A MANUAL OF TOXICOLOGY A CONCISE PRESENTA TION OF THE PRINCIPAL FACTS RELATING TO POISONS, WITH DE- TAILED AND DESCRIPTIVE DIRECTIONS FOR THE TREA TMENT OF POISONING A TABLE OF DOSES OF THE PRINCIPAL AND MANY NEW REMEDIES AND VARIOUS STATISTICAL TABLES By ALBERT H. BRUNDAGE, A. M., M.tt., Phar. D, M.S. Consulting Toxicologist to the Bushwick Hospital. Medical Inspector and Lecturer, Department of Health of th’e City of New York. Major, Medical Staff, Police Reserve, City of New York. Assistant in Immuno- therapy, Polh'emus Clinic, Long Island College Hospital. Visiting Physician, Jamaica Day Nursery. Examining Surgeon and Secretary, Board of Examining Surgeons (Queens County, New York), U. S. Bureau of Pensions. Formerly: Professor of Toxicology and Physiology in the Departments of Medicine, Dentistry, and Pharmacy of Mar- quette University; 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 American Medical Association; the American Associa- ( tion for the Advancement of J Science; Etc. FOURTEENTH EDITION ILLUSTRATED AND ENLARGED Price $3.00 net THE HENRY HARRISON CO. NEW YORK: 70 Linden Street, Brooklyn, New York 1923 Copyright, 1901 Copyright, 1923 By The Henry Harrison Co. Registered at Stationers’ Hall, London, England BURR PRINTINC HOUSI NEW YORK, TJT. S. A. DEDICATED TO THE MEMORY OF MY MOTHER, WHOSE ATTAINMENTS AND NOBILITY OF CHAR" ACTER HAVE BEEN THE INSPIRATION AND BENEDICTION OF MY LIFE. SARAH MERVINA BRUNDAGE, PREFACE TO FOURTEENTH EDITION In this edition the author has endeavored to better provide for the increasing demand for comprehensive information concerning poisonous foods, common, habit-forming narcotic poisons, and certain vegetable and animal proteins which poison thru being inhaled. He has also incorporated much extended information concerning “mad-dog-bite.” Apparently, by so doing he could best cooperate with the very active efforts of the Department of Health of the City of New York, and of other organizations, in the saving of life, by the dissemination of information concerning rabic virus, rabic symptoms, and the proper protective and preven- tive measures as well as the alleviating treatment to be employed against the deadly effects of the rabic poison. Treatments of various poisonings have been revised. Certain data and measures, of service in the determina- tion or treatment of some poisonings, have also been introduced as new text or in the auxiliary matter. ALBERT H. BRUNDAGE. New York City, August 8, 1922. PREFACE TO TWELFTH EDITION It has been suggested that the reason for employing the red and white cover used for this book is not generally understood and would be of interest to some of those who use it: Some time before the publication of the first edition of this book, there were very many poisonings by virulent poisons; especially by morphine and its salts, through the latter being mistaken for quinin sulphate or for other comparatively harm- less drugs, or through the careless and indiscriminate use of such poisons, for anodyne, soporific or other hazardous pur- poses, by the general public; there was also a notable increase in the prevalence of the morphine habit and associated habits. These matters were the subject of very active and wide- spread discussion. To remedy the laxity in laws relating to these matters, and thereby materially modify the existing menace to public health and to life, many States, including New York, passed laws, carefully restricting the sale of these poisons, and designated a special and very conspicuous poison label for them. In New York, the Penal Code was amended to require that all packages containing morphine or its salts, should be labeled with a scarlet colored label, with the name of the contents in white letters. As such labeling became gen- erally known, the label served as an instantaneous and im- pressive warning of deadly poison; truly a danger sign in medical, pharmaceutical and related matters, just as a red flag is recognized as a danger sign in matters relating to trans- portation, structural, and various other interests. The author thought that if the cover of this book was made to imitate the gross appearance of such label it would be in- stantly recognized by many as a danger sign, and emblematic of virulent poisons; therefore quite readily understood to indicate that the contents were a treatise on poisons. After careful consideration such cover was adopted. In this new edition, various text features have been revised, and many new and important facts have been introduced, in the effort to bring the book fully up to date. It is hoped that its usefulness will have been thereby proportionately enhanced. ALBERT H. BRUNDAGE. September 6, 1920. 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 it. 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 PART II. Poisons and Acute Poisoning:— History, Symptoms and Treatment in Detail 61-229 Principal Poisonous Plants, etc 230-244 A Key to Constituents 245-248 A Key to Treatment 249-252 PART III. The Indications of Various Symptoms 253-260 The Special Senses— Determination of Their Condition for Recog- nition of the Toxic Effects of Certain Poisons 2600260/ PART Ilia. Simulation of Poisoning by Disease 261-263 Relation of Poisoning to Disease 264-268 Action and Elimination of Poisons 269-272 PART IV. 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 PART VII. The Signs of Death—Tests to Determine Death 311-312 PART VIII. Sudden Death—Causes—Modes of Death 313-316 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 PART IX. PART X. Transfusion 332 Unconsciousness or Coma—Interpretation, Treatment, etc 333-336 Hints on Brain and Heart Poisons 338 PART Xa. Feeding in Poisoning 338a 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; Poisons of Suicides .. 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 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 of Life 418 Inks—Constituents of; etc 419 Stains—Removal of; etc 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 APPENDIX. PAGES A MANUAL — OF — TOXICOLOGY PART I. GENERAL CONSIDERATIONS. 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 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- der, 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, will 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, Penal 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.” Acute Poisoning is produced by taking an exces- 14 A MANUAL OP '_oXICOLOGY. 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 A.ntidote 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- ** 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 x/i 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 new remedies. This table will be found in the Appendix. 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 be ly 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 Abdominal Regions 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. Effects. Alcohol, Anemia, often leucocytosis. Amyl nitrite, Methemoglobinemia. Acetanilid, Methemoglobinemia. Ammonium hydroxid, Leukocytosis. Antipyrin, Methemoglobinemia. Bromin, Methemoglobinemia. Chloral, Leukocytosis. Chromic acid, Methemoglobinemia. Ether, Oligochromemia, Guaiacol, Hemocytolysis, leukocytosis. Hydrogen cyanid, Methemoglobinemia, [mia.] Illuminating gas, Methemoglobinemia, polycythe- Iodin, Leucocytosis, methemoglobinemia Lead, Anemia, granularbasophilia, of- ten leukocytosis. Nitrobenzene, Methemoglobinemia, megalo- blastic anemia. Nitroglycerin, Methemoglobinemia. Phenacetin, Methemoglobinemia. Phosphorus, Polycythemia, occasionally leu- kocytosis. Potassium chlorate, Methemoglobinemia, anemia, leukocytosis. Sodium nitrite, Methemoglobinemia. Poisonous mushrooms, 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, 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 svstem. Potassium iodide, turpentine, antimony, Vid 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 319. 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; unclue 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 25T. 121- 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 bv the white blncA 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 wrall. 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 veriomous 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 narcqtized 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. True Irritants. 1. 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. Corrosiyes. 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. Z. NEUROTICS. A 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. Asthemcs. 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. NEUROTICS. 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 leei- 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- 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 Virfde, 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. Volatile Non-Metallic Poisons. CHEMICAL CLASSIFICATION OF 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. Mineral Acids. Arsenic, Arsenous, Chromic, Hydro- bromic, Hydrochloric, Nitric, Phos- phoric and Sulphuric Acids. Mineral Alkalies. Ammonium, Potassium, and Sodium, Hydroxides and Carbonates. 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, 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. Glucosids. Digitalin; Salicin; Santonin; Solanin; Strophanthin, etc. 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 (opium), 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. Corrosives. 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— I. 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 mav suddenly give rise to suspicious symptoms. The history, THE CLASSIFICATION OF POISONS. 35 mode of attack, etc., will generally negative any suspicion ot 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, 1st. 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 f 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, “oenanthe crocata, phellandrinum aquaticum, sethusa, 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 its 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 (lolium 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 andveratrine; “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 -nts and other insects. 38 A MANUAL OF TOXICOLOGY. I. Poisons Which Cause Coarse Anatomical Changes ox the Organs. ROBERT’S CLASSIFICATION OF POISONS. 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 a? 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. 8. Poisons which, with or without primary solution of the red blood corpuscles, produce in the blood methse- 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 affecting 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., uraemia, 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, chloral, 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 inflate, 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 volatile 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 oxalates 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 oh 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. Amyl- 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 acith' 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. Division 1.—Poisons Secreted by the Living. 1. Poisonous amphibia; 2. Poison of the scorpion; 3. Poison- ous fish; 4. Poisonous insects, spiders, wasps, bees, beetles, etc.; 5. Snake poison. Division II.—Poisons Formed in Dead Animal Matters. 1. Ptomaines; 2. Poisoning by putrid or changed foods— sausage poisoning. F. The Oxalic Acid Group. G. Inorganic Poisons. 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. Victor C. Vaughan classifies poisons into: (1) Mineral.— (a) metallic poisons, (b) acids, (c) alkalies and (d) inorganic gases. (2) Vegetable.— (a) alkaloids, (b) organic acids, (c) pot- 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, ?mtipyrin. 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: 1. 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 or pump; 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. THE STOMACH TUBE AND THE STOMACH PUMP. MECHANICAL ANTIDOTES. 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 ?), the stomach pump (Fig. 3), or by emetics. 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 teaspoonfuls 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. SYSTEMIC 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 Y3. 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—34 to V2. teaspoonful. Tartar Emetic—1 to 3 grains. Children y2 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 in doses of y2 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 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. OILS, ALBUMIN, TANNIN, ETC. 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 white of one egg, or sometimes 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 alkaline 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- ica, 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. It 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. It is considered a valuable antidote in Carbolic Acid poi- soning. Four ounces of Alcohol in as much or more wa- ter may be administered repeatedly, each time removing it 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 A MANUAL OF TOXICOLOGY. 52 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 the 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 limited, 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 if 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 which it combines to form a ferric arsenite and also acts locally as a protector of the mucous mem- brane of the alimentary canal. It is a reddish- brown, 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 250 parts. The solution of Ferric Sulphate and the Ammonia Water should be kept on hand in separate bottles 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 be washed by pressing it in a wet muslin strainer until no more liquid passes, then suspending it in 250 parts of water. The dose is a teaspoonful in Avater, repeated every 5 or 10 minutes.* •Although such is in accordance with the U. S. P. direction, it would seem 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), 10 grammes, rubbed up with water 750 cc., in a bottle of 1000 cc. capacity. When the preparation is re- 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 i)4 to 2 ounce doses of such mixture, frequently at 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 1 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 V2 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 p2 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) 2p2 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 iy2 to 3 ounces, frequently repeated. PHYSIOLOGICAL ANTIDOTES, ETC. 60a PHYSIOLOGICAL ANTIDOTES AND MEASURES— THERAPEUTIC AGENTS AGENTS ACTING ON CENTRAL NERVOUS SYSTEM: (Stimulants): Alcohol, strychnin, (Act on spinal cord). Atropin, bella- donna, caffein, (Act on brain and medulla). (Depressants).—(Act as sensory paralyzants): Chloroform, ether, ethyl chlorid, (Induce sleep, quiet, rest). Alcohol, asafetida, chloral and preparations, bromides, codein, morphin, opium and its preparations, camphor monobromate, hyoscin, paraldehyd, physostigma—(depresses cord), scopalamin, sumbul, sulphonal, trional, valerian, veronal, etc. ANESTHETICS (General): Chloroform, ether, nitrous oxide gas. (Local): Oocain (eucain, novocain, procain, etc.), ether, ethyl chloride, ice, menthol. ALIMENTARY SEDATIVES (Motor and Reflex): Gallic and tannic acids; belladonna; bismuth, calcium and opium preparations; delmulcents. ANODYNES AND ANALGESICS (Quiet pain): Aeetanilid, aconite, alcohol, ammonia, aspirin, atropin, belladonna, bromides, camphor, chloral, chloralamid, chloroform, cocain, codein, cold, cresol, hyoscin, Hoffman’s anodyne, hypnotics, lupulin, ether, ice, lysol, morphin, menthol, oil of wintergreen, opium, phenacetin, potassium and sodium salts and preparations, salicylic acid, soap, fixed oils, etc. ANT-ACIDS: Calcium and magnesium carbonates. Ammonium, lithium, sodium and potassium salts and preparations. Urotropin. ANTHELMINTICS: Aspidium, chenopodium, chloroform, calomel, pelletierin, purgatives, spigelia, salol, santonin, thymol, turpentine, etc. ANTI-EMETICS: Bismuth, camphor and sodium, preparations; cerium oxalate, cocain, camphor, calcium preparations, cresol, chloral, chloroform, ingluvin, lime water, menthol, various opium preparations. ANTISEPTICS (Urinary, etc.). Aspirin (acetylsalicylic acid), ben- zoic, boric and salicylic acids; naphthalin, copaiba, cubeb, mecury salts, resorcin, lysol, phenol, hydrogen peroxide, iodoform, potassium per- manganate, salol (phenyl salicylate), sandalwood oil, sodium benzoate and sulphocarbolate, salicylates, thymol, urotropin, etc. ANTIPYRETICS: Aeetanilid, antipyrin, aspirin, phenacetin; aconite, quinine, salicylic acid, salicylates, guaiacol, diaphoretics, diuretics, purga- tives, cold applications. ASTRINGENTS: Alcohol, alum, bismuth, copper, iron, lead and zinc preparations; kino, krameria, witch hazel, gallic and tannic acids. BITTERS (Increase alimentary secretion): Gentian, cinchona and nux vomica preparations, etc. CARDIACS: Digitalis, strophanthus, (Strengthen contraction). Atropin, caffein, camphor, (Accelerate pulse). Aconite, digitalis, vera- trum, (Slow pulse). Infundin (pituitrin) (Slows and strengthens heart beat and increases blood pressure). CARMINATIVES: Alcohol, ammonia, menthol, peppermint, rhu- barb, spearmint, wintergreen, camphor, capsicum, cardamon, essential oils, ginger and other spices, etc. DEMULCENTS (For mucuous surfaces): Acacia, almond, barley, honey, soap, starch, licorice, egg, glycerin, fixed oils, milk, certain pulpy fruits, moss, potassium chlorate, tragacanth, marshmallow, slip- pery elm, flaxseed, gelatin, etc. EMMENAGOGUES: (To encourage menstrual flow): Vegetable purgatives (especially the more drastic); corpus luteum. EMOLLIENTS (Skin remedies): Almond, lard, linseed, etc., oils; cacao butter, clay, glycerin, paraffin; petroleum preparations—albolene, lavolin, vaselin, etc.; bismuth, magnesium, talcum, zinc, etc., prepara- 60b A MANUAL OF TOXICOLOGY. tions; fomentations; poultices of bran, bread, flour, figs, flaxseed and oatmeal; meat, molasses, soap, starch, etc. EYE AND SKIN ACTION AGENTS: To Dilate Pupil and Relax Accommodation: Atropin, belladonna, cocain, homatropin, scopolamin, hyoscin. To Contract Pupil and Ciliary Muscle: Physostigmin salicylate, pilo- carpin hydrochlorate, etc. To Increase Perspiration: Camphor, ipecac, morphin, opium, pilo- carpin, etc. To Reduce Perspiration: Agaricin, atropin, belladonna. GENITO-URINARY AGENTS: Genital: Analgesies, anodynes, ant- acids, antipyretics, antiseptics, astringents, calomel, demulcents, emollients, narcotics. Gonorrhoeal and syphilitic remedies.—arsenic, mercury, etc.; sedatives, etc. Urinary: Antacids—(To reduce acidity): Hexamethylenamin (uro- tropin), potassium acetate, bicarbonate and citrate; sodium bicarbonate and carbonate. Diuretics (Increase flow of urine): Acetates, carbonate, and citrates; caffein, calomel, digitalis, infundin (pituitrin), potassium and sodium salts, spartein, sulphate, squill, strophanthus, theobromin, water, etc. To Increase Hemoglobin: Iron, manganese, potassium permanganate. To Alkalinize: Alkaline acetates, carbonates, bicarbonates, citrates. To Increase Coagulability of Blood: Calcium salts; coagulose, serum of horse, or of human blood, etc. HEPATIC AGENTS—To Increase Secretion and Flow of Bile— (Cholagogues, etc.): Aloes, calomel, colocynth, jalap, podophyllum, rhu- barb, sodium phosphate and other salts, etc.—Salicylic acid, ox gall (fel bovis), etc. HYPNOTICS OR NARCOTICS: Alcohol bromides, cannahis Indica, chloral and compounds, hyoscyamus, hyoscin, scopolamin hydro- bromid, opium, morphin—Dover’s powder, and various opium alkaloids and their preparations and combinations, etc.; paraldehyd, sulphonal, trional, veronal, etc. PURGATIVES: Mineral, Saline, Animal: Calomel, magnesium, potassium and sodium preparations; glycerin, mineral oil, ox gall, sulpnur, petrolatum, phenol- phthalein, infundin (pituitrin) (increases intestinal peristalsis). Vegetable: Aloes, aloin, castor oil, olive oil, cascara, .colocynth, croton oil, elaterium, jalap, podophyllum, rhubarb, sonna. RECTAL AGENTS: Enemata, salves,—suppositories, etc. Enemata: Nutritive.—First cleanse bowel by using soap suds or other purgative enema, followed by salt solution irrigation. Nutritive enema of not over 6 ounces, to be given at temperature of 100° F. Give slowly every 3 to 6 hours through small, soft tube. A nutritive enema: Beat up egg and add to Yi pint of warm milk; then add the contents of a Fairchild’s peptoniz- ing tube and let mixture stand, in warm place, an hour. Take one-half of this and add to it 1 or 2 ounces of thick corn or oatmeal gruel, or flour paste, and give, through tube, as high enema; set other half aside for next time. Purgative:—Soap suds made with such soap as castile: Introduce a quart hot; may add 1 to 2 drams of turpentine well stirred in, or a tablespoonful of glycerin, for effectiveness. The “1, 2, 3 Enema of hospitals is epsom salt 1 ounce, glycerin 2 ounces, water 3 ounces; 1 or 2 teaspoonfuls of turpentine is sometimes added. In gaseous disten- sion of the bowel, milk and molasses each a pint well mixed, to which is slowly added a tablespoonful of turpentine well stirred in acts like- wise; °I ma7 use a turpentine emulsion of: turpentine 1 teaspoonful added drop by drop to a beaten-up egg; then stir in glycerin 6 table- spoonfuls gradually added, and complete by adding soap suds to make a pint. Starch enema: a teaspoonful of starch stirred in cold water until smooth to which is then slowly added about l/2 pint of boiling water, then boil 2 minutes. Cool to about 100° F. and inject. PHYSIOLOGICAL ANTIDOTES, ETC. 60c Olive oil (sweet oil), linseed and cotton seed oils at about 90° F, are each given, as an enema, in doses ranging from an ounce to a pint, and followed by a soap suds enema in 2 to 4 hours; by mouth, these oils, in one or more teaspoonfuls. However, in poisoning by cantharides, copper salts, or phosphorus, it is best to avoid using them either way. Rochelle salt 4 to 6 ounces, or epsom salt 2 to 4 ounces, in warm saturated solu- tion as an enema at bed time, followed by soap suds in about 8 hours is serviceable. RESPIRATORY AGENTS: To Stimulate the Respiratory Center; Atropin, caffein, camphor, strychnin. To Reduce Irritability of Respiratory Center and Lessen Cough: Chloroform, codein, heroin, morphin, opium, etc. To Increase and Thin Bronchical Secretion: Ammonium carbonate and chlorid; apomorphin, ipecac, potassium and sodium salts, iodids, squill. To Lessen Bronchical Secretion: Atropin, belladonna, benzoin, tur- pentine, etc. To Relax Bronchical Spasm: Amyl nitrite, atropin, belladonna, bromides, chloroform, nitroglycerin, potassium iodid, sodium iodid, sodium nitrate, chloral and preparations, morphin, opium, etc. SKIN IRRITANTS: Alcohol, ammonia, camphor, cantharides, capsi- cum, croton oil, cold and heat, iodin, menthol, mustard, peppermint, wintergreen, turpentine, etc. VASCULAR AGENTS: To Contract Vessels—(Increasing blood pressure): Adrenalin (epinephrin), belladonna, caffein, ergot; and vari- ous hypophosphis (or posterior lobe of the pituitary body) preparations, such as infundin (pituitrin, dessicated pituitary body, dessicated hypo- physis, pituitary extract, etc.). To Relax or Dilate Vessels—(Reducing blood pressure): Amyl nitrite, nitroglycerin, sodium nitrite, sweet spirit of niter, heat, etc. To Deplete and Remove Fluid: Cold, Digitalis, calomel, squil, strophanthus; also diaphoretics, diuretics; saline and vegetable purga- tives, etc. As a rule, the best time to administer a medicine is between meals when the digestive processes will not be interfered with; but there are various exceptions to this rule. Dilute acids, alkaline tonics, bitters and other stomachics should be given 10 to 20 minutes before food is taken, as they then diffuse best through the mucous membrane into the blood, and stimulate the secretion of the gastric juice. By giving an acid shortly before food is taken will also restrain movement of normal acid-forming materials toward the stomach, thereby preventing excessive formation of the acids of the gastric juice; but, dilute acids and alkaline tonics given as digestants, and pepsin, should be administered about IS to 30 minutes after the meal. Alkalies as correctives of acidity ]/2 hour or more after eating. Diastase should be given at beginning of meal; panereatin and oxgall 1 or 2 hours after eating. Laxatives and cathartics act best when stomach is empty. Iodin and the iodids should be given, when the stomach is nearly empty, and they will rapidly diffuse into the blood; if given when much food is in stomach, starch or acids present alter and weaken. Silver oxid _ and nitrate, after digestion is completed; for, if given during it, action will be interfered with by chemical .changes. Corro- sive sublimate, gallic and tannic acids, weaken gastric digestion and should be given between meals. Narcotics at bedtime or earlier; also purgatives then, or in early morning. Irritating medicines and powerful metallic and other salts, such as BEST TIME TO GIVE MEDICINES 60d MANUAL OF TOXICOLOGY those of zinc, copper, arsenic, mercury, iron, bromids, etc., as well as oils, malt extracts, phosphates, etc., should be given, as a rule, with or immediately after food. Sodium bicarbonate on empty stomach enters blood as alkali; if given during digestion neutralizes the HC1 of the gastric juice and is changed to sodium chlorid and sets COa free. FREQUENCY IN ADMINISTRATION There is no established, general rule covering the frequency with which medicines should be given. Some years ago it was the custom to give most medicines, except laxatives and hypnotics, at or about meal- time. This was partly due to the fact that very many medicines were more or less nauseous, and were more readily retained if taken in conjunction with the food; it was also in part due to the belief that at least the main and dependable effects of most medicines were ex- hausted at the expiration of the time ordinarily considered as required tt complete digestion, or in about 4 to 6 hours. Since that time more definite and accurate knowledge, as to manj physiological functions, has been acquired. The field of pharmacody namics has been developed and has furnished much valuable information as to the action of various medicines; chemistry and pharmacy have supplied very many, altogether new, very palatable or actually tasteless, as well as very -convenient, products and preparations, for medicinal use. All of these have materially influenced medical methods and procedures, including frequency in the administration of medicines. It is evident that frequency in giving a medicine largely depends upon how long it takes a dose of it to begin to act; and upon how long before its action practically ceases. Some medicines are slow to act and may be very slowly or imperfectly eliminated or used up; therefore accumulate in the system; perhaps are deposited in -certain organs; therefore they may act sometime after administration of them has ceased—among these are arsenic, atropin, belladonna, the bromides; digitalis, digitali, mercury and its salts, strychnin, anodynes, hypnotics, etc.; ordinarily these should not be given often without close and -careful observation. Some medicines such as the volatile ones (ammonia, etc.), act very rapidly, and as a rule their effects are comparatively transient; usually they should be given every 1 to 3 hours; but in some instances 3 times a day or less suffices.