarrhoea, the blood may be thickened and all the organs will present a very dry appearance. In the narcotic form of poisoning the vessels of the brain are usually very plain. The characteristic lesions usually found in Arsenical poisoning are inflammation of the stomach and intestines and a fatty degeneration of the heart, liver and kidneys, with infiltration of the epithelial cells. In acute cases the stomach is most affected. In chronic cases the whole alimentary canal presents an inflamed and ulcerated appearance, par- ticularly the duodenum and rectum. Sometimes the tongue is greatly swollen. The Stomach : The stomach may be empty or it may contain blood mixed with mucus. It may be contracted and the inner lining corrugated, or the whole interior may show streaks of severe conges- tion or be of a light-red or brownish color. Some- times the congested patches are thickened: they may be covered with a false membrane mixed with particles of Arsenic. It is common to find an ex- travasation of blood into the mucosa. Although the poison be absorbed by the skin or otherwise, there are usually evidences of acute gastritis. Frequently there are thick, pasty, whitish-gray, or green (from Paris Green) patches, usually surrounded by brightly injected membrane, where particles of solid Arsenic adhere to the walls of the stomach ; yellowish streaks from formation of Arsenic Sulphide. Hem- orrhagic spots may be eroded by gastric contents. The stomach may appear white externally but show a softened and ulcerated condition internally. The Intestines: Usually similar but less severe BELLADONNA AND ATROPINE. 353 inflammation in this part of the alimentary canal. Congestion and inflammation of the whole intestines may be present. Unless the patient has lived for some days after taking the poison, the large intes- tine is usually unaffected. Sometimes Peyer's patches, the solitary lymph nodules, and the mesen- teric nodes are found to be swollen. The Tongue, Pharynx and Esophagus: They may be more or less inflamed. The esophagus streaked in dull or bright red patches or even cor- roded. The Heart: If death is sudden the heart is usually unchanged; if otherwise, shows evidences of fatty degeneration. The walls of the heart are pale, yel- lowish, and unnaturally yielding. Ecchymosis of muscular tissue under the endocardium and usually Qn the left ventricle, the posterior walls or the intra- ventricular septum of the heart. The Liver: It may be enlarged, as is usual after sudden death. Sometimes marked symptoms of fatty degeneration. In subacute cases fatal results are as much due to inflammation of liver and kid- neys as to the poisonous effects produced in the stomach. The Kidneys: Enlarged, soft, and pale. Upon section, microscope shows a general or streaked yel- lowish-gray color and a thickened cortex. BELLADONNA AND ATROPINE. Usually no very characteristic appearances. The eyes dilated and brilliant and the cerebral vessels and lungs congested, are the chief points. Tongue may be red and mucous membrane of stomach and small intestines injected. If Belladonna berries Were eaten, the mucous membrane of the tongue may be purplish. Sometimes there are no post' mortem effects observable. 354 A MANUAL OF TOXICOLOGY. BROMINE. Interior of stomach coated with thick, black layer and mucous membrane greatly congested. Ex- terior of stomach may be injected. Stomach con- tents generally thick reddish and give forth odor of Bromine. The viscera in the vicinity of the stom- ach may be a deep yellow color. The peritoneal coat of the duodenum is usually injected. CANTHARIDES. Mucous membrane of the stomach and intestines is intensely inflamed. Inflammation of the mouth, esophagus, throat, ureters, kidneys, and bladder. The mouth is swollen. The tonsils may be ulcer- ated. May be purulent matter covering the mucous membrane of the intestines. Sometimes congestion of the brain. When the powder has been taken, can recognize the shiny green particles in the stom- ach and intestines. Blood and fatty epithelial casts and pus in the urine. CARBON MONOXIDE -COAL GAS. Often rose-red or bluish-red. irregularly shaped patches on face, neck, chest, abdomen or inside of thighs, but not on the back. Due to paralysis of small arteries of skin, which arteries consequently become injected wit.i the changed blood, it is said. Blood is fluid generally and peculiarly red with a bluish tinge. Face calm, pale, and as a rule no foam on the lips. Right heart usually filled with blood; left contains very little. Usually some of the internal organs are congested. Putrefaction usually greatly delayed. Membranes of brain usu- ally much injected. Sometimes lungs congested or even oedematous with effusion. Sometimes the most congestion is in the abdominal cavity. CHLORAL. 355 CHLORAL. Odor of drug may be observed. Hyperaemia of brain in some cases. No characteristic lesions. CHLOROFORM. Frequently odor of anesthetic perceptible. Rigor mortis persistent. Retarded putrefaction. No characteristic lesions in death from inhalation. Bronchial tubes, lungs and vessels of brain may be congested. Heart often found flabby and collapsed. 1 he blood is dark and fluid. The post-mortem ap- pearances when Chloroform has been swallowed are chiefly a redness of the mucous membrane of the stomach. Epithelium of pharynx, epiglottis and esophagus partly detached, whitened and softened. CHROMIUM - POTASSIUM BICHROMATE. The blood thin and black. The stomach inflamed and destroyed or marked with dark-red patches. COLCHICUM. Usually inflammation of stomach, intestines, and lungs. May be congestion of pia mater. Some- times there are no abnormal appearances. COPPER. The surface of the body may appear yellowish. The stomach and intestines show signs of inflamma- tion ; may be ulcerated. There may be a distinct dirty, bluish-green discoloration of the intestinal mucous membrane, produced by the contact of the Copper. This is a valuable sign when present. Touching with Ammonia intensifies the tint. Par- ticles of Copper may be found adhering to the intes- tinal coats. The lungs may be congested, the rec- 356 A MANUAL OF TOXICOLOGY. turn ulcerated. Sometimes the mucous membrane of the stomach and small intestines is thickened and inflamed; may be softened, ulcerated, or even gan- grenous. The substance of the liver may be friable and fatty; the kidneys swollen and the cortical sub- stance colored yellow; the pyramids a pale brown and compressed. DIGITALIS AND DIGITALIN. No very characteristic lesions. May be inflam- mation of the mucous membrane of the stomach, and congestion of the brain and its membranes. The blood dark and fluid. Right ventricle and auricle filled with blood ; left empty. ETHER. If the autopsy is performed soon after death, the odor of the anesthetic is perceptible. The cavities of the heart are filled with dark fluid blood. Usu- ally there is congestion of the brain and lungs. ERYTHROXYLON AND COCAINE There are no very characteristic lesions. There may be congestion of the lungs and other organs and the blood fluid and dark. In acute Cocaine poi- soning, hyperaemia of liver, spleen, kidneys, brain and spinal cord have usually been found. HEMLOCK (CONIUM). There are no characteristic post-mortem appear- ances. The blood usually is dark and fluid. There may be congestion of the brain or lungs. Stomach, lungs and brain usually found congested. Intestines invariably healthy. WATER HEMLOCK. 357 WATER HEMLOCK (COWBANE). Stomach red, blood fluid. May be corrosion and perforation of the stomach. HYOSCYAMUS. There are no characteristic lesions after death, hhe brain and its mebranes usually are congested. IODINE. Appearances of a corrosive irritant poison. The uver enlarged and congested. The brain may also he congested. Ulcers are sometimes found in the stomach. Lungs natural. The other lesions are such as are usually produced by an iritant poison. LEAD. r The post-mortem signs are not very distinct. I here may be inflammation and contraction of the alimentary canal; the stomach may be whitened. In chronic lead poisoning there is a granular condi- tion of the kidneys; the large intestines may show S1gns of contraction, and the muscles specially af- fected present a whitish, flabby appearance. May he a grey-black appearance of the intestinal mucous niembrane, due to a deposit of Lead Sulphide. As a rule the stomach contains no unabsorbed poison. MERCURY - CORROSIVE SUBLIMATE. Corrosive Sublimate is said to take 2 hours to reach the urine, 4 hours to reach the saliva, and is eliminated from the system in 24 hours. Post- ruortem signs are mainly found in the alimentary canal. The mucous membrane of the mouth, fauces and esophagus is softened and presents a whitish or bluish-grey color. Frequently the stomach is 358 A MANUAL OF TOXICOLOGY. softened, particularly at the cardiac end of it, and portions of it may be destroyed. More or less intense inflammation always present; the mucous membrane often of a siate-grey color and corroded. The stomach coats are sometimes very much blackened, probably resulting from Sulphide of Mercury. The intestines, particularly the caecum, may present the same ap- pearances. There may be inflammation of the kid- neys and bladder, the bladder empty and contracted. There is marked congestion of the kidneys about the Malpighian bodies; the epithelial cells deformed, granular, and more or less destroyed. More or less intestinal inflammation has been caused by Mer- curic Cyanide, Mercuric Iodide, White Precipitate, and Turpeth Mineral. MERCURIC CYANIDE. Stomach and intestines appear greatly inflamed. POISONOUS MUSHROOMS. Stomach and intestines usually inflamed and may be gangrenous. The vessels of the brain are as a rule much congested. The liver is enlarged. Search, the stomach for the gills and spores of the mush- room. The spores of the common mushroom are oval and dark slate-colored. The discovery of pink irregular spores, or of rusty brown irregular spores, or of round white prickly spores, would be good evi- dence that a poisonous mushroom had been eaten. Plain round spores might indicate either edible or poisonous. Identify the fungus. NUX VOMICA AND STRYCHNINE. No characteristic appearances. Brain and spinal cord may be congested and considerable blood ef- fused. Blood usually fluid and often very dark.. Stomach and lungs sometimes found intensely con- gested. Heart usually has right side gorged with OPIUM AND MORPHINE. 359 hlood, sometimes is empty* and contracted. Lungs congested. Usually relaxation of body at time of death, but rapid, extreme, persistent rigidity ensues soon after it. Rigidity usually remains for a long time; may disappear within 24 hours or last two months. All these leading symptoms rarely pro- huced except by this poison. Bladder usually con- tains urine, which should of course be preserved for chemical analysis. OPIUM AND MORPHINE. No very certain nor characteristic signs. The mood is as a rule fluid. Stomach and intestines usu- aUy appear normal. The peculiar Opium odor may Pe noticed as soon as the stomach is opened. The vessels of the brain usually found in a turgid state, a serous effusion into ventricles and at the base of the brain. Lungs and other vascular organs may be congested. May be heart clots in both sides of heart and a thrombosis of the pulmonary artery. External surface of body is either livid or pale, bladder is full of urine. These are, however, not characteristic of death from this poison. Pupils are sometimes contracted, sometimes dilated. Some- times there is nothing abnormal in the post-mortem aPpearances, and a pathologist could not in any Single case positively determine the cause of death Torn only the organic appearances. PHOSPHORUS. Post-mortem appearances vary according to the iorm of poison taken, but usually those of a corro- sive irritant poison. When the poison is taken in a Pure state or dissolved in oil, the esophagus and r)ther portions of the alimentary canal usually show me injurious effects. Rapidly fatal cases exhibit S1gns of irritant poisoning. ' If death is delayed there may be a softening of the stomach, a peculiarly 360 A MANUAL OF TOXICOLOGY. jaundiced skin and ecchymosis beneath pleura, peri- toneum, pericardium, and in lungs, kidneys, bladder, uterus, muscles and subcutaneous tissue (probably all due to a rapid disintegration of the blood corpuscles). The lesions in many respects resemble the most aggravated forms of sea scurvy. The vis- ceral cavities may contain bloody fluid. May be luminosity of the stomach or other parts. The liver is usually enlarged, doughy with well marked acini and cells filled with large fat drops. A remarkable, acute, fatty degeneration of the liver, kidneys, heart and other muscles and usually of the walls of the arterioles and capillaries constitute the most marked lesions. The blood is usually dark and fluid, but of. a syrupy consistence. The most constant stomach lesion is a granular degeneration of the cells, filling the gastric follicles, thus altering the appearance of the mucous membrane, which becomes white, grey or yellow and thick and opaque. There may be perforation, but usually small circumscribed spots of inflammation, erosion or gangrene. The small intestine may be normal or congested. The heart is usually discolored, empty and contracted, but may contain a small quantity of fluid blood. Phos- phorus has caused death without leaving recognized lesions. POTASSA - SODA - AMMONIA. The mucous membrane of mouth, throat, eso- phagus and stomach softened, detached, and choco- late-colored or black in recent cases. Signs of ul- ceration in esophagus and stomach or intestines, associated with more or less constriction, when death has resulted from the secondary effects of the poison. In some cases of poisoning by stronger Ammonia there may be perforation of the stomach, with congestion and blackening of its mucous mem - brane. POTASSIUM CHLORATE. 361 POTASSIUM CHLORATE Blood usually brownish and thickened. Kidneys injected. POTASSIUM CYANIDE. The appearances in poisoning by Potassium Cy- anide are mainly such as are described under Hydro- cyanic Acid, with the addition perhaps of caustic local action. When the poison is taken directly after a hearty meal, there may be no signs of corro- sion or even redness, owing to the protection of the stomach by its contents, or the neutralization of the Potassium Cyanide by the acid of the stomach. Erosions of the lips may be caused by a very strong solution of the poison and the caustic effect may be traced in the mouth and esophagus to the stomach and duodenum; but this is not common, the stomach and duodenum only showing the local effects. The mucous membrane is swollen, feels soapy, may be ulcerated, and is colored a deep red or blood-red; its reaction is strongly alkaline; crests of stomach folds may be grayish white. The contents have odor of bitter almonds. There may be ammoniacal odor Present. The coloring matter of the blood, dissolved °ut by the Potassium Cyanide, frequently dyes the upper layers of the epithelium, as a post-mortem effect; this can can be imitated by digesting the mucous membrane of a healthy stomach in a Po- tassium Cyanide solution. The dose of the poison and the condition of the stomach as regards empti- ness, of course, entirely govern the intensity of these changes. Although the stomach may be empty when the poison is taken, a dose just large enough to destroy life may produce but little redness or swelling of it. Inflammatory changes in the larynx may be produced by vomit drawn into the air pas- sages in vomiting. The blood often exhales the odor of the poison, and as the acid may often be dis- tilled from it, some of it should be preserved for analysis. 362 A MANUAL OF TOXICOLOGY. Essence of Almonds may produce the slight in- flammation of the other essential oils, but no ero- sion, no strong alkaline reaction, nor effects, such as the caustic Potassium Cyanide produces. POTASSIUM NITRATE. The contents of the stomach may be mixed or tinged with blood. Interior of stomach and in- testinal canal exhibit signs of severe inflammation. Mucous membrane may be detached in places, and there may be perforation. PTOMATROPINES. Swelling of pharynx, esophagus and mucous mem- brane of the stomach. May be venous hyperaemia of brain, lungs and kidneys. There may be injec- tion of intestines and swelling of the solitary and Peyer's patches and degeneration of the heart muscle. SAVINE. The capillary and venous systems usually con- gested. Heart full of blood, particularly on right side. The blood is of a black color. A general plethora of intestinal vessels. Usually more or less inflammation of bowels, stomach and intestinal tract, with congestion of kidneys. SILVER CYANIDE IN POTASSIUM CYANIDE. (Counterfeiter's Silver Coating). Distinct smell of Hydrocyanic Acid. Eyes glisU ening; pupils dilated; jaws clenched; strong rigor SILVER NITRATE. 363 mortis; cerebral membranes congested; lungs highly congested; bronchial tubes and lung cells filled with frothy mucus; right side of heart full of black fluid blood, left side empty; bladder empty; stomach red. (Death in 40 minutes; autopsy after 32 hours). SILVER NITRATE. In rapid poisoning, a blue line around gums; in slow poisoning, a bluish tint of the body. Stomach and intestines show either a white color from the action of the caustic salt, a black from decomposi- tion of animal matters, or an intensely red color, due to inflammation. TOBACCO AND NICOTINE. No characteristic signs from Nicotine. Is con- gestion of liver, brain and lungs. A diffused red- ness over the mucous surfaces of the stomach and bowels. The heart is empty. Blood dark and fluid. May detect Nicotine in the body a long time after death. Has been found in animals after the lapse of years. Nicotine should be sought in the stomach, lungs and liver. ZINC. Zinc Sulphate is apt to produce inflammation. Intestinal tract inflamed and usually congestion of brain and lungs. Mucous membrane of stomach may be much wrinkled. Stomach and intestines contracted. Zinc Chloride corrodes. A peculiar whiteness and opacity of mucous membrane of mouth and eso- phagus. Stomach usually corrugated, contracted, opaque, leaden color, leathery and hard. All parts of very acid reaction. Lungs and kidneys congested as a rule. The fluid in the stomach has the appear- ance of curds and whey. There may be fatty de- generation of various internal organs. 