—Among these are ammonia preparations, alcohol, camphor preparations, caffein, chloral, chloralamid, iodids, nitroglycerin, salicylates, strophanthus, strophanthin, strychnin, etc. It should be noted, that when given frequently, the dose of a powerful medicine is less, usually, than when given only 2 or 3 times a day, but is influenced by the urgency of the symptoms or condition and the effects secured. In summer the system does not bear strong medicines as well as in winter. When a prompt and emphatic physiological effect is desired a single large dose may suffice, as with purgatives, hypnotics, etc. A drug will produce its characteristic effect more readily if it is given with other drugs of the same class; and both together may produce a more emphatic effect than either could alone; such is true of bromides and chloral for sleep; calomel and jalap as purgatives; etc. On the other hand, drugs of opposite, physiological effects, although acting on the same structures, may each lose much or all of its power, if given to- gether: e. g., bromides prevent strychnin convulsions, although both act on the spinal cord. Digitalis slows the heart, by stimulating the vagus center; but atropin depresses the vagus nerve endings, preventing such effect; therefore they should not be given close together if such effects is desired. A medicine intended to be used to counteract a poisonout effect must frequently be given in larger doses than usUal; but always cautiously. 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. HISTORY: 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 'For hints on suspicious symptoms of poisoning, see page 331. Diag- nostic bints, 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 lo grammes. Poisoning has resulted from 7 grains of Antipyrine; also from 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. SYMPTOMS: 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.] Put patient in the recumbent position. Loosen clothing; supply fresh air and give Oxy- gen if possible, to overcome the cyanosis. 1. 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 occurred). 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—SOLUTOL—ETC. HISTORY: Carbolic Acid, a coal tar, is a colorless product when anhydrous; upon adding 5 per cent, of water it becomes liquid; upon exposure to light it may turn red. It is a powerful escharotic and neurotic poison. Probably Phenol, Lysol, Oxalic Acid and Gas are the poisons most commonly used for sui- 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 *4 to 4 hours after the poison has been taken. The shortest times have been, in one case 3 minutes in another 5 minutes; longest times, 60 hours; also 5 and 7 days. Fatal dose of Phenol, from 34 drachm up; usually y2 to 2 ounces. As a rule, ounce fatal; 6 or 7 grains have caused dangerous symptoms; recovery from over an ounce. Death from J4 ounce Creosote; 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 established. Cresol is cresylis acid or methyl phenol—3 varieties: ortho-, meta- and para-cresol. Solutol: cresol and sodium cresolinate. Lysol is an impure para-cresol, consisting of tar, resin, rat, linseed oil, soap and potassium, saponified by boiling. Saprol: oily mix- ture, 40 per cent impure cresols in petroleum hydrocarbons. Creolin contains various aromatic substances, mainly cresols.] [Lysol: cresol, linseed oil, potassium, soap. Cre- sol is methyl phenol.] SYMPTOMS: * [Usually, but not always, an immediate burning pain from mouth to stomach, accompanied sometimes by vom- iting; usually a whitening of lips and mouth, also of eso- phagus and stomach; the breathing is labored; as a rule there is dizziness and later loss of consciousness; early low temperature, sometimes 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.] Usually treatment must be prompt to be effective. Remember that Carbolic Acid, although so called, TREATMEMT: uncondensed text. ACID CARBOLIC. 65 is noi 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 (1/10 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 preventing 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 as Sodium or Magnesium Sulphate (in 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, 34 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 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 34 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 an 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 34 to 2 hours), or Laudanum (20 drops every 34 to 2 hours by mouth, or 34 teaspoonful in gruel by rectum as frequently), or Morphine Sul- phate (34 grain by mouth or hypodermically every ACID CARBONIC. 67 x/\ 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 DIOXID; CO.)—CHOKE DAMP (CO and CO.). 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 COa. 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 of 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 Yz ounce has been recovered from. A piece of Chromate of Potash the size of a hazel nut has 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: Pain in stomach; colic; cramps in legs; vomiting; purging; dilated pupils; great depression; collapse. Chromic Acid vomit produces yellow stain on cloth. SYMPTOMS: ACID CHROMIC. 69 TREATMENT : 1. 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 JG 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 34 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 34 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 ()4 grain by mouth or hypodermically every 34 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. 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 1]/* 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 y2 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 hrs. HISTORY: SYMPTOMS: The symptoms come on in the very act of swal- lowing or almost immediately. The breath has ths 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 (Y\ 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 (1 grains) and Solution of Ferric Chloride (16 drops) in a 72 A MANUAL OP TOXICOLOGY. wineglassful of water. Mix these and give them, to counteract about 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 (i oz. of */2% 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). HISTORY: 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; p2 ounce has been recov- ered from; shortest fatal period, ify 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, 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. Pain in digestive tract; thirst intense; swallow- ing difficult; vomit dark-colored, acid, and con- taining mucous shreds, parts of membrane of eso- SYMPTOMS: 74 A MANUAL OP 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 whit' 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.) 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. 1. 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 }i or % grain), or Deodorized TREATMENT: 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. Chlorinated Soda inhalations for Sulphuric Acid. External parts injured by these acids (as in “vitriol 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. HISTORY: 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. 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 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- TREATMENT: 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 shouid 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 Yz 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 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. HISTORY: SYMPTOMS: Dilated pupils; quick, deep respirations; dys- pnoea; flushed face; ringing in ears; deafness; de- lirium ; may be nose-bleed. 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 TREATMENT: 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 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 l/\. teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every l/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. Taken by mistake for an aperient. Fatal dose: 1 ounce. HISTORY: Abdominal pain; vomiting; prostration; convul- sions; collapse; death. Antidote: Lime or chalk. 1. 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.). SYMPTOMS: ACIDS, VEGETABLE (CORROSIVE): ACETIC—OXALIC—TARTARIC. Symptoms and treatment under each name (q. v.) ACONITE (MONKSHOOD, WOLSFBANE)— ACONITINE—PULSATILLA— ANEMONIN. HISTORY: 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- 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 1 /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 and has been delayed to 4 days. 80 drops of the Tincture of Aconite taken in 10 doses caused death in 4 days. Death results from asphyxia or syncope. 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. SYMPTOMS TREATMENT: Put the paiient 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 restoration and stimulation, resort to the following: •Variation in temperature-sense, of surface, may be determined by- employing the TOPOTHERMESTHESIOMETER. 82 A MANUAL OF TOXICOLOGY. 1. Endeavor to wash out the stomach, syphoning with a stomach-tube and much water containing Lugols Solution y2-1 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, y 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 y teaspoonful hypodermically as frequently) ; also with Strych- nine Sulphate (1/60 to 1/20 grain hypodermically every y to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every y2 to 2 hours). Tinc- ture of Digitalis, as the physiological antidote (30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypo- dermically every y to 1 hour), should be given. Caffein Citrate (1 to 4 grains every y to 1 hour), may be used for supporting purposes. Draughts of strong coffee may be given. Also Nitroglycerine. Camphorated Oil, (hypod.) x-xv min., or in 2 or 3, v min., doses; or a 10% Camphor solution in ster- ile olive oil, in vii min. doses (hypod.) every 15 min., 4 times if required. It helps sustain heart and circulation between doses of Strychnine. 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. ALCOHOL 83 4. May give Opium (Powdered Opium, i or 2 grains every Yz to 2 hours), or Laudanum (20 drops every to 2 hours by mouth, or teaspoonful in gruel by rectum as frequently) or Morphine Sul- phate (grain by mouth or hypodermically every l/i-2 hrs.) to relieve pain and nervous irritability. Apply a mustard paste to the pericardium, and rub the back and legs with hot towels. (See 4, p. 224-) 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. TREATMENT: 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, 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 *4 teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little 84 A MANUAL OF TOXICOLOGY* water every 10 to 15 minutes, or Ya 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 ]/2 to 2 hours), or Tincture of Belladonna (20 drops in water every y to 2 hours). Tincture of Digitalis (15 to 20 drops by mouth, or half as much hypodermically every p2 to 2 hours), or Digitalin (1/100 grain hypodermically every 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 in- haled, using one every Ya to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. ALCOHOL, ETHYL OR GRAIN (ETHYL HY- DROXIDE; ETHANOL) — BRANDY — WHISKEY—GIN—RUM—WINES — BEER —CIDER. * [Acute Poisoning.] (See p. 138.) Symptoms of poisoning usually appear within an hour. The fatal dose of Alcohol varies. 2]/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 to 5 ounces; smallest fatal dose cone. Alcohol, 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 ]/2 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 HISTORY: #For Alpohcl, Denatured, see p. 138. ALCOHOL. 85 10 per cent, of Wood Naphtha. Percentage of Al- cohol in some alcoholic drinks: Brandy, 53; Rum, 40 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; conjunctivse 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. Provide fresh air. 1. 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). Follow with a laxative and oil emulsion. Ammonium Chloride or Ammonium Carbonate (30 grains in y2 pint of water, at one draught); cold head-affusions sometimes remarkably restore. 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- TREATMENT: 86 A MANUAL OF TOXICOLOGY. haled, using1 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 (y2 pint). Digitalin hypodermically (1/100 gr. every % to 1 hour). 3. Employ artificial heat (hot water bottles, or hot water in ordinary bottles, or bags of salt, bricks, plates, or stove-lids, heated, applied to feet and sides of body), to maintain bodily temperature; moist heat over kidneys. Cold affusions to head. Fric- tion. For asphyxia employ galvanic current; for mania, Hyoscine and Morphine. Catheterize a dis- tended bladder. Give oxygen. Use diuretics. Arouse. ALCOHOL, METHYL (METHYL HYDRATE, METHYL HYDROXIDE, “METHANOL,” WOOD ALCOHOL, WOOD NAPHTHA, WOOD SPIRIT, CARBINOL) Note: METHYLATED SPIRIT consists of Methyl Alcohol io parts and Ethyl Alcohol go parts. HISTORY: The swallowing, or even the exposure to the fumes, or the cutaneous absorption, of Methyl Hy- droxide or Methanol—as it is now being called, since the refiners and others have so re-named it and now commonly label it—has produced serious re- sults. The drinking of Bay Rum, Essence of Ginger, and other preparations which have been made from it, or contain it, has produced more or less serious symptoms, even permanent blindness. It is Quite evident that when swallowed it is im- WOOD ALCOHOL 87 perfectly oxidized in the body and Formaldehyd, Formic Acid or Sodium Formate is formed. Usu- ally, in actively poisonous doses, it attacks and dis- ables the retina and the optic nerve. It is distilled from birch, beech, maple, oak, elm, and alder. Crude Wood Alcohol is a complex mix- ture. It is “a vile-smelling, greenish-yellow to dark-brown, nauseous liquid.” When highly re- fined, pure and deodorized, it is colorless, has a burning taste, and a vinous odor. When deodorized (97-}-%), Methanol so closely resembles pure Ethanol that the average person can scarcely dis- tinguish the difference. It is then sometimes known as Acetone Alcohol, Purified Alcohol, “Bloom,” “Columbian Spirits,” “Eagle Spirits,” “Hasting’s Spirits,” “Colonial Spirits,” “Manhattan Spirits,” “Union Spirits,” “Lion d’Or,” etc. In Canada called “Greenwood Spirits,” “Standard Wood Spir- its,” etc. When mixed with Grain Alcohol, in various proportions, and drunk, it poisons in vary- ing degrees of severity. Painters, shellackers, dyers, rubber tire makers, etc., exposed to the fumes of breathing air charged with the poison may become poisoned. Fat people absorb less of it than lean. Blindness has resulted from free application of Bay Rum, liniments or toilet preparations, or use of flavoring extracts containing it. Sponging the sur- face of the body with Methanol, or even bathing in water containing it, has injured. Severe symptoms usually result from swallowing such small quantities as from 1 to 8 drams; taken pure, one teaspoonful has produced blindness, and one ounce, death. Death may occur soon after swallowing Methanol, or in one or two days, or even later. Recovery has occurred after taking half a pint. Prompt remedial measures strongly influence the result. If the poison is taken well diluted with Grain Alcohol, or if early vomiting occurs, or if prompt and suitable treat- ment is employed, a favorable result may com- monly be anticipated, at least as regards life. In 87a A MANUAL OF TOXICOLOGY. the early stages there is an acute acidosis; the poison is eliminated mainly thru lungs, skin, kid- neys and alimentary tract; the balance is oxidized into the corrosive formaldehyd and formic acid; latter is end product excreted by kidneys and re- duces Fehling’s Solution like sugar. The primary lesion may be injury to pituitary body. [Since active enforcement of the National Prohibition Amendment began, there have been very many cases of Wood Alcohol poisoning, owing to a wide use of it as a beverage or as an adulterant of various beverages. Sometimes such use was due to ignorance of its toxic char- acter and sometimes the result of deliberate and inhuman deception, inspired by greed. The Federal Government has severely penalized many of those who have thus sacrificed or jeopardized the lives or health of others. Gradually the general public has learned that Wood Alcohol is toxic at practically all strengths and in all of its various grades or degrees of refinement. The supply has been reduced through govern- mental forestry restrictions. There has been increased demand for it in various industries, which now require the full output. The market price has been rising until it is three times that of Denatured Grain Alcohol, although formerly less. Because Wood Alcohol (Methanol) was cheaper than Grain Alcohol (Ethanol), unscrupulous persons have taken every advantage of the fact. As Dr. Charles Baskerville so well says, they “were tempted to use it as a substitute for Ethanol in adulterating whiskey, essences, extracts, bitters, washes, liniments, balsams, perfumes, etc. The victims were generally those who indulged in the commoner forms of whiskey, rum and wine, although persons not addicted to the use of intoxicating drinks were undoubtedly often affected innocently from drinking Jamaica ginger, lemon extract, essences, bitters, medicines, etc., whose chief menstrum was deodorized wood alcohol.” The Federal Government now permits the addition of 1/5 as much Wood Alcohol, as was formerly required, when used in producing De- natured Grain Alcohol. In denaturing Grain Alcohol for use in the arts and industries, and to be tax free, it must have such a substance mixed with it as will “destroy its character as a beverage, or render it unfit for liquid medicinal purposes.” The Commissioner of Internal Revenue selected Wood Alcohol as the principal of various substances, such as benzin, formaldehyde, etc., which might be used for that pur- pose. But even at 2% strength it has been flavored, diluted, and used as a beverage by some, but with injurious effects. It is evident that a lower grade of Methanol, more nauseating and less toxic, will soon be used in producing Denatured Grain Alcohol. Employing the term Methanol for Wood Alcohol must greatly help to reduce any disposition on the part of the general public to consider it akin to Grain Alcohol (Ethanol) for beverage purposes; and thus, in conjunction with other facts above stated serve to greatly diminish the frequency of poisoning by it.] ALCOHOL 87b The Symptoms and results vary according to the quantity and form in which the poison is taken, and the promptness and character of the treatment given. Unless a dose large enough to produce coma has been taken, the poisonous symptoms do not occur, usually, until the second or third day after taking the poison. The principal ordinary symp- toms produced by swallowing the poison are ex- hilaration, neusea, vomiting, and headache. There may be also abdominal distress, disturbance of vision (dimness, deficient accommodation and re- action to light, dilated pupils). Nausea, vomiting abdominal pain arwl sudden blindness, should cause suspicion of poisoning by Methanol. As a rule, if vision is disturbed it is observed by second day of symptoms, but may not be before the fifth. In a severe poisoning by swallowing, quite com- monly there is malaise, nausea, vomiting, muscular incoordination, confusion of mind, vertigo, weak, rapid pulse, ashy or cyanotic skin, pain over kid- neys, restlessness, diminished respiration, perhaps odor of the poison on the breath, incontinence of urine and feces, and a total blindness may ensue, which may be sudden; it occurs usually in from 12 to 48 hours after first symptoms, if at all, and in a few days, or even a month, slight or nearly complete vision is restored; but frequently it is soon, again, and often permanently, lost, through optic atrophy, etc. There may be depression or excitement, even delirium, a sense of coming and going of sight, eye- bails sensitive to pressure and to rotation, perhaps loss of color sense, unconsciousness, semi-coma, death. The fumes often produce vomiting, head- ache, chills, vertigo and stupor; sometimes blind- ness and even death. In a chronic poisoning, due to daily or frequent exposure to the poison, the visual loss may be gradual and the other symptoms obscure. SYMPTOMS: 87c A MANUAL OF TOXICOLOGY TREATMENT: The treatment is evacuant, neutralizing and elimi- native ; also stimulative and supportive. In carrying out these measures a great variety of agents and methods have been recommended and variously em- ployed. i. Evacuant, Neutralizing and Eliminative.—If it appears that the poison was swallowed within a short time (about ten or twelve hours), and some of it is still in the stomach, endeavor to wash it out, by using a stomach tube, with Sodium Citrate, Carbonate, or Bicarbonate (5 to 15 grains to the ounce), or Ammonium Carbonate (5 to 10 grains to the pint), or Magnesium Carbonate, or Oxide, in the lavage water; in their absence may use a weak soap-suds. With care this may be accom- plished even when the patient is unconscious. The lavage helps prevent further absorption of the poison, dilutes and tends to neutralize the effects of such poison as may have been excreted into the stomach, also dilutes the acid fluids present. If near- ly or quite conscious, and but little abdominal pain, instead of lavage, an emetic, such as Ipecac, Must- ard, soap-suds, Copper Sulphate, or Apomorphine Hydrochlorate (hypoderm.), may be employed, to empty the stomach. (Cases of early and free vomit- ing are less serious.) After emptying introduce into the stomach, preferably through the stomach tube, Magnesium or Sodium Sulphate (if4 to 2 ozs., in an equal quantity of warm water). Croton Oil (a drop or two on the tongue) is given early, by some. If possible, lavage soon after giving purgative; then repeat latter salt and leave it in stomach. While waiting for action of purgative salt, also during the first day or longer, well to give Sodium Bicarbonate (2 drams to 1 pint of water) per rec- tum ; or in severe acidosis as in very active symp- toms may well give intravenously (1 pint of same WOOD ALCOHOL m or even double strength solution), observing aseptic precautions and avoiding introduction of air. When purgative salt has had an opportunity to produce its evacuant and other effects (usually in one to three hours), give by mouth small quanti- ties of a weak alkaline solution, such as Sodium Bicarbonate ()4 to 1 dram in pint of water), or Carbonate (same), or Magnesium Carbonate, or Oxide (2 drams in *4 pint of water), or Ammonium Carbonate (5 grs. in y2 pint of water every two or three hours, for 12 to 15 hours) to alkalize and counteract the acidosis produced by the poison. When alkalization seems well induced the alkali may be required only 3 or 4 times a day ()4 to 1 hour before meals) until recovery, but should in- crease the frequency, if the urine is not alkaline, until it is and less so maintains it. Giving Lime Water and milks occasionally helps. Excessive alkalosis should be avoided lest the kidneys be seri- ously irritated. A laxative Magnesium or Sodium salt should be employed daily or as needed, to main- tain a fairly free catharsis. Normal salt solution (9 grams of table salt in 1 liter of water, or about 2)4 level teaspoonfuls to 1 quart of water, at ioo° to iio° F.) per rectum, as an irrigation, also stim- ulates; or may well introduce and leave it in ()4 as much, y2 to 1 hour) ; or still better employ it subcutaneously (aseptically, not over one pint at one site, and at no° to 1150 F.), or intravenously (also with due aseptic and air-exclusion precau- tions, and at about same temperature). Fischer’s solution (Sodium Carb. 0.37%; Sodium Chlorid 1.4%) intravenously, or per rectum, is much favored by some. Hot packs, or Pilocarpine, Hydrochlor, 04 to y* grain, hypoderm.) used early to cause free perspiration may be very helpful. Potassium Iodid also Don«van’s Solution in small doses are favored for their eliminative effects. Elimination of the poison is by the lungs, kidneys and skin, also in 87e A MANUAL OF TOXICOLOGY the feces. The poison, as formic acid, etc., is also excreted into the stomach; gastric lavage for two or three days may therefore help much. 2. Supportive.—In addition to the restorative effects of the salt solutions referred to above, the lagging forces may be aided by fresh air, a coffee enema (4 to 8 ozs. at 105° to 1150 F.), or by Am- monia inhalations, to arouse, etc. Either Caffein (*/2 to 1 grain every to 2 hrs.), Camphorated Oil (15 minims), or Camphor in Almond Oil (1 or 2 grs.) or Digitalin (1/100 gr. every x/\ to 2 hrs), or Strychnine Sulphate (1/100 to 1/40 gr. every to 2 hrs.), given hypodermically, is helpful. Give each less often as condition improves. Apply heat to the body and feet if the temperature is lowered. Apply moist heat over the kidneys. Give Atropine Sulphate (1/120 gr. every *4 to 2 hrs.) hypoderm. to increase frequency of heart action and respiratory strength and relieve cyanosis. Aromatic Spirit of Ammonia (15 minims, hypoderm., every to Yi hour). Oxygen inhalations, and artificial respira- tion, may prove very helpful in pulmonary or car- diac failure. Epinephrin (Adrenalin) solution (15 minims of 1 to 10,000 solution, subcutaneously; or much better, diluted with saline solution to 1 to 100,000 and used intravenously), or Thyroid Body for lowered blood pressure. Also solution of Pituitary Body (Liquor Hypophysis—from the posterior lobe—16 minims hypoderm. repeated in to 1 hour if required) to stimulate or to compensate for pituitary injury when such seems to be indicated for incoordination symptoms. Sodium Carbonate, or Citrate, or Borax, or soap-suds enemas may aid. Venesection is rec- ommended for a severe congestion of the venous circulation; if present, remove 3 to 6 ounces of blood before giving an intravenous solution. Cal- cium Chlorid in 10 grain doses, 3 times a day, may be useful. In coma, use warm baths, then cold af- fusions. Galvanism for asphyxia, etc.—Ziegler ad- vises negative galvanism, high voltage and low am- ALKALIES 87/ perage, applied directly to eye, for blindness, unless there has been complete destruction of nerve fibers. Hyoscine for mania, or Morphine as a sedative, if re- quired. As recovery progresses, give liquid foods, such as milk, thin custard, chicken broth, etc., until it is well advanced. Demulcents, milk of magnesia, etc., may be found useful at any time. ALKALIES: AMMONIA—BARYTA (see Bar- ium)—Lime (q. v.)—POTASSA—SODA, and Their Carbonates. HISTORY: Aqua Ammonia is sometimes taken by mistake for Lime Water or other Liquid of similar appear- ance. Ammonia Liniment taken in a similar way. Caustic Potash is rarely taken except by accident. [In contrast to acids, in poisoning, alkalies do not withdraw water from the tissues and precipitate albumen, but dissolve the latter.] Fatal dose: 2 drachms strong solution of Am- monia may be fatal; 4 drachms usually so, but an ounce has been recovered from. Death from y2 oz. Caustic Potash. Death usually in 24 hours; may be months. SYMPTOMS: Burning pain from mouth to stomach; difficulty in swallowing; vomiting (alkaline) ; may be vomit- ing and purging of mucus and blood; skin cold and clammy; pulse feeble; anxious countenance; rapid exhaustion; symptoms of suffocation; convul- sions ; stupor or coma may be developed. (Excessive inhalations of Ammonia are poisonous or fatal by the resulting irritation and bronchitis). (Baryta Muriate and Carbonate produce also headache, deafness, and dimness of sight.) 1. As antidotes, give diluted acids, especially vege- table acids: Vinegar and water, equal parts; Acetic TREATMENT: 88 A MANUAL OP TOXICOLOGY. Acid, diluted (a teaspoonful in y2 pint of water); Citric Acid or Tartaric Acid (}4 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 34 teaspoonful doses hypoder- mically as frequently) ; also with Strychnine Sul- phate (1/60 to 1/20 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 grain hy- podermically every y2 to 2 hours), or Tincture of Belladonna (in 10 to 15 drop doses). Tincture of Digitalis (30 drops by mouth, or half as much hypo- dermically, every *4 to 2 hours), or Digitalin (1/100 grain hypodermicallly every y2 to 1 hour), or Caf- fein Citrate (1 to 4 grains every )4 t° 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every y2 to 1 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 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 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. TREATMENT: For symptons and treatment in detail see each alkaloid under respective title. 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. HISTORY: Fatal dose: Aloes, }§ to yz oz.; Podophyllin, 5 to 10 gr.; Elaterium, 6 or 8 grs. SYMPTOMS Severe irritation of the intestinal canal, causing pain, vomiting, and purging; cold sweats; usually great prostration; sometimes convulsions; collapse. 90 A MANUAL OF TOXICOLOGY. 1. Evacuate the stomach (if not emptied) : sy- phon out stomach with stomach-tube, using much water, with y2 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 34 teaspoonful as often hypodermically). 4. Give Opium (Powdered Opium, in 1 to 2 grain doses every l/2 to 2 hours), or Laudanum (10 to 20 drops in water every y2 to 2 hours), or Morphine Sulphate (34 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. TREATMENT : TREATMENT: ALUM. Administer Ammonium or Potassium Carbonate or Bicarbonate as antidote. Use emetic and demulcents. 91 AMYL NITRITE. AMYL NITRITE — NITRITE OF ETHYL — NITRITE OF POTASSIUM—NITRITE OF SODIUM—AMYL ACETATE (PEAR OIL). SYMPTOMS: 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.” TREATMENT: N. B.—Whether poison was swallowed or inhaled, put patient in horizontal position and provide plenty of fresh air. 1. If the poison has been swallowed, evacuate the stomach; syphon out stomach with a stomach-tube, or use a hypodermic injection of Apomorphine Hy- drochlorate (i/io grain). For Acetate, Sod. Bicarb. 2. Support. Give Brandy or Whisky (in table- spoonful doses every 5 to 10 minutes, or *4 tea- spoonful doses hypodermically every 5 to 10 min- utes). Give Strychnine Sulphate, hypodermically (1/60 to 1/20 grain every y to 2 hours).- Aid heart by Tincture of Digitalis (15 drops every 10 to 20 minutes), or give Digitalin (1/100 grain every y2 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. TREATMENT: When inhaled: 1. 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 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. 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 p2 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. 1. 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 )/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 Sulphate grain by mouth or hypodermically every 54 to 2 hours), to relieve pain and nervous irritability. Remainder of treatment as in poisoning by in- halation. ANIMAL AND VEGETABLE PROTEINS (See page 224a). 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. Test urine and vomited matter for Antimony to dis- tinguish from disease. In poisoning by Antimony, urine never suppressed as in Arsenic. Prompt treat- ment is highly important. In incessant vomiting suspect Antimony compounds or Zinc. Fatal dose: Tartar Emetic, grain has caused serious symptoms; grain killed a child in an hour; 2 grains killed an adult; x/z 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. TREATMENT: 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 with 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 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 bod}')r to main- tain bodily temperature. Mustard to epigastrium. 4. Give Opium (Powdered Opium, 1 to 2 grains every y2 to 2 hours), or Laudanum (20 drops every Yz to 2 hours by mouth,or half a teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (Y 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 y teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every l/2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every y2 to 2 hours), or Tincture of Belladonna (20 drops in water every y2 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 )4 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 *4 to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. ARROW POISON: The sap or dried juices of plants belonging to the Strychnos (including the Curare combinations) and Strophanthus families, also the Euphorbiaciae (Spurges). Also such proteins as snake venom; etc. (q.v.). 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. 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 or manufacturing certain wall papers, etc., and from various 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 2.1/2 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. HISTORY: 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 y2 to 3 hours.] Atrophy and degeneration of 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 Magnesiafreely, in water. Ferri Oxidum Hydratum cum Magnesia—the of- ficial antidote—made byprecipitatingsolution of Ter- sulphate of Iron by Magnesia, is usually considered ARSENIC. 99 best antidote. Give often in y2 oz. doses or more. Or give: Tr. Chloride of Iron2 oz.; Water 2 pints; Mag- nesia to excess, in 4 doses 15-30 min. apart. May give Dialysed Iron (3/4-6 followed by salt 3 1, every to 4 hrs.) Follow any Iron antidote by >4 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 Arsenous Acid. 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 in- flamed surfaces. Also give alkaline mineral waters. 3. Give Opium (Powdered Opium, 1 or 2 grs. every Yi 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 (y grain by mouth or hypodermically every y2 to 2 hours), to re- lieve pain and nervous irritability. 4. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 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 y2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every y2 to 2 hours), or Tincture of Belladonna (20 drops in water every y2 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 y 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 purpose. Draughts of strong coffee may also be given. Saline solution (5, P-n8). 5. Employ artificial reat (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 Nitie (2 to 4 teaspoonfuls), to relieve the tendency to suppression of urine. Ice for thirst. ATROPINE. (See Belladonna) AUTO-INTOXICATION — INTESTINAL AUTO-INTOXICATION; FERMENTATION AUTO-INTOXICATION AND PUTREFAC- TION AUTO-INTOXICATION. ALIMEN- TARY TOXEMIA, AUTO-TOXEMIA. [Intes- tinal Fermentation and Intestinal Putrefaction.] HISTORY: * [Auto-intoxication, perhaps, is best defined to be the result of an abnormal general metabolism, or of an abnormal decom- position, originating in the digestive tract—a fermentative or a putrefactive process, or both. The term food-poisoning is applied to the effect produced by the ingestion of foods already in a state of decomposition or in some way poisoned or poison- ous before being taken as food. (See Food, Poisonous, p. 144.) Under food-poisoning would be included the ptomain poison- ing, so called, which is due to the ingestion of a protein de- composed previous to its ingestion; also botulism, tyrotoxicon and various similar meat, fish, milk, etc., poisonings, from the ingestion of food unfit for or unsuited to human consumption, ordinarily. Constipation interferes with the elimination of waste mate- rial of toxin-producing, or toxic substances in the ali- mentary canal, consequently a more or less serious train of symptoms readily results. Poisonous principles may be pro- duced in the alimentary canal and if not destroyed or not eliminated from it, may be absorbed into the blood and poison the tissues of the body. A condition of alimentary auto- toxemia. The digestive, absorptive and assimilative vascular, nervous and eliminating functions of the body are more or less as dis- ordered by the auto-toxemic condition—constituting a disturb- ance of metabolism. SYMPTOMS: Fermentation Auto-intoxication—(The effects of an alimen- tary decomposition, mainly of a fermentative character.) * Author’s uncondensed text. AUTO-INTOXICATION, ETC. 100a The symptoms exhibited by this variety of poisoning are produced mainly by a pathological or abnormal fermentation of carbohydrate foods—the starches and sugars—perhaps aug- mented and aggravated by the presence of their food associates. The fermentation processes of the carbohydrate foods produce carbon dioxide, acetic, butyric, formic, lactic, propionic, succinic, valerianic and other organic acids, and acrid-acetone or ketone; an alcoholic fermentation also occurs. The symptoms are eminently more mechanical than toxic. The chief symptoms are: Gastrointestinal; distension, ,sense of epigastric and abdominal oppression and tenderness; more or less belching, palpitation, dyspnea, anxiety, irritability, nausea, labored vomit- ing, constipation, coated tongue, offensive breath and stools (scanty), feverishness, headache, languor, and exhaustion. The severity of the symptoms are largely dependent upon the char- acter of the food taken and of the bacili present, as regards the fermentative activity; also upon the gastro-intestinal mobility, the rate at which the fermentation products are absorbed, and upon the promptness and vigor of the eliminative measures. Putrefaction Auto-intoxication.— (The effects of an aliment- ary decomposition, mainly of a putrefactive character.) The symptoms exhibited by this variety of poisoning are due mainly or primarily to an intestinal pathological or abnormal decomposition of proteid or albuminous foods. These bacilli- instigated, putrefactive processes occur chiefly in the large in- testine; but they may take place in the small intestine and ex- tend into the stomach; or the digestive disturbance may begin in the stomach with a fermentation or some imperfect digestive process by which highly irritant food enters the intestine; and in the presence of very many bacteria, various toxic products may result and be absorbed; gastric hyperacidity, and more particularly hypermotility of the stomach, are conducive to a putrefactive process. In such a process sulphur and nitrogen compounds are formed—chiefly those related to beneze, and called coal-tar, aromatic, or closed-chain compounds. Among such are cresol, indol, phenol, skatol, free nitrogen and hydrogen; acid carbu- retted and sulphuretted hydrogen also are produced; cadaverin, cystin, leucin, neurin, intrescin, etc., also the blood and nerv- ous system particularly exhibit the effects of. the putrefaction. This form of auto-intoxication is characterized by symptoms which are more of a toxic than of a mechanical nature—there is less abdominal distension and tenderness than in the fermen- tation form; breath and stools are more foul, usually, and headache more severe and persistent. Vertigo, skin discoloration and eruptions are quite common and severe, also vomiting and diarrhoea; dyspnea, feeble heart action and intense exhaustion with perhaps stupor and collapse may follow.* ’Author’s uncondensed text. TREATMENT: Evacuation of the stomach and a free catharsis 100b A MANUAL OF TOXICOLOGY. should promptly be secured. Wash out the stomach with Bicarbonate of Soda water (i or 2 level teaspoon- fuls to the quart of water), or use plain water if other is not convenient. Use much water, and repeat if food or bile come away, but incompletely; if such lavage cannot be employed may give an emetic of mus- tard (i tablespoonful in a small cupful of water, re- peated in io minutes if not effective, or syrup of Ipecac, a teaspoonful every io minutes until vomiting results or until 3 doses are taken; or, if stomach appears to be in foul condition and vomiting seems desirable, may give Ahomorphine Hydrochlorate, hypodermically, 1/10 grain, (repeated in 10 or 15 minutes if necessary). In a few minutes give Calomel (5 grains) or Castor Oil (l/2 oz. or both), judged by torpidity of liver and intestines; follow in 15 min. with copious drafts of water. Intestinal lavage with hot, normal salt solution level teaspoonfuls to the quart), may be found very helpful. Salines, as Epsom, or Rochelle Salt, or a Seidlitz Powder. After 20 or 30 minutes, water should be drunk freely to help wash the alimentary canal. Various antiseptics, such as Creosote Salol, Bismuth, Subgallate or Beta Naphtha, Bromide may help de- stroy the poisons. Supportive treatment followed by a bitter tonic, should be found serviceable. If necessary draw the urine. Use of the Opium salts, if necessary to relieve pain in head, etc. Employ Heat; hot water to the feet, and hot bricks, bottles, or water bags to the body. Apply a mustard paste to the feet and over the heart. Arouse by alternate hot and cold douches to chest. Apply cold to head. Give Chloral or Hysocine for de- lirium. Stimulate. Give 15 to 30 drop doses of Aro- matic Spirit of Ammonia, and Brandy or Whiskey (a teaspoonful in water by mouth, or % teaspoonful teaspoonful in water by mouth, (or teaspoonful monia Water to the nostrils. Give strong coffee. 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). BARIUM AND ITS COMPOUNDS. 101 BARIUM AND ITS COMPOUNDS: BARIUM ACETATE — BARIUM CHLORIDE — BARIUM NITRATE — BARIUM OXIDE (BARYTA)—ETC. Barium Chloride is sometimes mistaken for Ep- som Salt. Barium Nitrate has been mistaken for Sulphur. Fatal do-su: Death has resulted from ioo grains of Barium Cnloride in 15 hours; death has resulted from a drachm of Barium Carbonate; half an ounce of Barium Cnloride has been fatal in 2 hours; half an ounce of the Nitrate of Baryta killed a man in hours. Recovery from 370 grs. Chloride. HISTORY: Abdominal pains; cramps; purging; vomiting; feeble pulse; labored and short respiration; dilated pupils; excessive urination; loss of voice, sight or hearing; convulsions; collapse; death. SYMPTOMS: 1. Evacuate the stomach; syphon out the stomach with a stomach-tube, or give Mustard (a tablespoon- ful in a wineglassful of water), or Zinc Sulphate (20 grains in )4 wineglassful of water), or inject Apomorphine Hydrochlorate, hypodermically (1/10 grain). Repeat in 15 minutes if necessary. As an antidote, give Dilute Sulphuric Acid ()4 to 1 teaspoonful in a wineglassful of water), or give Aromatic Sulphuric Acid (same amount), or Mag- nesium or Sodium Sulphate ()4 to 1 ounce, or 1 to 2 tablespconfuls, 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 V2 cupful of water). Again wash out stomach. 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 TREATMENT: 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 teaspoonful doses every 10 to 15 minutes, or 34 teaspoonful doses hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 min- utes, or 34 teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every 34 to 2 hours), or Tincture of Belladonna (20 drops in water every y2 to 2 hours), to prevent col- lapse. Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every 34 to 2 hours), or Digitalin (1/100 grain hypodermically every 34 to 1 hour), or Caffein Citrate (1 to 4 grains every 34 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every 34 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 every 34 to 2 hours), or Laudanum (20 drops every 3-4 to 2 hours by mouth, or 34 teaspoonful in gruel by rectum as frequently) or Morphine Sulphate (34 grain by mouth or hypodermically every )4 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. Belladonna: Belladonna berries are sometimes eaten by mistake. Infusion of leaves, and extract HISTORY: 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 50 berries. Death from Extract of Belladonna 1 drachm in hours; also recovery from 3 drachms of 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 J/s 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. TREATMENT: 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 stomach in 5 or 10 min. Pot. Permang. is good: (See Opium). 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 Sweet Spirit of Nitre (in teaspoonful doses), or Pilocarpine Nitrate, the most perfect antagonist 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 y2 to 2 hours), or Laudanum (15 to 20 drops every y2 to 2 hours), or Morphine Sulphate (in y to y2 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 tlie effects of Atropine on the cerebrum, kidneys, heart, pupils, respiration and arterial tension. Muscarine is probably the best general antagonist (in doses of 54 to 1 grain). 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 a 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 W atei 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. . Used in dyeing, cleaning and as a cough medi- cine. Death in 17 hours from 3 drachms of Ben- zene. HISTORY: SYMPTOMS: Nausea; gastro-intestinal distress; dizziness. 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 Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 minutes if vomiting is 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. odium or Potassium Carbonate or Bicarbonate may be administered as an antidote. 1. When inhaled, provide much fresh air. Arti- ncial respiration should be resorted to if necessary TREATMENT: 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 y2 to 2 hours), or Tinc- ture of Belladonna (15 to 30 drops every 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. BENZINE. (See Petroleum). 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- trointestinal 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. 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.) SYMPTOMS: TREATMENT: 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- BROMINE. 107 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-warni water to encourage vomiting. 2. Give Opium (Powdered Opium in 1 to 2 gram doses every 1 to 3 hours), or Morphine Sulphate (in 34 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 x/2 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 y2 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 )4 teaspoonful hypodermically every % to 1 hour) may be given with the Opium, as a nervous stimulant. BROMINE. An ounce on an empty stomach caused death in 7 hours. HISTORY: 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. SYMPTOMS: 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 y2 to 2 hours). Irri- tation to bronchi relieved by chloroform inhalations. 1. 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. BRUCINE. (See Strychnine.) BRYONIA. (See Aloes.) ’CAFFEINE. HISTORY: Recovery after 200 grains. 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. SYMPTOMS: CAFFEINE. 109 1. Evacuate the stomach: s)rphon 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 y 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 to 1/20 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every y to 2 hours), or Tincture of Belladonna (20 drops in water every to 2 hours). Morphine Sulphate hypodermically (in % grain doses every to 2 hours) often helps. Digitalin (1/100 grain hypodermically every % to 1 hour), and inhalations of Amyl Nitrite (a 3 cr 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. TREATMENT: A MANUAL OF TOXICOLOGY. 110 applied to the feet and sides of the body) to main- tain bodily temperature. CALABAR BEAN (PHYSOSTIGMA, THE WESTERN AFRICA ORDEAL BEAN) — PHYSOSTIGMINE (ESERINE). 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. HISTORY: 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. SYMPTOMS: 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 y2 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 % 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 J4 to 2 hours, as preceding). If this treatment is ineffec- tive, give Chloral (in 10 grain doses every 14 to 1 hour in syrup and water by mouth, or in water by irectum). Give Strychnine Nitrate, hypodermic- ally (1/60 to 1/20 grain every 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 y/2 teaspoonful in tablespoonful of water every T5 t° 3° 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 back to sides again, 20 times a minute, with tongue kept forward. (See Lime, also Alkalies) CALCIUM. 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 1 to 10; Cam- phorated Oil 1 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. 1. 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 2 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- clination to convulsions. Relieve cramps with TREATMENT: CANNABIS, AMERICAN. 113 alternate hot and cold douches. May give Aco- nite (Tincture of Aconite, 1 drop every 1 to 2 hours), Potassium Brbmide (in 10 grain doses every *4 to 1 hour), or Opium (Powdered Opium 1 or 2 grains every to 2 hours), or Laudanum (20 drops in water every 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 of 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.—MARI- HUANA. 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- Ifuls of water, repeated in 15 minutes if vomiting is hot produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if jjiot 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 Hvdrochlorate, 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 y2 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 cotfee, 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. SYMPTOMS: A violent gastro-enteritis, with abdominal tenderness; burning sensation in pharynx and eso- phagus ; sense of constriction of throat; burning pain in back, bladder, and urethra; frequently CANTHARIDES. 115 great thirst; vomiting, the vomit containing shin- ing 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. 1. 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- 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. 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 l/2 to 2 hours; or Laudanum, 20 drops every l/2 to 2 hours by mouth, or x/2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate 04 grain by mouth, or hypodermically every x/2 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 54 teaspoonful doses hypo- dermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or V\ teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate 116 A MANUAL OF TOXICOLOGY. (i/6o grain hypodermically every p2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermic- ally every 34 to 2 hours), or Tincture of Belladonna (20 drops every 34 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 % 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 inhaled, using one every 34 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 feet and sides of body) to maintain bodily temperature, etc. Poultices to abdomen; anesthetics for convulsions. Wash out bladder with warm water for severe irri- tation of it. Assist excretion of urea by pilocarpin. CARBON MONOXID (CARBONIC OXID; CO)—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. Defec- tive combustion, open charcoal, coke or stove coal fires, defective stove-pipes or furnace flues and es- caping illuminating gas are among its sources. It also collects in mines, pits, wells, etc.; also is pro- duced by gunpowder explosions in quarries, mines and other confined spaces. (See pages 67, 141, 149, 155.) This gas enters the blood, combining with the hemoglobin of the red corpuscles and displacing the oxygen. The symptoms become urgent when the red blood corpuscles of the body have become half saturated with the poison. After the blood has been CARBON MONOXIDE. 117 nearly or quite saturated with this gas it will not carry oxygen from the lungs to the tissues of the body; and after 4 to 8 hours of cerebral asphyxia, edematous and degenerative processes seem to begin in the brain; and although the blood may have discharged much of the carbon monoxid poison by that time, the brain cannot adequately be supplied with oxygen, nor its integrity restored; recovery is almost or quite impossible. The blood of those poisoned by this gas is of a persistent flu- idity and bright, cherry-red. Air containing one per cent, of this gas will kill a dog in a minute and a half. The gas is a narcotic poison. When patient 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, i. e., the degree of systemic asphyxia or oxygen deprivation. Death may occur hours or even days after partial recovery. Carbon monoxide is the chief constituent of coal gas and poisoning by latter is mainly due to it. But suffo- cation by coal gas is not to be confused with poisonous effects of coal gas. “Water gas” contains about 30% carbon monoxide. SYMPTOMS: [In Poisoning:—Dizziness; severe headache; weakness; may be nausea, vomiting; convulsions; face pale, or livid; pupils dilated. When poisoning is very slow, symptoms are languor, debility, anorexia, headache, anemia, perhaps a dry cough, and mental disturbances. Symptoms resemble those of malaria. In Choking Suffocation:—Symptoms are choking; gasp- ing; suffused eyes; congested face; collapse. 1. Promptly provide plenty of fresh air. For absence of breathing, or in feeble breathing, resort to artificial res- piration—Schaefer, Marshall Hall, Michigan or Sylvester methods. Oxidizing the poison by using hopcalite (etc., see page 117) has been recommended. The pulmotor is of doubtful utility. Give inhalations of oxygen, or also of ammonia. Recently TREATMENT: 118 A MANUAL OF TOXICOLOGY. Henderson, Haggard and Scott of Yale University Labora- tory, and others, have had excellent results by using, with a special inhaler devised for such purpose, a gas mixture of oxygen containing 5 per cent, of carbon dioxid. This mixture, prepared by the Linde Air Products Co. and the Union Carbide Co., of New York City, and others, has proved very helpful when given simultaneously with the Schaefer prone, pressure method of artificial respiration. As soon as spontaneous breathing is secured these inhala- tions are suspended, although the patient be still in coma; usually giving them for 20 to 40 minutes is sufficient. They help to prevent the commonly fatal pneumonia. Rest and feed- ing should complete the recovery. Oxidize the poison by using hopcalite (a mixture of oxids of manganese, copper, cobalt and silver). 2. Other measures, sometimes employed are: Cold, wet applications to head and neck. Douching chest with hot and cold water alternately to arouse and stimulate. Hot appli- cations to feet and body. Stimulation of heart, circulation and respiration with Brandy or Whisky or Aromatic Spirit of Ammonia, or Strychnine and Atropine; also use of Tincture of Digitalis or Digitalin, Caffein Citrate or Coffee, or inhalations of Amyl Nitrite, or Camphorated Oil (15 min.) hypodermic- ally, or giving lime water, or milk by same; also transfusion of blood, within an hour or two of inception of poisoning. Rectal, intravenous or intracellular injection of normal salt solution sometimes proves very beneficial. Saline Solution (sterilized normal salt solution = 139 grains of pure table salt in 34 ounces (a liter) of boiling water, a 9/10% solution; about 2)4 level teaspoonfuls of salt in 1 quart of boiling water). Inject 1 to 3 pts. at 100° to 110° F., into rectum, flank, back, arm or abdomen (See pages 57 and 87d) ]. N.B.: The bracketed statements in the foregoing are those of the author. 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 alkaloid from the plant. Fatal dose: 3 seeds were fatal to an adult male in 46 hours; 20 seeds killed an adult female in 5 days. Recovery from 30 seeds. Abdominal pam, cramps; prostration; vomiting; intense thirst; severe griping, purging, and tenes- mus ; collapse. SYMPTOMS: CHLORAL. 119 TREATMENT: 1. 