364 A MANUAL OF TOXICOLOGY. POST MORTEM KEY TO POISON. Appearance (Post Mortem). Probable Cause of Death. ( Black in patches Arsenic, silver. Bright-red spots or patches Blue | Marble-like, pale Skin -J Hemorrhages into Coal gas, cyanides, hydrocyanic acid. Carbolic acid,coal gas, nitro-benzol,silver* nitrate. Cyanides. Arsenic, aconite (occasionally). Phosphorus, poisonous mushrooms. Phallin, phosphorus, solanine. Alkalies, bromine, carbolic acid, chro- mates, corrosive acids, ergot, iodine. Bromine. Icterus of Papular, pustular or ulcerative alterations of , Tan-like and partly necrosed Extremities gangrenous ,. Ergot. Rigor Mortis persistent Chloroform, nux vomica, strychnine. f Greatly retarded Putrefaction-^ tt a i Hastened (no rigor Alcohol, arsenic, carbolic acid, chloro\ form, mineral acids. [ mortis) (Yellowish or Lips and around Mouths brownish... Poisonous mushrooms. Carbolic acid, nitric acid, sulphuricacid. ( Whitish . ... tt ( Greenish HAIR ] Sudden loss of Puph s J Contracted pupils Dilated Muscles, Atrophy of Carbolic acid, oxalic acid, sulphuric acid Copper (chronic poisoning). Arsenic. Opium, physostigmine. Belladonna, gelsemium, hyoscyamus, scopolamine, stramonium. Alcohol (as . • , , [a rule). Arsenic, ergot, lead. Mouth, Inflammation of Iodine. Tongue and mouth inflamed, teeth loose Bismuth, mercury. Gums < \me on ( Dark line on Lead. Bismuth, mercury, silver. Jaw necrosed Phosphorus. Yellow, green or brown.... Mouth fr . a Gray^sh'tb.r°wrish Tunn*^ {Corroded or blackish Nitric acid, oxalic acid (occasionally). Sulphuric acid. 1""T* and -{Whitish * n<Lu 1 softened Stomach I Chocolate-colored , or black Intensely red. Bluish-red or cherry-red, fluid.. Brownish and thickened Black Blood Extended coagulation of Frothy Transparent ... Very fluid Carbolic acid, chloroform (by mouth),' corrosive sublimate, hydrochloric acid, oxalic acid (occasionally). Hydrochloric acid, nitric acid, ammonia, potassa, soda. Quick-lime. [gas. Carbon monoxide, cowbane, illuminating Arsenic (occasionally), potassium chlo- rate, nitric acid. > Savine, tobacco, carbon dioxide, mor- phine, strychnine, potassium chlorate, hydrogen sulphide. [lies? Bromine, castor oil beans, mineral alka- Chloroform, ether, hydrogen peroxide. Various fungi, hydrogen arsenide. Carbon monoxide, chloroform, strychnine, morphine, oxalates. POST MORTEM KEY TO POISON. 365 Post Mortem Key to Poison (Continued). Appearance (Post Mortem). Probable Cause of Death. Qdor (characteristic); especially notice- able upon opening body 'Green or bluish green Yellow or reddish yellow [a/so watts] Turn black when ex- Contents-^ p?sed t0 an,mo. nium sulphide.. Hematic Luminous in dark. Contain shining green particles.. Stomach Gills and sPores • • • 'White spots P u r p 1 e-red (mu- cous membrane). Black Red (deep or dark) Walls Yellow stains...,. Yellow-brown Leathery Wrinkled, con- tracted Corrugated and , thickened 'Small pieces of wood... Leaves Fragments of h air-coated seeds Fragments of 'Contains non-coated seeds Mineral particles Gastro Intestinal Canal Hemorrhagic [ material Wa!ls (Acid a"d (Alkaline [Contents ' Alcohol, amyl nitrite, anilin, acetic acid, arsenic, ammonia, bromine, camphor, carbolic acid, chloroform, chlorine, cyanides, ether, ethyl bromine, hydro- chloric acid, hydrocyanic acid, iodine, nicotine, nitrobenzol, opium, phospho- rus, rue, savine, tobacco. Copper salts, Paris green. Lead chromate, orpiment, picric acid, potassium bichromate. Bismuth, copper, lead, mercury. Arsenic, potassium nitrate. Phosphorus. Cantharides. Poisonous mushrooms. Arsenic, carbolic acid. Zinc. Corrosive sublimate, acetic acid (near pylorus), oxalic acid (occasionally). Arsenic. Arsenic. Iodine. Zinc. Carbolic acid, oxalic acid, zinc, H,C1 [(Ridge's). Arsenic. Matches (phosphorus). Aconite, belladonna, hyoscyamus, savine, stramonium, tobacco. Nux vomica. Castor oil, hyoscyamus, laburnum, stra- monium. Antimony, antimonious sulphide, arsen- ous oxide or sulphide, metallic arsenic, calomel, chromium preparations, iodine, mercuric oxide. Arsenic, baryta, phosphorus. Acids, acid salts. Alkaline earths, caustic alkalies, potas- sium cyanide. 366 A MANUAL OF TOXICOLOGY. Post Mortem Key to Poison (Continued). Appearance (Post Mortem). Probable Cause of Death. Intestines - Villi turn black Walls and f Yellowish Contents 1 Greenish of Duo- । denum, (Brownish etc. T ( Black and ulcer- La>ge ) ated Intestine | Dysenteric General contraction of or gray-black mucous mem- brane Bluish-green mucous mem- brane Silver. Nitric acid, picric acid, plumbic chromate. Cupric sulphate, Paris green, Scheele's green, verdigris. Bromine, iodine, phosphorus, potassium chromate. Bismuth. Castor beans. Lead. Copper. Abdominal Viscera (Yellow patches... J Red . " '.Grayish or blackish ( patches, and corroded... Arsenic. Antimony. Mercury. Liver, fatty Heart, fatty degeneration of, also of muscles and kidneys Kidney, rough, grating, sound in cutting Ammonia, antimony, arsenic, iodine, phallin, phosphorus. Ammonia, antimony, arsenic, iodine, phallin, phosphorus. Baryta, lead, mercury, oxalic acid. Lungs, CEdema of (Odor of peach pits or hydro- Brain-< cyanic acid ( Congestion of Morphine, muscarine, nicotine, pilocarp- ine, etc. Hydrocyanic acid in some form. Alcohol, digitalis, etc. Photographers are apt to use potassium cyanide for self destruction; hospital attendants, corrosive sublimate; domestic servants, illuminating gas, car- bolic acid, lysol, or oxalic acid; physicians, hydro- cyanic acid, morphine or other powerful alkaloid. Suicides are apt to take large doses; in homicidal poisonings post-mortem findings often indicate poisonous dose was not large. (See p. 260.) POISON OF OCCUPATION, ETC. CHRONIC POISONING AND DRUG HABITS. CHRONIC POISONING 369 PART XII. CHRONIC POISONING AND DRUG HABITS. By more or less continued and prolonged use of the various preparations of Alcohol, Opium, Mor- phine, Chloral, Chloroform, Cocaine, Ether, Paralde- hyde, Wormwood, etc., some persons acquire a habit for such poison, and a state of chronic poi- soning. The brain structure is deranged, mental function is more or less seriously disturbed, the vital organs are weakened or actually diseased, and a degenera- tion of the whole physical economy is induced. Furthermore, the effects, most unfortunately, are not limited to the individual, but may be trans- mitted to succeeding generations, producing var- 1Qus brain abnormalities, perversion of morals, and defects of mind. Of all the various kinds of chronic poisonings, the most important are those by Alcohol, Opium (including Morphine), and Cocaine. Dr. Kellogg, formerly superintendent of the New York State Asylum, says: "There are chronic intoxications from poisons inten- tionally taken, as in the widespread drug habits. * * * In their physiological effects there is a specific difference in poisons as to the prevailing emotional mood excited, but in their pathogenetic relations to insanity they result in maniacal or melancholic states more in accordance with in- dividual and constitutional peculiarity. Toxic insanity is acute or chronic vesania caused by the 370 A MANUAL OF TOXICOLOGY. medium of toxic substances acting on the cerebro-spinal or sympathetic nervous system and clinically manifested by motor, sensory, trophic, vasomotor and psychic disorder, varying according to the individual idiosyncrasy of reaction to the toxic agencies which have invaded or been generated in the organism. In some toxic cases, motor anomalies, in others sensory perversions, and in others intellectual disorder may predomi- nate, according to the vascular areas and nervous tracts in- volved in the pathological changes initiated by the poison. The cerebro-spinal lesion may give rise to a symptom com- plex like that of general paresis. Some of the more common toxic agents which cause in- sanity are here named and classified: I. Mineral Poisons and Drugs.-1, Lead; 2, Mercury; 3, Arsenic; 4, Chloral; 5, Bromide of Potassium; 6, Iodoform; 7, Paraldehyde. II. Vegetable Poisons.-1, Opium; 2, Belladonna; 3, Can- nabis Indica; 4, Hyoscyamus; 5, Stramonium; 6, Tobacco; 7, Cocaine; 8, Conium; 9, Erythroxylon Coca; 10, Astragalus Hornii; 11, Secale Cornutum. III. Intoxicants and Noxious Gases.-I, Alcohol; 2, Ether; 3, Chloroform; 4, Carbonic Oxide; 5, Sulphurous Acid Gas. IV. Acute Infections and Diseases.-1, Typhoid Fever; 2, Smallpox; 3, Scarlet Fever; 4, Typhus Fever; 5, Diph- theria; 6, Cholera; 7, Puerperal Sepsis; 8, Epidemic Influenza; 9, Purpura; 10, Erysipelas; 11, Bubonic Plague; 12, Lepra Vera; 13, Lessa Humana. V. Auto-Intoxications.-1, Leucomains; 2, Ptomains. Some of these toxic agents only act upon special tissues, but most of them deleteriously affect the entire organism, and their evil effects continue long after their elimination from the system." ALCOHOL - ALCOHOLOMANIA - CHRONIC ALCOHOLISM (CHRONIC ALCOHOLIC POISONING). By alcoholomania is meant the possession of an overpowering impulse, crave, craze or mania for in- toxication by alcohol. ALCOHOL, ETC. 371 By chronic alcoholism is meant the. morbid effect of chronic excess in the use of alcoholic beverages. The spirit obtained from potatoes is the most in- jurious of all the alcoholic beverages, owing to the large amount of amyl alcohol (fusel oil) which it contains. Many of the cheap spirits have this as their basis. The system gradually undergoes an alcoholiza- tion. Nutrition is impaired, the various organs of the body gradually undermined, the natural physio- logical processes being by degrees converted into Pathological ones. The alcohol irritates the stom- ach and digestive apparatus, and precipitates the pepsin of the gastric juice, inducing heart burn, neuralgia of the stomach, belching, melancholia and various distressing symptoms associated with chronic dyspepsia. The structure of the liver is gradually altered and it becomes enlarged and fatty pr contracted and cirrhosed. The kidney is seriously ^paired. The heart becomes more or less fatty, hypertrophied, weak, flabby and incapable, so that the patient suffers from palpitations, dyspnoea, stitches," etc. Frequently the tongue is parched and furred, and the breath foul. There is often per- sistent and urgent thirst, nausea, flatulence, severe Pain in the vicinity of the stomach, loss of appetite, dislike for food, sense of severe coldness or heat, stabbings, twitchings and uneasiness throughout the body. The limbs become enfeebled and trem- nlous. There is more or less mental degredation, low-spiritedness, indeterminate fears of impending disaster, irritability, cowardliness, cunning, inde- cision of character, inability to concentrate the thought, violence of temper, untruthfulness and Weakness of purpose. The chronic alcholic is a va- cant, silly and foolish dement. The morbid tissue changes produced by the alco- hol deprave the brain, intellect and moral sense. SYMPTOMS: 372 A MANUAL OF TOXICOLOGY. and the anesthetic influence of the alcohol so dulls the perceptive faculties as to make the alcoholic unconscious of the damage being done to his body and mind. Destructive changes, which normally are painful, elicit no complaint from the benumbed senses. Violent acts, even manslaughter, may un- intentionally be committed through the inability to estimate or determine the amount of force em- ployed in various physical efforts. An intended friendly tap may thus be delivered with crushing force. Unusually immoral and indecent acts may be committed through an enfeebled, deteriorated and degraded moral sense, dependent upon cerebral and other tissue changes. There is a more or less complete paralysis of will power, mind and morals. Delirium tremens, dementia, mania, epilepsy, or even general paralysis may characterize the prog- ress of the disease. In beer and other malt-liquor-drunkards, there is more or less tendency to obesity. There is puffing and blowing upon the least exertion, and the move- ments are more or less sluggish and clumsy. The features become dull and expressionless, the face red or purplish, and the blood vessels in the regions of the eyes and nose enlarged and congested. The skin is blotched, greasy and glistening, the eyes red and moist and the conjunctiva yellowish. Death, frequently, finally occurs from embolism, syncope, or dropsy. Spirit drinkers incline to emaciation, but ulti- mately, from ascites or anasarca resulting from cirrhosis of the liver and kidneys and fatty degen- eration of the heart, may become quite rotund or large limbed. Their restlessness, imaginings, and disturbed, unrefreshing sleep often induce a highly dangerous resort to opiates or other narcotics. They suffer from delusions of persecution, and some of them experience a sense of double consciousness. ARSENIC, ETC. 373 TREATMENT: Various mysterious chemicals, medicinal prepara- tions and processes, including hypnotism, have from time to time been exploited and claimed to be a specific remedy for chronic alcoholism. The so- called "gold cure" has seemed to prove efficacious ;n some cases, and a most dismal failure in others. As a rule the best plan to pursue is to commit the alcoholic to some institution where he will be in- spired with hope, his will fortified, poisoning dis- continued, and his system built up with such tonics as iron, arsenic, cod-liver oil, etc. ARSENIC - CHRONIC ARSENICAL POISON- ING. HISTORY: Chronic poisoning by arsenic may be caused by arsenical wall papers, candles, artificial flowers, toys, India rubber balls, carpets, advertising and playing cards, floor-cloths, the colored wrappers of some cigarettes, japanned goods, etc. SYMPTOMS: Thirst and dryness of mouth; nausea; vomiting; perhaps slimy, bloody diarrhoea; voice rough and harsh; eyes red and smarting; eyelids puffed; appe- tite lost and a sense .of weight or soreness at the pit of the stomach; skin dry, covered with sore spots or scales; disturbed sleep; aching in joints or limbs; there may be spitting of blood, great Joss of flesh, and general debility. Remove the cause. Provide plenty of fresh air and various tonics, such as iron, quinine, cod-liver oil, strychnia, etc. A complete change of air and scene often .proves of the greatest benefit. TREATMENT: 374 A MANUAL OF TOXICOLOGY. CHLORAL-CHLORALISM. HISTORY: Chloralism may be the result of the long contin ued use of the drug as a sleep producer, to relieve: neuralgia or other pain, etc. The chief symptoms are a disturbance of diges- tion, chiefly from the direct effect of the drug upon the mucous membrane of the stomach; an eruption of the skin, dyspnoea, depression, vertigo, insomnia, excitement, volubility, reduction in nerve power, lessened mentality, etc. SYMPTOMS: Prevent the obtaining of the drug, and build up the system. This can ofttimes be best accomplished by placing the patient in a good sanitarium for a time. TREATMENT: COCAINE - THE COCAINE HABIT - CO- CAINOMANIA-COCAINE INEBRIETY- COCAINISM. The dangers and disasters resulting from a pro- tracted or habitual use of cocaine can scarcely be enumerated or estimated. This is probably the most seductive, dangerous and mentally, physically' and morally destructive of all the drug habits. Erlenmeyer has denominated cocaine the third scourge of humanity, following in order after al- cohol and opium, in this respect. Cocaine fascinates by the promptness with which it relieves all sense of exhaustion, dispels gloom and exhilarates, produc- ing a sense of happiness and well-being which trans- ports at once to a longed-for elysium. Primarily, the after-effects are scarcely percept- ible, but through continual indulgence an intense craving for the drug or its effects is produced. HISTORY: COCAINE, ETC. 375 SYMPTOMS: The habitue is afflicted with sleeplessness, ner- vousness, tremulousness, nervous and muscular ir- ritability, illusions of sight and hearing, insensibility to pain, indecision, dyspepsia, palpitation, disincli- nation to work, avoidance of friends and society, in- sane jealousy, mistrust, moral perversion, bodily emaciation, decay of mind, etc. When the toxica- tion is frequently repeated there is a tendency to raving insanity. Regarding cocainism, Superintendent Kellogg, of the State Asylum, says: "Cocainism develops a reasoning form of mental aliena- tion with change of hallucinations and corresponding de- lusions, anxious and excitable moods, attaining melancholic states of agitation on withdrawal of the drug, or even at- tacks of stuporous collapse." Regarding a comparison of the cocainist with the morphinist and the deleterious effects of cocaine, Professor Berkley, of Johns Hopkins University, in his "Treatise on Mental Diseases," in speaking of drug habits, says: "Even less than the Morphinist are the Cocaine de- bauchees to be trusted, inasmuch as their moral rectitude and will power have always suffered severely. * * * Under the deleterious influence of the continued use of Cocaine, especially when it is superadded to the Morphine habit, the gravest somatic indications may arise. The bodily Weight sinks rapidly, even 1-5 to 1-3 of the whole being lost within a few weeks. The skin hangs in folds and has a dirty yellow tint, the countenance assumes a distressed look, muscular weakness and tremor become profound. As happens in other states of inanition, the reflexes be- come exalted, cramps make their appearance, there is mus- cular unrest with tremor, particularly noticeable in the tongue. The symptoms of collapse increase. There is a growing tendency to fainting attacks, with irregularity in the cardiac action, accompanied by profuse sweating and dilatation of the pupils. Sleep is much disturbed. The patients usually retain their appetite and powers of as- similation, but the waste being greater than the supply, rapid 376 A MANUAL OF TOXICOLOGY. emaciation results. Sometimes from the direct poisonous influence of the alkaloid, sometimes from the continued de- nutrition of the entire body the person habituated to Co- caine acquires an indubitable insanity, which assumes the customary type of a hallucinatory psychosis. Usually after a short prodromal period of motor unrest, anxiety, mis- trust of family or companions, and increasing irritability are noted. Hallucinations which may involve all the special senses, quickly follow. Those of hearing are the most frequent. Obscene language and scolding voices are overheard; vile words are shouted at the sufferers; they hear noises made by thieves in the midnight watches; they are threatened with in- jury; their most secret thoughts are blazoned forth to the edi- fication of the populace; they are made exhibitions of to the delight of their enemies; the roar of machinery, the clanging of bells, wailings, loud screams, and shrieks of murder are somewhat less frequent. Hallucinations of sight customarily accompany those of hearing. * * * Soon the cocaine suf- ferer becomes dangerous to himself, his family or the com- munity." Regarding the prognosis in these cases, Prof Berkley says: "This is most gloomy. Even though the patient recover from one attack, he very frequently relapses into his evil habits. In the most favorable cases there ever remains an ex- traordinary weakness of the will power, with accentuated ten- dency to relieve the physical and psychical languor, by substi- tuting for the cocaine, alcohol, morphine, antipyrine and other nervines in large quantities." Although the cocaine habit has in some instances been the result of experimentation or of unwise medication, it usually results from the careless and persistent taking of cocaine as an analgesic, or of taking remedies to cure various ailments, or taking so-called cures for the alcohol or opium habit, which remedies or cures contained cocaine. The attempt to substitute cocaine for alcohol or opium, is as hazardous as it is unsuccessful, the evil only being added to, instead of lessened. The treatment is practically the same as that for morphinism (q. v.). Berkley says: TREATMENT: THE CYANIDES. 