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 Iiydrochlorate, 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 l/2 to 2 hours; or Laudanum, 20 drops every Yz to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate 04 grain by mouth or hypodermically every y2 to 2 hours), to relieve pain, griping, and tenesmus. CHLORAL—BROMIDIA—CHLORALAMID— SOMNOS—ETC. HISTORY: Chloral, and its compounds, quite frequently, injudiciously used by the public to quiet nerves and induce sleep. Chloral 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 poi- 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- 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. Maybedelirium ; Coma. SYMPTOMS; Put in horizontal position and elevate feet. 1. 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 to2 should be given hourly as re- quired. 2. Stimulate : give draughts of strong coffee by mouth, or introduce 1 pt. into rectum through tube TREATMENT: CHLORINE. 121 or give Citrate Caffein (in 5 to 10 grain doses every 34 to 3 hours). Give Strychnine Sulphate, hypo- dermically (in 1/60 grain doses every l/± 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 04 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 fruit-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 oedema, 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. 1. 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 until 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 vom- iting. 2. Give Ammonia Water (54 teaspoonful in a 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 54 teaspoonful doses hypodermically as frequently), also with Strychnine Sulphate (1/60 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every 54 to 2 hours), or Tinc- ture of Belladonna (20 drops every l/2 to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically every ]/2 to 2 hours), or Digitalin (1/100 grain hypodermically every )4 to 1 hour), or Caffein Citrate (1 to 4 grains every J4 to 1 hour), and inhalations of Amyl Nitrite (a CHLORODYNE. 123 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. 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 ]/2 wine- glassful of water). 5. Give Opium (Powdered Opium, 1 to 2 grains every ]/2 to 2 hours; or Laudanum, 20 drops every y2 to 2 hours by mouth, or ]/2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate ()4 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. Fatal dose: an ounce has caused death. Treatment as in Opium or Prussic Acid poisoning. CHLOROFORM. (See Anesthetics.) CHOKE DAMP. (See Acid Carbonic.) CHROMATE—BICHROMATE. (See Acid Chromic.) CICUTA VIROSA — CICUTA MACULATA (WATER HEMLOCK) — CICUTOXIN — WATER PARSNIP—ETC. 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; 2/3 of a grain a woman of 71 years; 23 grains, also 32 grains, have been recovered from. Death from 13/2 gr. hypodermically; also recovery from 14 grs.; 1/20 gr. hypoderm. caused dangerous symptoms in girl 12 years old; 43/2 grains swallowed have produced very alarming symptoms. Used sub- cutaneously or, in solution applied to eye or mucous membrane acts rapidly, may produce, suddenly, serious symptoms; 7 or 8 minims of a 4 per cent, solution, in eye, have produced spasm and uncon- sciousness ; 20 to 30 drops of a 4 per cent, solution applied to teeth and gums have produced serious symptoms. Twenty minims of 4 per cent, sol., also 3/2 dram of 10 per cent, sol., also 23/2 grs. in solution injected into urethra, have been fatal. Death has occurred in 40 seconds; has been delayed to 4 and even to 20 or more minutes. Recovery is quite cer- tain after 30 minutes. Death usually occurs from apnoea or heart failure. HISTORY: SYMPTOMS: The symptoms vary. As a rule, great nervous excitement, sense of oppression and fulness in head, sometimes associated with nausea and vomiting. In 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, imperceptible, pulse, convulsions, coma and death. There may be COCAINE 125 early delirium and unconsciousness or almost no symptoms except those of asphyxia. 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 ten minutes), or Ether in 15 minim doses hypoder- mically, 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 % to 2 hours) has been highly recommended. Chloro- form or Chloral may be required for convulsions. Morphine Sulphate (in % to % grain doses) often is beneficial. 1. 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), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful), or Apomorphine Hydrochlorate, hypodermically (1/10 grain). After giving an emetic, always give plenty of luke-warm water, to encourage vomiting. Give Tannic Acid or Gallic Acid (30 grains in cupful of water). Again in 10 minutes wash out the stomach or empty it 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 (ia grains) in y2 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 y 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 y 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 y 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 % to x/2 grain doses every y to 2 hours), or Laudanum (20 drops every y to 2 hours by mouth, or x/2 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 COCCULUS INDICUS (LEVANT NUT, IN- DIAN BERRY, FISH BERRIES)— PICRO- TOXIN. HISTORY: Picrotoxin is used as a fish poison (ground, mixed with bread and thrown on the water, taken by fish stupifies them, then they float and are taken), as a bird poison, as a medicine, sometimes as “knock- out” drops, and sometimes to adulterate beer. Beer extract containing Picrotoxin is fatal to flies. Pic- rotoxin poisoning produces an extraordinary swell- ing of the abdomen in frogs, which Strychnine does not. SYMPTOMS; Nausea; vomiting; muscular weakness; drowsi- ness; sometimes convulsions; may be scarlet-fever- like rash ; pain ; salivation; diarrhoea ; coma. Fatal dose: 2 to 3 grains of Picrotoxin is consid- ered to be a dangerous dose. Death from paralysis of heart in diastole. TREATMENT: Treat as in poisoning by Strychnine (q. v.), and give Paraldehyde. COLCHICUM (MEADOW SAFFRON, AU- TUMN CROCUS) — COLCHICINE. HISTORY: All parts of the plant are poisonous. The wine has been taken by mistake for sherry and other wines. Fatal dose: 45 grains of dried bulb; a tablespoon- ful of the seeds; of the Wine 354 drachms, and an ounce of the Tincture. il/2 ounces has caused death; an ounce has been recovered from. The fatal dose of the alkaloid is less than 54 grain. Death from paralysis of respiratory centres. Death usually occurs within 24 hours; it has occurred in 7 hours, and has been delayed for several days. 128 A MANUAL OF TOXICOLOGY. 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. SYMPTOMS: TREATMENT: There is no altogether satisfactory known anti- dote. 1. 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 ]/2 wine- glassful of water), or a decoction of oak bark, or strong tea. Irrigate colon with Tannic Acid water. 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 34 to 2 hours; or Laudanum, 20 drops every y2 to 2 hours by mouth, or j4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (J4 grain by mouth or hypodermically every Vt. 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 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 34 teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hy- podermically every 34 to 2 hours), or Tincture of Belladonna (20 drops every J4 to 2 hours). Tinc- ture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically every 34 to 2 hours), or Digitalin (1/100 grain hypodermically every 34 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 34 to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. Apply hot fo- mentations to the abdomen. Finally, give a dose of 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. The bruised leaves of the Wild Hemlock have a mousy 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- HISTORY: 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. 1. 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 effec- tive). After giving emetic, always give plenty of 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 (10 grains) in a wineglassful of water. Then again 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 starch 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 )4 teaspoonful doses hy- podermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or 34 teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every )4 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 )4' to 2 hours), or Digitalin 1/100 grain hypodermically every )4 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 34 to 1 hour if necessary) may be used for the same purposes. 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. 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). The common preparations—the extract and fluid £xtract—contain the two active principles Con- vallarin and Convallamarin. The former is a pur- gative. while the latter is a heart poison, quite sim- ilar in action to Digitalin. Symptoms and treatment similar to Digitalis (q. v.). HISTORY: 132 A MANUAL OF TOXICOLOGY. COPPER AND ITS COMPOUNDS: COPPER SULPHATE (BLUE STONE, BLUE VIT- RIOL)—VERDIGRIS (COPPER SUBACE- TATE) — ETC. 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. HISTORY: SYMPTOMS: 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. TREATMENT: Avoid Vinegar, and Oils. 1. 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- 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 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 y2 to 2 hours; or Laudanum, 20 drops every y2 to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (Lf grain by mouth or hypodermically every y2 to 2 hours), to relieve pain and nervous irritability. If the breath- ing becomes much labored, employ artificial respi- ration. 6. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or y teaspoonful doses hypo- dermically 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) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 grain hypo- dermically every /2 to 2 hours), or Tincture of 134 A MANUAL OF TOXICOLOGY. Belladonna (20 drops every y2 to 2 hours). Tine- ture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically every ]/2 to 2 hours), or Digitalin 1/100 grain hypodermically every y 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 in- haled, using one every y 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). 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.). CORN COCKLE (Crown of the Field). CROTON OIL (CROTON TIGLIUM). HISTORY: 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. SYMPTOMS: 1 Severe abdominal pain; vomiting; purging; fluid stools; pulse small and thready; skin moist; face pinched; prostration; collapse; death. i. Evacuate the stomach: If abdominal pain is slight, syphon out the stomach with a stomach-tube, using much water, with y2 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, TREATMENT: CROTON OIL. 135 30 grains) of 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, flour 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 l/2 io 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate ()4 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- tain 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 34 teaspoonful doses hypodermically as frequently), or with Spirit of 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 54 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every x/2 to 2 hours), or Tincture of Belladonna (10 to .20 drops in water every y2 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. If Curare swallowed action much less severe, (see 1.) HISTORY: 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, consciousness unaffected. Death by asphyxia. SYMPTOMS • TREATMENT: 1. 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 1/60 grain hypodermically every y2 to 2 hours), or Tincture of Belladonna (10 to 20 drops in water every 72 to 2 hours) has a similar effect. 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. CYANIDE OF MERCURY (MERCURIC CYANIDE). HISTORY: 10 grains, also 20 grains have destroyed life. Symptoms, chiefly Mercuric; also Cyanic. Treat- ment: Give Ferrous Sulphate and Magnesium Car- bonate (See 1, p. 71). Follow with whites of 3 eggs in cupful of water and flour or thick starch water or milk. Evacuate stomach. Stimulate (See 3, p. 178). Also see Mercury, p. 174). CYANIDE OF POTASSIUM (POTASSIC CYANIDE). Potassium Cyanide is used in electro silvering and gilding, in photography, to clean lace, and also for the purposes of suicide and murder. 2p2 grains are equivalent to one grain of the Anhydrous Prussic Acid. Fatal dose: about 2p2 grains is considered to be the fatal dose. Usually 5 grains is a fatal dose, in about 15 minutes. Recovery after 50 grains. HISTORY: The Acid properties of Hydrocyanic Acid are very feeble, so that it does not have the effect of the mineral acids on the skin or mucous membrane; but Cyanide of Potassium is very alkaline and has even caustic properties—thus, on an empty stomach has produced a condition similar to that resulting SYMPTOMS: 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 short; 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. Treat as in poisoning by Acid Hydrocyanic (q. v.), also employ demulcents if caustic action has been severe. TREATMENT: CYANIDE OF SILVER (SILVER CYANIDE). SYMPTOMS: The action is similar to that of Hydrocyanic Acid, but weaker. Give large draughts of Ferrous Sulphate (Green Vitriol, y2 to 2 grains in much water). Then treat as for poisoning by Hydrocyanic Acid. TREATMENT: DENATURED ALCOHOL is Alcohol (Ethyl) rendered unfit for use as a beverage or for medi- cinal purposes. Formaldehyde, Benzin, Methyl Alcohol, and various other agents have been em- ployed to produce such preparation. In the South- west, deodorized Wood Alcohol was added to Whiskey, etc., to adulterate such cheaply; the mix- ture then “known as ‘White House,’ ‘Old Mule,’ etc.” When Methyl Alcohol is present in a mixture, treat as for such, in case of poisoning. 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 drugs or through ignorant use. Has been used for the purpose of murder. Maximum dose: Powdered leaves, single, gr.; daily, 15.4 gr. Infusion, single, 480 min.; daily, 1,440 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. SYMPTOMS: (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- 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. 1. 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 in 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 y2 to 1 hour), or with Aro- matic Spirit of Ammonia (a teaspoonful every 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. EXPLOSION GASES. 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, 152.) ERGOT. Given or taken to produce abortion. 15 to 60 grains of Ergot have produced very seri- ous symptoms. HISTORY: 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. TREATMENT: Recumbent position. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If 142 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 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 (10 grains) and Iodine (1 grain in y2 wineglassful of water). 2. Give Castor Oil (2 tablespoonfuls), or Epsom Salt (2 tablespoonfuls in y2 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 hvpodermically as frequently), or with Aromatic Spirit of Am- monia (a in a little water every 10 to 15 .minutes, or y teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every y 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, or half as much dermically every y to 2 hours), or Digitalin (1/100 grain hypodermically every to 1 hour), or Cafifein 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 FORMALDEHYDE. 143 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 rest are most important measures. GLOB. FLY PAPER, POIS’N’S (Treat as for Turpentine) (Commonly, Arsenic (q.v.) EUPATORIUM AGEROTEIDES (Ageratum Altissimum) White Snake Root Found in woodlands, mainly of some Middle West States. Poisons animals, by eating it; man, through milk, butter, cheese, meat. Causes “Milk Fever,” “Trembles,” or “Puking Fever.” Symptoms in man: Restlessness; languor; headache; nausea; severe vomiting; thirst and constipation; intestinal paralysis; fetid “sewer-gas” breath; emaciation; prostration; tremblings; stupor; perhaps convulsions, coma, death. Duration 2 to 10 days or more. Recovery slow. Treat with antiseptics, stimu- lants, tonics, local heat, enemata; concentrated, nutritious food.] This is a white crystallizing powder. It has been taken, by mistake for starch, cream of tartar, certain laxative salts, and various similar appearing powder. It is a constituent of various vermin exterminators such as roach-food, etc. It has been found in some beverages. It produces a severe local irritation, also a general protoplasnuc, toxic effect. Weakness, various nervous protoplasnuc, such as chills, more or less paralysis espe- cially of facial muscles, also aphonia, pain, vomiting, diarrhea, and more or less gastro-intestinal irritation. Summer cold. Treatment: Free lavage, with lime water to make the Sodium salt insaliable and inactive. Also give emollients such as milk, for its calcium and as food. FLUORAL (SODIUM FLUORID) FORMALDEHYDE— FORMALIN. is a powerfully disinfectant gas. It is em- ployed as a disinfectant for clothing, rooms, etc. Formalin is a 40 per cent, solution of gaseous Formaldehyde, and is used as an antiseptic and disinfectant in solutions ranging from 1 to 2,000 to 1 to 200. When swallowed it has a caustic effect. History: * Author’s uncondensed text. 144 A MANUAL OF TOXICOLOGY Symptoms: *[From inhalation: Intense irritation of eyes and nose; dyspnoea, throbbing pain in head; sense of suffocation. From swallowing a Formaldehyde solution (commonly a 4, 10, or 40 per cent, solution) : Pain in stomach; nausea or vomiting; vomit may be bloody; dyspnoea; vertigo, intense anxiety; pulse rapid and 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, forming a harm- less hexamethylene amine. Three volumes of Spirit of Min- dererus should be administered for every volume of 40 per cent. Formaldehyde solution 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 or evacuated by Apomorphine Hydrochlorate (in 1-10 gr. doses). 2. Stimulate with hypodermic injections of Strychnine, Digitalin, Aromatic Spirit of Ammonia, etc. 3. Gice demulcents as milk, barley water, etc.] Treatment: * Author’s uncondensed text. FOOD, POISONOUS; FOOD POISONING, Poisonous Cheese; Poisonous Fish; Poisoned or Poisonous Meat (as putrid meat). Oysters Milk. All protein food poison. (Also see p. 224a) Fungi (such as Poisonous Mushrooms, Toadstools, Truffles, etc.). Also, Muscarine; Sausage Poison, and other varieties of Botulism, etc. (Also see p. 199 and Part IV., p. 261, etc.) HISTORY AND SYMPTOMS It is supposed that the symptoms of food-poison- ing are due either to toxins, ptomains, a proteose, or to several causes combined. Phallin, a toxal- bumin from Amanita Phalloides, breaks up red blood corpuscles. The only antidote is transfusing fresh blood or salt solution. Food poisoning is commonest from bacterial products, but there are other causes. FOOD, FUNGI. 145 In a food poisoning the usual symptoms are those of a powerful gastro-intestinal irritant; and as a rule there is a i to 6 hour incubation period. The specific symptoms, as commonly encoun- tered are nausea, vomiting, abdominal pain and diarrhoea; there may be, also, more or less fever, rigors, headache, ocular disturbances, weakness and collapse. In severe cases the following symptoms may ap- pear: Nausea; sudden and severe retching; ab- dominal pain; dilated pupils; reddened or scar- latina-like skin; great thirst; very offensive diar- rhoeal discharges; elevated or reduced temperature; muscular twitchings; prostration and tendency to collapse; coma, perhaps death. In poisoning by some food substances, such as cheese, the toxic agent may be a protein or proteose, and not a bacillus, or an alkaloidal or simliar sub- stance. Therefore the symptoms may be different in some respects from those commonly exhibited in a food poisoning—as, there may be an obstinate constipation instead of diarrhoea, etc. (Proteose is described as a secondary protein derivative, re- sulting from further cleavage of the meta-protein molecule, one of the intermediate products of pro- teolysis beween protein and peptone.) Poisonous Cheese, Milk, Ice Cream, or Curd, usu- ally causes retching, vomiting, purging, abdominal pain, dyspnoea, dilated pupils, rapid pulse, and de- pression of temperature. Such poisoning is com- monly believed to be due to the action of the butyric acid bacillus forming a toxic substance, a crystal- line ptomain, called tyrotoxicon; but tyrotoxicon is not present in all poisonous cheese, etc. Apparently the tyrotoxicon found in the cheese in some of the poisonings was not an alkaloid, but resembled diazo benzene; but it seems certain that cheese poison- ing, etc., like most forms of food poisoning, is quite frequently caused by powerful toxins produced by bacteria; and among the latter are specially viru- lent strains of bacillus coli, the bacillus enteritidis, bacillus botulinus, bacillus lactis aerogenes, some 146 A MANUAL OF TOXICOLOGY of the proteus group, etc. It should be noted that poisonous cheese—for instance, a “Dutch Cheese”— may be normal in taste, odor, and appearance. In Ice Cream poisonings the incubation period has been found to vary, being in many cases from 3 to 9 hours; sometimes to be delayed to 24 hours. (Also see Ptomains.) Potato Poisoning: Potato poisoning is usually at- tributed to solanin which is present in unripe, germ- inated, or decomposed potatoes and in the berries; but the symptoms and findings have not always pointed to that substance. Sometimes the symptoms have been the usual symptoms of a food poisoning and apparently due to an infective soiling and bacterial activity, with headache, nausea, vomiting, diarrhoea, and debility. In some potato poisonings there have been severe abdominal pain—greatly in- creased by pressure—marked rectal and anal tender- ness, obstinate constipation, almost complete sup- pression of urine, and partial collapse; no narcotic symptoms. Poisonous Fish (such as craw-fish, land crab, yel- low-billed sprat, dolphin, gray snapper, conger eel, mussel, smooth bottle-fish, grooper, rock-fish, Por- tugese man-of-war, king fish, porgie, fugu, old wife, blower, etc.) causes symptoms of severe irri- tation of the gastro-intestinal tract, somewhat re- sembling cholera morbus. Some fish are always poisonous, from gland secretions, sting or bite, etc.; others only in spawning season. Fish poisoning may also occur: from an idiosyncrasy; from a ptomatropinism from eating dried, etc., fish (such as sturgeon, etc.) ; or from the presence of bacteria and toxins in fish, especially in canned fish. A botulism may occur from eating bacillus- botulinus infected (hence, its soluble toxin changed), canned or other fish. In poisoning from canned fish, probably the infecting bacteria were present before the tin was sealed. In fish poisoning the symptoms may be severe intestinal and grave nervous disturbances, prostration, etc. FISH, SHELL-FISH 147 Shell-fish, such as oysters, clams, mussels, lob- sters, cockles, etc., altho in good condition, may act upon some persons as a severe gastro-enteric irritant, producing more or less nausea, vomiting, abdominal pain, diarrhoea, dyspnoea, skin eruptions (urticaria—“hives,” “nettle rash”), dilated pupils, etc. Tomato, vinegar, horse radish, mustard, etc., may also produce quite similar effects. Decom- posed shell-fish may poison like decomposed meat. Oysters from oyster-beds polluted with typhoid germs may convey that disease. Mussels fre- quently produce very alarming symptoms: from having produced while alive a powerful toxin or leukomain called mytilotoxin, the action of which resembles that of Curarine; or, because of their having putrefied—but the toxin is not found in de- cayed mussels. The mytilotoxin type of symptoms commonly differs from that of the usual food poi- soning. Usually there is no abdominal pain nor di- arrhoea; but as a rule, there is nausea and vomiting, perhaps urticaria, pain in back, and dilated pupils. Mussels gathered from the bottom of a ship, in dock, are apt to be contaminated with Copper from the sheathing, or with Arsenic from the paint. In lobster poisoning, pain, urticaria and eye symptoms may be absent. Pickled or Tinned Sal- mon or Herring sometimes produces poison 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 symptoms of gastro-eneric irritation are slight. The chief nervous symptoms are delirium, weakness, thirst, sense of heat about head and eyes, dilated pupils, gradual insensibility, dyspnoea, coma, and convulsions. Sometimes an eruption appears resembling nettlerash and associated with asthmatic symptoms. POISONOUS MEAT, MILK, ETC Poisoning- by such food may be produced: By a botulism; by decomposed (putrefied, rotted) meat; or by meat from a sick animal, such as one sick with 148 A MANUAL OF TOXICOLOGY peritonitis, metritis, puerperal or milk fever, foot and mouth disease, diarrhoeal affections, or other diseases of a bacterial and putrefactive character— the true condition may not be indicated by appear- ance, smell, or taste of the food; by such germs in food as those of typhoid; by such specific disease of an animal, as tuberculosis, anthrax, etc.; by food infected with parasites, or their ova—as trichina; by meat unsanitarily exposed after preparation, etc. The flesh of animals or of birds which have fed upon stramonium, laurel, or other poisonous plants or substances may produce the characteristic symp- toms of poisoning by the respective poison ; likewise the milk of such animals may produce them. Honey may poison from the presence of bee-col- lected products of poisonous plants as in a car- bohydrate or protein poisoning; or as a result of its acting as a gastro-intestinal irritant, produc- ing urticaria, etc. Putrid or decaying meat may produce symptoms of a gastro-enteric irritation; or of a typhoid char- acter; of an atropin (ptomatropin) type; or of a true septicsemic type. (See Wounds, Poisonous.) A true meat poisoning is caused, usually, by a ptomain or toxalbumin, or by bacteria belonging to the coli-typhosus group. The bacillus enteriditis of Gaertner, and similar organisms, or the bacillus botulinus are as a rule associated with such meat poisonings. In poisoning by meat or flesh contain- ing the bacillus enteriditis or its toxin, the poison- ous symptoms appear usually in six to twelve hours from the time the flesh was eaten. The chief symp- toms are nausea, perhaps vomiting, diarrhoea—the stools being frequent and fetid; headache, vertigo, skin-rashes, debility and collapse. In poisoning by meat or other flesh (especially by sausage) containing the bacillus botulinus (such poi- soning being known as botulism or allantiasis) the symptoms are quite different, being of a neurotic type or character; the chief symptoms are dyspep- sia, commonly a barking cough, dilated pupils, and a gradual emaciation, and progressive muscular par-, POISONOUS MEAT, MILK, ETC. 148a alysis. Altho the virulence of the enteriditis toxin does not seem to be reduced by cooking, smoking or pickling, that of the botulinus is destroyed at about 158° F.; but not by putrefaction or alimentary di- gestion. Sausage Poisoning (Botulism—an intoxication not an infection), as previously indicated, may be caused by eating poisonous sausage or ham, whose poisonous condition is the result of the action of the bacillus botulinus. It is claimed that in uncured sausage-meat, a ptomain is some- times developed which causes symptoms of saus- age poisoning. Some observers have concluded that sausage poison is allied to the tetanus, diphtheria, and certain other toxins. Serious illness, also, 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 par- asites. 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 the walls to the muscular tissues of the body, where they lodge in the muscular fibre-sheaths. Trichinae produce ma- laise, anorexia, sleeplessness, fever, severe muscular pains, swelling of joints, sometimes contraction of flexor of extremities, oedema of face and eyelids, diarrhaea. Sometimes typhoid symptoms appear, and death in an unconscious state results. Death usually within 30 days. Chemical and microscopi- cal examinations of the suspected food or of a por- tion of the subject’s muscle should indicate the nature of the poison (p. 244). Fungi: Various forms of fungi, such as mush- 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 tried through ignor- ance of their possible poisonous properties, produce 148b A MANUAL OF TOXICOLOGY. such narcotic-irritant symptoms as violent vomit- ing, purging, anxiety, thirst, gastric and abdominal pain, delirium, stupor, etc.; perhaps suppression of urine and convulsions. 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 the stomach contents. Muscarine is a deadly alkaloid from various mush- rooms—such as the Fly Fungus (Fly-Brown Agaric, False Orange). Fly Fungus is used in Kamchatka and Siberia to produce intoxication. Muscarine pro- duces salivation; free perspiration; desire to uri- nate; violent colic, with thirst; slow, weak pulse; contracted pupils, dilating before death; dyspnoea; paralysis. Death from effect upon the heart; usu- ally 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. Re- ject mushrooms which have white gills or milky juice, or in which the color changes when they are broken or cut. Canned Fruits and Vegetables (a Botulism, etc.) ; Sometimes carelessly cleaned, unsound, improperly cooked, or imperfectly sealed canned fruits and veg- etables may cause a severe food poisoning. Occasionally the imperfect sealing causes a poi- soning through a union of the malic or other acid of fruit juices with the metal used in canning. Various strains of bacillus botulinus have been found in canned vegetables and fruits, which had caused food poisoning; but the germ is commoner in the home-canned than in the factory-canned foods; among such foods were home-canned string beans, corn, asparagus, peas, beans, ripe olives (pre- served), home-canned apricots (with incubation 12 to 20 hrs., dysphagia, visual disturbances, etc.), salads, etc. It is said that by cook- ing canned olives in their preserving fluid for fifteen minutes, the bacillus botulinus will be CANNED FOODS. ANAPHYLAXIS 148c destroyed, if present. Usually such poisonous foods are offensive, but the heating will bring out any obscure odor of decomposition. Quite recently there have been outbreaks of botulism caused by the eating of poisoned (by bacillus botulinus and its toxin) spinach, although the spinach in some cases was apparently normal. The wise plan is to avoid the use of canned foods in which there is bulging or “swelling” of the ends of the can due to decom- position of the contents and the formation of gas, or in which the contents are at all offensive. Kemp- ner has produced a helpful antitoxin for the toxin of bacillus botulinus; without serum treatment death in a day or two in about 1/3 of the cases. *Some persons are unable to eat at all freely of certain com- mon foods, without such producing food-rashes or other phenomena, more or less indicative of a poisonous action. This occurs in spite of their being fond of these foods, and of the good condition of the latter. There may be, either on occa- sion of special indulgence in certain food or foods, or, more or less frequently (almost daily and for weeks or months, or years), from frequent eating of some individually, but more or less unrecognizedly, unsuited food, such symptoms as the following: languor, headache, coated tongue, obstinate con- stipation and debility; perhaps some nausea, vomiting, sallow- ness of. skin, and urticaria. There may be more or less fre- quent so-called “bad spells” (explosions), with these symptoms aggravated, especially the vomiting, debility, and headache. The condition may be the result of an excessive and prolonged or 'Other injudicious use of the respective food or foods, or from some unknown cause. The condition and “spells” may well be regarded as more than simply an indigestion or an intestinal auto-intoxication; such may be interpreted as an idiosyncratic, cellular irritation, chiefly of proteid origin, and toxic character, resulting in a more or less constant disturbance of metabolism; characterized also by more or less cyclic exacerbations appar- ently occurring when the blood and liver become heavily charged with the toxic materials. The condition may be self-adjusting by production of an abundance of antibodies, producing im- munity, but often is not. In an acute attack, treat as in Nos. 1, 2, 3, 4 of General Treatment, pages 149-150. The determina- tion or identification of the actual and elementary, or funda- mental agent or agents concerned in such condition is some- times very difficult. Edible—Protein Anaphylaxis! Poisoning *Author’s uncondensed text. 148d A MANUAL OF TOXICOLOGY. It may be one or more of various food-proteins, (also other proteins), either animal or vegetable or both. Frequently the offending food-protein or pro- teins may be determined by injecting into the skin of the patient (as in the Schick test), or vaccinating (as in the Von Pirquet test), or otherwise inoculat- ing him with, as diagnostic tests, various protein extracts, one or more at a time, each having been carefully prepared from the protein of a different food. Also using, if indicated by asthma-like or catarrhal, etc., symptoms, protein extracts or solutions, prepared from the pollen of various non-edible plants, and even those prepared from the epidermis, hair- scales, feather-scales, or other scales, of various animals, birds, etc., suspected of having a poisonous effect upon the affected person, thru his inhalation, etc., of the respective protein poison. (See Proteins, Anim. & Veg., p. 224a.) Each disturbing protein is indicated as such, by its giving quite promptly a wheal-like, or other distinctive, cutaneous reaction, or inflammation, at the site of its introduction. Over one hundred and fifty varieties of such test- substances from foods have been produced and marketed. Among these foods are wheat, oat, rye, barley, bean, beet, onion, potato, tomato, etc.; vari- ous fruits; beef, veal, lamb, mutton, chicken, goose, duck, eggs, etc.; such fish as pickerel, perch, bass, and other varieties; also various shell-fish, such as oyster, clam, lobster, mussel, etc.; nuts, etc. Cor- rective and curative measures for the recognized protein poisoning (a sensitized or anaphylactic— i. e., unprotected state or condition), are ab- staining from food which contains the recognized poisonous protein or proteins; and avoiding the in- halation or other introduction of the recognized as thus injurious proteins; also, the establishment of a systemic immunity to the respective protein or proteins, by a protracted and graded vaccination of the individual with an extract or extracts of such, to produce gradually, sufficient anti-bodies, in such individual’s blood and tissues, as shall be able to fully combat the poisonous effects of the respective PROTEINS. 149 protein when it is taken into the body; i. e., to es- tablish an immunity to that protein, or those pro- teins, in place of, or instead of, the existing sensi- tiveness to such. Several strengths of an attenuated or diluted extract or solution of the respective pro- tein, is employed, usually (or several proteins may be thus or otherwise used), in gradually increasing doses and strengths, beginning with the weakest of the attenuations and therapeutically vaccinating, or inoculating, one to three times a week for a number of weeks, until the tendency to disturbance seems to be relieved and an immunity established. (Regarding protein foods, it should be noted in this connection, that: pellagra—a serious disease supposed to be due to poverty, to eating diseased corn, etc.—has been found to be very commonly caused by living on foods deficient in protein of an animal origin; hence it is unwise to abstain from or to eat only a slight ampunt of such nutrient. Fat pork has very little of it, but other meats, milk, butter, cheese and eggs contain good percentages of animal protein. Milk is the best food for the prevention or cure of pellagra. A milk drinker and meat-eater can scarcely have the disease.) i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. (In poisoning by fungi, wash out stomach with Pot. Permang. solution, 5 or more grains to the pint.) 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 (1/10 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- GENERAL TREATMENT: 150 A MANUAL OP TOXICOLOGY. ing, give, if at hand. Tannic Acid or Gallic Acid (3.0 grains in 2 tablespoonfuls of water), or charcoal freely or 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 canned foods, fungi, and such, employ saline catharis, as by Epsom Salt (2 tablespoonfuls in small cupful of water), or Glauber Salt (2 teaspoonfuls in 4 tablespoonfuls of water). For fungi, after purging, give vinegar in water. 3. Stimulate. If depression is very great, sup- port heart with Nitroglycerin (in 1/100 grain doses), or stimulate with Brandy or Whisky (a tea- spoonful dose by mouth every 10 to 15 minutes, or %. teaspoonful doses hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or l/\. tea- spoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every to 2 hours), or Atropine Sulphate (1/120 grain hypodermically every /2 to 2 hours), or Tinc- ture of Belladonna (20 drops in water every y2 to 2 hours). Tincture of Digitalis (15 to 20 drops by mouth, or half as much hypodermically every 14 to 2 hours), or Digitalin (1/100 grain hypo- dermically every to 1 hour), or Caffein Citrate (1 to 4 grains every 14 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every 14 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 FUNGI 151 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). Give oxygen if required. 5. Give Opium (Powdered Opium, 1 to 2 grains every to 2 hours), or Laudanum (20 drops every y2 to 2 hours by mouth, or teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (34 grain by mouth or hypodermically every y2 to 2 hours), to relieve pain and nervous irritability. Also give Tincture of Capsicum (15 to 20 drops in y2 cupful of water). Give solution of Ammonium Acetate (in doses every y2 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 Chloroform, if required. Some avoid Calomel. In poisoning by the Fungi give, as early as pos- sible, Atropine Sulphate, hypoderm. (1/120 grain every to 2 hours) as a specific antagonist; or after stomach emptied. Tincture of Belladonna (20 drops in water every y2 to 2 hours by mouth) instead. Atropine exactly opposes Muscarine. Antiseptics (such as Resorcin, Thymol, Salol, Naphthalin, Calomel or small doses of Bichloride of Mercury, and tonics are recommended for after- treatment in most food poisonings; also Potassium Permanganate (one grain, 4 times a day, in 4 ounces of water) ; Sodium Bicarbonate (one dram 4 times a day) ; and antitoxins. There is no known remedy for trichinae poisoning. GASEOUS POISONS. (IN GENERAL.) BROMIDE (q. V.) CARBON DIOXIDE (seeCarbonic 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). 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). 152 A MANUAL OF TOXICOLOGY. 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: In a general sense, may say of gaseous poisons, that: they cause dizziness, headache, nausea, per- haps sense of suffocation, exhaustion, and collapse. GENERAL TREATMENT: Fresh air, Oxygen and Ammonia inhalations, cold douche to head and chest, saline solution (p. 118), stimulation, heat, friction, artificial respiration, rest. GASEOUS POISONS IN WARFARE. HISTORY, Etc. There are three varieties of gas attack: i. 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 GASEOUS POISONS IN WARFARE. 153 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 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. 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 irritant character of mustard; etc. The “A” Tear Shells (Lacrimal, or Lachrymal Gas Shells, or “Weepers”) of the Germans, were found to contain Bro- macetone (Acetone—“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.” Regarding the tear gas, Xylol Bromide, it has been shown that man is more than one thousand times as susceptible to it as the horse and ten times as susceptible as the dog. The “T” Shells of the Germans contained “Xylylbromide.” (Xylyl, a radical from Xylene; the latter is a constituent of coal tar and of wood tar). It is notable that of the so-called war gases many of them are liquids at ordinary pressures and temperatures. There are two general classes of such gases: The first class, the 154 A MANUAL OF TOXICOLOGY. lethal or deadly, consists mostly of those which kill by asphyxiation. The second class, the neutralizing, are not as_ poisonous as those of the first class, but have a more or less prolonged disabling effect. Among this class are the lachry- mators (lacrimators) or tear gases, the sternutators or sneeze- producing gases, and also the eye, lung and skin irritants; the three latter varieties inflame the eyes, more or less seriously disturb respiration, or blister the skin. The most effective gas employed during the World War was, from a military standpoint, the so-called mustard gas (dichloro-ethyl sulphide). It is not a gas but a liquid, and readily volatilizes. It is a heavy substance, its vapor being much heavier than air. It clings to trees, to the walls of buildings, and to the ground, and sinks into shell holes, trenches and other hollows or. depressions. In its liquid form, leather and ordinary clothing are readily penetrated by it. Government reports state that from four to twelve hours after being exposed to it, burns appear upon the skin. These burns are not readily healed. In its vaporous form it produces an inflammation of the eyes, resulting in temporary blindness; and it also attacks the throat and bronchial tubes, producing bronchitis or a broncho-pneumonia. “Mustard gas” is very active, and one part of it in 12,500,000 parts of air will inflame the eyes and quite disable, in the course of a few hours; although no truly specific remedy has been found for the burns it produces, nevertheless, it is claimed that the burns may be prevented by washing and scrubbing the skin, exposed to its effects, with kerosene, im- mediately after such exposure. 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 explosion, 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. Arsine (arseniureted hydrogen gas) is a heavy, deadly gas which attacks the more important nerve centers and causes death in a very short time. There is no true antidote. GASEOUS POISONS IN WARFARE. 155 When very dilute, Chlorine may be recognized by its pecu- liar, Chloride-of-Lime-like smell, but stronger and more pene- trating. Chlorine and Phosgene gases have a strongly corro- sive action on metals, so that metal parts of ai;ms 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- 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 cough- ing. Exposure to such gas when it is highly concentrated, or long exposure to such when of low concentration, injures the tissues of the lungs, breathing becomes more and more diffi- cult and distressing, until impossible, and death by suffocation ensues. Death may result from only two or three breaths of such gas. When present in sufficient 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. Nearly or quite all of the asphyxiating warfare-gases produce, immediately or remotely, intense distress in breathing, or a severe irritation of the eyes, or both. Their use is some- times concealed or otherwise aided by being associated with the use of smoke-clouds or smoke-shells. 156 A MANUAL OF TOXICOLOGY. Smoke screens to hide troops, or to conceal ships from sub- marines, etc., have been produced largely from phosphorus, but titanium tetrachlorid, sulphur dioxid and ammonia, zinc dust and carbon tetrachlorid, and silicon tetrachlorid have also been experimented with for screen purposes. . Prussic Acid gas is not much used; partly because it is too quickly fatal. Almost all of the other gases terrorize by the obviously agonizing distress they cause; and they reduce the number of combatants through the urgent efforts of the vic- tim’s companions to afford him immediate relief, m what appears to be a critical, perhaps only temporary disability. It has a direct action upon the nervous system. When it is in a concentrated form, inhalation of it is followed almost immediately by unconsciousness and death. When it is in the dilute form it produces dizziness, headache, pains in the chest and difficult respiration; these may be followed by coma, con- vulsions and death. . The following are the chief symptoms, as observed in the World War, in those affected by the suffocating gases to which reference has been made in the foregoing pages. (Those most familiar with such poisonings assert that they are, as a whole, essentially and practically Chlorine poisonings in character, effects and treatments.) : 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 in his chest and a sensation as if it were in a vise. Death may take place immediately. (Usually 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 nose. 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 trained, anxious expression. The posture is that of being propped up in bed or on stretcher, with head thrown back, and gasping for breath; some lie upon the side with GASEOUS POISONS IN WARFARE 156a head 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 may 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 forthy 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 and gasping, but more shallow and a short time before death as high as 70 per minute. 0eath 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 be placed in the open air, or in an airy room; heat should be 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 be en- couraged to use his finger to vomit; usually the vomiting affords great relief, and brings away quantities of yellow- ish, frothy fluid. Very often the soldier, suddenly gassed, is fortunate enough to vomit profusely at once; this serves to clear out the deeper respiratory passages. If the gassed per- son is vomiting well, no efforts should be employed to in- crease the vomiting unless the respiratory passages become obstructed with the secretion; but if he has not vomited, he should be made to do so. The choking and gagging which occurs when the gassing fakes place, accounts for the en- trance of the gas into the stomach. Chlorine poisoning deaths are called "dry land drowning” because the deeper respiratory passages become filled up with serous transudation. There- fore the Schaefer method of artificial respiration is very beneficial in that and similar poisonings. Ammonium Car- bonate in 10 to 15 grain doses, every three hours and, 10 to 15 minims of Wine of Ipecac with the same frequency, act as stimulating expectorants. Atropin is of minor value and if used should be given early. Some have favored prompt venesection, to unburden the venous circulation, while others are opposed to it. Opium, best in form of the tincture in 5 to 15 minim doses, relieves the restlessness and allays the mental strain. Oxygen inhalations are helpful in marked cyanosis and dyspnea. A MANUAL OF TOXICOLOGY 156b Desiccated Pituitary Body (Substance), (Posterior Lobe) hy- podermically in half-grain doses, and Brandy, _for failing heait and general circulation is recommended. Some give oxygen hypodermically. Warmth and much fresh air are of special importance. Not only is the quiescent period, in those who have been gassed, usually followed by a severe bronchitis, but they are quite apt to develop a gastritis and gastro- enteritis, characterized by furred tongue, loss of appetite, discomfort and burning in the gullet, tenderness over the stomach, recurrent vomiting, even of blood, from the stomach, bilious and bloody stools, diarrhoea and more or less jaundice; the liver may be enlarged, and albuminuria and hemo- 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. From U. S. Government reports it appears that the gas masks first used, by the U. S. soldiers in the World War, were such as were in use by the English. The wearer breathed through his mouth and the air was inhaled after it had passed through a box or canister which contained absorbents. The absorbent filling had been previously tested and proved to be effective in absorbing chlorine, phosgene and prussic acid. It was found that the rubberized cloth for the face piece must also be very impermeable to gases, and the canister fill- ing material be made so hard that it would not break up into a fine powder, thereby clogging the canister and inter- fering with respiration. Chlorpicrin and other new gases were introduced by the Germans soon after the U. S. entered the war. The masks were found to be an inadequate protec- tion and immediate efforts were instituted to meet the need. It having been found that charcoal was a good gas absorbent, various substances were carbonized in the effort to produce the most serviceable gas absorbing and neutralizing charcoal. Among the substances thus tried were various kinds of wood, nut shells, sea weed, ivory nuts, blood, lamp black, etc. The basis of most of the charcoal used was nut shells. It appears that hard, soda lime granules consisting of a mixture of caustic soda and calcium hydroxid was finally used to remove poisonous gases, or acid vapors, from the “ingoing air.” To oxidize certain gases or vapors and to facilitate their absorp- tion by the other substances in the filler, sodium permanganate was put in the mask. Dr. J. C. Frazer and other chemists developed an absorbent for gas masks to absorb carbon GASEOUS POISONS IN WARFARE 156c monoxide. It is claimed that carbon monoxide gas can be continuously oxidized by the oxygen of the air in the presence of hopcalite (a mixture of the oxids of manganese, copper, cobalt and silver) in a gas mask. “When the allied forces were caught in the first gas attack 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 and advice along the lines, thus saving thousands of lives. “The P. H. Helmet” considerably used in the World War, was thus described: “It consists of a double flannelette bag 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 was claimed that the phenol was 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 was supposed to take out the phosgene; the glycerine to hold the chemicals in solution. A common French type of anti-gas appliance was a mask which consisted of several layers of gauze, each saturated with chemicals, and so adapted as to fit under the chin, up the sides of the face, and across the forehead, and held in place by rub- ber bands. The goggles of these masks are made of cellulose acetate, which will not break or fog from the breath. The mask must so fit as to prevent air from entering the space in front of the face. Each man must be fitted and use his own mask. The Box Respirator, commonly in use, consisted of a small canvas haversack, called a satchel, of two compartments, one of which contained the metal filter with its charcoal and sodium hyposulphite to absorb and neutralize the gas. The other, the mask, called the facepiece, was made of rubberized material, with mica eyeglasses, a nose clip (nose pincers), a rubber mouthpiece which was held in the teeth and which terminated on the outside of the facepiece in a flat, rubber exhaling valve, like that on the P. H. Helmet. Connecting the facepiece or mask and the metal filter, was a short length of non-collapsible tubing. The mask fitted the face closely and was held in place by broad elastic bands, passing around the head. Slight imperfections in helmets or respirators might easily permit of fatal results in gassing; hence, frequent in- spections were made as to their condition. It was commonly asserted that a person in danger of gassing should learn to apply the mask or respirator in from four to six seconds. 156d A MANUAL OF TOXICOLOGY Improved methods have been evolved for the removal of carbon dioxide, hydrogen and engine gases from the air within submarines. 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 hours. A concentrated Tincture equiv- alent to 1/6 grain of Gelsemine caused death in 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, skih cold, moist; face anxious; voice lost; pain in chest; respiration slow, labored; sensibility diminished; suffocation; spasm ; foaming at mouth ; coma.. SYMPTOMS: 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 or 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 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 bark (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 34 to 2 hours).] Stimulate heart, circulation, and res- piration with Brandy or Whisky (2 teaspoonfuls doses, by mouth every 10 to 15 minutes, or 34 tea- spoonful doses hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or 34 tea- spoonful hypodermically as frequently; also with Strychnine Sulphate (1/60 to 1/20 grain hypo- dermically every 34 to 2 hours). Tincture of Digi- talis (15 to 30 drops by mouth, or half as much hypodermically, every 34 to 2 hours), or Digitalin (1/100 grain hypodermically, every )4 to 1 hour), or Caffein Citrate (1 to 4 grains every 34 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every 34 to 1 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 34 grain every 34 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 SYMPTOMS: Irritant symptoms. It causes a pink stain upon the skin. TREATMENT: 1. 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. 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. 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 HYDROGEN SULPHIDE. 159 wineglassfuls of water). Then evacuate the stom- ach again, unless vomiting continues. 3. 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 little water every 10 to 15 minutes, or 34 teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every 34 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every 34 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, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically every 34 to 1 hour), or Caffein Citrate (1 to 4 grains every 34 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every 34 to 1 hour if necessary), may be used for the same purposes. 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. GROUND GLASS. Although not a poison, when given in food, kills by irritation—mechanical action. Treat by giving bread or mush freely; emetic; castor oil; demul- cents ; use counter irritation. HYDROGEN SULPHIDE (SULPHURETTED HYDROGEN). HISTORY: A very active narcotic poison, but its characteris- tic offensive rotten-egg-like odor prevents frequent accident. May prove instantly fatal if inhaled pure; even when diluted, if breathed, causes prompt inseiv A MANUAL OF TOXICOLOGY. 160 sibility and even death; probably the result of rapid destruction of the blood corpuscles. Encountered by workmen in drains, sewers and cesspools. Usually, when encountered, is combined with other gases resulting from putrefaction of animal matter. The dark-brown or black color of the blood is due to the destruction of the blood corpuscles. Death by asphyxia. Spectroscope shows sulph- meth-hemoglobin. Breathed in a diluted state, it quickly produces unconsciousness and death. Persons remaining long in an atmosphere contaminated with this gas experience nausea, weakness and giddiness, loss of blood from mouth, pupils dilated and fixed, face livid, convulsions, coma. SYMPTOMS: TREATMENT: 1. Take patient into open air; or if possible, pro- vide the patient with air containing Chlorine Gas to break up the Hydrogen Sulphide. 