377 "Persons addicted to the combined morphine-cocaine habit should be allowed their morphine, at least until the immediate effects of the cocaine have passed away. In chronic cocaine msanity home treatment is rarely admissible, especially as there are nearly always dangerous tendencies." THE CYANIDES. Photographers, electroplaters and gilders fre- quently suffer from chronic poisoning by the cy- anides. HISTORY: SYMPTOMS: Headache, dizziness, ringing in the ears, pains in the cardiac region, dyspnoea, nausea, pallid skin, of- fensive breath, etc. Promptly resort to ammonia inhalations, cold douches, chloride of lime held to the nostrils, etc., etc. Employ electricity, friction and artificial respira- tion if necessary. A mixture of ferrous and ferric sulphates with sodium or potassium hydroxide or carbonate is the best antidote to employ. TREATMENT: ETHER - ETHERISM - CHRONIC ETHER POISONING. Ether drinking as a habit was at one time quite extensively practiced in Ireland. It was indulged in by people of all classes and even by children. It was sold in shebeens and groceries, often bartered for poultry and farm produce, being delivered at the doors of the people by hawkers. From a tea- spoonful to two or more fluid ounces were drunk at a time by the users. The average daily quantity by the moderate ether-drinker was two drachms three or four times a day. The habit, in time, extended to England, Scot- HISTORY: 378 A MANUAL OF TOXICOLOGY. land, France and the United States. Some ether- tipplers inhale it instead of drinking it, thus using about a pint per day. SYMPTOMS: Ether-drinking produces mainly symptoms of a purely functional disturbance. There is burning pain in the stomach, digestive disturbances, loss of appetite, and symptoms of acute or chronic gastritis. Insomnia, tremors, pallor, gloom, fear, despair, sus- picions, chills, lemon-colored or blue skin, irregular heart action, tottering gait, loss of strength, prema- ture decay, etc., are among the chief symptoms. Isolation, predigested food, soothing gastric treat- ment, and the general treatment employed in chronic alcholism. TREATMENT: LEAD: PLUMBISM - LEAD COLIC - LEAD PALSY - WRIST DROP. HISTORY. Compositors, house painters, potters, card play- ers, paper hangers, file cutters, electric light work- ers, japanners, enamellers and others are very apt to be afflicted with lead poisoning. Some hair dyes and cosmetics, hat linings, or goods whitened with a lead preparation, tea packed in lead, water or beer which has stood for some time in lead pipes, or soda water from lead-topped syphons, spirits which have been in leaden recep- tacles, wine sweetened with lead acetate, foods from lead-soldered tins, or lead wrappers, or loaf sugar from lead moulds, snuff adulterated with red lead, etc., are sometimes the source of lead poisoning. SYMPTOMS: A general sense of ailing, anaemia, dull-colored skin. A blue line at the edge of the gums where they meet the teeth is one of the first and most last- MERCURY, ETC. 379 ing symptoms. It is not found when there are no teeth and shows plainly in those who neglect to clean their teeth. Not found usually on those who attend to them. It is the result of the formation of lead sulphide. In Lead Colic - "Painters' Colic" - the chief symptoms are a tearing pain in the umbilical region, which, as a rule, is relieved by pressure; the walls of the abdomen are rigid and retracted; there are usually also constipation and other digestive dis- turbances ; there may be lead paralysis or wrist drop in lead poisoning; also cramps in the calves of the legs, in the scrotum and penis in men, in the uterus in women; pain may occur in the joints, par- ticularly those of the extremities. Other symptoms of lead poisoning are headache, vertigo, insomnia, irritability of mind, anaemia, emaciation, disturbed digestion, anesthesia of por- tions of body, sexual degeneracy, tearing, burning pain in arms and shoulders, convulsions, etc. In women profuse menstruation or even abortion may occur. Give a blue pill at night, followed by a saline in the morning. Iron, Magnesia, Chloroform, and Potassium Iodide, 3 or 4 times a day, are beneficial. Pincture of Belladonna may be given to relieve the colic. Nourish well, and give Cod-liver Oil, Malt Extract, Hypophosphites, Wine, etc. Faradization and massage are helpful. Strychnine in large doses is beneficial. Employ warm baths frequently. TREATMENT: MERCURY - MERCURIALISM - PTYAL- ISM (SALIVATION) - MERCURIAL TREMORS (SHAKING PALSY). SYMPTOMS: In chronic mercurial poisoning there is usually debility, nausea, vomiting, colicky pains, a metallic taste in the mouth; the gums are dark red, swollen 380 A MANUAL OF TOXICOLOGY. and tender; the teeth adhere; the tongue is furred and swollen and the breath foul; may be hacking cough and spitting of blood. In ptyalism the saliva is greatly increased in quantity (sometimes as much as i% pints secreted in 24 hours). There may be ulceration of the mucous mem- brane of the mouth, a skin eruption, and even peri- ostitis ; later there may be mercurial tremor, paraly- sis, or convulsions. The mercurial tremors of those engaged in handling mercurial compounds or exposed to the fumes of mercury, affect first the upper extremities and gradually the whole body. Co-ordination power is lost and the movements are erratic; ultimately result in mania and imbecility. [Salivation is sometimes produced by Antimony, Bromine, Lead, Hydrocyanic Acid, Nux Vomica, Gold, Cantharides, Digitalis, Conium, Belladonna, Opium, and especially by Potassium Iodide. Great fetor of breath and painful sponginess of gums is peculiar to mercurial salivation, and in case of doubt the saliva should be examined for mercury]. TREATMENT: Tonics, fresh air, albumin, port wine, chlorate of potash, gargles, plenty of g'ood food, and perhaps small doses of Potassium Iodide, comprise the best treatment. OPIUM AND MORPHINE - THE OPIUM HABIT - THE MORPHINE HABIT - OPIOMANIA - MORPHINOMANIA - CHLORODYNOMANIA - ETC. Opiomaniacs and morphinomaniacs by long-con- tinued habitual misuse of these drugs are enabled to take enormous doses of them without the effects proving immediately fatal. Various devotees have HISTORY. OPIUM AND MORPHINE. 381 been known to average such large quantities, daily, of one or the other, as. the following: Opium, 30 grains; an ounce or'more of Tincture of Opium; of Morphine salts, 8 grains or more. Three ounces of Laudanum daily have been taken for a week or two at a time by a young woman habitue; another wo- man drank ounces daily for 7 months; still an- other woman drank of a mixture of Laudanum, Spirit of Chloroform and Spirit of Lavender (equal parts), 7 ounces daily; every day for years, an adult, 50 years of age, drank 2)4 ounces of Laudanum and 1% ounces of Paregoric; De Quincey finally took 8,00c to 10,000 drops of Laudanum daily; doses of 20, 40, or 60 grains of Sulphate of Morphine are not rare. Such surprising quantities as the following have been recorded: The drinking by an adult female of a pint of Laudanum daily; the taking by a man of 150 grains of solid Opium in one day in 30 grain doses; the daily hypodermic injection, in a man, of 60 grains of the Hydrochlorate of Morphine; the taking of a fluid ounce of Chlorodyne (Oil of Pep- permint; Prussic Acid and Muriate of Morphine; the Morphine 2^4 gr. to the ounce), etc. It would appear that some children are kept more or less under the effects of Morphine by the use of various soothing nostrums. Mrs. Winslow's Sooth- ing Syrup is said to contain about one-eighth grain of Morphine to the ounce; Godfrey's Cordial about one grain of Opium in two ounces, and Dalby's Car- minative one grain in six. SYMPTOMS. By the narcotizing, anesthetic influence, of both Alcohol and Opium, sensation is deadened, nervous ability benumbed, the vital powers and intellectual faculties undermined by starvation, resulting in an atrophic physical wasting and a depraved moraJ sense. Opium produces so depressant an effect on the 382 A MANUAL OF TOXICOLOGY. special nerve centres and general nervous system as to cause frequently sterility in women and impo- tence in men. The hereditary influence of these drugs is more apparent in alcoholists than in opiumists or mor- phinists. Cardialgia is a common symptom where either of these two poisons are heavily indulged in. Opium users, as a rule, take the drug regularly. Alcohol- ists are apt to be periodical in their excessive use of alcohol. Opium lessens the peristaltic action of the intestines, resulting in constipation, acidity of the stomach, anorexia, deficient digestion, a foul tongue, incontinence of the urine., etc. Cardiac innervation is disturbed, resulting in attacks of false angina pectoris, and pericardial anxiety, producing alarm- ing symptoms of distress. The opiumist's or morphinist's skin becomes yel- low, nails brittle, teeth loosened, a most profound anaemia usually results; furthermore an exceed- ingly obstinate sleeplessness is encountered in the final stages of chronic morphinism." The morphine habit greatly depraves both brain and body nutrition. The body gradually emaciates. The higher brain functions undergo serious alter- ation manifested by loss of self-respect, a tendency to coarseness, baseness, and untruthfulness, to seek questionable associations, and, in fact, a loss of all moral restraint. Persons addicted to the morphine or opium habit seem incapable of a correct statement of facts or occurrences. Their untruthfulness and deceitful- ness are amazing. As McBride declares: "They misconstrue statements, they habitually misrepre- sent and misunderstand. If a statement can be given two meanings they will apply the wrong one." Their ability to inspire confidence in their state- ments, by earnestness, apparent frankness, and im- pressive solemnity of manner, although, in fact, they are cunningly and deliberately lying, is as mar- OPIUM AND MORPHINE. 383 velous as it may prove serious. In this respect some of them are possessed with a most distinct and depraved viciousness, indifferently or even with heartless satisfaction grievously misrepresenting and irreparably wronging innocent persons. And for this they may afterwards show no contrition, either lacking the moral courage to acknowledge their fault or their cerebral degeneration prohibiting their subsequent faithful interpretation of the true facts. They are thus a serious menace to the well-being of not only their own households but to the com- munity in which they live. As a rule the person addicted to Opium does not exhibit the tendency to violence manifested by. so many alcoholists. But owing to the narcotic hold the drug has upon the nervous system, opium users are more difficult to cure than alcoholists. Dr. Kellogg, formerly Superintendent of the State Asylum, says in his "Text Book of Mental Dis- eases," regarding the effects of morphinism: "Morphinism results in amnesic states, affective perver- sion, irritable, suspicious and fearful delusions, complete moral degeneracy, suicidal impulses lacking force of execu- tion and distressing hallucinations on cessation of the drug, with cramps and vasoparetic states." Chronic Opium Intoxication is a condition of abandonment to self-gratification and utter indiffer- ence to duty and the rights and interests of others, as is confirmed by various authors, as follows: Regarding the Morphine habit, Berkley says: "In the mentally robust the most common cause of morphin- ism is the continued use of the drug for the relief of pain, neuralgias, sciatica, repeated migraines, tabetic pains, rheuma- tism, hepatic or renal colic, dysmenorrhoea, and a host of other somatic troubles; then, when the pain has ceased, the habit is continued for the pleasurable excitement and feeling of tem- porary happiness induced by it. * * * In another class of cases the patients are of a neuropathic disposition and have the same craving for morphine as a stimulant that others have for alcohol, ether, or essence of ginger. The neurasthenic, the 384 A MANUAL OF TOXICOLOGY. hysterical, the hypochondriac, the periodical melancholic or i drunkard, all turn to opium for that sense of well-being only attainable while they are under the influence of some perni- cious anodyne. Still another class of morphinists is met with. * * * Persons who have become a prey to grief or despondency * * * as well as those who are sleepless or overworked are too apt to seek the haven of rest and rare sense of mental relief only to be found in the extract of the poppy. The sleep of the opium habitue is never profound but is broken by the recurring visions which in the dream state are constantly changing. The majority of these are agree- able. * * * [but] may be of a disagreeable nature; in- numerable faces float before the eye of the imagination. * * Time is annihilated or increased to an eternity. * * * The permanent effect * * * is shown in pronounced moral obliquities, and in the resort to any means, no matter how unscrupulous, even actual forgery and theft, to obtain the drug. The idea of any personal responsibility falls to the lowest ebb; thought action, and even the most impera- tive duties, are shunned. While the largest number of these unfortunates are not insane in the stricter sense of the word, there is always present a certain degree of ethical obliquity, irritability, peevishness and moroseness. It is never safe to believe the word of an opium eater; he will prevaricate with or without reason, his disposition is uncertain and treacherous, his conscience is obtunded, he is dissolute, and has tendencies to morbid impulses." And the distinguished author and president of the British Society for the Study of Inebriety, Dr. Norman Kerr, of London, in speaking of the chronic morphinist, says: "He is harassed by frequent palpitation of the heart, op- pressed breathing, cramps in the abdomen and leg muscles, nocturnal pains, fitful sleep with terrifying dreams, trembling and fear at imaginary or real voices. There is an exaggerated sensibility, slight pains seem to be acute agony, resolution is transformed into irresolution, with uncertainty of purpose, confusion of thought, morbid melancholy and despair, ano- rexia alternating with fitful voracious appetite, general consti- pation with, it may be, frequent prostrating diarrhoeal or dysenteric attacks, salivation, listlessness, and indifference to cleanliness, personal appearance, and the claims of duty. The OPIUM AND MORPHINE. 385 moral sense is by and by perverted, so that the person's word cannot be relied on, and the no longer pleasant though neces- sary opiate oblivion is procured, if it cannot be honestly, by theft, the sale of one's living body, or murder. * * * r Sexual function is in general disturbed. In the female amenorrhoea prevails, in the male impotence, but in both sexes functional normality is gradually recovered on aban- donment of the drug. The effects of the cachectic marasmus, which is apt to have a fatal ending, often remains long after abandonment, though in most cases they are in time over- come. Death may supervene in various ways: from some mtercurrent malady, opiumists being peculiarly prone to be attacked by some diseases, while apparently almost proof against others; from an overdose taken either intentionally or accidentally; or, at rare times, from the effects of the shock incident on some surgical operation." McBride, of California, in his most excellent ar- ticle on "The Morphine Habit," says: "In respect of the moral qualities the morphinist is a 9riPple and he will remain so until he regains health, if he ever does, by a slow process of character growth which can only be begun after the drug is stopped and then con- tinued for some time subsequently. The quitting of the morphine habit is, therefore, but part of the cure. Though the patient may have quit the drug, and though he is com- fortable without it, the cure is far from complete." Nearly all morphine or opium habitues will offer some plausible, self-exonerating excuse or expla- nation for having become addicted to the use of the drug. They very commonly place the blame for having acquired the habit, upon the family physi- cian, if they have such, or upon some remedy given Or recommended by a friend. In the vast majority of cases their own deliberate and wanton self-indul- gence and dream-state seeking, are the true cause of the habit. McBride sums up the results of his own extended experience and observations, in these cases, as follows: "It is certainly true of a very large proportion of mor- phinists that they are people who are originally weak in self-control, and usually, too, they are impulsive and selfish. I have exceptionally been able to verify the common state- 386 A MANUAL OF TOXICOLOGY. ment of patients that they became addicted to the habit from the drug having first been given by a physician, so that I think many of the statements to this effect are misrepresen- tations. It seems to me that very many of them are volun- tary victims in the sense that they began taking the drugs from precisely the same motive that most alcoholic in- ebriates begin to drink liquor, that is because they find pleasure in it. As a rule we have in the morphinist as in the alcoholic inebriate, a man who was originally weak m self-control, and strong only in the qualities that thrive on human frailty. The number of these people who have origin- ally some twist in the mental make-up is surprisingly large, for, however talented they may be, and I have found some unfinished geniuses among them, the majority are certainly ill-balanced, unadjustable people, with a genuine talent for selfishness, and who in their constant attempts to make themselves comfortable fall upon the habit that becomes their ruin. The chapter is yet to be written which will fitting- ly describe the mental peculiarities and moral deficiencies of these people from whom this straggling, ruined army of humanity is recruited. It is not, therefore, probable, indeed it is hardly possible, that such people who in health begin the habit, will, when self-control, always weak, has been further weakened by disease or morbid habit be able to resist the temptation to indulgence. To consider the morphinist cured and ready to go back into the world soon after the use of the drug has been discontinued, is like expecting the typhoid patient to go about his business as soon as the tem- perature has dropped to normal, ignoring the tedious con- valescence and the perils that beset it. The cure of the morphine habit, like the cure of chronic insanity, to be permanent must be carried to a restoration of lost character elements." TREATMENT: Of the various methods of cure of the opium or morphine habit, that of more or less rapid reduc- tion of the size of the dose is undoubtedly the most successful and inflicts the least suffering upon the patient. Sudden and complete withholding of the. drug is rarely if at all practiced now as a means of cure. The latter course entails severe suffering Without any material benefit. OPIUM AND MORPHINE. 