2. Employ friction of limbs and trunk. 3. Apply heat to the body (such as hot water bot- tles, 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. 4. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or *4 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 grain hypodermically every j/2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically everv to 2 hours), or Tincture of Belladonna ( 20 drops in water every *4 to 2 hours). Tincture of Digitalis v3° drops by mouth, or half as much hypodermically, every to 2 hours),_or Digitalin (1/100 grain hy- ILLUMINATING GAS 161 podermically every 34 to i hour), or Caffein Citrate (i to 4 grains every )4 to i hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every 34 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). HYDROPHOBIA. HYOSCYAMUS. (See Rabies Virus). (See Belladonna). 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 OP 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. No true antidote known for poisoning by the Gas. For true poisoning by the Gas, treat as for Car- bon Monoxide (q. v.). For suffocation by the Gas, fresh air inhalations and gentle stimulation. If necessary, artificial res- piration. (See i and 4 under Carbon Monoxide). TREATMENT: INKS (See Appendix) Treatment: According to chief toxic ingredient. Treat as in Arsenic Poisoning (q. v.). For Dalmatian, Persian (Pyrethrum) : Evacuate; free catharsis.] INSECT POWDER, POISONOUS. INSECTS, POISONOUS. (See p. 244.) The bite or sting of bee, hornet, wasp, etc. Insect may inject formic acid to repel by irritation, or, to thin blood and keep it fluid to suck up. Usually mainly local irritation. When by taran- tula or scorpion may be serious and consist of: pain; swelling; fever; erysipelas; suppuration; gan- grene; death. SYMPTOMS: TREATMENT: In mild cases apply strong solution of Ammon. Chlor. strong soap-suds, or other alkali, or Tr. Iodine, to affected part. If stinger was left in, extract. Cold wet cloths, Camphorated Chloral, or Beta Naphthol Oint. (30 gr. to 1 oz.)f for pain. Stimulate.* IODINE AND ITS COMPOUNDS. 163 *[To repel insects, apply kerosene, or oil of cedar, citronella, lavender (y2 drachm, in alcohol—to saturation sol.), or pennyroyal; or in room, hang sweet clover. In severe cases treat as in snake bite. (q. v.)]. 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 1 )4 drachms. Death from 1 drachm of Tincture. Death usually occurs within 30 hours. SYMPTOMS: Pain in throat and stomach; metallic taste in mouth; 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; high fever; pain in larynx; eyelids sometimes swollen; albuminuria; cyanosis; great excitement; convulsive movements; collapse. TREATMENT: i. Evacuate the stomach: syphon out the stomach with a stomach-tube, using plenty of water contain- ing egg and starch paste. If 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 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- spoonful, every 10 to 15 minutes until vomiting re- sults), or Apomorphine Hydrochlorate, hypodermi- cally (1/10 grain, every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. Starch is the antidote to free Iodine forming Iodide of Starch. Promptly and freely give large quantities of starch, wheat flour or arrow-root water (water made by boiling starch in water or by pour- ing boiling water upon such), or give Sodium Thio- 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 or 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 by mouth every 10 to 15 minutes, or y teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or y teaspoonful hypodermically as frequently) ; also with Strych- nine Sulphate (1/60 grain hypodermically every )4 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every to2 hours), or Tinc- ture of Belladonna (20 drops in water every y2 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 hypodermic- ally every % 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 handker- chief 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. 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, 10 to 20 drops every y2 to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sul- phate (y grain by mouth or hypodermically, every IODOFORM. 165 y2 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: 1. 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 34 teaspoonful doses hypodermically as fre- quently). 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 grain hypo- dermically every 34 to 2 hours) and Atropine Sul- phate (1/120 to 1/60 grain hypodermically, every 34 to 2 hours), or Tincture of Belladonna (20 drops in water every 34 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 34 to 1 hour), or Caffein Citrate (1 to 4 grains every 34 to 1 hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in handkerchief and inhaled, using one every 34 to 1 hour if necessary), may be used for same purpose. Draughts of strong coffee mav also be given. Give Po- tassium Bromide. Potassium Bicarbonate aids elimi- nation. , «XT A XTYT A TREATMENT: IPECACUANHA. SYMPTOMS: Vomiting; hematemesis; hemoptysis. 166 A MANUAL OF TOXICOLOGY. 1. Wash out the stomach if possible. 2. Give vegetable acids, such as vinegar and water (equal parts), Acetic Acid, diluted (a teaspoonful in 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 VA teaspoonful doses hypodermically as fre- quently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or y teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypo- dermically every J4 to 2 hours) and Atropine Sul- phate (1/120 to 1/60 grain hypodermically, every y2 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 hypo- dermically. every y2 to 2 hours), or Digitalin (1/100 grain hypodermically, every y to 1 hour), or CafTein Citrate (1 to 4 grains every y to 1 hour), and in- halations 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. Give Opium or Morphine for pain. TREATMENT: JABORANDI (PILOCARPUS) — PILOCAR' PINE. HISTORY: Ihe dangerous dose of Pilocarpine is assumed to be 2 grains subcutaneously. SYMPTOMS . Profuse, sweating; dizziness; salivation; vomit- m£C purging; tearing pain in eyeballs; contracted pupils; myopia. JABORANDI. 167 TREATMENT: 1. 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 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 *4 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 l/2 to 2 hours), or Digitalin (1/100 grain hypodermically, every )4 to 1 hour), or Caffein Citrate (1 to 4 grains every l/A to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every )4 to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 4. Morphine Sulphate (34 grain every 34 to 2 hours) to control nausea and vomiting. JALAP. SYMPTOMS: Large, watery stools ; tormina ; tenesmus. 1. 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 *4 teaspoonful TREATMENT: LABURNUM. 169 doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a litue 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 34 to 2 hours), or Tincture of Belladonna (20 drops in water every l/2 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 % 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. “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)—CYTI- SINE—ARNICA—GOLDEN ROD. 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. HISTORY: Symptoms usually come on very rapidly; vomit- ing ; purging; restlessness; drowsiness; twitchings; rigidity; convulsions; coma. SYMPTOMS • TREATMENT: 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 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- 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. 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 plenty of strong tea or a decoction of oak bark. 2. Give Epsom Salt (J/> 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 34 teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or )4 teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every to 2 hours), and Atropine Sulphate (1/120 grain hypo- dermically every 34 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 y2 to 2 hours), or Digitalin (1/100 grain hypodermically every 34 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every 34 to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given (a pint by enema). 4. Employ alternately, hot and cold douches to the head and chest to arouse the patient. LEAD AND ITS COMPOUNDS, 171 Symptoms somewhat similar to those of Opium, Treat as in Opium poisoning (q.v.). LACTUCARIUM. 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. HISTORY: 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. iy2 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 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. SYMPTOMS: 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. 172 A MANUAL OF TOXICOLOGY. TREATMENT: Give soluble sulphate, such as Magnesium 01 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 colio. Put iY 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 (10 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: 1. Give a vegetable acid: lemon juice or orange juice freely; or Citric Acid (i 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 Yi 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 y2 to 2 hours), or Lau- danum (20 drops every to 2 hours by mouth, or Yi teaspoonful in gruel by rectum as frequently), or Morphine Sulphate grain by mouth, or hypo- dermically every y2 to 2 hours.), to relieve pain and nervous irritability. TREATMENT: LOBELIA. 173 LOBELIA (LOBELIA INFLATA, INDIAN TOBACCO). HISTORY: A drachm of the powdered leaves is considered a fatal dose. Death in >4 to 4 days. 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. SYMPTOMS: Keep in recumbent position, even after acute symptoms are relieved. 1. 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 TREATMENT: 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 >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 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. 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 l/2 to 2 hours), or Laudanum, 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 to 2 hours), to relieve pain and nervous irritability. LOCO LOCO WEED (Colorado Itch) HISTORY; (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. MAD-DOG-BITE (See p. 201). MALE FERN. Evacuation, stimulation, as in Lobelia. Avoid oil. MERCURY AND ITS COMPOUNDS. Bichloride of Mercury (Corrosive Sublimate) Red Precipitate (Red Oxide of Mercury)— w^te PreciPitate (Ammoniated Mercury) 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 hour or be delayed to 2 weeks. An alcoholic solution of Corrosive Subli- mate (80 grs. to ounce) applied to scalp for ring worm killed girl 9 yrs. of age. Death, usually mainly due to nephritis and uremia. 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 pints in a day. There may be a mercurial tremor, and anuria. SYMPTOMS: 176 A MANUAL OF TOXICOLOGY TREATMENT: i. Promptly evacuate the stomach, giving anti- dotal albumin in so doing or before. Syphon out the stomach with a stomach-tube, using albumen- water‘(white of one egg to a quart of water) or, a magnesia-water (Heavy Magnesium Oxide, a tea- spoonful or more to a quart of water—add the Mag- nesia as a thin paste). While the lavage fluid is being prepared, administer if possible, the white of egg or other albuminous substance described be- low (see “2”). If stomach-tube is not available em- ploy emetic instead such as Mustard (a tablespoon- ful in a small cupful of water, repeated in 15 min- utes if not effective) ; or Syrup of Ipecac (2 tea- spoonfuls every 10 minutes, 3 or 4 times if required to secure effect), or, Apomorphine Hydrochlorate (1/10 grain repeated in 15 minutes if necessary). (1). “2.” Stir up white of egg in water or milk (whites of 4 eggs to 1 pint) and give before or when begin to evacuate stomach. In poisoning by Corrosive Sublimate, 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 alkaline contents of the intestines, and may be absorbed. 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 and milk. 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 possible. Give Magnesium Sulphate MERCURY AND ITS COMPOUNDS. 177 (i or 2 ozs. in 2 or 3 ozs. of water) by stomach- tube or as drink; and in 2 quarts of water may use it or use Fischer’s solution as a helpful enema. May well give as cathartic Sodium Sulphate or Phos- phate. Potassium Iodide (io to 20 grains, in water, every 2 to 4 hrs., has been recommended. Neutralizing the free acids of the stomach and secretions by lavaging the stomach 2 or 3 times a day with a weak solution of Sodium Bicarbonate (40 grains in 3 ozs. of water), or Sodium Carbonate (20 grs.), or Citrate (40 grs.), or other alkali, as in some other poisonings, is proving very helpful as a continuing treatment. Also the giving of Calcium Sulphid (5 gr. in 3 or 4 ounces of water 2 or 3 times a day), or Magnesia to 1 dram in 3 or 4 ounces of water). Use mouth gargle of Hydrogen Perox. Schisler and Brashear report great success by giving Magnesium Oxide 30 to 60 grains in water, every 3 or 4 hours; and with Sodium Bicarbonate used similarly. They maintain a salt-free diet and encourage free perspiration to aid elimination. Rosenbloom favors lavage of stomach with Calcium Sulphid, one grain to one ounce of water. He gives about 3 ounces of such solution by mouth for two days; and also gives a tablet of Sodium Phosphate 0.35 gram, and Sodium Acetate 0.24 gram, 3 times a day as an antidote. He uses Fischer’s solution (Sodium Chlorid 14 gm., and Sodium Carbonate 20 gm., in 1,000 c.c. of water), intravenously; also washes out the stomach twice daily, giving immedi- ately afterwards 5 grains of Calcium Sulphid in 3 ounces of water. 3. Stimulate heart, circulation, and respiration 178 MANUAL OF TOXICOLOGY. with Aromatic Spirit of Ammonia, or Brandy or Whiskey; also with Strychnine Sulphate (1/60 to 1/20 grain, hypoderm., every to 2 hours). Atropine Sulphate (1/120 to 1/60 grain hypoderm- ically, every to 2 hours), or Tincture of Bella- donna (5 to 10 drops in water every 2 to 6 hours) lessens the secretion in ptyalism. 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 1 hour), and inhalations of Amyl Nitrite (3 or 5 minim pearl crushed in handkerchief and inhaled, using one every 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 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 [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 grains of Calcium Sulphide in ounces of boiled and filtered water has been fqjind beneficial. Also Fischer’s, or normal salt solution. [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 NAPHTHALIN. 179 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, continu- ously, to induce copious diuresis. Wash out the stomach and irrigate the colon, twice daily, to re- move 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 de- layed for one or more days, it may be necessary to continue it for as long as three weeks. If the treat- ment 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. SYMPTOMS: Depression; cyanosis; twitching; strangury; dark-brown changing to inky-black urine, 180 A MANUAL OF TOXICOLOGY. 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 )4 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 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 *4 to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may alsp be given, TREATMENT: NITROBENZENE—NITROBENZOL'. 181 NICOTINE. 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). HISTORY: NITROBENZENE (NITROBENZOL, ES- SENCE OF MIRBANE, ARTIFICIAL OIL OF BITTER ALMONDS). HISTORY: 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 blackings and 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. SYMPTOMS : 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. TREATMENT: When swallowed. I. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, uemg plenty of water. If 182 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 (1/10 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 {y2 to 1 tablespoonful in water every * to 4 hours), or 2. Stimulate heart, circulation and respiration with Aqua Ammonia (}4 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 % 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 g*rain 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), or inhalations of Ammonia may be given for the same purposes. Draughts of strong coffee may also be given. The transfusion of a normal saline solution (2)4 level tea- spoonfuls of salt to 1 quart of water, used at no° F.) may prove serviceable. [Blood is thick and brown.] Avoid alcohol by stomach as favors absorption. NITROGLYCERINE. 183 3- Employ alternate hot and cold douche to thest, 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. HISTORY : 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. 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- cular 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. 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 y2, to 2 hours), or Tincture of Belladonna (20 drops in TREATMENT: 184 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 (# 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. (See Anesthetics). OILS, VOLATILE. (See p. 222). NUX VOMICA (STRYCHNOS NUX VOM- ICA, POISON NUT, QUAKER BUTTONS, RAT’S BANE)—STRYCHNOS IGNATII — STRYCHNINE — BRUCINE. 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 y2 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 Jaours, Fatal results have occurred in 5 minutes. HISTORY: NUX VOMICA. 185 There was death after 6 hours in a case where 6 grains of Strychnine were given with some Morphine. Average fatal dose Strychnine about gr. Death in i$4 hrs. from %. grain. 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: 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), TREATMENT: 186 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 Q4 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. In syphoning use Chloroform inhalations. 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 *4 to 2 hours), or Potassium Bromide (1 to 2 drachms in water every to 1 hour by mouth, or U4 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. 187 in 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 (y& 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. HISTORY: Poisoning has resulted from an infusion or decoc- tion 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- ing 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, 2/ grains (equal to 5 grains of Opium) ; Morphine from 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- 188 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 but 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 an hour; the longest 4 days. If patient survives 12 hours, chances of recovery are good. Patient con- sidered comparatively safe when respirations stay above 10 per minute. The symptoms of Morphine poisoning appear in from to 1 hour, and a fatal result may occur in J4 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 to cause homicidal mania in Japanese and Malays. SYMPTOMS: 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; 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 a 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- hol and Opium in some form frequently are taken OPIUM, LAUDANUM, ETC. 189 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 in the diagnosis. In Chloroform or Ether poison- ing 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. 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 dmetic, 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- TREATMENT: 190 A MANUAL OP 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 y2 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 noc 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 9 height frequently repeated. drying patient in the OPIUM, LAUDANUM, ETC. 191 intervals. Avoid applying so much cold water as to cause collapse. Alternately hot water and ice tc .he 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 % to 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 an enema of a pint, introduced hot, is often very beneficial. (Although Brandy,Whisky, Ether or Cam- 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 the brain, etc.) May use Cocaine gr. hypoderm.) 7. Give Sweet Spirit of Nitre (1 teaspoonful in a wineglassful of water every hour) to aid elimina- tion of the poison by the kidneys. Evacuate the bladder 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, or bags of salt, bricks, plates, or stove-lids, heated 192 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. (Seep. 118.) PARALDEHYDE, HISTORY: Has been recommended as a substitute for Chloral. Odor of drug in breath and urine. Fatal dose: 1 drachm has produced serious symp- toms. Recovery from 3E2 ounces. Unconscious- ness may last for more than 30 hours. Death by paralysis of respiratory centres. Slight stimulation ; excited; incoherent; muscular relaxation ; rapid pulse; pupils contracted and in- sensible to light; insensibility; collapse. SYMPTOMS: 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, 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 14 to 1 hour, 2 or times), or Tincture of TREATMENT: PETROLEUM—ROCK OIL, ETC. 193 Belladonna (io to 15 drops every y to 1 hour, for 2 or 3 doses), or Strychnine Sulphate (1/60 to 1/20 grain doses hypodermically every y2 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 (PETROL —BENZINE) — NAPHTHA—RHIGOLENE—ETC. HISTORY: Petroleum or the products of its distillation have been drunk accidentally for ginger beer and other beverages with serious results. 3 ounces of Naph- tha (the kind usually burned in lamps) killed a boy 12 years of age. Recovery after swallowing a pint of Petroleum and 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 use of Gasoline as a wash may cause dysphagia, head- ache, cyanosis, coma, perhaps death; mania may occur during a recovery. Treat these forms of Gasoline poisoning as in poisoning by Carbon Monoxide, but stimulate cautiously.] SYMPTOMS: When kerosene or gasoline swallowed: Severe burning in mouth and stomach; vomiting; stools covered with oily layer; cold skin; feeble pulse; sighing respiration; pale, anxious face; great thirst and restlessness at night; unconsciousness. If gasoline inhaled: Giddiness, feeling as if con- traction of head, headache followed by partial or 194 A MANUAL OF TOXICOLOGY. complete insensibility, flushing or facial cyanosis; a maniacal tendency while returning to conscious- ness. Facial cyanosis greater from inhaling vapor of raw or unburned gasoline than from fumes or gases of imperfectly consumed, carbonized gasoline. TREATMENT: 1. If poison inhaled: Place patient in fresh air. If swallowed: Evacuate the stomach: Syphon out the stomach with a stomach-tube, using plenty of water. If 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 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. 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 little water every 10 to 15 minutes, or y teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every *4 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every y2 to 2 hours), or Tincture of Belladonna (20 drops in water every y2 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 *4 to 1 hour), or Caffein Citrate (1 to 4 grains every /4 t° I hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using °ne every y to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given, and friction of the skin resorted to. PHOSPHORUS—“RATSBANE,” ETC. 195 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. Resort to artificial respiration (raise extended arms from sides to up over 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. 5. When Swallowed.—If pain is severe, give Opium (Powdered Opium, 1 or 2 grains every to 2 hours; or Laudanum, 20 drops every to 2 hours by mouth, or teaspoonful in gruel by rec- tum as frequently), or Morphine Sulphate (]/\ grain . by mouth, or hypodermically, every x/z to 2 hours), to relieve pain and nervous irritability. PHENACETIN. (See Acetanilid). PHENOLS. (Acid Carbolic, etc.) PHOSPHORUS—“RATSBANE”—“RAT POISON”—MATCHES. Yellow (common) Phosphorus is poisonous, lum- - mous, 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 ' With Yellow (waxy) Phosphorus mixed with Potassium Chlorate, sand, and glue. “Safety” matches are tipped only with Potassium Chlorate and Antimony _i 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: iy2 grains of Phosphorus; 1/9 grain has caused death. The chewing of two HISTORY: 196 A MANUAL OF TOXICOLOGY matches killed a child. Recovery after suck- ing 300 matches. 1/50 grain of Phosphorus killed a child; 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 R2 hour to 12 days; usually between the 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 ordinary oils and fats and substances con- taining them, such as milk, as they increase solution and absorption of the Phosphorus. Liquid petro- latum has been given successfully on account of its being physiologically inert, as it envelops the poison and delays its absorption. It should be fol- lowed by lavage, in which this oil may also be used. There is no known chemical antidote. PHOSPHORUS—“RATSBANE,” ETC. 197 1. 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 is not at hand, may use a stomach-pump or give an 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 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), or Mustard (a tablespoonful to 2 of water), may be given. [Recto-colonic irrigation later on.] 2. Give without delay old, resinified Oil of Tur- pentine, or better still, French Oil of Turpentine {x/2 teaspoonful or more, floated on hot water or in capsules, and repeat 3 or 4 times, at 15 to 30 minute intervals. Avoid oil, soup, milk, white of egg or other albuminous substances; also avoid mucilagi- nous or alcoholic drinks. If it cannot be determined what quantity of Phosphorus has been taken, the old or French Oil of Turpentine may be given in 4 doses of teaspoonful at 15 minute intervals. If the stomach will not retain the Turpentine, it has been recommended that it be injected into the rectum, atomized into the lungs, the air of the room satur- ated with its fumes, or that it be rubbed into the skin in the form of a liniment. The French Oil of Tur- pentine is quite soluble in Ether and Alcohol. Tur- pentine (old) forms with Phosphorus an almost insolu- ble mass, the so-called Turpentine-phosphoric Acid. (100 times as much Turpentine should be given as there was Phosphorus taken.) It should be given in hot water or alone (floated on the water or in cap- sules) immediately after the Phosphorus has been taken or as soon thereafter as possible. It is con- sidered valueless if not given within 12 hours after. 198 A MANUAL OF TOXICOLOGY Potassium Permanganate recommended (4 gr. in an ounce of water, frequently, or several pints of the same strength used to wash out stomach). Or 1 to 3$ Hydrogen Peroxide solution may be used instead. Lime Water freely, or Charcoal (a teaspoonful mixed in a small cupful of water) may be given to prevent action upon the tissues. If nothing else is at hand, some recommend giving Gum Arabic or 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 of Nitre (a teaspoonful in water) or more old Turpen- tine (in y2 drachm doses in mucilage every y2 hr.). If the bladder is inactive use a catheter frequently. 4. Give Opium to counteract the pain and the cardiac and systemic depression. Powdered Opium (1 to 2 grains every y2 to 2 hours), or Laudanum (10 to 20 drops every to 2 hours by mouth, or l/2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate ()4 grain by mouth or hypoder- mically every y2 to 2 hours). 5. Transfusion may be necessary to repair the blood. Inhalations of highly diluted Turpentine vapor are beneficial; also of pure oxygen. Hydro- gen Peroxide, given in solution or injected subcu- taneously, has been highly recommended. 