387 McBride's views are expressed as follows: "Of the possible methods of cure that of sudden, entire Withdrawal is not practiced now as far as I know. Either rapid or slow reduction enables the habit to be broken off With comparatively a small amount of suffering." Kerr says: 'In the drastic abrupt withdrawal, however, the agonies °f the sufferer are so practically unbearable, as a rule, that only in rare cases has the writer carried out this plan suc- cessfully." The opiumist or morphinist can, except very barely, only be treated successfully when under per- fect control. This is almost impossible in private practice, hence an institution is the proper place for such habitue. There he can be carefully watched, constantly prevented from obtaining the drug, and medicine and nourishment administered according to the indications. Depressed vitality, weak and mefficient circulation, gastric hyperacidity and catarrh, anorexia, nausea, vomiting, various pecu- liar pains, prostration, sleeplessness, and over- whelming craving for the drug can all be promptly dealt with. The patient will require tonics, perhaps trional, chloral, hyoscyamus, or some other hypnotic to pro- cure sleep; the hyperacidity of the stomach which not only distresses but also either precipitates or aggravates the insatiable craving for the accus- tomed drug, calls for the administration of an alka- line carbonate or bicarbonate, such as sodium bi- carbonate. The opium or morphine may be rapidly or very gradually reduced, according to the indications noted by frequent observations, such as are best provided for in an institution. The dosage may fluctuate, in the reduction process, according to the tolerance of the patient's nervous system to the shock of reduction. The final reductions are the least well borne, the system clinging tenaciously to every fraction of usual effect. 388 A MANUAL OF TOXICOLOGY. The patient should not know how much of thi drug he is taking when the reduction is made or the drug altogether discontinued. A hot bath, massage, rubbing the legs with alco- hol and ether, the use of bromides, gentian, nu> vomica, strychnine, digitalis, quinine extract of cocoa and coffee are among the beneficial measures] to be employed; chloralamid and even codeine may be required. Fresh air and a fair amount of exer- cise in the convalescent part of the treatment, and a healthful occupation of the mind throughout, are important points. Every case is to a certain eXi tent a law unto itself and will call for the physid cian's highest skill and persistent patience. Re-/ lapses, which may prove permanent, are apt to. occur, even after long abstinence perhaps extend ing over years. Probably the great difficulty ex' perienced of late by habitues in obtaining habit- forming drugs, thereby impelling them to secure medical aid, very materially contributes to per- manent relief and a marked reduction in the num- ber of habitues. Berkley says: "Comparatively few Morphine habitues are ever broker of their slavery to the alkaloid, and many that recover I under treatment relapse in the course of a few months. Especially difficult to treat are those patients who have superadded Cocaine or Alcohol to the original habit, the combinations inducing new trains of. symptoms even mon difficult to combat than those from Morphine alone." * * "Not more than ten per cent, of all cases permanently re- cover; the remainder relapse within a few months." PARALDEHYDE - CHRONIC PARALDE- HYDE POISONING. SYMPTOMS: Constipation, flatulence, muscular weakness tre- mors, restlessness, feeble, unsteady gait, insomnia, anxiety, discontent, unreasonableness, deficient memory, difficult speech, delusions, hallucinations of sight and hearing, irregular heart action, anaemia and emaciation are the chief symptoms. PHOSPHORUS, ETC. 389 TREATMENT: Discontinuance of the drug, with quieting and tonic treatment are, as a rule, promptly effective in establishing a cure. THOSPHORUS - CHRONIC PHOSPHORUS POISONING. Phosphorus may produce necrosis of the jaw Tom a periostitis resulting from the slow and con- tinuous action of phosphorus. The periostitis, as a rule, spreads from decayed teeth. The lower jaw ls> generally, the one affected. The remedy for such necrosis is surgical. SULPHONAL - TRIONAL - CHRONIC SUL- PHONAL POISONING - CHRONIC TRI- ONAL POISONING. HISTORY: Chronic poisoning by sulphonal or trional are in- variably the result of the daily taking of one or the °ther drug to produce sleep. SYMPTOMS: The symptoms are, in many respects, similar. Chief among these are noted frequently, disturbance digestion, nausea, vomiting, constipation or diarrhoea, noises in the ears, headache, vertigo, men- ial and physical incapacity, difficulty of speech, un- steadiness of gait, sometimes more or less paralysis, great emaciation, etc. The treatment consists of a discontinuance of the drug, rest, a carefully regulated diet, tonics, mas- sage, etc. TREATMENT: 390 A MANUAL OF TOXICOLOGY. WORMWOOD - ABSINTHE - ABSINTH- ISM. Wormwood combined with alcohol and some- times adulterated with other noxious substances,': and in either case known as absinthe, is an intense' poison, rather than a tonic and aid to digestion as^ many suppose. Absinthe, so freely used in France, particularly in Paris, and increasingly in other parts of Europe, is undoubtedly one of the greatest curses of the French nation. A reckless absinthe mania is said to pervade both' rich and poor classes. The craving for the draught./ is most intense, the poison becoming almost an ab- solute necessity of existence. Its effects on the human brain are very serious. An alcoholic infusion of wormwood with other plants may be distilled to produce absinthe or as is now more commonly done, alcohol is added to vari- ous herb essences with essence of wormwood. (The liquer is also said to be an alcoholic solution of oil of wormwood with a little angelica, anise, and mar-h joram). HISTORY: SYMPTOMS: Absinthe reduces the gastric juice, inter- feres with digestion and produces a most distressing dyspepsia. The drug is said to produce its effect mainly on the cervical portion of the spinal cord-' There is nocturnal restlessness and morning nausea ; and vomiting; the tongue and hands tremble, there is blindness, stupor, headache, apathetic listlessness., epileptiform convulsions, unconsciousness, falling, foaming at the mouth and throwing the limbs about, etc. The alcohol of the absinthe relaxes, the worm- wood tightens, so that the action of the former is succeeded by that of the latter. Alcohol produces coldness which absinthe increases, so that nervous WORMWOOD, ETC. 391 'Chills, unnatural coldness, trembling, nausea and staggering may result from drinking absinthe. The alcohol has paralyzed the inhibitory power so that the voluntary muscles, urged by the absinthe and unrestrained and uncontrolled, are forced into convulsions of an epileptic character associated with complete unconsciousness. A repetition of the ab- sinthe effect during the alcoholic relaxation is apt to result in confirmed epilepsy. It is said that "the characteristic phenomena of absinthecum-alcohol inebriety-are the epileptic explosion, vertigo, and early delirium." It is also said that "the more con- centrated the poison the more pronounced is its local gastric causticity, alcohol being an irritant as well ns a narcotic poison." If the poison be freely di- luted with water it is more rapidly and completely absorbed, consequently increasing the other toxic properties. . The fascination which absinthe has for the ab- sinthe drinker is intense. Perhaps the mental ef- fect of his indulgence is a sufficient explanation of this. Under its influence he may believe himself to be a participant in the most momentous affairs. A panorama of battling hosts, raging elements, scenes of unrestrained revelry, of the transit of Worlds of indescribable beauty and brightness, etc., passes swiftly before his distorted vision. He is lost in admiration and ecstacy, or overwhelmed with the intensity of stormy passions. He lives in another realm, and revels in T. He may be afflicted with terrifying hallucina- tions. TREATMENT: Although some claim that absinthism may be cured by discontinuing the poison and building up the nervous system, there can be no question but that the habit has an exceedingly strong hold upon its victim, greatly injures him, and that it is very difficult to permanently discontinue it. APPENDIX Showing the Minimum and Maximum Doses of the Principal and Many New Remedies. DOSE TABLE. (.This table is the result of the author's comparing and averaging the doses stated by the leading American and European authorities'). Note 1.-Approximate reduction to Metric doses may be ob- tained by multiplying Grains or Minims by 6%, giving Centi- grams ; by multiplying Drachms by 4, giving Grams; by mul- tiplying Ounces by 31, giving Grams. It is customary to count 8 teaspoonfuls to the ounce, especially when a gradu- ated medicine glass is used.) Note 2.-The following signs are used to confirm large doses intended to be prescribed in a prescription (2 grains are taken as an example) : By underscoring thus: gr. ij or thus: gr. ii. By emphasis after, thus: gr. ij ! or !!! By spelling out the quantity: gr. ij two grains. By writing after the quantity : gr. ij correct dose. By writing after the quantity: gr. ij large dose intended. Note 3.-Dr. Young's Rule for finding the fractional adult dose for a child:- Divide the age by the age plus 12. Thus a child 3 years of age should get 3 1 of the adult dose. ■^or children the doses of narcotics should be still smaller and of purgatives larger. At the age of 20 or 21 years the full dose of a medicine is given. The hypodermatic dose is about % that by the mouth. The rectal or vaginal dose about twice that by the mouth. 3+12 5 For his own convenience, the author has devised the following rule, to determine the proportionate dose for a child less than one year old:-To the number of months the child lacks of being one year old add 12, to form the denominator of a fraction the numerator of which shall be 1 (the figure of the full year). This fraction may be considered to indicate the approximate frac- tional part of the adult dose suitable to the required age. Example.-Age 3 months, which is 9 months less than 1 year' Author's Rule for child less than one year old: 1 of adult dose. At birth the dose should be usually about one-half that computed by this method. 1 9-1-12 21 After careful review, the author has adopted, for some of the Newest remedies, doses recommended by Merck & Co., Burroughs, Wellcome & Co., and Parke Davis & Co., for their own very reliable products- 394 A MANUAL OF TOXICOLOGY. APPORTIONATE DOSE TABLE. From 20 to 60 years of age give full dose; From 60 to 80 " " % to % full dose; From 80 to 100 " " % to % " From 14 to 20 " " % At 14 years of age give % full dose; At 12 " " y2 At 8 " " 2-5 At 6 " " i/3 At 4 " " % At 3 " " 1-5 At 2 " " 1-7 At 1 " " 1-12 At 6 months of " 1-16 " At 3 " " 1-20 At birth give 1-60 to 1-30 " DOSE TABLE. Remedy. Dose. Minimum. Maximum. Absinthin 15 to 30 gr. Acetal 1% to 3 dr. Acetanilidum 2 to 10 gr. Acetonum 5 to 15 min. Acetum Opii [Black Drop (E)].. 5 to 15 min. Acidum Agaricicum 1-12 to % gr. Arsenosum 1-60 to 1-10 gr. ' Benzoicum 5 to 30 gr. Boricum 5 to 30 gr. Camphoricum 10 to 30 gr. Carbolicum % to 3 min Catharticum 4 to 5 gr. Chrysophanicum .'... % to 10 gr. Citricum 5 to 30 gr. Fluoricum Dilutum 15 to 20 min. Gallicum 5 to 30 gr. Gynocardicum % to 3 gr. Hydrobromicum Dilutum % to 2 dr. Hydrochloricum Dilutum .... 5 to 30 min. Hydrocyanicum Dilutum Hypophosphorosum Dilutum .. 1 to (10 per 5 min. cent.) 10 to 30 min. Lacticum 15 to 30 gr Nitricum Dilutum 5 to 30 mm, DOSE TABLE. 395 Remedy. Dose. Minimum. Maximum. Acidum Nitrohydrochloricum 1 to 10 min. Dilutum 5 to 20 min. Oxalicum 14 to 1 gr. Phosphoricum Dilutum 5 to 30 min. Picricum % to 5 gr. Salicylicum 5 to 30 gr. Sulphuricum Aromaticum 5 to 15 min. Dilutum 5 to 20 min. Tannicum 1 to 20 gr. Tartaricum . 10 to 30 gr. Valerianicum 2 to 10 min. ^conitina (Potent., Cryst.) . 1-650 to 1-200 gr. (Mild Amorph.) . 1-60 to 1-20 gr. Duquesnel . 1-400 to 1-100 gr. Aconitinae Nitras . 1-500 to 1-250 gr. Adonidin . . 1-16 to 14 gr. Aether 5 to 60 min. Hydrobromicus 10 to 60 min. Agaricin . % to 1 gr. Agathinum . 5 to 10 gr. Alantol (Inulol) . 1-6 to % gr. Allyl Tribromidum 3 to 8 min. Aloe Purificata Aloinum .... 1 to 5 gr. 1 to 3 gr. Alumini Hydras 3 to 15 gr. Aminiformum (Urotropin. Formin) 5 to 20 gr. Ammonii Arsenas . 1-20 to 1-12 gr. Benzoas 5 to 15 gr. Bromidum 5 to 30 gr. Carbonas 3 to 15 gr. Chloridum 1 to 20 gr. lodidum 2 to 10 gr. Phosphas 5 to 20 gr. Pieras % to 16 gr. Salicylas 2 to 20 gr. Valerianas 1 to 5 gr. Ammonol (Ammonium Phenyl Acetamid). 3 to 20 gr. Salicylas 4 to 8 gr. Amyl Nitris 14 to 1 min. Amyleni Hydras 15 to 90 min. Amylum lodatum Anal gen 3 to 30 gr. 2 to 15 gr. Anarcotina (Narcotin) •...., 1 to 3 gr. 396 A MANUAL OF TOXICOLOGY Remedy. Anemonin Dose. Minimum. % to Maximum. % gr. Antifebrin 2 to 10 gr. Antikamnia 4 to 10 gr. Antikol 3 to 10 gr. Antimonii et Potassii Tartras 1-20 to % gr. Oxidum 1 to 2 gr. Sulphidum Purum U to 1 gr- Antimonium Sulphuratum 1 to 2 gr. Antipyrinum (Phenazonum, B. P.).... 2 to 20 gr. Antisepsin (Asepsin) 3 to 10 gr. Antispasmin % to 2 gr. Antithermin 3 to 8 gr. Antitoxin (Diphtheria) 5 to 10 cc. Apiolinum 1% to 3 gr. Apiolum 2 to 10 min. Apiolum (Cryst.) 4 to 15 gr. Apocodeinas Hydras 3 to 4 gr. Hydrochloras 1 to 1% gr. Apocynin % to % gr. Apolysin 1 to 30 gr. Apomorphinae Hydrochloras 1-10 to 1-6 gr. (Hypodermically) .... 1-30 to 1-10 gr. Aqua Ammonias 5 to 30 min. Creosoti 1 to 4 dr. Laurocerasi 5 to 30 min. Arbutin 2 to 15 gr. Arecolin 1-20 to 1-16 gr. Argenti Cyanidum .... 1-60 to 1-20 gr. lodidum '. % to 1 gr. Nitras % to % gr. Oxidum % to 2 gr. Arsenauro .'.... 5 to 15 min. Arseni Bromidum 1-60 to 1-20 gr. lodidum .... 1-20 to 1-12 gr. Asaprol 3 to 10 gr. 3 to 10 gr. Aspidosperminae Plydrochloras 1-50 to 1-30 gr. Sulphas 1-30 to 1-10 gr. Aspirin 3 to 15 gr. Atropina 1-120 to 1-60 gr. Atropinae Sulphas 1-120 to 1-60 gr. Auri Bromidum 1-10 to 1-50 gr. Auri et Sodii Chloridum 1-30 to 1-10 gr. DOSE TABLE. 397 Remedy. Dose. Minimum. Maximum. Balsamum Gurjunae 10 to 50 min, Baptisin % to 5 gr. Barii Chloridum . 1-10 to 1 gr. Sulphidum % to 1 gr. Eenzanilidum 10 to 15 gr. Benzolinum 3 to 10 gr. Benzonaphtol 4 to 8 gr. Benzosol (Benzol-guaiacol, Guaiacol-ben zoas) 3 to 15 gr. Berberina 1 to 10 gr. Berberinae Hydrochloras 1 to 10 gr. Beta-Naphtol 3 to 6 gr. Betol . 5 to 8 gr. Bismuthi Benzoas 5 to 15 gr. Benzonaphtolas 15 to 30 gr. Beta-Naphtolas (Orphol) . 5 to 15 gr. Carbolas (Phenol Bismuth) 5 to 15 gr. Lactas 5 to 15 gr. Oxyiodidum (Subiodidum) 5 to 15 gr. Salicylas .. 5 to 15 gr. Subcarbonas 5 to 60 gr. Subgallas (Dermatol) 5 to 15 gr. Subnitras . 5 to 60 gr. Tannas (Bismuthan) 5 to 30 gr. Blennostasin 1 to 4 gr. Bromalin 30 to 60 gr. Bromoformum 1 to 10 min, Bromol . 1 to 2 gr. Brucina 1-12 to % gr. Bryonin 1-6 to 2 gr. Butyl-Chloral Hydras (Croton Chloral)..., 5 to 10 gr. Caffeina 1 to 5 gr. Citrata 1 to 10 gr. Effervescens 1 to 2 dr. Caffeinae Hydrobromas % to 2 gr. Hydrochloras . 1 to 5 min. 1 to 3 gr. Sodio-Benzoas ■ 2 to 10 gr. Sodio-Salicylas . 2 to 10 gr. Tri-iodidum ■ 1 to 4 gr. Valerian as 1 to 3 gr. Calcii Bromidum 5 to 30 gr. Chloridum • • • . 5 to 20 gr. 398 A MANUAL OF TOXICOLOGY. Remedy. Dose. Minimum. Maximum. Calcii Glycerophosphas. .; 2 to 5 gr. lodidum 1 to 3 gr. Lactas 3 to 6 gr. Lactophosphas 3 to 10 gr. Phosphas Praecipitatus 8 to 20 gr. Calx Chlorata 3 to 6 gr. Sulphurata 1-10 to 1 gr. Cambogia 1 to 4 gr. Camphora 1 to 10 gr. Monobromata 1 to 10 gr. Salicylata % to 3 gr. Cannabina (alkaloid) 1 to 4 gr. Cannabinae Tannas 2 to 10 gr. Cannabinon % to 1 gr. Capsicin % to U gr. Capsicum 1 to 5 gr. Carbo Animalis Purificatus 10 to 60 gr. Ligni 10 to 60 gr. Cascarine 2 to 3 gr. Castoreum 10 to 50 gr. Caulophyllin (resinoid) % to 2 gr. Cerii Oxalas 1 to 5 gr. Chinoidinum 1 to 30 gr. Chinol 3 to 5 gr. Chinolinae Tartras 5 to 20 gr. Chloral 5 to 20 gr. Chloralose 3 to 10 gr. Chloralamidum 10 to 40 gr. Chloral-Antipyrin (Hypnal) 15 to 30 gr. Chloral-Caffeina 3 to 7 gr. Chloretone 5 to 20 gr. Chlorodyne 5 to 30 min. Chloroformum 2 to 10 min. Chrysarobinum 1-60 to 1-12 gr. Cimicifugin 1 to 3 gr. Cinchonina 1 to 30 gr. Cinchoninae Salicylas 1 to 30 gr. Sulphas 1 to 30 gr. Cinchonidinae Sulphas 1 to 30 gr. Citrophen 3 to 15 gr. Cocainae Hydrochloras % to 2 gr. Salicylas % to 2 gr. Codeina % to 1 gr. DOSE TABLE. 399 Remedy. Dose. . Minimum. Maximum. Codeinae Phosphas % to % gr. Sulphas 14 to 1 gr. Valerianas % to 1 gr. Colchicin 1-120 to 1-30 gr. Colocynthin 1-20 to 1 gr. Coniina 1-60 to 1-30 gr. Convallamarin 14 to 1 gr. Convallarin 2 to 4 gr. Convolvulin 1 to 2 gr. Cornutin (Ecboline) 1-20 to 1-10 gr. Cotoin 14 to 5 gr. Creatinum 1 to 114 gr. Creolin % to 5 gr. Creosotal (Creosote Carbonate) 3 to 15 min. Creosotum 1 to 3 min. Cupri Acetas % to 1 gr. Arsenas 1-130 to 1-100 gr. Sulphas 14 to 10 gr. Daturina 1-150 to 1-50 gr. Daturinae Sulphas 1-150 to 1-50 gr. Digitalin, German (Merck) 1-16 to 14 gr. Digitoxin 1-250 to 1-120 gr. Dionin (Ethyl-Morphine Hydrochlor.) 14 to 1 gr. Diuretin (Theobromin Sodio-Salicylate) ... 5 to 20 gr. Duboisinae Sulphas 1-100 to 1-60 gr. Duotal (Guaiacol Carbonate) 5 to 15 gr. Elaterinum 1-60 to 1-12 gr. Elaterium 1-10 to 14 gr. Emetina, Expectorant 1-120 to 1-60 gr. Emetic % to 14 gr. Eosote 3 to 5 gr. Ergotinum, Bonjean 2 to 8 gr. Ergotole, by mouth 5 to 30 min. Hypodermic 5 to 20 min. Eserina (Physostigmin) 1-200 to 1-60 gr. Eucalyptol 1 to 15 gr. Eudoxin 5 to 8 gr. Euonymin 14 to 3 gr. Euphorin 14 to 3 gr. Euquinin (Euchinin) 1 to 30 gr. Exalgine 1 to 3 gr. Extractum Aconiti 14 to 14 gr. 400 A MANUAL OF TOXICOLOGY. Remedy. Dose. Minimum. Maximum. Extractum Aconiti Fluidum % to 2 min. Ailanthi Fluidum 10 to 60 min. Aloes Aquosum % to 3 gr. Apocyni Fluidum 5 to 20 min. Baptisiae Fluidum 2 to 10 min. Belladonnas Foliorum Alcoholicum.... 1-10 to % gr. Fluidum 3 to 6 min. Radicis % to % gr. Fluidum 1 to 3 min. Berberis Vulgaris Fluidum 5 to 30 min. Boldi Fluidum 1 to 5 min. Buchu Fluidum 10 to 60 min. Cacti Grandiflora Fluidum 5 to 10 min. Cannabis Indicae % to 1 gr. Fluidum 1 to 5 min. Cinae Fluidum 15 to 60 min. Colchici Radicis % to 3 gr. Fluidum 2 to 5 min. Seminis Fluidum . 1 to 5 min. Colocynthidis % to 2 gr. Conii 1 to 2 gn Fluidum 2 to 5 min. Convallariae Fluidum 1 to 15 min. Digitalis % to gr. Fluidum 1 to 3 min. Ergotae % to 8 gr. Fluidum 15 to 60 min. Euonymi 1 to 5 gr. Gelsemii Alcoholicum % to % gr. Fluidum 1 to 5 min. Glandulae Suprarenales 3 to 8 gr. Guaranae Fluidum '.... 10 to 30 min. Hyoscyami Alcoholicum 1 to 3 gr. Fluidum 3 to 10 min. Ignatiae % to % gr. Jambolanum Fluidum 10 to 20 min. Nucis Vomicae % to % gr. Fluidum 1 to 5 min. Opii to 1 gr. Passiflorae Fluidum 5 to 10 min, Physostjigmatis 1-16 to % gr. Fluidum 1 to 3 min. Rhamni Purshianae Fluidum 10 to 30 min. DOSE TABLE. 401 Remedy. Dose. Minimum. Maximum. Extractum Rhois Toxicodendri Fluidum. ... 1 to 15 min. Scillae Fluidum 1 to 5 min. Stramonii 1-6 to 54 gr. Veratri Viridis Fluidum 1 to 5 min. Viburni Prunifolii Fluidum 54 to 1 dr. Febralgene 5 to 15 gr. Fei Bovis Inspissatum 5 to 15 gr. Purificatum 5 to 10 gr. Ferratin 4 to 10 gr. Ferri Albuminas 10 to 20 gr. Arsenas 1-16 to % gr. Benzoas 1 to 5 gr. Bromidum 1 to 5 gr. Citras 2 to 10 gr. et Strychninae Citras 1 to 3 gr. Glycerophosphas 1 to 5 gr. lodidum 1 to 5 gr/ Lactas 1 to 3 gr. Oxalas 1 to 2 gr. Phosphas 5 to 10 gr. Pyrophosphas 1 to 5 gr. Salicylas 3 to 10 gr. Subcarbonas 5 to 30 gr. Sulphas 1 to 5 gr. Exsiccatus % to 3 gr. Valerianas % to 2 gr. Ferropyrin 5 to 15 gr. Ferrosomatose 15 to 60 gr. Ferrum Dialysatum 10 to 30 min. Reductum 1 to 5 gr. Formin (Urotropin) 5 to 30 gr. Fuchsin (Rosein) 1-10 to 3 gr. Gelsemin (resinoid) % to % gr. Gelsemina (alkaloid) 1-120 to 1-30 gr. Gelseminae Hydrochloras 1-120 to 1-30 gr. Geosote (Guaiacol Valerianas) 2 to 10 min. Glandulae Pituitae 2 to 4 gr. Prostatae, Sicc. Pulv 54 to 2 gr. Suprarenales Sicc. Pulv 1 to 4 gr. Thymi (Thymus Gland) 4 to 10 gr. Thymi Sicc. Pulv 3 to 10 gr. Thyroideae Siccae 1, gradual to 10 gr. Glonoinum (Nitroglycerin) 1-200 to 1-50 min. Guaicol 54 to 2 min. Benzoas (Benzosol) 3 to 15 gr. 402 A MANUAL OF TOXICOLOGY. Remedy. Guaiacol Carbonas (Duotal) Salicylas (Guaiacol Salol) Valerianas (Geosote) Guaiamar Dose. Minimum. Maximum, 5 to 5 to 2 to 5 to 15 gr. 15 gr. 10 20 min, gr- Guaiaperol . 4 to 20 gr- Guaiaquin (Guaiacol Quinin Bisulphonas). 1 to 5 gr- Guaranin 1 to 5 gr- Helonin . to 3 gr- Hemalbumen . 10 to 20 gr- Hemogallol . 5 to 20 gr- Hemoglobin .. % to 2 gr- Hemol 5 to 10 gr- Heroina . 1-12 to 1-6 gr- Heroinae Hydrochloras . 1-12 to 1-6 gr- Homatropinae Hydrobromas .1-120 to 1-20 gr- Hydrochloras .1-120 to 1-20 gr- Salicylas .1-120 to 1-20 gr- Hydrargyri Chloridum Corrosivum . 1-80 to 1-10 gr- Mite 1-10 to 20 gr- Cyanidum .1-100 to 1-10 gr- lodidum Flavum . 1-6 to 1 gr. Rubrum . 1-50 to 1-10 gr. Oxidum Rubrum . 1-10 to 1-5 gr. Salicylas . 1-10 to % gr- Subsulphas Flavum (Turpeth Mineral) x/4 to % gr- as emetic for child 2 to 3 gr. Tannas . % to 2 gr Thymol-Acetas . 1-12 tc 1-6 gr- Hydrargyrum cum Creta (Gray Powder). % to 10 gr- Hydrastin (resinoid, eclectic).. 5 to 10 gr- Hydrastina (alkaloid) . 1-16 to % gr- Hydrastinse Sulphas .... '. . 1-16 to % gr. Hydrastinina . 1-16 to 1-6 gr. Hydrastininae Hydrochloras . 1-16 to 1-12 gr. Hydrochinonum (Hydroquinone) 5 to 30 gr- Hyoscina .1-120 to 1-60 gr- Hyoscinae Hydriodidum .1-120 to 1-60 gr. Hydrobromas .1-120 to 1-60 gr. Hydrochloras .1-120 to 1-60 gr. Hyoscyamin (resinoid, amorphous) to U gr. Hyoscyamina (alkaloid, cryst.) . 1-120 to 1-60 g-r. Hyoscyaminse Hydrobromas .1-120 to 1-60 gr. Sulphas .1-120 to 1-60 gr. DOSE TABLE. 403 Remedy. Hypnacetin Hypnal Hypnone Ichthalbin Bosk. Minimum. , 3 to , 15 to 1 to , 5 to Maximum 4 gr. 30 gr. 7 gr. 10 gr. Ichthyol . 3 to 10 gr. Infusum Digitalis . 1 to 4 dr. Infusum Sennae Comp. (Black Draught).... 1 to 3 oz. lodipin . 15 to 60 min. lodocaffein 2 to 5 gr. lodoformum 1 to 3 gr. Iodol % to 3 gr. lodothyrin (Thyrein) 5 to 10 gr. Ipecacuanhas 1-6 to 30 gr. Iridin 1 to 3 gr. Jalapa . 10 to 20 gr. Juglandin 1 to 5 gr. Kairin 15 gr. 5 gr. Kalagua % to Kryofine 4 to 12 gr. Lactophenine 8 to 15 gr. Largin 5 to 8 gr. 5 min. Liquor Acidi Arsenosi 3 to Arseni et Hydrarg. lodidi (Donovan's Sol.) 1 to Epinephrin Hydrochlor. Adrenalin. 10 min. Chlorid. (1 to 1,000) 5 to 30 min. Ferri Chloridi 2 to 10 min. lodi Compositus (Lugol's Solution)... 1 to 10 min. Morphinae Bimeconatis 5 to 40 min Opii Compositus (Squibb) 3 to 20 min. Potassae 5 to 30 min. Potassii Arsenitis (Fowler's Solution). 1 to 8 min. Sodii Arsenas 1 to 8 min. Lithii Benzoas 5 to 15 gr. Bjomidum 5 to 20 gr. Carbonas 2 to 10 gr. Citras * 2 to 5 gr. lodidum ; 1 to 8 gr. Salicylas 5 to 30 gr. Lobelin % to 1 gr. Lupulinum 5 to 10 gr. Lycetol . 15 to 30 gr. Lysidin 1 to 5 gr. Massa Ferri Carbonatis . 3 to 5 gr. Hydrargyri . 1 to 10 gr. Magnesii Glycerophosphas . 2 to 5 gr. 404 A MANUAL OF TOXICOLOGY. Remedy. Malakin Dose. Minimum. Maximum. 5 to 10 gr. Malarin 5 to 15 gr. Mangani Dioxidum (Binoxide, Peroxide). 2 to 5 gr. Hypophosphis , .. 10 to 20 gr. Sulphas .. 2 to 5 gr. Menthol 3 to 5 gr. Methyl Salicylas ,. 5 to 10 min. Methylal 2 to 5 min. Methylene Blue 1 to 8 gr. Migrainin 2 to 15 gr. Morphina . 1-20 to ¥2 gr. Morphinas Acetas . 1-20 to gr. Hydrochloras . 1-20 to % gr. Sulphas . 1-20 to % gr. Muscarina . 1-30 to 2 gr. Napellin % to % gr. Naphtalinum 2 to 15 gr. Narceina . 1-6 to 1 gr. Narceinae Hydrochloras . 1-6 to 1 gr- Narcotina 2 to 15 gr. Neosalvarsan (intravenously every 2d day, 4 times) 1° gr. Nepenthe 5 to 30 min. Neurodin 5 to 10 gr. Niccoli Bromidum 2 to 8 gr. Nicotina ..1-20 to 1-10 gr. Nitroglycerinum .1-200 to 1-50 min. Nosophen (lodophen) 5 to 8 gr. Nuclein 20 to 60 gr. Oleoresina Aspidii % to 1 dr. Capsici % to 1 min. Piperis % to 1 min. Oleum Amygdalae Amaras % to 1 min. Anisi 1 to 5 min. Anthemidis 2 to 10 min. Cajuputi 1 to 5 min Cari 1 to 5 min. Caryophylli 1 to 5 min Chenopodii 5 to 10 min. Cinnamomi 1 to 5 min. Copaibae 1 to 15 min. Erigerontis 1 to 10 min. Gaultherias 3 to 20 min. Hedeomae 2 to 10 min. Junioeri 5 to 20 min. DOSE TABLE. 405 Remedy. Dose. Minimum. Maximum. Oleum Lavandulae Florum .. 1 to 5 min. Menthae Piperitae . 1 to 5 min. Phosphoratum 1 to 3 min. Rutae 1 to 5 min. Sabinae 1 to 5 min. Santoli 5 to 30 min. Sinapis Volatile % to % min. Tanaceti 1 to 3 min. Terebinthinae 5 to 60 min. Tiglii % to 2 min. Opii Pulvis 34 to 2 gr. Opocerebrinum 3 to 6 gr. Opohepatoidinum 5 to 10 gr. Opohypophysinum % to % gr. Opolieninum % to 1% dr. Opomamminum 15 to 25 gr. Opomedullinum 3 to 15 gr. Opoorchidinum 8 to 12 gr. Opoossiinum 3 to 15 gr. Opoovariinum 3 to 12 gr. Opopancreatinum 3 to 12 gr. Opoprostatinum 1 to 3 gr. Oporeniinum 8 to 12 gr. Oposupranelinum 3 to 6 gr. Opothymiinum 3 to 8 gr. Opothyroidinum % to 1% gr. Orexin 2 to 6 gr. Orexinae Tannas 2 to 8 gr. Orthoform 5 to 15 gr. Orphol 5 to 15 gr. Oxycamphor 10 to 15 gr. Papain (Papoid) 2 to 5 gr. Papaverina % to 34 gr. Papayotin 34 to 1 gr. Paraldehydum 30 to 60 min. Pelletierinae Hydrobromas 4 to 8 gr. Hydrochloras 4 to 8 gr. Sulphas 5 to 10 gr. Tannas 5 to 10 gr. Pellotina % to 1 gr. Pellotinae Hydrochloras % to 1% gr. Peptenzyme 10 to 20 gr. Peronin Vj to 1 gr 406 A MANUAL OF TOXICOLOGY. Remedy. Phenacetinum Dose. Minimum. Maximum. 5 to 20 gr. Phenalgin Pheno-Bromate 5 to 20 gr. Phenocoll Hydrochloras 5 to 10 gr. Salicylas (Salocoll) 3 to 30 gr. Phenol-Bismuth (Bismuthi Carbolas) 5 to 15 gr. Phenolid 5 to 10 gr. Phenosal 5 to 8 gr. Phesin 8 to 15 gr. Phloridzin (Phlorizin) ,. 15 to 30 gr. Phospho-Albumen 5 to 15 gr. Phosphorus .1-120 to 1-50 gr. Physostigmina (Eserin) .1-200 to 1-60 gr. Physostigminae Salicylas .1-120 to 1-60 gr. Sulphas .1-120 to 1-60 gr. Phytolaccin .. 1 to 3 gr. Phytoline 15 min. Picrotoxinum . 1-60 to 1-20 gr. Pilocarpinae Hydrochloras . 1-60 to % gr. Piperazinum 5 to 10 gr. Piperidin Guaiacolas 5 to 10 gr. Piperinum .. 1 to 8 gr. Plumbi Acetas % to 3 gr. lodidum % to % gr. Potassi Acetas 5 to 60 gr. Arsenas .1-120 to 1-10 gr. Bichromas . 1-12 to % gr. Bromidum ,. 10 to 60 gr. Carbonas 2 to 20 gr. Chloras 2 to 20 gr. Ferrocyanidum 5 to 10 gr. lodidum 2 to 30 gr. Permanganas % to 3 gr. Salicylas 5 to 15 gr. Protopin 100 gr. Pulvis Antimonialis (James' Powder)..., .. 3 to 10 gr. Elaterini Compositus % to 5 gr. Ipecacuanhae et Opii (Dover's Powder) 2 to 15 gr. Jalapae Compositus .. 10 to 60 gr. Morphinae Compositus (Tully's Powder) 5 to 15 gr. Rhei Compositus (Gregory's Powder). . 20 to 60 gr. Quinidinae Sulphas 1 to 30 gr. Quininae Arsenias . % to 1 gr. DOSE TABLE. 407 Remedy. Dose. Minimum. Maximum. Quininae Bisulphas 1 to 20 gr- Ferrocyanidum 5 to 10 gr- Hydrobromas 1 to 20 gr. Hydrochloras 1 to 20 gr. lodidum 1 to 5 gr. Sulphas 1 to 20 gr. Sulphocarbolas 1 to 6 gr. Tannas 1 to 6 gr. Valerianas 1 to 3 gr. Salicylas 1 to 5 gr. Resina Podophyllii to 1 gr. Resorcinum 2 to 10 gr. Rubidii Bromidum 2 to 10 gr. et Ammonii Bromidum 1 to 15 gr. lodidum 1 to 5 gr. Saccharin (Glusidum, B. P.) 2 to 5 gr. Salacetol (Salantol) .. 20 to 30 gr. Salfene 5 to 10 gr. Salicinum 5 to 30 gr- Saligenin 5 to 30 gr. Salipyrin (Antipyrin Salicylas) 5 to 30 gr. Salocoll (Phenocoll Salicylas) 3 to 30 gr. Salol 3 to 30 gr. Salophen 5 to 20 gr. Salvarsan ("606") (intravenously) 10 gr- Sanguinarina . 1-12 to % gr. Sanguinarinae Nitras . 1-12 to % gr. Sulphas . 1-12 to % gr. Santoninum 1 to 5 gr. Saponinum . to 2 gr. Scoparin to 1 gr. Scopolaminse Hydrobromas (Hypoderm.). .1-250 to 1-60 gr. Sodii Acetas .. 15 to 60 gr. Arsenas . 1-60 to 1-10 gr- Benzoas 5 to 60 gr. Bromidum 5 to 60 gr. Cacodylas (hypoderm.) 1 gr ..(per ora) 3 gr. Glycerophosphas 3 to 10 gr. Salicylas 5 to 30 gr. Santonas 1 to 10 gr. Sozoidolas 5 to 30 gr. Sulphocarbolas 5 to 30 gr. Sulphoichthyolas 3 to 10 gr. Valerianas 1 to 5 gr. Solanina .. % to 1 gr. 408 A MANUAL OF TOXICOLOGY. Remedy. Dose. Minimum. Maximum. Somnal 15 to 30 min. Sparteinae Sulphas ITO to 14 gr. Spiritus Aetheris Compositus 5 to 60 min. Nitrosi 14 to 2 dr. Ammonias Aromaticus 15 to 60 min. Camphors 5 to 40 min. Chloroformi 10 to 60 min. Glonoini 1 to 3 min. Strontii Bromidum . .■ 5 to 20 gr. lodidum 5 to 60 gr. Salicylas 5 to 15 gr. Lactas 1 to 10 gr. Strophanthin 1-120 to 1-60 gr. Strychnina 1-60 to 1-12 gr. Strychninse Arsenas . 1-60 to 1-12 gr. Nitras 1-60 to 1-12 gr. Sulphas .. 1-60 to 1-12 gr. Syrupus Acidi Hydriodici % to 3 dr. Allii 1 to 4 dr. Ferri lodidi 5 to 30 min. Ipecacuanhas 14 to 6 dr. Mangani lodidi 10 to 30 min. Scills 30 to 60 min. Compositus 10 to 30 min. Sulphonal 10 to 40 gr. Svapnia % to 3 gr. Tannalbin 5 to 20 gr. Tannigen 2 to 10 gr. Tannopin (Tannone) 3 to 15 gr. Terebenum 2 to 20 min« Terpini Hydras . 2 to 10 gr. Terpinol ; 3 to 5 gr. Tetronal 10 to 30 gr. Thallin % to 8 gr. Thallins Sulphas % to 8 gr. Tartras 14 to 8 gr. Thebain 14 to 1 gr. Theina (Hypoderm.) 1-6 to 1 gr. Theobromin Theobromins Lithium Salicylas 5 to 15 gr. (Uro- pherin) . . 5 to 15 gr. Sodio-Salicylas (Diuretin) .... Thermol 5 to 20 gr. 3 to 6 gr. DOSE TABLE. 409 Remedy. . Mi Thiocol Dose. inimum. Maximum. 5 to 20 gr. Thiol 2 to 10 gr. Thymol % to 2 gr. Thymus Gland 4 to 10 gr. Dried, Powdered 3 to 10 gr. Thyreoids 2 to 5 gr. Thyrogiandin 3 to 5 gr. Tinctura Aconiti 1 to 5 min. Fleming (4 tO 2 min. Ailanthi 10 to 120 min. Baptisias 5 to 30 min. Belladonnas Foliorum 1 to 20 min. Berberis Vulgaris 10 to 60 min. Boldi 10 to 20 min. Bryoniae 5 to 30 min. Cannabis Indica 5 to 60 min. Cantharidis 1 to 20 min. Capsici 10 to 60 min. Catechu Composita 10 to 60 min. Chloroformi Composita 20 to 60 min. Cimicifugae 5 to 60 min. Colchici Seminis 10 to 60 min. Conii 5 to 30 min. Digitalis 5 to 30 min. Gelsemii 5 to 15 min. Hyoscyami 10 to 30 min. lodi 1 to 5 min. Ipecacuanhas 2 to 15 min. Ipecacuanhas et Opii (Liq'd Dover's Powd.) 2 to 15 min. Lobelia 5 to 30 min. Nucis Vomicae 5 to 20 min. Opii (Laudanum) 3 to 20 min. Camphoratae (child. 3 to 30 drops). 1 to 4 dr. Compositus (Squibb) % to 1 dr. Deodorata 3 to 20 min. Physostigmatis . 5 to 30 min. Simuli *4 to 2 dr. Stramonii 5 to 20 min. Strophanthi 2 to 10 min. Sumbul 15 to 60 min. Veratri Viridis 1 to 5 min. Tolysal (Tolypyrin Salicylas) 5 to 30 gr. Tribromphenol Bismuth (Xeroform) 8 to 15 gr. 410 A MANUAL OF TOXICOLOGY. Remedy. Trimethylaminse Hydrochloras Tri-nitrinum. See Nitroglycerin. Trional Dose. Minimum. Maximum. ... 1 to 10 to 3 gr. 30 gr. Triphenin ... 4 to 15 gr. Tuberculin (Koch) ...1-250 to 1-60 gr. Tussol (Antipyrin Mandelate) ... 1-20 to 8 gr. Uranii Nitras % to gr- Urea 15 to 30 gr. Urethanum .... 10 to 30 gr. Uropherin ... 5 to 15 gr. Urotropin (Aminoform) .... 5 to 30 gr. Veratrin (resinoid) % to % gr. Veratrina ... 1-60 to 1-1Q gr. Vinum Antimonii ... 1 to 20 min. Colchici Radicis 5 to 20 min. Seminis ... 20 to 60 min. Ergotse .. ... 1 to 4 dr. Ipecacuanhse ... 1 to 60 min. Opii ( Sydenham's Laudanum)...... .... 3 to 20 min. Xeroform (Tribromphenol Bismuth)... .... 8 to 15 gr. Xylol 5 to 20 min. Zinci Acetas % to 2 gr. Bromidum ... to 2 gr. Cyanidum ... 1-10 to 1 gr. lodidum % to 2 gr. Phosphidum ... 1-20 to 1-10 gr. Sulphas ... 10 to 30 gr. Sulphoichthyolas % to 1 gr. Sulphocarbolas u 1 to 4 gr. Valerianas ... ... % to 3 gr. In addition to materials for an emergency uranalysis, an antidote bag should contain: the arsenic antidote in two solu- tions, chloroform, ether, magnesia, magnesium sulphate, old oil of turpentine, tannic acid, animal charcoal, zinc sulphate, copper sulphate, ipecacuanha, castor oil, acetic acid, chloral, potassium permanganate, solution of potash, hydrogen per- oxide, saponin, tincture of aconite, amyl nitrite pearls, alcohol, brandy, aromatic spirit of ammonia, hypodermic tablets of pilo- carpine nitrate, morphine sulphate, atropine sulphate, apomor- phine hydrochlorate, strychnine sulphate, digitalin, nitro- glycerine. A hypodermic syringe, stomach tube, mouth gag, tongue'forceps, fountain syringe, inf usion apparatus, catheter, «tc. THE ANTIDOTE BAG. 411 Table of maximum daily doses. (Total of safety in 24 hours.) (Arranged from P. G., Merck, etc.) ■ -1 ■■ ■ ■ Medicine. In a Day. Grains. Acetanilid 60 ' cid, Arsenous ....... J 9 u Carbolic .... Hydrobromic. Dil * Iodic 18 Valerianic . 40 Drops 1 Adonidin Agaricin 2 Aloin .. 10 Amylene Hydrate Antifebrin .... .. 60 ^piol, crystallized (solid Parsley-camphor) 60 ^pocodeine . .. 1J4 ^pomorphine Hydrochlorate. ,....••■••••••••••••••• % Asparagin 4^ Atropine Sulphate ......... ......■•••r..... ®aptisin. . 20 benzene (Benzol) berberine Hydrochlorate 45 ^utyl-chloral Hydrate 60 + C^nnabine Tannate ..... 40 -annabinon 4J4 Cerium Oxalate 15 Chrysarobin Ji Cocaine Hydrochlorate-r. 6 Colocynthin 2 Coniine Hydrobromate Mt Convallamarin ....••••• 5 Copper Arsenite 1 Cotoin .. 10 Creosote . . 15 M.+ & Daturine.... .. .. ■ Plgltahn (French) (Merck) .. digitalis, Infusion 3 Ounces ** Extract - , . . . . , . . . . . ........... a ...... a ■ e .••••■■■• • 12 U Tincture ......... ... ....a... a. •• a • Drachms A Digitoxin Duboisine io Euonymin (the pure Resinoid!) 15 Fluid Extract• Boldo •••••••••••••• 45 m. " Golden Seal (Hydrastis) 150 m. 412 A MANUAL OF TOXICOLOGY. TABLE OF MAXIMUM DAILY DOSES. (Continued). Medicine. In a Day. Grains. Fluid Extract of Grindelia Robusta ................... " " Kava-Kava (Piper Methysticum). . • " " Lily of the Valley (Convallaria Majalis) " " Piscidia (Jamaica Dogwood) Fuchsine 12 Gelseminine Hydrochlorate 14 Guaiacol _ . Guaiacol Carbonate |30-|-90 Homatropine Hydrobromate ; or Sulphate & Hydroquinone (Hydrochinone) 30 + Hyoscine Hydrochlorate 0 Hyoscyamine Sulphate Hypnone (Aceto-phenone) ........ 23 Ichth vol ............... 60 Iodine Trichloride. ............... 114 lodothyrine 40 Menthol . ••••••••••••••..•••• 30+90 Mercury Bichloride 41 Cyanide Methylene Blue (Medicinal) ••....••••••••• 15 Naphtalene .. 90 Naphtol Beta- T.... . - 30 Nickel Bromide 23 Nitroglycerine A Nux Vomica, Extract 3 Opium, Extract (aq.) . 5 Paraldehyde Pelletierine Sulphate ; or Tannate 75 Phenacetin 75 Picrotoxin Piperin 18 Resorcin •. 150 Salol 150 Silver Cyanide 14 " Iodide 2 + Solanine •, 7>4 Sparteine Sulphate 2 Strophanthin A Sulphonal •••••••••• 120 Terpin Hydrate 45 T erpinol. . .... 45 Thalline Sulphate ..••••• 24 Tincture of Strophanthus 30 m. -J- Means dose may be develoned higher. KEY TO URANALYSIS. 413 KEY TO URANALYSIS. (For exclusion purposes in toxicological investigations.) Fresh Normal Urine: Amber-colored, transparent, aromatic odor, bitter Saune taste, acid reaction, specific gravity, 1018 to 1022. Consists "chiefly of a ■solution of urea and certain organic and inorganic salts, holding in suspension epithelial cells and mucus." Composition not constant, but influenced by amount water and other fluids taken, by temperature of skin, by emotions, local or general blood pressure, by amount of work done, time of day, age, sex, medicine, etc. (Condensed from Bartley.) CLEAR LIQUID PORTION OF URINE. If urine dark colored and specific gravity high, it indicates urea, uric acid or blood ; if urine light colored, indicates sugar. When specific gravity is more than 025 - If gives crystals with nitric acid, indicates urea If gives reaction by Trommer's test or fermentation, indicates sugar. . If is neutral or feebly acid, precipitates on boiling and precipitate is soluble jn nitric acid, indicates earthy phosphates. If this last precipitate is not soluble 111 nitric acid, indicates albumin. If hydrochloric acid gives needle-shaped crystals, indicates hippuric acid. If is high colored and boiling produces coagula, indicates blood. If gives red color with hydrochloric acid, indicates excess of coloring 'natter. (Urorrhodin.) If color changes upon adding nitric acid (iridescent), indicates bile. (Adapted by the author.) URINARY DEPOSITS. (Bartley). Chemical Examination. Draw off a portion of the sediment with a pipette or glass tube, and transfer to a watch-glass or small test-tube. Dissolves on heating urine Ammonium urate. White Deposit. Sol. in NH4OH, Cystin. Soluble in acetic acid. Earthy Phosphates. Insoluble in acetic acid, Calcium oxalate or oxalurate. Insoluble on heating. Insol. in NH4OH, Yellow, cross or whetstone shaped, or in groups, Uric acid. Regular octahedra, envelope-shaped, . . Calcium oxlate. Hexagonal plates, soluble in N H4OH (white), . Cystin. Bundles of needles crossing each other, .... Tvrosin. Gelatinizes in NH4OH, Pus (see above). deposit is Crys- talline. Urine, Acid. Large prisms, soluble in aeetic acid (coffin-lid shaped), Ammonium magnesium phosphate. Brown, double spheres, STfcvhaXeA,Ur ate of ammonium. Club-shaped crystals, single or in groups, Calcium phosphate. Double spheres, radiated structure soluble in acetic acid with effervescence, _ Calcium carbonate (rare). Double spheres, insoluble in acetic acid, Calcium oxal- urate (rare). Double spheres, yellow or red, striated, . . Uric acid. Alkaline Urine. Red or yellow discs, biconcave; sometimes irregular in outline, Blood-cells. Cellular Elements. Granulated corpuscles. With diluted acetic acid, show 3 to 5 nuclei, Albumin present, .... Pus. -Albumin absent, Mucous corpus- cles. Round, conical, or flat cells with one nucleus, Epithelium from urinary tract. Tadpole-shape, with long tail (small), .... Spermatozoa. Cylinders, parallel margins, clear, granular, or containing, epi- thelial cells or blood-cells, . . . Casts of uriniferous tubules. Fungi, yeast, hairs, threads, etc., etc. • Extraneous matters. 414 A MANUAL OF TOXICOLOGY. KEY TO URANALYSIS. (Continued.) Visibly crystalline (red), Uric acid. Colored Deposit. Amorphous, Pale, easily soluble by heat, Urates Deep-colored, slowly soluble by heat, Acid urates with uroerythrin. Red, insoluble by heat, alkalies, or acids, . . . Blood. With a clean pipette draw off a small portion of the sediment, transfer to a clean glass slide, and examine with a %-in. or M-in. objective. A cover-glass may be dispensed with. Microscopical Examination. Deposit is Amor- phous. Small granules with spicules on larger granules ; vanishes on adding KOH or NaOH lightsSodium urate. dark =A mmonium urate. Permanent on adding KOH or NaOH, Calcium carbonate (rare)., L Globules, strongly refracting light, .......... Fat. ABNORMAL CONSTITUENTS FOUND IN URINE (adapted) "Albumin.-Often present in parenchymatous nephritis, Bright's disease, poisoning by certain substances, rheumatism, infectious fevers, after violent exercise, etc. Sugar.-Present in diabetes; a very small quantity may sometimes be present temporarily after pneumonia, typhus, rheumatism, affections of the brain and spinal cord after ex- cessive eating of carbo-hydrates, etc. Leucin and Tyro sin.-In acute atrophy of liver, and in poisoning by phosphorus. Pus.-Present in pyelitis, renal abscess, urethritis, cystitis, prostatitis, or discharge into the urinary canal of a peri- nephritic, pelvic, or other abscess. May also be of vaginal origin (in gonorrhea). Blood.-From hemorrhage in urethra, neck of bladder, ure- ters, kidneys, genital tract, or external sources. Acetone.-In diabetes, hydrophobia, and certain febrile con- ditions. Diacetic Acid.-Mental diseases .with excitement, inanition, carcinoma, and particularly diabetes. Indican.