6. Magnesia, Milk of Magnesia, Chalk, or Lime suspended in gruel have been recommended. After acute symptoms over, give Sodium Carbonate freely for acid intoxication. Apply heat to feet and body. PHYTOLACCA (POKE: “Berry,” “Root,” and “Weed.” Garget; Pigeon Berry; Crow Berry; Cancer Root; Red Weed; Red Ink Plant, etc.). _ Nausea; vomiting; slowing of heart and respira- tion; depression; dyspnea; palpitation, SYMPTOMS: PHYTOLACCA 199 1. Vomiting and purging are frequently pro- duced by the poison, but syphoning out the stom- ach with stomach-tube and much water is desir- 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 (J/2 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 to 2 hours), or Digitalin (1/100 to 1/50 grain doses hypoderm- ically every x/2 to 2 hours). 3. Give Opium (Powdered Opium, 1 to 2 grains every p2 to 2 hours), or Laudanum (20 drops every x/2 to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate grain by mouth or hypodermically every y to 2 hours), to relieve pain and nervous irritability. TREATMENT: POTASSIUM CHLORATE—Chlorates— Nitrates. HISTORY: Fatal dose: from y> ounce upward, inpj to 12 days. Poisonous doses interfere witli the oxygenation of the blood corpuscles and produce toxic haema- globinuria. Evidences of severe irritation of the alimentary canal and of the nervous system; severe dyspnoea; cyanosis; the skin usually jaundiced; delirium; coma. Acute tubal nephritis is pro- duced ; the excretion increased, but its chemica| reaction, unchanged. x SYMPTOMS: 200 A MANUAL OF TOXICOLOGY TREATMENT: 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 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 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 emetic, give plenty of lukewarm water. Pilo- carpine cautiously, favors salivary excretion. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, gelatin, flour and water, barley or starch water, oatmeal gruel, or even crushed bananas) to soothe and protect the irritated and 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. 4. Give Opium (Powdered Opium, I to 2 grains every y2 to 2 hours; or Laudanum, 20 drops every V2 to 2 hours by mouth, or *4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (/4 grain by mouth, or hypodermically every *4 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 1 hour if necessary). Avoid stimulants, or anything likely to increase the congestion of the kidneys, if severe. PRECIPITATE, RED OR WHITE. (See Mercury). PROTEINS (Poisoning: As food p. 224a. By inhala- tion p. 148c). PTOMAINES. 201 PTOMAINS (PUTREFACTIVE, CADAVERIC OR ANIMAL ALKALOIDS). 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. Frequently such poi- soning is an auto-intoxication (q. v.). The reactions of certain Ptomains duplicate the actions of the following alkaloids: Atropine, Colchi- cine, Coniine, Delphinine, Digitalin, Nicotine, Strychnine and Veratrine. HISTORY: SYMPTOMS: 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 tmtrid game. 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 ioi to 104, convulsions, almost a palsy; even death, from paralysis of the heart. Post mortem examinations may show con- gestion 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 MANUAL OF TOXICOLOGY. 202 A substance giving most of the reactions of Col- chicine has been found in beer. Poisons formed during putrefaction, etc. £ Tyrotoxicon is said by some to be a poisonous proteid allied to the tetanus and diphtheria toxins; It is 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 hypodermically 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. TREATMENT: Treat as in Food, Poisonous (q. v.). PULSATILLA. Death by paralysis of heart. HISTORY: SYMPTOMS: Reduced heart action, respiration, and tempera- ture ; pupils dilated; motion and sensation para- lyzed. 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 as Zinc Sulphate (20 grains in 2 tablespoonfuls of PULSATILLA. 203 water, repeated in io 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. 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 % teaspoonful doses hypodermically as frequently), and Tincture of Digitalis (15 to 20 drops by mouth, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour).. 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 y2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (y grain by mouth or hypodermically, every to 2 hours), to relieve pain and tenesmus. -RABIES VIRUS, Rabic Poison—[Infection (Poison- ing) by Saliva—(“Mad-dog-bite,” etc.)].— [ Rabies ( Hydrophobia) ]. HISTORY: Rabies (hydrophobia) may result from bite or other salivary infection by dog, cat, wolf, fox, horse, cow, .hog, skunk, deer, human being, or other warm- blooded animal; also by laboratorial inoculation. Certain spherical and oblong bodies called Negri bodies are found only in the brain cells of animals which have died from hydrophobia, or have been killed during its course in them. Microscopical recognition of the presence of these bodies determines the condition was that of rabies. If a portion of such brain be in- jected into the brain of another animal the latter will develop rabies and die of it. 204 A MANUAL OF TOXICOLOGY Rabies is declared to be quite common in Russia, France, Belgium, Turkey and Italy; rigid quaran- tine, muzzling, and other precautions in Australia, Canada, England, Germany, Holland, Switzerland, etc., make its occurrence there infrequent. It is claimed that about 16 per cent of the persons bitten by rabid animals develop rabies, if not given the Pasteur anti-rabic treatment, i.e., injections of anti- rabic virus (virus vaccine, rabies vaccine) ; and that the employment of the Pasteur treatment has reduced this percentage to one-half of one per cent. It is evi- dent that this percentage might be reduced still further by early injections of anti-rabic virus administered to all persons bitten by, or in any way possibly infected, i.e., poisoned with the perhaps rabic virus of an animal suspected of being rabid. It is obvious also, that the prevalence of rabies, in general, might be almost elim- inated, by similar treatment of bitten animals; or better still, by the immunization of all dogs, and perhaps of other domestic animals. Rabies is quite prevalent in the United States, and definite medical knowledge of suitable palliative meas- ures, in rabies, is insufficient. There is great need of wide publication of the measures which should be em- ployed in suspected or known infection, and of the fact that they must be employed early, before the ap- pearance of the symptoms in order to be salutary; also information as to effective, preventive, or immune measures against infection. It should be common knowledge, especially that rabies vaccine should be given, by injection, in all cases of suspected or at all probable infection. Rabic bites through thick clothing may be harmless. Rabic bites near large nerve trunks, or where there are many small nerves, are among the most serious ones; also those about the neck, face or head, owing to proximity to the brain—as the infection travels along the nerve routes to the cord and brain. Great care should be exercised in handling sick dogs or cats as rabies might be present and a bite or a scratch prove fatal. Rabic saliva falling upon cuts, tears, cracks RABIES VIRUS 202a or abrasions of the skin—scratches, hang-nails, chafed surfaces, etc.,—may infect. The incubation or developing period in man or other animal, when infected, is from two weeks to a year; as a rule from about three weeks to two months. It may be hastened or delayed according to the facility or dif- ficulty with which the infecting, poisoning virus was introduced; also by the quantity, location, etc., in intro- duction. Not all of those bitten by rabid animals de- Rabies (Incipient) (Case and Photo. Dept, of Health, City of New York) velop rabies, although not treated after being bitten. Harvey and Acton state, and Cruickshank and Wright agree, that: “The saliva of a rabid dog need not neces- sarily be infective, need not necessarily contain the virus at all.” But it is best to be on the safe side—“safety first”—and to exercise due precaution by employing the Pasteur treatment early. SYMPTOMS: Dogs infected by a rabid animal, unless immunized, usually show signs of the infection in two weeks or possibly less; sometimes not for many weeks or months. The infected dog should be placed under observation mi A MANUAL OF TOXICOLOGY for seven to ten days and promptly and well immunized, if seen soon after being bitten. The poison may be communicated by the saliva of an infected animal at any time during the course of the rabic symptoms and for two or three days before their onset. If a susceptible bitten animal develops rabic symp- toms, he should be killed and search made for the Negri bodies, and animal inoculation tests also employed if necessary (see also pages 202h and 202i). A dog infected by rabic virus, usually shows first a noticeable change in disposition. It may become more affectionate than usual, like a sick child seek- ing comforting attention ; or it may become sullen, dull, depressed, nervous, irritable and suspicious, and al- though previously good-natured, may become snappy, cross and easily excited. The eyes become red, and as a rule, the appetite is fickle or absent. As the disease progresses, the dog may develop either the furious type of rabies, or the paralytic or so- called “dumb,” or “sullen,” type. A dog sick with rabies may not act as mad dogs are commonly supposed always to act—i.e., he may show no violent symptoms; on the contrary he may be quiet and sleepy, without disposition either to bite or to run away; also weak, especially in the hind legs, with spasm of the throat muscles upon trying to swallow liquids. Quite often such dog crawls into a quiet, dark place and, with increasing weakness, dies in two to five days (“dumb rabies”). In furious rabies, or furious madness, the dog commonly leaves home and wanders aimlessly about, eating such strange substances as straw, rags, earth, excrement, wood, stones, etc. Usually there are illusions, delusions or hallucinations, and the animal springs at imaginary objects. It may have severe spasms of the throat with choking and vomiting, becoming more and more excited until finally it becomes furious and runs “amuck” with blood-shot eyes and the mouth dripping saliva. As a rule it runs in nearly a straight line, snapping and biting at all animals it encounters, even human beings. It may bite itself RABIES VIRUS 202c and heedlessly chew its own legs. If not destroyed, it usually dies in a convulsion, or from weakness and a resultant paralysis, in 3 to 6 days from the onset of the symptoms. In this type of rabies a peculiar bark is comonly noted. The bark is hoarse and muffled; and a full bark is apt to be followed by five to eight weird, uncanny, unearthly, sinister, throaty howls, the mouth being kept party open after each howl. Furious Type of Rabies (Author’s illustration) It is claimed that once heard this sound is never for- gotten. However it is said that the mad dog in biting and fighting furiously, rarely or never barks, but that in thus fighting, a non-rabid dog almost always barks. In the paralytic or dumb variety of rabies a short period of excitation is followed by severe spasms of the throat with perhaps choking. The animal is mostly tame, and voiceless; silent, quiet, gloomy, de- pressed and dull. Usually exhibits but little inclina- tion to stray or bite; the mouth, dripping saliva, is kept open, from paralysis of the lower jaw; the eyes are expressionless and staring. Increasing muscular 202d A MANUAL OF TOXICOLOGY weakness and paralysis usually result in death by the fourth or fifth day. In the human being, commonly the first signs are tingling and pain at the site of the bite and extending towards the brain. The patient is excitable, talkative, with increase in his reflex responses. A current of air on the skin may cause exaggerated reflex response even a convulsion (Romberg’s sign). The voice often be- comes hoarse or croaking; there is increasing difficulty Paralytic Type of Rabies (Case and Photo. Dept, of Health, City of New York) in swallowing; convulsions and paralysis of legs, etc., commonly follow. There are two types of rabies in man: The furious and the paralytic. Usually in the furious type the disease develops rapidly. The person infected, feels smothered and gasps for breath; he has difficulty in swallowing, due to convulsive contraction of the throat muscles. The convulsive contractions soon extend more or less widely over the whole body. A sudden noise, strong draft of air, or flash of light may precipitate a convulsion. At intervals the patient becomes excited and may be actually maniacal. However, as a rule, clearness of mind is RABIES VIRUS 202e not lost, and altho often panicky, in terror and in dread of the consequences, he maintains a certain de- gree of self-control and is not likely to attack those about him; but the poisonous and excessive salivary flow may easily infect others by coming in contact, with wounds, cracks or abrasions of their skin. The patient may die in a convulsion; but usually more or less of a paralytic condition develops and in three or four days from the onset of the disease he dies from cardiac or respiratory paralysis. Although the typical paralytic variety of the disease is unusual in man, it may occur from an in- tense infection. The convulsive features of the furi- ous type of the disease are then slight or absent; there is muscular tremor and increasing muscular debility, resulting in a general paralysis and death in from four to six days. Prompt preventative measures should be employed in all suspicious cases. The wound should be well opened and evacuated; then thoroughly cauterized with fuming nitric acid applied by the drop by drop method, and using a medicine dropper or a pointed glass rod: how- ever, at bony, cartilaginous or bloodless points, pure carbolic acid should be used, as it is less likely to pre- vent due healing; these measures should be followed by the employment of the Pasteur anti-rabic treatment. The cauterization should be very prompt. Author- ities differ as to how long, after a person has been in- fected, by bite or otherwise, cauterization is effective. Some claim only half an hour, others extend the time to 48 hours. One, believes it should be done as late as 72 hours. The poison or virus passes very slowly thru the nerve fibres towards the brain, from the original point of infection. In fact it is said to remain “for a num- ber of hours, localized in the nerve-fibres in the region of the wound.” Proper cauterization may so destroy the infected nerve fibres and connections as to prevent distribution as well as all local existence of the virus. TREATMENT 202f A MANUAL OF TOXICOLOGY If cauterization is rather late or even imperfect it may diminish the amount of poison sufficiently for the pa- tient to produce enough antagonists (antibodies) to counteract the otherwise unopposed or unaffected virus. If the bite inflicted by an apparently innocuous dog, or by any other animal which is susceptible to rabic in- fection, is seen within 24 hours after the bite, the wound should be freely evacuated. If a punctured wound, or one not well opened, it should be freely opened. It should be well squeezed to express any con- tained saliva or to make it bleed freely, thus cleansing Paralytic Type of Rabies (Case and Photo. Dept, of Health, City of New York) itself. It should then be thoroughly washed with cor- rosive sublimate solution (1 to 2,000), and dressed sub- ject to inspection. The animal should be placed under observation for a week. According to the circular of information of the De- partment of Health of the City of New York: . The Pasteur Treatment” [inoculating a person, already infected with rabic virus thru the saliva of a rabid animal, with an attenuated and prepared rabic virus, as an anti-rabic virus or rabies vaccine]* “is a preventive treatment against N.B.. The bracketed statements are those of the author. RABIES VIRUS 202g rabies. It is not curative and is of no value after rabies has developed. The course consists of twenty-one daily injections of anti-rabic virus. This material (rabies vaccine) is a virus vaccine, not a serum. As it deteriorates rather rapidly, each dose is prepared daily and sent by special delivery mail.” “To save time, the treatment should be ordered by telegram addressed to the Assistant Director, Vaccine Laboratory, foot of East 16th Street, New York City. The order should give the name and the age of the patient.” “Bites on the face, head or neck increase the dangers of infec- tion on account of the many nerves in these localities and the close proximity of the brain; the treatment in these cases is an intensive one. Such cases especially should not only begin treatment promptly but any irregularity in the course of injec- tions should be most carefully avoided. For this reason, we advise that severely bitten patients be sent, if possible, to New York City, or other place where the vaccine is prepared, in order to avoid any delays due to irregularities in the mail. In extremely severe face, head or neck bites, a second course of treatment is advised. This second course should be started, two weeks after the last dose of the first course. Cost.—The cost of one course of treatment sent by mail is $25.00. If the patient comes to New York and has the vaccine injected by one of the Department of Health phy- sicians, the cost is $50.00. Should the patient wish a private physician here in New York to give the injections, the cost is $25.00 for the vaccine and whatever charge his physician may make for attendance. Checks should be made payable to the City of New York Department of Health. Cauterization.—Prompt cauterization of the wound should not be neglected. The earlier it is done, the more effective it is. Fuming nitric acid is the best cautery and is helpful if used within 48 hours of the bite. The acid should be applied on the point of a tapered glass-rod or drop by drop from a capillary pipette, so that the amount may be care- fully controlled. Contact with bony, cartilaginous or blood- less parts should be avoided if passible. To these parts apply pure carbolic acid and the fuming nitric acid to the other tissues adjacent. Such tissues heal well after the use of nitric acid. The actual cautery is effective as far as it reaches the parts of a wound, but fuming nitric acid, being a fluid, reaches the deep crevices which tjie hot iron may not touch. The use of pure carbolic acid, iodine, silver nitrate, etc., on wounds made by rabid animals have but little value as compared with fuming nitric acid. Do not suture wounds made by rabid animals. 202h A MANUAL OF TOXICOLOGY Anti-Rabic Treatment Should Be Given: To persons bitten by animals which have been proven rabid either by clinical symptoms, or by microscopic ex- amination of the brain. To persons whose hands or face have been contaminated with saliva of a rabid animal without being bitten. This is because of the possible presence of cracks, hang-nails or other small open wounds. To persons bitten by stray dogs which cannot be located. The treatment is given as a precautionary measure. To persons bitten, pending the laboratory diagnosis on the brain of the biting animal, provided that the symptoms or actions of the animal were suspicious. Routine to Be Followed in Regard to Biting Dog A dog which shows clinical symptoms suspicious of rabies should be killed at once and the brain sent to a laboratory for diagnosis. If an apparently normal dog bites anyone, it should be kept under observation for ten days to three weeks. The saliva of the dog may be infective on an average of three or four days before the animal shows clinical symptoms. [Dr. A. Silkman, Chief Veterinarian of the Department of Health of the City of New York, states that “it has recently been quite commonly accepted, among scientific observers, that it has been well demonstrated that rabic poison (rabies virus) does not appear in the saliva of a dog, infected with rabies virus, at an earlier date than two or three days before he manifests the first clinical symptoms of rabies. Therefore, a dog which has bitten a person (or under certain conditions, a susceptible animal) should be quarantined for a week under the observation of a skilled veterinarian; and if at the end of that time he has manifested no symptoms of rabies, it may be considered certain that his saliva did not contain the rabic poison at the time of the bite and that there- fore the bite could not have infected, and the dog may be released.”]* The longest time that a dog, with symp- toms of rabies lives, is, usually, five or six days. This period, added to the three or four days above makes a period of about nine or ten days, at least, during which the animal should be under close observation and confinement. Since, however, a prolonged incubation period may occur, it is safer to hold the animal for three weeks. Such ani- mals should not be killed too soon for the reason that a satisfactory laboratory examination of the brain cannot always be made in the stages of the disease. The microscopic evidence of rabies (the Negri bodies) appears but little earlier than the clinical symptoms. When this *N.B.: The bracketed statements in the foregoing are those of the author, RABIES VIRUS mi evidence in the brain is lacking, a part of the brain must be injected into test animals. This test requires from two to four weeks for completion. [*See page 202h] FACTS ABOUT RABIES.—Incidence.—About 16 per cent of the human beings develop rabies if not treated after a bite by a rabid animal. Antirabic treatment has reduced this figure to 0.5 per cent. Period of Incubation.—In human beings, the shortest known time is fourteen days, the longest, seven months (possibly one year). The average time is twenty to sixty days. The period of time depends on the quantity of virus introduced, the point bitten and the strength of the virus. Bites through several layers of clothing are not so dan- gerous as those on the bare skin. Since the infection travels along the nerve routes, bites about the face, head or neck are more serious because of their location near the brain and the many nerves present; so also bites involving the large nerve trunks. In such cases, the period of in- cubation is apt to be short. The saliva of a human being, who has developed rabies, is not so dangerous as that of the dog; neither is the saliva of a herbivorous animal so dangerous. Nevertheless, all the precautions as to cauterization and treatment should be taken if exposure has occurred. The period of incubation in a dog which has been infected is usually fourteen days or less. Since, however, this period is sometimes prolonged, the animal should be held in quar- antine at least six to twelve months. [More extended observations and increased knowledge have demonstrated that the incubation period for an infected dog is from two weeks to three months, but a dog bitten by a rabic animal may be released from quarantine within ten days, after the bite, if it shows no symptoms of rabies before that time, by promptly immunizing it by giving it 3 to 5 of the anti-rabic injections.]* Immunity.—The Pasteur treatment requires four to five weeks for the full development of immunity. Three weeks of this time are required for the injections. In a person who is taking the treatment, there is a contest of speed be- tween the passage of the virus from the wound to the brain, by way of the nerves, and the development of im- munity due to the absorption of the vaccine through the circulatory system. This immunity lasts, apparently, a variable length of time. The treatment is considered as having failed to protect only when the patient dies two weeks or more after the end of the course of injections. In those cases in which *N.B.: The bracketed statements in the foregoing are those of the author. 202/ A MANUAL OF TOXICOLOGY death occurs within the two week period there may have been unusual susceptibilty or marked intensity of the in- fecting- virus. Delay in starting treatment may be re- sponsible for a failure in protection.” [If the patient “has been bitten by a positively known rabid animal,” Drs. Silkman and Regan, of New York, favor a second series of injections after the expiration of six months; and it is recommended that “in cases of face-bites or very extensive wounds from a known rabid animal the course of treatment be repeated two weeks after the com- pletion of the first course,” * * * “to reenforce the immunity conferred by the first treatment.” The person under treatment should avoid excitement, severe exercise, exposure to wet and cold and all nervous disturbances.]* Vaccination of Dog (Preventing Rabies) (Author’s illustration) Recently, anti-rabic treatment of dogs, in order to make them immune to rabic infection, has been em- ployed, with seeming complete success, in some towns and cities. Dogs thus treated are tagged, allowed at large and not muzzled. The humanity and wisdom of this procedure will appeal to all friends of animals. . New York City, it is now the custom, based upon increasing experience and knowledge as to rabic infec- N.B.. The bracketed statements in the foregoing are those of the author. RABIES VIRUS. 202k tion, to hold under observation for seven days, if alive, a dog, which has bitten a person or an animal. If no symptoms of rabies develop during that week it is recognized that the saliva of the dog was free from rabic poison at the time he bit the person or animal and it is so stated; it is also stated that at the present time he manifests no symptoms of rabies and therefore he is released from quarantine. Attention is also called to the fact that it is considered advisable to immunize all dogs against rabies, by giving them one anti-rabic vac- cine injection. If the dog died before it could be placed under skilled observation, or while under it, the brain is searched for Negri bodies, and if necessary inocula- tion tests are made also. If the owner is willing to go to the expense, a valu- able dog which has been bitten by a suspected-to-be- rabid, or by an evidently-rabid dog, may be treated by immunizing him against rabies, by giving him three to five anti-rabic injections, instead of the usual single one. A. Silkman, D.V.S., Chief Veterinarian of the De- partment of Health of the City of New York, sometime since asserted, in conjunction with the opinion of Joseph C. Regan, M.D., of the Kingston Ave. Hospital of the Department of Health, that: “Bites by stray dogs, when inflicted without provocation are considered suitable for anti-rabic treatment. The be- havior of the dog is the important point in the determina- tion of whether or not bitten persons should receive treat- ment. The animal should not be killed but be placed under the observation of a competent veterinary. However, if the circumstances of the bite are at all suspicious, the per- son bitten is placed under treatment without waiting for a veterinary or laboratory diagnosis. If the examination of the dog by a veterinary, or of the animal’s brain for Negri bodies, is negative the treatment is discontinued. If it proves positive, valuable time will not have been lost. Ex- amination of the brain for Negri bodies is not always con- clusive. Resort then must be had to animal inoculation of the suspected material; this process requires from ten days to two weeks, which delay might prove disastrous if the establishment of the diagnosis by this method was waited for.” 202/ A MANUAL OF TOXICOLOGY. Give Chloroform (5 to 30 drops) in sugar and water. Give Morphine hypodermically (*4 grain every 1 to 3 hours) until under influence. Rectal injections of Chloral up to 2 drams per day and with Potassium Bromide is recommended. Spray throat with 4 per cent solution of Cocaine. Hyoscine is helpful. Feed per rectum with nutritive enemas and sup- positories. Put patient in a dark room and keep quiet and warm. Exclude all draughts. Place patient in a restraining sheet and on a narrow bed if inclined to be violent. Nitrite of Amyl or Chloroform inhalations help. PALLIATIVE TREATMENT IN HYDROPHOBIA: RAT PASTE—“ROUGH ON RATS”; ETC. (See Arsenic; also Barium and Phosphorus.) Feeding-: If liquids can not be swallowed give such semi- solids as ice cream, custard, jelly, etc.; or resort to nutrient enamata. RESORCIN. HISTORY s Is used as an antipyretic and antiseptic. Very few cases of poisoning. Fatal dose: 2 drachms have nearly caused death. Death by paralysis of respiratory centres. SYMPTOMS : Dizziness; tingling sensation—“pins and needles”; severe perspiration; lips blanched; dry tongue; low temperature; normal pupils; black urine; clenched teeth; unconsciousness. RESORCIN. 