-Minute quantities present in normal urine, but greatly increased by intestinal obstruction, diseases of liver which interfere with bile formation, etc.; also by use of sul- phur baths, in Addison's disease, and in early stages of cholera; also in auto-intoxication, and it is said in terminable pregnancy. Ammonium Carbonate.-Vesical catarrh. I Hydrogen Sulphide.-Sometimes present in albuminous urine from decomposition of albuminous matter within the bladder. Bile.-Defective bile excretion; jaundice, hepatic congestion and cirrhosis, malarial and other high fevers." APPROXIMATE MEASURES. 415 TABLES. 1 minim varies from 1 to 2 drops; 1 fluid drachm equals about 1 teaspoonful (cochlear parvum); 2 " " " 1 dessertspoonful (cochlear me- dium); 4 " or % fluid ounce " " 1 tablespoonful (cochlear mag- num); 2 " *• " 1 wineglassful (cyathusvinarius); ■4 " ° " 1 small teacupful or gill; teacup (poculum); 6 " " ** 1 ordinary teacupful; 8 " 1 coffee cupful (% pt.), 1 tum- blerful; 1 pint M " 1 pound (of water); pound (libra); 2 pints " " 1 liter or kilogram of water. APPROXIMATE MEASURES. The number of drops in 20 minims of the following Acids: Drops. Acetic 40 Hydrocyanic .15 Hydrochloric 18 Nitric Dilute 17 Sulphuric 30 Sulphuric Dilute 17 Aether 50 Fowler's Solution 19 Oils: Essential oils of vegetables 40 Tinctures: of all vegetables 40 Vinegars 26 Water: Distilled IS Strong water of ammonia 18 Dilute water of ammonia 15 Wines: Of Antimony 24 Of Colchicum 25 Of Opium 26 Number of drops will also vary according to size of neck and flange of vessel from which the fluid is dropped. 416 A MANUAL OF TOXICOLOGY. APOTHECARIES WEIGHT. 20 grains make one scruple ; 3 scruples " drachm (60 grains) ; 8 drachms " ounce (480 grains) ; 12 ounces " pound (5760 grains). 1 lb. = 12 ounces = 96 drachms = 288 scruples = 5,760 grains 1 ounce = 8 drachms = 24 scruples = 480 grains 1 drachm = 3 scruples = 60 grains 1 scruple = 20 grains TROY WEIGHT. 24 grains make one pennyweight; 20 pennyweights " ounce (480 grains); 12 ounces " pound (5760 grains). 1 lb. = 16 ounces = 256 drachms = 7,000 grains; 1 ounce = 16 drachms = 437% grains; 1 drachm = 27 3-10 grains. 1 grain Troy = 97-100 grain Avoirdupois. AVOIRDUPOIS WEIGHT. Pint. Fluid ounce. Fluid drachm. Minim. Gallon = 8 = fluid oz. 128 = fluid drm. 1024 = minim 61440; 1 = fluid oz. 16 = fluid drm. 128 = minim 7680; fluid oz. 1 = fluid drm. 8 = minim 480; fluid drm. 1 = minim 60. U. S. OR APOTHECARIES MEASURE. WEIGHT OF WATER. At 60° F. the U. S. fluid ounce of distilled water weighs 455.7 grains. The British fluid ounce-437.5 grains. COMPARISONS. I minim of water weighs 0.95 grain; equals 0.0616 c.c. 1 fluid ounce-wine measure 29.57 c.c. 1 fluid ounce-imperial 28.4 c.c. 1 fluid ounce of water, wine measure at 6o° F. equals 437.5 gr. 1 pint-wine measure equals 16 fluid ounces. 1 pint-imperial equals 20 fluid ounces. 1 quart-:wine measure (32 fluid ozs.) equals 58.30 cu. in. 1 quart (imperial) (40 fluid ozs.) equals 69.97 cu. in. 1 gallon (wine) equals 231 cu. in., (imper'l) equals 277.27 cu. in. 1 kilogram equals 1000 grams or 2.7 lbs. Troy. 1 ton-Avoirdupois (2000 lbs.) equals 29,167 ozs. Troy. METRIC MEASURES, 417 METRIC MEASURES. 1 meter equals 39,368 inches. 1 decimeter equals 3.9368 inches. 1 centimeter equals 39368 inch. .1 millimeter equals 039268 of an inch. 1 decameter equals 393.68 inches. 1 hectometer equals 3,936.8 inches. 1 kilometer equals 39,368 inches. 1 myriameter equals 393,680 inches LENGTH. WEIGHT. 1 gramme equals 15.434 grains. 1 decigramme equals 1.5434 grains. 1 centigram equals 15434 of a grain. 1 decagramme equals 154.340 grains. 1 hectogramme equals 1,543,402 grains. MEASURE. 1 litre equals 2.113 pints or 15,434 grains. 61.027 cu. in. 1 decilitre equals 3.381 fluid ounces or 1,543.4 grains. 1 centilitre equals 2.705 fluid drachms or 154.34 grains. 1 millilitre equals 16.231 minims or 15.434 grains. 1 decaliter equals 2.641 Cong's or 154,340 grains. 1 hectoliter equals 26.419 C. or 1,543,000 grains. 1 kiloliter equals 264.19 C. 1 myrialiter equals 2,641.9 C. METRIC EQUIVALENTS Troy Metric gm. gr. 1 .... 0.065 gr. 3/4 . . 0.049 gr. 2/3 . . 0.043 gr. 1/2 .. 0.032 gr. 1/3 . . 0.022 gr. 1/4 .. 0.016 gr. 1/5 .. 0.013 gr. 1/6 . . 0.011 gr. 1/7 .. 0.009 gr. 1/8 .. 0.008 gr. 1/10 . 0.0065 gr. 1/12 . 0.0054 gr. 1/15 . 0.0043 Troy Metric gm. gr. 1/16 . ....0.004 gr. 1/20 . ....0.0032 gr. 1/24 . ....0.0027 gr. 1/25 . ....0.0026 gr. 1/30 . ....0.0022 gr. 1/32 . ....0.002 gr. 1/40 . ....0.0016 gr. 1/50 . ....0.0013 gr. 1/60 . ....0.00108 gr. 1/64 . ....0.001 gr. 1/75 . ....0.00086 gr. 1/80 . ....0.00081 gr. 1/96 . ....0.00067 Troy Metric gm. gr. 1/100 ...0.00065 gr. 1/120 ...0.00054 gr. 1/130 ...0.0005 gr. 1/150 ...0.00043 gr. 1/180 ...0.00036 gr. 1/200 ...0.00032 gr. 1/240 ...0.00027 gr. 1/250 ...0.00026 gr. 1/300 ...0.00022 gr. 1/400 ...0.00016 gr. 1/500 ....0.00013 To convert grammes into grains X ^.432 10 convert grammes into ounces, avoirdupois X 0.03527 Io convert kilogrammes into pounds X 2.2046 io convert grains into grammes X lo convert avoirdupois ounces into grammes X 28.35 To convert troy ounces into grammes X 31.104 lo convert cubic centimetres into U.S.A, fluid ounces... X 0.0338 lo convert litres into U.S.A, fluid ounces X 33.814 lo convert fluid ounces into cubic centimetres X 29.57 1'0 convert pints into litres X 0.4732 lo convert metres into inches X 39.37 lo convert inches into metres.......... X 0.0254 \ J inch equals 2.54 centimeters. Ll foot equals 34.48 " The above tables give metric equivalents of Troy measures. 418 A MANUAL OF TOXICOLOGY. TEMPERATURE EQUIVALENTS. 1° Fahrenheit = 5-9° Centigrade - 4-9° Reaumer. To re- duce F. to C., subtract 32 from F. degrees given and divide remainder by 1.8. To reduce C. to F. multiply C. degrees given by 1.8, and then add 32° to this. Giving Average Frequency at Different Ages (in health). In the foetus in utero.. 'between 150 and 140 beats per minute In new-born infants.... " 140 " 130 During 1st year .. .from 130 down to 115 " 2d " " 115 " 100 " 3d " " 105 " 95 From 7th to 14th year... " 90 " 80 " " 14th to 21st " " 85 " 75 " 21st to 60th " ...between 75 and 79 In old age " 75 " 80 or more. The pulse is, as a rule, more frequent in females, by 10-15 beats per minute; during and after exertion, unless long con- tinued; during digestion or mental excitement; generally, more frequent in the morning than later in the day. It is tempora- rily accelerated after sudden change of posture from the re- cumbent to the sitting, and from either to the standing posi- tion especially during convalescence and in other states where the action of the heart is feeble. PULSE TABLE. RESPIRATION AT VARIOUS AGES. No. Resps. per Min. First year . 35 Second year 25 No. Resps. per Min, At puberty 20 Adult age . 18 to 20 Income. Grains. Solid food 8,000 Water 37,650 Oxygen 13,000 Total 58,650 INCOME AND EXPENDITURES OF LIFE. Expenditure. Grains. Lungs give off 20,000 Skin 11,750 Kidneys 24,100 Intestines 2,800 Total 58,650 "The body of a man weighing 148 pounds is made up as follows: Water, 90 pounds; living matter, 26 pounds; fat, 24 pounds; minerals, 8.3 pounds. Food must construct this frame and must repair whatever losses it sustains. POISONING FATALITIES. 419 "Nitrogenous foods are obtained from the juice of meat, the white of egg, the curd of milk, the legumen of peas and beans and the gluten of bread. These foods build up the living parts of the body, the cells and tissues. The fats are heat and energy producers. Starches and sugars are energy-makers in a less degree. Minerals form bone and are used by the body in many ways. Water is the most important food." POISONING FATALITIES. Blyth says: Although so large a number of sub- stances destroy life by accident or design, yet there are in the list only about 21 which kill about 2 per- sons or above each year. The 21 substances ar- ranged in the order of their fatality are as follows: the following seems to be the order, 1851-1871: IN ENGLAND Caustic potash 19 Poisonous fungi 23 Aconite 59 Mercury 60 Belladonna 76 Sulphuric acid 93 Ammonia 98 Chlorodyne 102 Alcohol 108 Arsenic 110 Chloroform 113 Vermin killer 127 Chloral 127 Phosphorus 155 Cyanide of potassium 166 Strychnine 201 Nitric acid 204 Prussic acid 260 Carbolic acid 762 Lead 1,043 Opiates 1,324 Suicidal Poisoning.-Poisons which kill more than one person suicidally each year are only 19 in number, as follows: 420 A MANUAL OF TOXICOLOGY. IN GERMANY. Deaths from suicide during the ten years ending 1892- Potassic bichromate 10 Chloroform 14 Chloral 15 Chlorodyne 16 Aconite 19 Belladonna 20 Mercury '24 Nitric acid 27 Ammonia 34 Sulphuric acid 53 Arsenic 77 Phosphorus 84 Vermin killer 118 Prussic acid 122 Hydrochloric acid 138 Strychnine 150 Oxalic acid 200 Prussic acid 221 Opiates 281 Phenol 290 The following seems to be the order there, 1851-71- IN FRANCE. Arsenic 331 Phosphorus 301 Preparations of copper 183 The mineral acids 54 Cantharide.s 35 Strychnine . 14 Opiates 12 Mercurial preparations -. 9 Antimonial preparations 6 Preparations of iron 5 Cyanides (that is, Prussic and Potassic Cyanide) . 5 IMPORTANT FACTS. Be cautious in giving atropia to flaxen-haired, light-com, plexioned, nervous women. Be cautious in the use of morphia subcutaneously after opiates or morphia have been given by the mouth or rectum. The healthy mucous membrane of the bladder never absorbs medicine; an ulcerated vesical mucous membrane does. ORDER OF ERUPTION OF THE TEETH. 421 Children are especially susceptible to the narcotic action of opium and its alkaloids. A catheter should never be forced into the bladder. All catheters should be kept perfectly clean. After each using they should be dipped in carbolized oil, washed in warm water, and, if gum elastic, be put away in zinc powder, powdered soapstone, or starch. All soft-rubber articles are rendered hard and brittle by contact with oil or grease. Catheters used in puerperal cases should be rendered thoroughly aseptic. THE ORDER OF THE ERUPTION OF THE TEETH. (An aid in determination of age.) As a rule the teeth of the lower jaw precede those of the Upper, except in the case of the lateral incisors. Central incisors 5th to 8th month. Lateral incisors 7th to 9th month. First molars 12th to 16th month. Canines 16th to 20th month. Second molars 20th to 36th month. FIRST DENTITION. First molars 5th to 7th year. Central incisors 7th to Sth year. Lateral incisors 8th to 9th year. First bicuspids 9th to 10th year. Second bicuspids 10th to 11th year. Canines 11th to 12th year. Second molars 12th to 13th year. Third molars 17th to 21st year. SECOND DENTITION. (A table to aid in determining the source of eruption, in sus- pected, poisoning with eruption.) THE ERUPTIVE FEVERS. Period of Incubation. Four to seven days, or shorter. Mode of Onset. Sudden; very often at night; sore throat; vomiting; convulsions in severe cases; high fever. Eruption Appears.-At the end of the first or during the course of the second day. Eruption Fades.-In three to five days; disappearing first Where it first appears. IJanger of Contagion. As long as desquamation continues, Or a purulent discharge from the ear or an abscess keeps up; Disease-Scarlet Fever (Scarlatina). 422 A MANUAL OF TOXICOLOGY. indefinitely in clothing, toys, books, etc., which have not been disinfected. Disease-Measles (Morbilli, Rubeola). Period of Incubation. Eight to ten days. Mode of Onset. Rather sudden; catarrhal symptoms; mod- erate fever. Eruption Appears. Fourth day; less commonly on the third or fifth. Eruption Fades. In about four days. Danger of Contagion. So long as the fine, branny desqua- mation lasts. Disease-Rotheln (Rubella, German or French Measles). Period of Incubation. Two or three weeks. Mode of Onset. Gradual, fever slight and transient, some- times absent. Eruption Appears. The eruption usually the first symptom. Eruption Fades. Irregularly; in about four to six days, without desquamation. Danger of Contagion. The duration of the liability to com- municate the disease is not known. Disease-Smallpox (Variola). Period of Incubation. Ten to fourteen days. Mode of Onset., Sudden; chill; high fever; headache; pain in loins, etc. Eruption Appears. On the third or fourth day; typical evolution, about the sixth day or the ninth of the disease char- acteristic pustules fully formed. Eruption Fades. Desiccation at the end of second week; crusts slowly separate, leaving marked and enduring cicatrices. Danger of Contagion. So long as crusts reform; indefi- nitely in fomites, etc. Disease-Varioloid (Modified Smallpox). Period of Incubation. Ten to fourteen days. Mode of Onset. Sudden; chill; high fever; headache; pain in loins, etc. Eruption Appears. On the third or fourth day; typical evolution, about the sixth day or the ninth of the disease char- acteristic pustules fully formed. Eruption Fades. Pocks do not go on to suppuration, but begin to dry up from the vesicular stage, i. e., the sixth or eighth day of the disease. Danger of Contagion. So long as crusts reform; indefi- nitely in fomites, etc. THE ERUPTIVE FEVERS. 423 Pisease -Chicken-pox (Varicella). Period of Incubation. About two weeks. Mode of Onset. Sudden. Eruption Appears. At once, and often in successive crops. Eruption Fades. In a few days, dessicating, as a rule, with- out suppuration. Danger of Contagion. Duration of danger of contagion ends with the shedding of the dried crusts. TABLE FOR MAKING PERCENTAGE SOLUTIONS, Per cent. 1-10 of 1% Grains for Exact Solution 1.82 grains Approximate Amount required to make 4 fl. oz. grains 14^ % of 1% 2.28 a Cl 2^ 1-6 of 1% 3.03 cc Cl 3 % of 1% 4.55 cc IC 4i/ % of 1% 6.06 cc Cl 6 / of 1% 9.10 CC 9 1% 18.20 IC 18% 2% 36.40 cc ll 36/ 2/% 45.50 cc Cl 45/ 3% 54.60 cc Cl 54/ 4% 72.80 cc drachms 1 CC 12/ 5% 91.00 <i CC 1% 6% 109.20 cc cc 1 Cl 49 7% 127.40 cc CC 2 cc 7 ■ 8% 145.60 cc It 2 IC 25 10% 182.00 cc ll 3 CC 2 12% 218.40 cc Cl 3 cc 38 15% 273.00 CC ll 4 cc 33 20% 364.00 cc cc 6 ic 4 25% 455.00 CC Cl 7 cc 35 TO MAKE FOUR FLUID OUNCES OF THE SOLUTION. Distilled water q. s. to make 4 fl. oz. Find in the first column the per cent, desired. The second column shows the exact amount required in grains. The third column shows the approximate amount by weight required of any salt ; to this weight add distilled water enough to make four fluid ounces. DIRECTIONS. APPROXIMATE PERCENTAGE METHOD FOR DISINFECTANT SOLUTIONS. Consider 1 ounce fluid as 500 minims. 1% = 1 grain or minim in 100 minims; for 500 minims, 5 X 1 or 5 grains would be required. Hence, a 1% solution = 5 grains in 1 ounce. A 5% solution = 5 X 5 = 25 grains in 1 ounce, etc. bor ordinary-practical purposes (disinfectant, etc.), 1 dram (fluid) in 1 pint of water = 1% solution. Also 1 grain in 1 ounce of water = 1 to 500. Double the water - 1 to 1,000. 424 A MANUAL OF TOXICOLOGY. kN EPITOME OF IMPORTANT INCOM- PATIBLES. Acacia (gum) with alcohol, iron, lead-water, and mineral acids. Acids (mineral), with alkalies and relatively weak salts of other acids, such as bromides, chlorides, and iodides. Alkalies, with acids and with relatively weak salts. Antipyrin and antifebrin should be given with alcohol or water only. Arsenic, with tannic acid, salts of iron, and lime and mag- nesia. Bitter infusions and tinctures, with salts of iron and lead. Bromides, with acids, acid salts, or alkalies. Calomel, with antipyrin, alkalies, lime-water, salts of iron and lead, and iodide of potassium. Camphor (spirit of) with water. Carbonates, with acids and acid salts. Chloral, with cyanides. Chlorides, with silver salts, lead salts, and alkalies. Chloroform (except in minute quantity), with water. Corrosive sublimate, with alkalies, lime-water, salts of iron and lead, iodide of potassium, albumin, gelatine, and vegetable astringents. (It may, however, be advantageously combined with tincture of the chloride of iron and liq. acidi arsenosi, or with iodide of potassium.) Digitalis, with iron and preparations containing tannic acid. Iron (salts), with anything containing tannic acid. Tinc- ture of the chloride of iron, with alkalies, carbonates, muci- lages, and preparations containing tannic acid. Mucilages, with acids, iron salts, and alcohol. Potassium chlorate (and potassium permanganate) should not be rubbed up with tannic acid or other organic oxidizable substance. Potassium (iodide of), with all strong acids and acid salts. (See Corrosive Sublimate.) Spirit of nitrous ether, with antipyrin, sulphate of iron, tinc- ture of guaiacum, and most carbonates. Vegetable preparations holding tannic acid, with salts of iron and lead. xMkaloids are precipitated or destroyed by tannic acid, alka- lies, iodin or iodides, and chlorinocis compounds. Tinctures of gums or resins, with water. FREEZING MIXTURES. 425 FREEZING MIXTURES. (THOMPSON.) Ingredients. Parts by Weight. Temperature reduced from 10° C. or 50° F. to Hydrochloric Acid Sulphate of Sodium Snow or Fine shaved Ice . Chloride of Sodium Dilute Nitric Acid Sulphate of Sodium Dilute Nitric Acid Nitrate of Ammonium Sulphate of Sodium . Dilute Nitric Acid Phosphate of Sodium . 8 5 2 1 2 3 4 5 6 4 j 9 fcl ° rd o ib o Ci r-l Cl + 1 1 1 II II II II II o' o' d o' d 0 o o o o t- 00 Cl CO ci TH tH rH Ci Ci 1 1 1 1 1 LAWS RELATING TO THE SALE OF POISONS. Laws of most of the States in the United States, also laws of Great Britain, practically restrict the sale of poisons, when made to others than dealers, to sales by licensed pharmacists, druggists, or chem- ists. They require that the bottle or package con- taining the poison be carefully labeled with the name of the poison, the name and address of the seller, and the word poison (usually in red ink). Laws of nearly all the States, likewise the English Phar- macy Acts, not only anticipate that the seller will use discretion in making sales, but also require him to register, in a book kept for the purpose, sales of all very active poisons. The registration includes the name and quantity of article sold, use to which it is to be put, date of sale, name and address of purchaser, with his signature and that of the seller ; etc. In the State of New York the laws virtually require the registration of all active poisons. The new Harrison Law ot the United States pro- hibits the sale, to the public, of cocain, of opium and of their preparations (except Paregoric) except on a physician's prescription. In Great Britain the purchaser must be known to the vendor or introduced by some person the latter knows, and the signature of both of these must then 426 A MANUAL OF TOXICOLOGY. appear upon the registration book. The articles to be registered in Great Britain include "arsenic and its preparations, aconite and its preparations, all poison- ous vegetable alkaloids and their salts, atropine and its preparations, cantharides, corrosive sublimate, cyanide of potassium and all metallic cyanides and their prepa- rations, emetic tartar, ergot of rye and its prepa- rations, prussic acid and its preparations, savin and its* oil, strychnine and its preparations, vermin killers, if they contain any poisons or preparations of poisons ■ which are on this list." (In Ireland, preparations of prussic acid and all vermin killers are omitted from this list.) 41 QUESTIONS FOR SELF-EXAMINATION. Selected by the author from over 1,000 questions asked by him at College, and Board of Pharmacy examinations. (Board of Pharmacy questions are in sets of 15). I N. B.-In giving doses, write the name of the drug and give the minimum and maximum doses. 1. Name two vegetable and three mineral emetics,, and state the emetic dose of each. 2. Name a good antidote to the mineral acids. 3. What acid is considered a good antidote to the alkaloids? Why? - 4. What alkaloid and what Potassium salt are con- sidered very beneficial in Morphine poisoning; How should they be administered? 5. Which one of the mercurial preparations is most frequently employed for suicidal purposes? What is the best antidote in poisoning by it? How is the antidote used and what is formed h 6. Describe the characteristic symptoms of and give the emergency treatment for Strychnine'' poisoning. QUESTIONS FOR SELF-EXAMINATION. 427 7- What would you give for poisoning by any of the Barium salts? For poisoning by any of the Copper salts? 8. State what emergency treatment should be employed for poisoning by Iodine, and for poisoning by Silver Nitrate, naming the chem- ical antidote for each, if there be one. 9> What emergency treatment should be employed for poisoning by Carbolic Acid? For poison- ing by Phosphorus? io. What precautions should be observed in selling poisons? ii. What relation do hypodermic and mouth doses bear to each other as regards size, and why does the former act more quickly than the latter ? 12. What is the dose of Antimonial Powder, Ex- tract of Aconite, Gallic Acid, Oil of Gaul- theria ? 13- What is the dose of Creosote Carbonate, Red Mercuric Iodide, Sodium Bromide, Sulphonal? 14- What is the dose of Fowler's Solution, Infusion of Digitalis, Syrup of Ferrous Iodide, Syrup of Morphine Sulphate (N. F.) ? 15- What is the dose of Fluid Extract of Cimici- fuga, Tincture of Nux Vomica, Tincture of Veratrum Viride, Wine of Colchicum Root? i. By what avenues, other than the mouth, may poisons enter the system? By which one of these is the most prompt effect obtained? 2. What kinds of evidence, besides that called the symptoms, may serve to indicate the poison taken in a case of poisoning? Which of these is considered the most reliable? 3- Do all poisons produce their poisonous effects in the same time? Illustrate in answer. < What is meant by the local effect of a poison? Name one which has both a local and a gen- 428 A MANUAL OF TOXICOLOGY. eral or systemic poisonous effect, and state the emergency treatment for poisoning by it. 5. Name two substances which poison by being inhaled; also name two narcotic poisons, stat- ing the emergency treatment for poisoning by them. 6. Which would be the more dangerous poisonous dose of Arsenic, a small or a large one? Ex- plain. 7. What emergency treatment should be employed for poisoning by Laudanum? By Lead salts? 8. Name a poison, in poisoning by which, fats and oils should not be administered, and one in poisoning by which Sodium Bicarbonate should not be given. Explain. 9. Name a poison, in poisoning by which an emetic should not be given, and another in poisoning by which water should not be administered. Explain. 10. What does the Pharmacy Law direct regarding the sale of poisons belonging to "Schedule A"? 11. State the dose of Ammonium Chloride, Atro- pine Sulphate, Corrosive Mercuric Chloride, Guaiacol Carbonate. 12. State the dose of Ferrous Sulphate, Lead Ace- tate, Salol, Trional. 13. What is the dose of Antipyrine, Ingluvin, Naph- talin, Strychnine? 14. State the dose of Diluted Hydrocyanic Acid, Extract of Belladonna. Extract of Hyoscya- mus, Oleoresin of Aspidium. 15. What is the dose of Deodorized Tincture of Opium, Tincture of Strophanthus, Donovan's Solution, Fluid Extract of Viburnum Opulus? I. Name the best chemical antidote for: Corrosive Sublimate; Lead Water; Oxalic Acid; Paris Green; Tincture of Iodine. 2. Name the best physiological antidotes, with their antidotal doses and your method of ad' QUESTIONS FOR SELF-EXAMINATION. 429 ministration, in poisoning by Aconitine; by Morphine; by Strychnine. 3. What substance is considered a good antidote to the alkaloids? Why? In what dose is it given ? 4. Mention two substances which poison by being inhaled. Name two narcotic poisons. 5. Which is the more rapidly fatal poison, Potas- sium Cyanide or Potassium Hydrate? What emergency treatment should be employed for poisoning by each? 6. What emergency treatment should be employed for poisoning by Formaldehyde? By swal- lowing Chloroform ? 7- Name two stimulants of different character. When is artificial respiration applicable and how is it performed? 8. State the condition of pupils and skin in Bella- donna and in Morphine poisoning. 9- Name three good, vegetable emetics with emetic dose of each. What fluid aids emetic action? 10. What does the law require the pharmacist to ascertain and do when selling Carbolic Acid, Laudanum or Strychnine? II. What proportion of the adult dose of a medi- cine should ordinarily be given children at the following ages: 2, 4, 8, 10, 14 years? 12. What is the hypodermic dose of Morphine Sul- phate, Strychnine Sulphate? What is the rectal dose of Cocaine, Chloral, Extract of Belladonna? J3- What is the dose of Mild Mercurous Chloride, Sodium Benzoate, Strophanthin, Urethane? T4- What is the dose of Extract of Colocynth, Ex- tract of Digitalis, Lugol's Solution, Spirit of Chloroform, Tincture of Hyoscyamus? 15. What is the dose of Acetanilid, Silver Nitrate, Sodium Salicylate, Tincture of Conium, Tully's Powder? 430 A MANUAL OF TOXICOLOGY. I. What should be given for poisoning by Mer- curic Chloride? By any of the Zinc salts? 2. In Morphine poisoning, what oxidizing agent is employed and what alkaloid should be used for its physiological effects? 3. Name two different substances which may pro- duce eschars or stains on the lips or mouth? 4. How would you determine whether a suspected powder was Calomel, Corrosive Sublimate, or Morphine Sulphate? 5. What is meant by circumstantial evidence? symptomatic evidence? chemical evidence? Which is the most reliable? 6. Describe the characteristic symptoms of and give the emergency treatment for poisoning by Belladonna. For poisoning by Opium. 7. What emergency treatment should be employed for poisoning by Paris Green? By Salt of Sorrel? What is Paris Green? What is Salt of Sorrel? 8. What antidote, and how much, should be given for poisoning by Iodine? By Lunar Caustic? 9. What is the dose, and antidote for overdose, of Mercuric Cyanide? Of Tincture of Bella- donna? IO. What is the dose of Benzoic Acid, Digitalin, Salicylic Acid, Potassium Iodide? 11. What is the dose of Agaricin, Colchicin, Con- vallarin, Extract of Stramonium? 12. What is the dose of Creosote, Fluid Extract of Ergot, Methyl Salicylate, Oleoresin of Cubeb? 13. What is the dose of Tincture of Aconite, Com- pound Tincture of Catechu, Tincture of Col- chicum Seed, Tincture of Ipecac and Opium? 14. How large a dose of each of the following should you consider it safe, as a rule, to dispense in a prescription: Cocaine Hydrochlorate, Extract of Physostigma, Veratrin, Wine of Opium? QUESTIONS FOR SELF-EXAMINATION. 431 15- What is the dose of Mixture of Rhubarb and Soda, Syrup of Garlic, Wine of Antimony, Wine of Ferric Citrate? I. Define Toxicology, Antagonist, Corrosive, Nar- cotic, Ptomain. 2. Upon what does the rapidity of absorption of a poison depend? 3- Describe the condition of the stomach after a large quantity of undiluted Carbolic Acid has been swallowed. (a) Is the corrosion superficial or deep? 4- What are the symptoms of and what emergency treatment should be employed for poisoning by Oxalic Acid? (a) Should the stomach tube be employed and should alkaline carbonates or bicarbonates be administered? Explain. 5- What signs and symptoms would indicate pois- oning by Sulphuric Acid? (a) State what emergency treatment should be employed and explain regarding use of emetic, Sodium Bicarbonate and much water. 6. What emergency treatment should be em- ployed for poisoning by Arsenic? (a) By Tyrotoxicon? 7- What emergency treatment should be employed for poisoning by Cocaine? (a) By Trional. (b) State the proper dose of each. 8. Name three unrelated, mineral emetics, with dose of each. (a) Name three unrelated poisonous alkaloids (not mentioned in this paper), with dose of each. (b) Name five poisonous tinctures, with dose of each. (c) Name five demulcents and state for what poisoning such are employed. 432 A MANUAL OF TOXICOLOGY. 9. State the effect upon the heart and stomach, of the habitual, excessive use of Alcohol. (a) Of Tobacco. 10. What are the principal effects of the habitual use of Cocaine? (a) Of Morphine? I. Define Toxicology, poison, cumulative poison, demulcent. 2. Into what general classes are poisons physi- ologically divided? (a) Name the first subdivisions of these gen- eral classes and mention a poison belonging to each subdivision. 3. What should be done in poisoning when the nature of the poison is unknown? (a) By what may the effects of a poison be modified ? 4. State and illustrate the difference between an antidote and an antagonist. (a) State and illustrate the difference between antidotal measures and antagonistic measures. 5. In what kinds of poisoning should the follow- ing be avoided: emetics, the stomach pump, the stomach tube, glycerine, milk? 6. Name a drug acting directly upon the heart and give the treatment for poisoning by that drug, (a) Name a poison directly affecting the stomach, and give the treatment for poisoning by it. 7. Name a common household article of which Phosphorus is an ingredient. . (a) Should oil be used in poisoning by Phos- phorus? Explain. 8. When should the following be employed as chemical or mechanical antidotes: Potassium Permanganate, Sodium Chloride, starch, Tan- nic Acid, Alcohol? Explain. (a) What is the treatment for poisoning by Wood Alcohol? By Opium? QUESTIONS FOR SELF-EXAMINATION. 433 9. State the emetic doses of two vegetable and of three mineral emetics. (a) What is ordinarily the largest safe dose of Aconitine, Paraldehyde, Dover's Powder, Her- oin, Phenacetin? to. What are the symptoms of and what is the proper treatment for poisoning by coal gas? (a) Name a poison which uniformly produces blindness, more or less permanent. MISCELLANEOUS COLLEGE AND BOARD QUESTIONS. I. What effect does the dilution of a corrosive poison have upon its local effect? (a) If an ounce of Carbolic Acid, well diluted, were swallowed, would life be endangered ? Ex- plain. (b) What is the official antidote for poisoning by Arsenic, and how is it prepared? 2. What is .the best chemical antidote for poisoning by Silver Nitrate, and what does it do? (a) ForpoisoningbyChloralandwhatdoes it do? (b) For poisoning by Verdigris? (c) What symptoms would cause you to suspect Opium poisoning? 3- Is it the absorbed poison in the circulation, or the unabsorbed poison in the stomach, which causes death by a true poison? (a) What is the proper demulcent antidote to employ when Chlorine preparations have been swallowed ? (b) What Sodium salt should also be used? 4- What emergency treatment should be employed for poisoning by swallowing a Formaldehyde solution ? (a) For poisoning by Hyoscyamus? (b) By Ice Cream? 5- Name a good physiological antidote for poisoning by Aconite, and tell how to use it. (a) How may Oxalic Acid be distinguished from Epsom Salt? 434 A MANUAL OF TOXICOLOGY. (b) Should water be used in poisoning by Ox- alic Acid or by Oil of Vitriol? Explain. 6. With what substances does albumin form more or less inert compounds? (a) Describe the method of using it. (b) What precautions are to be observed in em- ploying it in poisoning by Corrosive Sublimate, and why? 7. What are the principal symptoms produced by a toxic dose of Strychnine ? (a) State the emergency treatment for poison- ing by Strychnine, giving the object of each pro- cedure in the treatment? 8. Should the following prescription be dispensed? Explain. Ii Heroin, gr. 21 Codeinae Sulph. Ext Hyoscyami, aa gr. IO Pulv Tully, drm 3 M ft in caps No. XXIV. Sig. Two every 2 to 4 hours. 9. If a wineglassful of concentrated Hydrochloric Acid were swallowed would death be likely to result if no treatment were employed? How could you tell it was not Carbolic Acid instead of Hydrochloric? IO. Which is the more rapidly fatal poison, Potassium Cyanide or Potassium Hydrate? To what is the effect due? What emergency treatment should be employed for poisoning by each ? 11. By what chemical tests or means would you iden- tify the following: Mercuric Chloride; Mor- phine ; Antipyrine; Strychnine ? 12. Poisoning by what drug would be indicated by the following symptoms: flushed face, thirst, dry fauces, double vision, dilated pupils, giddiness, delirium and stupor? What treatment should be employed? (a) In true poisoning by coal gas, where is the poison and what treatment should be employed ? INDEX. A Abortion, 253. Abrine, 38. Absinthe, 256, 384. Absinthism, 384. Absorption, 243, 244. Rapidity of, 16, 17, 18, 21. Delay in, 21. Acetanilid, 17, 32, 61, 247, 254, . • 257' Acid, Acetic, 29, 32, 63, 80, 247, 347. Boric, 106. Arsenous, 32, 97, 248. Carbolic, 19, 29, 32, 41, 43, 65, 247, 254, 255, 256, 259, 274, . 347. Carbonic, 31, 67, 247. Chromic, 17, 29, 32, 68, 255. Ergotinic, 257. Filic, 254. Formic, 260. Gallic, 229. Helvelaic, 255, 259. Hydrobromic, 32. Hydrochloric, 32, 40, 73, 247, T 274, 346. Hydrocyanic, 29, 32, 43, 70, 247, T 273, 254, 274, 348. Lactic, 29. Meconic, 32. Muriatic, 73. Nitric, 32, 40, 73, 247, 255, 275, 346. Nitrous, 146. Nitrous, Fumes, 149. Nitrohydrochloric, 73. Oxalic, 22, 29, 32, 39, 56, 75, 80, ^ 247, 259, 260, 276, 349. Oxaminic, 260. Oxabutyric, 253. Phenic, 63. Phosphoric, 32, 73, 247. Picric, 32, 38, 255, 258, 259. Potassium-oxalates, 75. Prussic, 70, 274, 348, 420. Salicylic, 29, 32, 78. Scheele's, 70, 79. Of Sugar, 75. Sulphuric, 32, 40, 73, 79, 247, 276, 346. Tannic, 58, 226. Tartaric, 22, 80, 350. Acids, 38, 40. Amido-fatty, 39. Corrosive, 80, 253, 255. Fatty, 39. Inorganic, 50. Mineral, 32, 247, 339, 346. (Concentrated), 29, 73. Organic, 32, 50. Vegetable, 89, 341. Aconite, 23, 29, 39, 80, 230, 231, 247, 254, 255, 257, 259, 351. Aconitine,, 32, 38, 43, 80, 254, 258, 351,. Aconitum Napellus, 230, 231. Acme, Pustule, 255. Action, Antagonistic, 22. Aenanthe, 39. Aesculin, 156. Agaricus Campester, 238. Age, 21. Adonidin, 339. Albumin, 49. Poisonous, 39. Albuminoid Combination, 19. Alcohol, 16, 29, 32, 38, 41, 51, 83, 248, 253, 351, 370. Amyl, 83. Ethyl, 84, 351, 370. Methyl, 86, 248. Wood, 86, 253. Alcoholism, Chronic, 254, 256, 370. Alcholomania, 370. Alkalies, 40, 87, 248, 277. Caustic, 24, 38. Corrosive (cone.), 253, 255. Mineral, 32. Alkaloids, 32, 39, 248. 277. Animal, 199. Liquid, Volatile, 41. Mydriatic Group, 41. Opium Group, 41. Oxidation of, 26. Strychnos Class, 39, 41. Vegetable, 41. Veratrines, 41. Allantotoxin, 254, 258. Almonds, Bitter and their Oil, 70. 179, 260. Aloes, 89. Alum, 46, 90. Amanita Muscaria, 239. Phalloides, 239. Verna, 239. Amines, 39. Ammonal, 218. Ammonia, 38, 40, 50, 87, 248, 253, 254, 257, 258, 260, 277, 360. Salts, 40. Water of, 29. Ammonium, 17, 32. Carbonate, 46, 50. Amyl, Nitrite, 16, 41, 91, 253, 256, 259. Amylene Hydrate, 253. Anaemia, 315. Analysis, Autenrieth's Method of, 304. Chart, 295, 296. Chemical, 25. Of Various Substances, 273-296. Analytical Plan, 302. Anesthetics, 20, 35, 92, 240. 436 A MANUAL OF TOXICOLOGY. Anhydrides, Poisonous, 42. Anilin, 32, 38, 61, 256. Dyes, 62, 94. Ink, 62, 94. Oil, 253, 254. Antagonist, 14, 247-250. Antidote, 14, 45, 46. Bag, 410. Bouchardats, 53. Chemical or True, 14, 45, 49. Definition of, 14. General, 60. Mechanical, 14, 45, 47, 48. Antifebrin, 61. Antiarin, 139. Antimony, 19, 32, 39, 94, 253, 254, 255, 258, 260, 281, 351. Comounds of, 32, 248. Wine, of, 47, 94. Antipyrine, 17, 29, 32, 96, 247, 256, 257, 281. Anti-toxins, Production of, 327. Aphonia, 244. Apocynum, 29. Apomorphine, 32, 260. Hydrochlorate, 47. Apoplexy, 24, 25. Appearances in Poisoning, Post- Mortem, 345-366. Apportionate Dose Table, 394. Arabic, Gun, 52. Argentum, Nitrate, 293. Argyria, 255. Aristol, 165. Arnica, 29, 169. Arsenic, 23, 25, 29, 32, 39, 55, 97, 230, 248, 254, 258, 260, 282, 352, 373, 393. Chronic Poisoning by, 373. Arsenical Fly Paper, 97. Melanosis, 255. Arseniuretted Hydrogen, 149. Asphyxia, 21, 316. Asthenia, 315. Asthenics, 31. Cerebro-Spinal, 29. Atropa-Belladonna, 230, 231. Atropine, 23, 32, 38, 100, 102, 254, 256, 257, 258, 284, 353, 396. Auto-infection, 100. Auto-intoxication, 100. Autumn Crocus, 127. B Balsam Copaiba, 256. Barium, 32, 101, 253, 256, 260, 284. Acetate, 101. Chloride, 101, 271. Compounds, 248. Nitrate, 101. Oxide, 101. Soluble Salts of, 29. Baryta, 39, 87, 101, 257. Bee, 162. Beer, 84. Belladonna, 29, 39, 102, 230, 231, 248, 253, 254, 256, 258, 260, 284, 353. Benzene, 29, 32, 105. Benzine, 106, 191. Benzol, 105. Benzophenol, 63. Benzocoll, 254. Benzaldehyde Oil, 259. Berry, Indian, 127. Bicarbonates, Alkaline, 56. Bichromate, 68, 123, 255. Bismuth,, 106, 256. Bittersweet, 102. Bhang, 113. Blindness, 253, 254. Blood, Coagulation of, 311. Change in, 16. Gravitation of, 27. Quantity of, in Blood Vessels. 18 Transudation of, 27. Bloodroot, 106, 205, 233. Bluestone, 132. Body, Pallor of, 311. Lividity of, 311. Brandy, 84. Botulism, 146. Breath, Phosphorescence of, 253. Specific Odor of, 253. Bromides, 106, 255. Bromine, 17, 29, 32, 38, 107, 149, 253, 255, 354. Bromism, 256. Bromoform, 253. Brucine, 29, 32, 108, 180, 250, 285. Bryony, 89, 108. Burial, Haste in, 24. Botulism, 145, 146. c Cadovine, 202. Caffeine, 108. Calabar Bean, 39, 108, 110, 233. Calcium, 111. Hydrate, 50. Carbonate, 51. Camphor, 29, 39, 41, 111, 256. Camphorated Oil, 111. Cancer Root, 196. Cannabis American, 113, 230, 248. Indica, 29, 113, 234, 246. Sativa, 234. Cannabinon, 256. Cantharides, 29, 38, 39, 114, 244, 256, 285, 354. Cantharidin, 114, 257, 258, 260. Cantharis, Vesicatoria, 242. Carbon Dioxide, 29, 67, 254, 285. Disulphide, 38, 41, 254. Monoxide, 32, 38, 40, 116, 149, 253, 260, 254. Carbolineum, 63. Carbonates, Alkaline, 56. INDEX, 437 Carbonic Oxide, 29. Cardiac Pulsation, Absence of, 311. Cardol, 256. Castor Beans, 29, 118. _ Oil, 48, 234. Cathartics, 48. Caustic, Lunar, 211. Centers, Respiratory, 21. Cephalanthin, 259. Cesspool Emanations, 149, 210. Charcoal, 51, 60. Fumes, 116. Chart, Analytical, 295, 296. Detection Acid Radicals, 296. Detection Metals, 295. Cheese, Poisonous, 26. Cherry Black or Wild, 121. Cherry-Laurel, 79, 119, 235, 349. Chest, Girth of, 344. Cholera, Morbus, 25. Chloral, 17, 29, 32, 38, 39, 119, , 249, 253, 256, 260, 355, 374. Chloralamid, 119. Chloralism, 374. Chlorate, Potassic, 38, 121, 198. Chlorates, 198. Chlorinated Lime, 121. Chlorine, 29, 31, 32, 38, 40, 51, PM 149' Chlorodyne, 123. Chlorodynomania, 381. Chloroform, 29, 32, 38, 39, 41, 9?, 123, 126, 248, 253, 260, 355. Choke Damp, 67, 123. Chromate, 68, 123. Of Lead, 68. Of Potash, 68. Chrome, 39, 68. Chromium, 29, 355. Zinc, Search for, 308. Chrysarobin, 260. Churrus, 113. Cjeuta, Maculata 129. Cicuta, Virosa, 129. Cjcutoxin, 123, 254. Cider, 84. Cinchona, 256. Cinchonism, 256. Classification, Chemical, 28, 32. physiological, 28, 34. fanners, 28, 33. "lyth, 28, 29. Robert, 28, 38. Coagulation, Venous, 311. Coal 32 123, 161, 253, 354. Oil, 191. Cobalt Salts, 97. Cockle, Corn, 134. coca, 229. Cocaine, 23, 29, 37, .38, 124, 249, 254, 256, 258, 260, 374. Habit, 254, 258, 374. Cocainism, 374. Cocainomania, 374. Cocculus Indicus, 127. Codeine, 32, 127, 179, 250, 258. Colchicin, 32, 41, 127, 253, 257, 260. Colchicum, 29, 39, 127, 236, 355. Antumnale, 236. Colic, 24. Colored Plate, 16. Collapse, 253. Colocynth, 89, 255, 260. Coma, 314. Profound, 253. Comparison of Height and Weight, 344. Condurangin, 254. Coniin, 32, 38, 129, 257, 258, 321. Conium, 23, 29, 129, 236, 249, 254, 260, 321. Maculatum, 236. Constitutional Pecularity, 23. Convallaria, 131, 139. Convallamarin, 139. Convulsions, 25, 254. Tetanus, 254. Convulsives, 39. Copper, 29, 32, 39, 132, 249, 255, 258, 286, 355. Arsenite, 256. Salts of, 255, 286. Subacetate, 132. Sulphate, 46, 52, 132. Cornutin,, 254, 256. Corpus Delicti, 300. Corpuscles, Neutralizing by, 26. Corydalin, 254. Corrosion, 27. Corrosive Metallic Salts, 255. Poisons, 255. Sublimate, 29, 55, 174, 260, 357, 379. Corrosives, 19, 21, 27, 29. Local Action of, 19. Cotton Root Bark, 256. Cough, Barking, 254. Counterfeiter's Silver Coating, 362. Crazy Weed, 174. Creeper, 203. Corn Cockle, 134. Creosote, 29, 32, 63, 65, 247, 253, 254, 286. Creolin, 63. Cresols, 63. Crocata, 39. Croton Oil, 29, 38, 42, 48, 134, 249, 255, 256, 260. Crowfoot, 256. Cubebs, 256. Curare, 29, 39, 136, 257. Curarine, 32, 38, 41, 136. Cyanides, 38, 39, 137, 247, 254, 358, 377. Cyanogen, 32. Cyanosis, 254, 258, 260. Cyclamin, 259. Cytisin, 254, 258, 260. Crystals, 294. D Daily Doses, Table of Maximum, 412. 438 A MANUAL OF TOXICOLOGY. Datura Stramonium, 232. Daturin, 102. Deadly Nightshade, 102. •fn pcc Q A Death, Quick or Sudden, 254, 313. Cause of, 22, 328. Modes of, 314. Signs of, 311. Tests for, 311. Deliriants, 31, 39. Cerebro Spinal, 29. Delirium, 256. Demulcents,, 49. Depressants, 31. Cerebro-Spinal, 29. Depression, Mental, 254. Devil's Apple, 102. Dionin, 185. Diamin, 259. Diamines, 39. Diarrhoea with Vomiting, 254. Digitalin, 32, 43, 139, 356. Digltaliresin, 254. Digitalis, 23, 27, 29, 38, 39, 42, 139, 237, 249, 253, 356. Purpurea, 230, 237. Diphtheria, Toxin of, 43. Discoloration, 255. Disease, 23, 24, 25, 27. Relation of Poisoning, 261-272. Simulation by, 261-272. Symptoms, 25. Dissecting Wounds, 228. Distillation, Separation by, 309. Diuretics, 21. Dog Bite, 141. Dogwood, 203. Donovan's Solution, 97. Dose, 14. Gradual Increase in, 23. Large, 22. Lethal or Fatal, 15, 328. Maximum, 15. Minimum, 15. Safe, 15. Size of, 21, Table, 294, 410. Table, Apportionate, 394. Toxic or Poisonous, 15. Doses, Large, 21. Repeated, 25. Table of, Daily, 412. Table of, Single, 394, 410. Drug Habits, 369. Duboisia, 102. Dulcamara, 102, 141. Dyes, Analin, 38, 94. E Effect, Local 15. Remote, 15. Elaterin, 89. Elaterium, 89, 141. Elder, 203. Elimination of Poisons, 26, 261, 272. Emetic, Action of, 48. Emetics, 22, 45, 46. General, 46, 47. Local, 46. Emetine, 32, 47, 255. Enzymes, 259. Eppedrin, 257. Ergot, 39, 42, 141. Ergotism, 254. Gangrenous, 255. Emaciation, 255. Eruptive Fevers, 411. Eruption, 255, 256. Causes of Skin, 329. Erythroxylon, 356. Coco, 235. Eserine, 56, 110. Ether, 17, 29, 32, 38, 51, 126, 143, 248, 255, 356. Brominated, 253. Ether Poisoning, Chronic, 377. Etherism, 254, 377. Eucaine, 124. Euphorbium, 89, 153. Evidence, Chemical, 25. Circumstantial or Moral, 24. Determinative, 24. Experimental, 26. Post-Mortem, 26, 27, 345. Presumptive, 24, 27. Symptomatic, 24, 25. Exalgin, 61, 143, 247, 254, 257. Examination, Post-Mortem, 27, 297, 339, 344, 345. Examinations, Post-Mortem, Di- rections for, 297, 339-, 341. Exhaustion, 24. Eyes, Changes in, 311. F Facts, Important, 420. Fainting, 24. Fats, Melted, 47. Feces, Color Changes, 330. Ferri, Oxidum Hydratum, 53. Cum. Magnesia, 54. Fevers, Eruptive, 421. Fish Berries, 29, 127, 1<3. Fish, Poisonous, 145. Fluorine, 32. Fly Paper, Poisonous, 123. Fly Stone, 97. Food, Poisonous, 24, 26, 29, 32, 39, 144, 249, 256, 358. Effects of, 329, 331, 358., Foods, 23. Formaldehyde, 143, 149, 287. Formalin, 143. Fowler's Solution, 97. Foxglove, 139. Freezing Mixtures, 425. Fuel Gas, 149, 155. Fungi, 29, 39, 145. Furnace Gas, 149. Fusel Oil, 83. INDEX. 439 G Gamboge, 48, 89. Gangrene, 27. Gangrenous Ergotism, 255. Gas, 147, 199. Acetylene, 161. Illuminating, 17, 31, 149, 161, 287._ Laughing, 92. Gases, 18, 31. Explosion, 141. Poisonous, 40, 141, 149. Gaseous Poisons, 21, 149, 249. Gasoline, 149, 191. Gelatine, 52. Gelsemine, 156, 237, 254, 258. Gelsemium, 29, 156, 249, 260. Sempervirens, 230, 237. Gin, 84. Glass, Ground, 159. Glucosids, 32 ,42. Gluten, 52. Glycosuria, 39. Gold, 158. Grain, 82. Growth, 344. Guachamaca Poison, 257. Guaiacol, 17, 63. Guanidin, 254. Guide to Post-Mortem Procedure, 339 Gums, 256. Gun j ah, 113. H Habit, 21, 23. The Cocaine, 374. The Morphine, 380. TThe Opium 380. Haschisch, 113. Hearing, 256. Heart, Drugs Acting Directly Upon, 36. Paralysis of, 21. Poisons, 38. Heat, Loss of, 159. Hellebore, 29, 159. Green, 226. Helleborin, 38. Helleborein, 139. Hemlock, 29, 39, 129, 356, 357. Spotted or Water, 129. Poison or Wild, 129. Height, Weight, etc, 344. Hemp, American 250. Indian, 39, 250. Heroine, 252. Hiera Piera, 89. Homatropine, 102, 258. Hydrocarbons, 41. Hydrogen Antimonide, 149. Arsenide, 149. Arsenuretted, 32. Cyanid, 17. Sulphide, 149, 159. Phosphoretted, 32, 149. Sulphuretted, 32. Hydrargyrum, 174, 250, 255, 256, 258, 288, 357, 379. Hydrazine, 38. Hydric, Cyanide, 38. Hydric, Sulphide, 38, 40. Hyoscine, 102, 258. Hyoscyamine, 32, 102, 254, 257, 258 Hyoscyamus, 29, 39, 102, 232, 248, 256, 258, 357, Niger, 232. I Identification Tests, Table ®f, 273. Idiosyncrasy, 21, 23. Ignatia, 29. Illuminating Gas, 161, 287. Illusion, 24, 256. Immobility,, 311. Incompatibles, Epitome of, 424. Inflammation, 27. Indian Berry, 127. Ink, Anilin, 94. Insect Powder, 97, 114, 162. Insects, Poisonous, 162. Insensibility, 314. Intoxication, 25. Investigation, Chemical, 25. Investigation of Residue, 309. Iodides, 23 163, 323. Iodine, 17, 29, 32, 38, 52, 163, 249, 253, 255, 256, 287, 323, 357 Iodoform, 165, 253, 254. Iodol, 165. Ipecac, Fluid Extract of, 47. Syrup of, 47. Wine, of 47. Ipecacuanha, 165. Pulverized, 47. Iron, 29, 39, 53. Dialyzed, 54. Hydrated Oxide of, 69. Sesquioxide of, 54. Irritants, 27, 29, 35. Simulation of, 25. True, 29. Itch, Colorado, 174. J Jaborandi, 166. Jalap, 89, 168. Jamestown Weed, 102. Javelle Water, 51, 121. Juice, Orange, 88, 114. K Kerosene, 169, 191. Key to Plants, 230. to Poison, Post-Mortem, 364. to Treatment, 247. to Uranalysis, 413, 414. Kombe Arrow Poison, 139, 216. "Knock-Out"-Drops, 120, 169. 440 A MANUAL OF TOXICOLOGY. L Labarraque's Solution, 121. Laburnum, 39, 169. LaCtucarium, 171, 185. Larkspur, 171. Laudanum, 171, 185, 250. Laughing Gas, 92, 171. Laws Relating to Sale of Poisons, 425. Lead, 17, 29, 32, 38, 39, 171, 249, 255, 256, 257, 258, 288, 357, 378. Chromate, 68. Neutral, 68. Colic, 378. Palsy, 378. Paralysis, 260, 378. Life, Income and Expenditures of, 418. Lily of the Valley, 131. Lime, 87, 172, 248. Chlorinated, 121. Quick, 29. Lips, Tingling, 259. Numbness, 259. Lithium Salts, 20. Lobelia, 29, 173, 238, 250. Inflata, 39, 173, 238. Lobelin, 258, 260. Lolium Temulentum, 39. Lungs Poisonous Gases Affecting, 31. Lye, Concentrated, 29. Lysal, 63, M Magnesia, 54, 60. Magnesium Sulphate, 48, 51, 55. Male Fern, 174. Mania, 24, 256. Matches, 193. Maydism, 254. Measure, Antagonistic, 14. Antidotal, 14. U. S. or Apothecaries', 416. Measures, Approximate, 399. Metric, 417. Meat, Poisonous, 145, 239. Putrid or Decaying, 145, 228, 261-272. Medicine, Definition of, 14. Mercurialism, 23, 254, 379. Mercurial Tremors, 379. Mercuric, Cyanide, 137, 358, 377, Mercury, 32, 39, 55, 174, 250, 255, 256, 258, 260, 288, 323, 329, 330, 357, 364, 377, 379. Ammoniated, 174. Bichloride, 174. Cyanide of, 137, 254, 377. Metals, 306. Methyl, 84, 226. Methylguanidin, 191. Mezereon, 89. Milk, 26, 50. Drug Excretion in, 329. Mother's, 329. Poisonous, 26, 145. Mines, Pitts, Wells, 116. Mirbane, Essence, 179. Miscarriage, 256. Mixtures, Freezing, 425. Monkshood, 80. Morphine, 23, 32, 38, 56, 177, 186, 250, 253, 256, 257, 258, 290, 292, 359, 380. Habit, 380. Morphinomania, 380. Mountain Wood, 171. Mummification, 311. Muscarine, 38, 41, 255, 257, 258, 260. Mushrooms 17, 29, 146, 238, 239, 254, 358. Containing Phallin, 254. Musk, 23. Mustard, 46. N Narcotic Irritants, 27. Naphtha, 177, 191. Naphthalin, 177. Narceine, 32, 185. Narcissus Poisoning, 260. Narcosis, 215. Narcotics, 24. 27, 39. Cerebral, 29. Narcotine, 32. Nettle Rush, 24. Neurotics, 29, 30. Cerebral, 30. Cerebro-Spinal, 30. Spinal, 30. Nicotiana Tabacum, 179, 363. Nicotine, 29, 32, 38, 179, 220, 253, 255, 257, 258, 260, 363. Nitrate of Ethyl, 91. Potassium, 91. Sodium, 91. Nitrates, 198. Nitrites, 91. Nitrobenzene, 17, 32, 38, 41, 179, 253 254. Nitrobenzol, 29, 177, 289. Nitrogen Monoxide, 149. Nitroglycerine, 17, 250. Nitrous Acid Fumes, 149. Oxide, 38, 92, 149, 182, 248. Numbness of Lips or Tongue, 259. Nux Vomica, 29, 182, 240, 250, 289, 324, 358. o Occupation Poisons, 356. Oedema, 257. Oil, Curcas, 256. Fusel, 83, 149. Mineral, 191. Olive, 47. Turpentine, 222. INDEX. 441 Oils and Fats,' 49. Ethereal, Volatile, 228, 256. Opiomania, 380. Oleandrin, 139. Opium, 23, 24, 29, 39, 56, 185, 230, 241, 250, 253, 256, 257, 258, 287, 359, 380. Opium and Morphine, 290, 380. the Habit, 380. Orange Juice, 88, 114. Organs, Anatomical Changes of, 38. Ouabain, 216. Oxalates, 39, 57. Oxaluria, 39. Oxamid, 260. Oxide, Nitrous, 38, 92, 149, 182, 248- Oxy Acids, 39. P Pain, 24. Palsy, Shaking, 378. Papaver, Somniferum, 241, 239, 250. Paraffin, 191. Paraldehyde, 190, 253, 388. Poisoning, Chronic, 388. Paralysis, 257. Paralyzants, 29. paregoric, 250. Parsnip, 130. Paris Green, 97, 191, 248, 255. Peach Kernels, 70, 191. Pennyroyal, 256. Pental, 253; Perforations, 27. Peroxide of Hydrogen, 38. Perspiration, Profuse, 257. Petrol, 191. Petrolatum, 225. Petroleum, 191. Phallin, 144, 255, 259. Phenacetin, 17, 29, 37, 61, 193, t,, 239, 244, 247. Phenol, 29, 63. 193, 273. Phenols, 63. Phenomena, Nervous Complex. 39. Phloridcin, 260. Phosphine, 149. Phosphorus, 17, 29, 32, 38, 39, 41, 54, 56, 193, 250, 253, 255, 256, 259, 359, 389. Phrynine, 38. Physic Nut, 89. Physostigma, 29, 110, 233, 256, 257, 258. Venenosum, 233. Physostigmine, 32, 41, 56, 110. Phytolacca, 196. Decandra, 240. Picric Acid, 32, 38. Pjcrotoxin, 29, 42, 127, 197, 254. Pigeon Berry, 190. Pilocarpine, 32, 41, 166, 197, 255, 257, 258, 260 Pilocarpus, 166. Pinkroot, 29, 197, 215. Plan of Analysis, 298, 300. Plant susceptibility, 23. Plants, Poisonous, Key to, 230. j34 ,( 82,51Plumbum Plumbism, 378. Plumbum, 288. Poison, 11. Absorbed, 16, 19, 21. Ante-Mortem Introduction of, 26, 27. Corrosive, 30, 31, 255, 260. Erecper, 203. Decomposition of, 26. Define Cumulative, 12. Deposited, 19, Deposition of, 19. Elimination of, 26. Fatal Dose of, 43. Indian Arrow, 136. Intense Action of, 21. In Urine, 19. Irritant, 22. Ivy, 203. Key to, 230, 247, 364. Key to, Post-Mortem, 364. Legal Definition of,-12, 13. Non-Selective, 19. Oak, 197, 203 . Outline, Search Procedure, 297. Occupation, Poisons, 366. Oxidation of, 26. Physical Properties of, 25. Post-Morten Introduction of, 26. Evidence 235. Post-Mortem, Key to, 364. Re-absorbed, 19. Removal of, 18, 19. Solubility of, 17. Sumach, 197, 203. True, 12. Unabsorbed, 19. Vine, 197, 203. Poisoning, Acute, 14. Alcoholic, Chronic,, 370. Arsenic, 255. Auto, 39. Chronic, 369. Death by, 20. Evidence of, 30. Fatalities, 419. Laudanum, 56. Motives for, 24. Paraldehyde, Chronic, 388. Phosphorus, Chronic,, 389. Post-Mortem, 25. Post-Mortem, Appearance in, 27, 345. Prompt Treatment for, 44. Ptomain, 145, 146, 199, 260. Observations in, 261. Relation to Disease, 261-272. Sausage, 43. Simulation of, 261-272. Suspicious Symptoms of, 253, 331, 345. Symptom, Indications, 253. Poisonous Cheese, 143. Gases, 1&. 442 A MANUAL OF TOXICOLOGY. Vapors, 18. Fish, 144. Food, 24, 26, 29, 32, 39, 144, 249. Insect Powder, 97. Plants, 231, 242. Plants, Key to, 224. Principles, Destruction of, 25. Principles, Neutralized, 26. Poisons Affecting Nervous Sys- tem, 39. Action of, 261, 272. Animal Insect, 29, 32, 43. Antagonistic Action of, 22. Blood, 38. Brain and Heart, 338. Causing Immediate Death, 39, 260. Change in, 16. Circulation of, 20, 243, 244. Classification of 28, 29, 32, 38, 39, 40, 41, 42, 43. (Blyth), 40, 41. (Robert), 38, 39. (Tanner), 28, 33. Combining, 22, 23. Corrosive, 255. Effect of, 15, 20, 21, 329, 330. Effects Modified by, 21. Elimination of, 261, 272. Food, 24, 26, 29, 32, 39. Formed in Dead Animal Mat- ters 43. Gaseous, 149, 249. In Warfare, 150. Heart, 38, 338. Identification of, 273. ■ Injected, 18. Inorganic, 32, 43. Irritant, 39. Irritant and Narcotic, 39. Laws Relating to Sale of, 425. Metallic, 32. Mineral, 19, 20. Non-Corrosive, 32. Organic, 32, 305. Outline of Procedure in Search for, 297. Sale of, 425. Secreted by the Living, 42. Suicides, 260. Specific Effects of, 20. Vegetable, 19. Volatile, 32. Poke, 195, 230, 240. Berry, 196. Root, 29, 196, 197. Poppy, 185, 197, 241. Posology, 14. Post-Mortem Appearance in Poi- soning, 345. Examination, 27, 331-333. Key to Poison, 364. Poisoning, 26. Procedure, Guide to, 339, 341, 345. Potash, 40, 248. Acid, Oxalate, 350. Chlorate of, 121, 198. Chromate of, 68. Cyanide of, 137. Potassa, 87, 276, 360. Potassium, 87, 197. Bicarbonate, 56, 166. Bichromate, 68, 255. Bromides, 106. Carbonate, 29, 32, 56, Chlorate, 17, 29, 198, 255, 260, 361. Chromate, 68. Cyanide, 29, 137. 254, 361, 362, 377. Ferrocyanide, 55. Hydroxide, 29, 32. Iodide, 19, 57, 89, 258. Nitrate, 29, 362. Nitrite, 91. Oxalate, 260. Permanganate, 55, 56. Powder, Insect, 97, 114, 162. Precipitate, Red or White, 174, 199. Priapism, 257. Principals, Vegetable, Poisonous,42. Privy Emanations, 210. Protein Poisons, 144. Prunus, Laurocerasus, 229. Ptomain Poisoning, 144, 199, 260. Ptomains, 26, 29, 32, 39, 43, 144, 199, 254. Ptomatropines, 362. Ptyalism, 379. Pulsatilla, 80, 201. Pulse, 257. Pupils, 258. Purgatives, 21. Purging, 260. Putrefaction, 311. Putrid Meat, 199. Pyrogallol, 63, 260. Pulmotor, 61. Pyrethrum, 162. Q Quaker Buttons, 182. Quassia, 47. Quinine, 253, 256. Questions, for Self-Exam'n. 426. Q. V„ 63. R Rabies, 204. Rat Paste, 97, 202. Poison, 193. Rats-bane; 182, 193. Redness, 27. Red Oxide of Mercury, 174. Red Precipitate, 174. Resorcin, 202. Respirations at Various Ages, 418. Respiratory Murmur, 311. Rhigolene, 191. Rhus, 191, 203, 24I. Radicans, 203, 241. INDEX 443 Toxicodendron, 203. Venenata, 203. Ricind, 38. Ricinin, 118. Ricinus Communis, 118. Rigor Mortis, 312. Rock Oil, 191. , Rough on Rats, 97, 202, 248. Rue, 256. Rum, 84. Respiration Artificial, 63. s Sabadilla, 226. Saffron, 127. Salicin, 32. Salicylism, 256. Saline, Solution (Salt), 57, 118. Saliva of Rabid Animals, 204. Salivation, 258, 379. Salol, 78. Salt Solution (normal), 57, 118. Salt of Lemon, 75. Sorrel, 75. Salts, Ammonium, 40. Caustic, 38. Corrosive, Metallic, 255. Lithium, 20. Neutral, Sodium, 40, 118. Potassium, 22, 40. Strychnine, 56. Sanguinaria, 205, 233. Canadensis, 233. Santonin, 32, 42. 207, 253, 259. Saponification, 311. Saponins, 38, 42. Saprol, 63. Saturnism, 254. Savine, 29, 38, 39, 208, 258 362. Scammony, 89. Scheele's Green, 97, 210. gcilla, 139, 216. Scillitin, 139. Scillitoxin, 139. Scoparin, 139. Scoparius, 139, 210. Scopolamin, 104, 254, 257, 258. Secrecy in Poisoning, 24. Sedatives, 24. Self Examination, Questions for, 426. Self Poisoning, 100. Senna, 48. Sewer Gass, 24. I49, 21®. Sex, 21. Shock, 20, 21. Siddhi, 113. Silver, 32, 39, 211, 256. Compounds, 250. Cyanide, 138, 362, 377. In Potassium Cyanide, 362. Nitrate, 211, 294, 363. Simulation of Poisoning, 261, 272. Skin, Dry, Moist, Yellow, 258. Sleep, 24. Snake Bite, 213, 243, 244. Sneeze Weed, 215. Venom, 22, 32. Snow on the Mountain, 203. Soap, Castile, 49. Suds, 47. Soda, 29, 40, 248, 276, 360. Sodium, Bicarbonate, 56, 164. Carbonate, 29, 32, 56, 66, 196. Chloride, 47, 57. Hydroxide, 20, 32. Hyposulphite, 57. Nitrate, 255, 260. Nitrite, 17. Sulphate, 51, 55. Softening, 27. Solanine, 29. 32, 102, 255, 259. Solution, Fowler's 248. Solutions, 21. Spanish Flies, 114, 244. Spartein, 32, 139. Spigelia, 215. Spurge, 216. Spirit of Camphor, 111. Of Turpentine, 222. Spotted Hemlock, 127, 129. Squill, 139, 222 . Syrup of, 47. Compound, 48. Squirting ucCumber, 89. Stagger Weed, 215. Starch, 57. Iodide of, 57, 184. State, Liquid, 21. Solid, 21. Stavesacre, 171. Stibin, 149. Stings, Bee, etc., 32, 162. Stomach, Condition of, 21/97. Contents of, 21. Pump, 45. Tube, 45. Ulceration of, 27. Stramonium, 29, 39, 102, 230, 232. Strophanthin, 32, 139, 216. Strophanthus, 139, 216, 234, 242, 248. Hispidus, 242. Strychnine, 23, 24, 29, 32, 38, 39, 43, 182, 253, 254, 256, 289, 358, Strychnos, Ignatia, 182. NuxVomica, 182, 240. Substances, Animal, Putrid, 39. Locally Irritating, Organic, 38. Suicides, Poisons of, 260. Sulphides, Investigation of, 307. Sulphonal, 216, 250, 253, 256, 257, 259, 389. Poisoning Chronic, 389. Sulphur, Baths, 172. Dioxide, 38, 149. Sulphurous Oxide, 149. Sulphuretted Hydrogen, 159 Surface, Character of to Which Applied, 18. Susceptibility, 23, 24. Swamp Sumach, 203. Symptoms, Ante-Mortem, 27. Characteristic, 24. Delayed, 254. Indications of, 253. 444 A MANUAL OF TOXICOLOGY. Objective, 24. Severe, 24. Subjective, 24. Suspicious, 331. Syncope, 315. T Table, Apportionate Dose, 394. Dose, 394, 411. Pulse, 418. For Making Per Cen^-Sol., 423. Of Tests, Identification, 473. Tanacetum Vulgare, 219. Tansy, 29, 219. Tar, 256. z ■ Tartar Emetic, 48, 94, 219, 258, 351. Taste, Foul, 258. Taxine, 41. Teeth, Order of Eruption of, 421. Tellurium, Salts of, 253, 260. Test, Distinctive, 26. ; . »t, Husemann's, 280. Tests for Poisons, Table of, 273. Tetanies, 35. Tetanus, 25. Spinal, 29. Bacillus, 254. Temperature, 260. Equivalents, 418. Tetronal, 218. Thebaine, 29, 254. Thorn, Applq, 102, 216, 258. Tin, 29, 32. Compounds, 219. Tobacco, 29, 39, 220, 241, 250, 363. Indian, 173. Tolerance, 235*24 Toludin, 264. Tolulene, 260.. '' . •• Tongue, Numbness, 260. Tingling, 259. Toxalbumins, 22. Toxicology, 10. Pharmacological, 317, 328. Toxin, 26. Toxins, 32. Transfusion, 332. Treatment, Key to, 247. Tremors, Mercurial, 379. Trichina, 29, 146, 244. Spiralis, 242. Trichinosis, 260. Trional, 218, 250, 253, 260, 389. Poisoning, Chronic, 389. Truffles, 146. Turpentine, 19, 23, 222. Oil of, 58, 222, 260. Turpeth, Mineral, 47. Tyrotoxicon, 26, 294. u Unconsciousness, 333. Uraemia, 24, 39. Uranalysis, Key to, etc., 413, 414. Uranium Salts, 260. Urethane, 223. Urine, 260. Abormal Constituents of, 414. Ulceration, 27. Causes of Odorous, 330. Color Changes, 330. V Vanilla, 256. Vapors, 18, 38. Vaselin, 47, 225. Venous Coagulation, 311. Veratrine, 23, 32, 226, 256. Veratpum, 226, 242, 250. Album, 226, 242. Viride, 29, 226, 242. Verdigis, 132, Vermin Killers, 228. Vinegar, 63, 147. Virus of Rabid Animals, 254. Visions, 256. Double, 260. Vitriol, Blue, 132. White, 228. Voice, Loss of, 260. Vomiting, 25, 260. and Purging, 260. Without Diarrhoea 260. Volatile Oils, 228. w Water, 59. Gass, 161. Javelle, 51, 121. Tepid, 47. Weed, Jamestown, 216. Weight, Apothecaries', 416. Avoirdupois, 416. of Water, 416. and Measures of Viscera, 343. Wells, Mines and Pits, 116. Wheaten Flour, 57. White Precipitate, 174, 228. Vitriol, 228. Whisky, 84. Wines, 82. Wolfsbane, 80. Wood Alcohol, 86, 253. Spirit, 86. Woorara, 136, 228. Wormwood, 390. Wounds, Poisonous, 228. Wrist Drop, 378. Y Yellow Jasmine, 156. Yew, 39. z Zinc, 29, 32, 39, 294, 363. Chloride, 229, 363. Compounds, 228, 229, 250. and Chromium, Search for, 308. Sulphate, 47. 228, 363. Ziratol, 63.