203 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 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 Lime. 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], or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or y± teaspoon- ful hypodermically as frequently) ; also with Strych- nine Sulphate (1/60 to 1/20 grain hypodermically every ]4 to 2 hours) and Atropine Sulphate {1/120 to 1/60 grain hypodermically every l/2 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 hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypo- dermically every J4 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 heur 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 TREATMENT: A MANUAL OF TOXICOLOGY 204 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. HISTORY: 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. SYMPTOMS: Itching; swelling; vesicular eruptions ; throat may be involved, causing cough; thirst; vomiting; col- icky pains, with fever and delirium. (Rhus poison- ing is due to an active principle, a non-volatile oil called toxicodendrol, contained in the pollen, hairs, etc.). Used internally, causes a species of intoxi- cation. TREATMENT i. Wash well with hot soap suds, then apply a dilute—alcohol solution of Lead Acetate. A lotion of Fluid Extract of Grindelia Robusta (i part, water io to 48 parts), 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 (l SANGUINARIA. 205 ounce to i pint of water) or iced, saturated solution of Sodium Bicarbonate, or the same of Boric Acid; or promptly sponge the part with Benzene, Chloro- form, Gasoline, Spirit of Camphor, or Formalde- hyde Sol., Phenol (weak sol.), or Potass. Permang., or Corrosive Sublimate, in a weak solution, or even lemonade. After blisters rupture, Lime Water, with or without milk, aids. An infusion of Lobelia (i oz. to water i pt.), or Witch Hazel, or Alum Water, are useful; also Ichthyol, Aristol toilet powder, etc. Secondary applications are cold cream, vaseline, oil, etc., after neutralizing the poison. If fats or oils are used early, they spread the poison. Treatment of the dermatitis, caused by poison ivy or poison oak, by giving 3 to 5 intramuscular injections (each 3 to 5 minims) of a weak solution of the active principle of the respective plant, at intervals of 1 to 3 days, seems to have been distinctly curative in some cases; and, by giving 4 such injections, at intervals of 3 or 4 days, then following them with a tincture of the respective plant, given by mouth in doses of 5 to 10 drops 3 times a day for a month, if well borne, seems to have estab- lished at least a temporary densitization or immuniza- tion in most persons thus treated. To prevent eruption after recognized exposure, apply wash of zinc sulph. (5 to 10 grs. to ounce of water, according to severity of exposure or irritation). 2. Give Magnesium Sulphate (a tablespoonful). 3. Give Opium (Powdered Opium, 1 to 2 grains, or Morphine Sulphate, 34 grain, or Laudanum, 20 drops; give every to 2 hours by mouth, or in gruel by rectum as frequently). Give simple diet. SANGUINARIA (BLOOD-ROOT). HISTORY: Death by paralysis of cardiac and respiratory centers. SYMPTOMS: Severe salivation; violent vomiting; severe purg- ing; faintness; vertigo; coldness; dilated pupils; re- 206 A MANUAL OF TOXICOLOGY. duced temperature; slow pulse; great prostration; intense thirst; convulsions; collapse. 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 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 34 teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or 34 teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every 34 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every ]/2 to 2 hours), or Tinc- ture of Belladonna (20 drops in water every V2 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 )4 to 1 hour), or Caffein Citrate (1 to 4 grains every 34 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every 34 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 l/2 to 2 hours), or Laudanum (20 drops every 34 to 2 hours by mouth or hypodermically every 34 to 2 hours), to relieve local irritant action. TREATMENT: SANTONIN. 207 SANTONIN. HISTORY: About 2 grains of Santonin killed a boy years of age 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. 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-fellow, alkaline urine cherry-red or crimson. SYMPTOMS: 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 (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- ing 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 Va teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a littfe water every 10 to 15 minutes, or x/\ teaspoonful hy- TREATMENT: 208 A MANUAL OF TOXICOLOGY. podermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every 14 to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every )/2 to 2 hours), or Tinc- ture of Belladonna (20 drops in water every 34 to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or as much hypodermically, every 34 to 2 hours), or Digitalin (1/100 grain hypodermically every 34 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 34 to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. Chloroform, or Chloral per rectum, for convulsions. SAVINE. HISTORY: 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 the 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. SYMPTOMS: Pain in abdomen; vomiting; straining and bloody stools; difficult respiration ; convulsions; coma ; col- lapse. Sometimes severe irritation of urinary organs, such as strangury and bloody urine; odor of drug in urine; may be vormting 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 Hvdrochlorate, hypodermically (i/io 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 .1/20 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every y2 to 2 hours), or Tincture of Belladonna (20 drops in water every y2 to 2. hours), or 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 y to 1 hour), or Caffein Citrate (1 to 4 grains every y to 1 hour) and inhalations of Amyl Nitrite (a 3 or 3 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. 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 y2 teaspoonful by rectum in'gruel), or Morphine Sulphate grain by mouth or hypodermically) every y 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). HISTORY: 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. 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. TREATMENT: If there is time to do anything, fresh air, stimula- tion with Ammonia to the nostrils, and Aromatic Spirit of Ammonia by mouth (J/2 to 1 teaspoonful in water every 10 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. SILVER COMPOUNDS (SILVER NITRATE, LUNAR CAUSTIC) — ETC. Nitrate of Silver turns black when contaminated with organic matters. It acts principally as a corro- sive poison when 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. HISTORY: 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 Iodid or Nitrate shown by blue skin. SYMPTOMS: 212 A MANUAL OF TOXICOLOGY. 1. Give Sodium Chloride—common salt—(a table- fcpoonful 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 y2 to 2 hours), or Laudanum (20 drops every to 2 hours by mouth, or 'l/2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate {l/% grain by mouth or hypodermically every y2 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 y teaspoonful hy- podermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 t° J5 minutes, or y teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours), TREATMENT: SNAKE VENOM 213 and Atropine Sulphate (1/120 grain hypodermically every to 2 hours), or Tincture of Belladonna (2c 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 (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 pear] crushed in a handkerchief and inhaled, using one every l to 1 hour if necessary) may be used for same pur* poses. Draughts of strong coffee may also be given, SNAKE VENOM [SNAKE BITE/ 3(The Bite of Various Poisonous Snakes.)] (See pp. 243-4.) HISTORY: The venom of the viper contains albumin, albtt moses and globulin, all poisonous. The venom o{ 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 occur quickly; more or less severe; commonly: intense shock; clammy skin; great thirst; severe pain in part bitten—pain area rapidly increases; locally, partial paralysis; intense swelling of portion of body injured—which later be- SYMPTOMS: •Author's uncondensed text. 214 A MANUAL OF TOXICOLOGY. comes livid and gangrenous; fainting; vomiting; small, fre- quent, irregular pulse; hemorrhages; bloody stools and urine; lethargy; difficult respiration; convulsions; death. It is thought the quantity of peptones in the venom determines the amount of local edema, severity of the convulsions and de- gree of the paralysis of respiration; it is supposed the globulins disorganize the blood and produce hemorrhage.] TREATMENT: *[1. Get the poison out where it went in, and do it quickly; keep it there until you do so. Seize the bitten part, with both hands, firmly between the wound and the heart (but close to the wound) to keep the poison at the wound; if the wound be on an extremity have some one tie tightly a strong band (rope, string, handkerchief—anything) around the part, close to your hands (but nearer the heart, and two or three more every \]/2 or 2 inches beyond that one, and keep them there for 20 or 30 minutes. Then (or even while the hands alone were holding, if there be help enough to do it,) cut deeply 4 or 5 horizontal lines about % inch apart, so placed that the bites will be about the center of the series; and in the same way cut 4 or 5 vertical lines across the horizontal ones, thus making a lot of little squares with the bites nearest the middle ones; this frees the poison and causes the blood to flow copiously and to wash it out and away; then suck the wound vigorously if neither lips nor mouth have cut or abrasion, (the gastric juice destroys any venom which may be swallowed accidentally), or use a cupping glass, or put alcohol in glass or bottle, and burn, then apply, or use breast pump, to encourage removal of the venom from the wound. When well done, or before com- pleted, if possible, surround the bites with a circle of deep injections (about inch apart) of a 1 or 2 per cent solution (1 grain in about 2 teaspoonfuls of water, or a wine-color solu- tion) of potassium permanganate, to oxidize, neutralize or burn up the venom; or if no hypodermic is at hand, such a solu- tion, or even one of only 5 or 10 grains to the pint, may advan- tageously be freely poured into the more or less evacuated wound and the wound finally dressed with any of these solu- tions on clean gauze or cloth. When the wound has been freely evacuated, and if possible oxidized by the permanganate, the circulation-interrupting bands may be carefully loosened and some of the blood from the injured part allowed to flow to the heart and then the bands retightened; if no markedly serious effects are observed from this loosening, it may be repeated at 10 to 20 minute intervals, until the safety of a restored free circulation from the wound seems to be established. The_ foregoing seems to be the best procedure; but some authorities favor quickly cutting out the bitten part or cauter- izing it thoroughly with caustic, or a red hot iron, or a live coal, or applying strong nitric acid, or even applying gunpowder and setting fire to it. Very many favor the subcutaneous injection or application of a potassium permanganate solution. Injec- tion about the wound of a 10 per cent solution of Calcium Hypochlorite or of a solution of Aurum Chloride has been rec- ommended; also free application of Ammonia Water; also SPIGELIA. 215 washing wound thoroughly, then applying a 25 per cent. Car- bolic Acid solution; also free application of Tincture of Iodine; also giving of Galium Circsezans, internally. Elimination may be aided by inducing free perspiration or salivation by Pilocar- pine Hydrochlorate (1/100 to 1/60 grain hypodermically). Bleeding bitten limb and transfusing new blood into other limb, recommended be done if severely poisoned by cobra. The administration, or hypodermic injection (in 15 to 30 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 it into abdominal, cellular tissue within 2 hours after bite; use Permanganate solution at bite, or inject into and around bite 8 c.c. of 1:60 solution of Calcium Hypochlorite. Bile, or the water soluble portion of it, is said to be beneficial also. 2. Encourage heart action and circulation by weak inter- rupted galvanic currents to chest near heart. Rub briskly over heart and firmly over body. Give coffee; fresh air freely. 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 % teaspoonful doses hypodermically as frequently) ; or give Aromatic Spirit of Ammonia (a teaspoon- ful in water, or inject 54 teaspoonful each of such Ammonia and of water, if possible, into radial vein, as frequently) ; or, Strychnine Sulphate (1/60 to 1/20 grain hypodermically every 10 to 20 minutes if necessary, for several doses). Some advise to carry whisky to point of narcosis—is debatable. If respiration is seriously interfered with, resort to artificial respiration and maintain for several hours. Keep patient warm, quiet. Transfusion of healthy blood or intravenous injection of normal salt solution may be required. In rattlesnake bite, Olive Oil freely, both externally and internally, is by some considered a specific. It is believed snake-charmers render themselves immune to venom by taking small doses by the mouth.] ’Author’s uncondensed text. SNEEZE WEED (Stagger Weed). Causes sneezing, staggering, dyspnea, convulsions, death. If swallowed, emetics, cathartics. However poisoned, employ rest, fresh air, oxygen, external heat, and sedatives and stimulants as indicated. SPIGELIA (PINK ROOT). Vertigo; dimness of vision; dilated pupils: dry throat; convulsions; delirium. SYMPTOMS: i. Evacuate the stomach: Syphon out the stomach with a stomach-tube, using plenty of water. If the TREATMENT 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.). STAINS (See Appendix.) Treat effects of a con- nected toxic solution according to the poison. 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: Pulse weak; urine increased; muscular rigidity; spasms. SYMPTOMS : TREATMENT: Recumbent position. i. Evacuate the stomach if just taken; syphon out the stomach with a stomach-tube, using plenty oi 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 vomit- STROPHANTHUS. 217 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- 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 % to 1 hour if necessary), may be used for the same purposes. Curare (1/20 to 1/6 grain hypodermically) 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. SULFONAL—TRIONAL—TETRONAL— VER- ONAL—AMMONAL—ETC. HISTORY: Death in 40 hours from two 15-grain doses Sulfo- nal taken in i)4 hrs. Also death on fourth day from taking over an ounce. Rocovery from 3 ozs. Veron- al, death from il/2 drams. 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. 1. 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 l/2 io 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 10 to 15 minutes, or l/[ teaspoonful doses hypoder- mically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or *4 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. TANSY (TANACETUM VULGARE). HISTORY: Fatal dose: As a rule j/2 ounce of the oil causes death; 1 drachm of it has caused death. The dose of the oil is 1 minim. Death by paralysis of heart. Characteristic tansy odor of breath; consulsions; unconsciousness; dilated pupils; hurried, stertorous breathing; full, gradually weakening pulse. SYMPTOMS: TREATMENT: Treat same as in poisoning by Savine. TIN COMPOUNDS. SYMPTOMS: Metallic taste in mouth; vomiting; diarrhoea; pain; diminished heart action. 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 220 A MANUAL OF TOXICOLOGY 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. Ammonium Carbonate (in 5 grain doses in a small cupful of water), also Sodium Bicarbonate, have been highly recommended for poisoning by the Chloride. Magnesia mixed in water should be freely given and followed by mucilaginous and albuminous drinks, such as flaxseed tea, elm bark water, gruel, gum arabic or gum tragacanth water, or white of egg in water. 3. Give Opium for pain (Powdered Opium, 1 to 2 grains every p2 to 2 hours), or Laudanum (20 drops every l/2 to 2 hours by mouth, or teaspoonful in gruel by rectum as frequently), or Morphine Sul- phate (}( grain by mouth or hypoderm. every }£ to 2 hrs.) to relieve pain and nervous irritability. 4. Stimulate as in Antimony. TOBACCO—NICOTINE. Pure Nicotine is a colorless oily liquid, and is rapidly fatal. Havana tobacco contains 2$. Kentucky, Ten- nessee and Virginia tobaccos, 6$ or 7$. Poisoning has resulted from mistaking infusion for coffee; from to- bacco chewing and smoking; from giving for worms, or to induce abortion: from children using old tobacc-' pipes to blow soap bubbles; from local applications of tobacco, etc. Death from enema of y2 dram of the leaves. Boys have died as result of smoking to- bacco. “The hot volatile, gaseous nicotine in the tobacco of the cigarette is released by the burning HISTORY: TOBACCO—NICOTINE. 221 process and absorbed by the mucous membrane of the mouth, larnyx, vocal cords, trachea, or the lungs with its 2,000 sq. feet of surface exposed to the action of the toxin.” The objectionable products, also in using cigar and pipe.—P. G. in Med. Counc. Fatal dose of Nicotine, M.iii—60 in J4, 2 or 3 hrs. Death by paralysis of respiration or of heart. 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. SYMPTOMS: TREATMENT: Put patient in a horizontal position. 1. 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 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 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- ing occurs or ceases, give Tannic Acid or Gallic Acid (30 grains in a small wineglassful of water), or in lieu 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 (l/2 ounce to a small cupful of water). 2. Give Spirit of Nitrous Ether (1 to 2 teaspoon- fuls 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 y 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 *4 teaspoonful doses hypodermically as fre- quently), or give Chloroform (20 to 30 drops in 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 is lost or lessened by rinsing mouth with Silver Nitrate solution (J4 to 1 grain to water 1 ounce) just before smoking. Should also avoid stimu- lating foods and beverages. TRIONAL. TRUFFLES. (See Sulfonal). (See Fungi). TURPENTINE—OIL OF TURPENTINE— (SPIRIT OF TURPENTINE). Usually given by mistake, or overdose when used to expel worms. A child died in 15 hours from ]/2 ounce of the oil; a teaspoonful killed a 5 months old infant; recovery in child under 2 years old after taking a tablespoonful. Death of adult from 6 ozs. Death by paralysis of respiration. HISTORY: A Turpentine odor in the breath. Usually there is giddiness and a kind of intoxication, followed by gastro-enteritis; there is strangury, bloody, scanty urine, with odor of violets; there may be purging; cyanosis; dilated pupils; stertorous breathing; dy, moist skin; feeble, rapid pulse; coma; collapse. Somewhat resembles poisoning by Opium, SYMPTOMS: i. Evacuate the stomach if seen promptly; sy- phon out the stomach thoroughly with a stomach- TREATMENT: 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 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 Savine (q. v.). 5. Give Opium (Powdered Opium, i to 2 grains every y2 to 2 hours), or Laudanum (20 drops every Y'i to 2 hours by mouth, or x/2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (y grain by mouth or hypodermically every x/2 to 2 hours), to relieve pain and nervous irritability. (See Fish Poison and Ptomains). TYROTOXICON. URETHAN. HISTORY: Death by asphyxia. Vomiting; reduced temperature and heart action; muscular weakness; general anesthesia. SYMPTOMS: 224 A MANUAL OF TOXICOLOGY. 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 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 34' teaspoonful doses hypo- dermically 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 to 1/60 grain hypo- dermically every y2 to 2 hours), or Tincture of Bella- donna (20 drops in water every 34 to 2 hours). Tinc- ture of Digitalis (30 drops by mouth, or half as much hypodermically, every 34 to 2 hours), or Digitalin (1/100 grain hypodermically every 34 t° 1 hour), or Caffein Citrate (1 to 4 grains every 34 to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every 34 to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. TREATMENT: VEGETABLE AND ANIMAL PROTEINS 224a VEGETABLE AND ANIMAL PROTEINS (Such as Poison Thru Being Inhaled) Vegetable Proteins from the pollen of: Ragweed, Rose, Sun- flower, Golden Rod, Lilac, various weeds, grasses, etc.—Animal Proteins from epithelial scales, scales of the hair, feathers, etc., of Cat, Cow, Dog, Horse, Hog, Sheep, Canary, Parrot, etc. The acute annual or occasional poisonings due to the inhalation mainly of the plant proteins are commonly known as “Annual Asthma,” “Seasonal Asthma,” “Hay Asthma,” “Hay Fever” (Pollinosis), “Rose Fever,” “Rose Cold,” “June Cold,” “July Cold,” “Peach Cold,” “Sum- mer Catarrh,” “Autumnal Catarrh,” “Nervous Catarrh,” “Nervous Coryza,” “Cold in the Head,” “Pollen Poisoning,” etc. The more or less irregular or occasional poisonings, which appear to be due to the inhalation of animal proteins, is called “Animal Asthma,” “Cat Fear,” etc. Proteins are formed mainly by plants, but there are no essential differences between the animal and the vegetable or plant proteins. All of the proteins contain carbon, hydrogen, nitrogen and oxygen; some contain also sulphur, phosphorus, or iron. Plant pollen, practically protein, is a fine dust-like powder or spherical or ellipse-shaped, grain-like substance formed within the anthers (the double-celled sacs of the stamens) of flowers. It is the fertilizing or male element in flowering plants; and nature provides that at the proper time is shall be transferred from the plant anthers to the stigmas, a part of the pistils or seed-bearing organs of the higher flower- ing plants. It is dusted upon the sticky surfaces of the stigmas or otherwise so placed as to reach the ovaries and the ovules. This con- stitutes the fecundating or fertilizing process called pollination. The pollen, representing the male element of the plant, is conveyed, ordinarily, to the ovary and ovules, representing the female element of it, either by the feet of insects or by the wind. Nearly all perfect flowers i.e., those which contain both elements, are either bright col- ored or white; they have a pleasing odor, yield honey, and give but a small amount of pollen, much of which, as a rule, is carried by the feet of bees and various other insects from the stamens to the pistils of those plants. The flowers of the other kind of plants, among which are various orchard and other grasses and many weeds, are not bright colored, and have no appreciable odor and no honey. They release a large quantity of very fine, light pollen which is carried by the air and wind from the stamens of the male to the pistils of the female of those plants. This pollen may fill the air at a distance from the plants, having been wafted thither by the wind. Thus, one susceptible to its effects, may, upon inhaling it, be poisoned by it at some distance from where it grew, its protein being more or less soluble in the secretions of HISTORY 224b A MANUAL OF TOXICOLOGY nose, eye, etc* Pollen not air-borne, as tbat of tbe rose and golden rod, may poison thru the handling and smelling of the flowers, thus causing the characteristic hay-fever type of poisoning, or pollinosis. In the blood and tissue cells of most persons are anti-bodies, or substances which neutralize these poisonous proteins when they enter the body; therefore such persons are said to be immune to these poisons. But some persons are sensitive or “sensitized” to certain of these poisons, therefore not immune to them, but more or less poisoned if exposed to them, and they enter into the body by inhalation, etc. These protein poisonings appear to be closely related to the protein poisonings produced in some persons upon eating the meat of certain animals, or the flesh, or eggs, of .certain fowl, birds or fish, or upon their eating certain cereals, vegetables, fruits, nuts, etc. (See page 149). All of these proteins are related to the proteins of snake venom and of certain arrow poisons, and of poisonings by bacterial proteins. Some persons seem to be immune to the various plant pollens but are not to the hair-scales of some certain kind of domestic animal, or to the feather-scales of some such bird as the parrot, canary, or the sparrow; others are immune to many of the plant pollens, such as those of the orchard grasses, roses, lilacs, etc., but are not to golden rod, or to rag weed, or to some other plant which flowers at the same time of the year as one of these. It appears, therefore, that the individual immunities, or the lack of such, to the various poisonous proteins, vary greatly in character, extent and degree; sometimes it is very difficult to determine, particularly among plant pollens, the protein or proteins, causing the individual poisoning, inasmuch as such may occur under obscure or very confusing conditions. Most cases of the “hay fever,” “hay asthma,” or pollen poisoning type occur, usually, between May and October in temperate zones, as during that time, in a region rich in vegetation, the air is more or less laden with the fecundating dust. Most persons who are affected are attacked between the 12th and the 20th of August and the attack is likely to last until a severe frost occurs in September or October. However, some persons are attacked in June or July, when certain orchard and other grasses ripen and the haying season approaches. The presence or handling or smelling of roses or certain other flowers may cause coryza, sneezing and dyspnoea in some persons at almost any time of the year. Some persons employed in greenhouses or handling flour, e*c., freely in bakeries show the poisoning effects. It is notable that if a person who is affected by the pollen of a certain plant or plants goes at the time of pollination to a region where there are none of these plants he is not likely to have an attack of the poisoning. The general symptoms in “hay fever,” “hay asthma,” or pollen poisoning are about as follows: There is a sense of dryness, also of irritation—such as tingling, itching or stinging, in the nose; this is followed by paroxysms of sneezing, more or less violent; the eyes are SYMPTOMS VEGETABLE AND ANIMAL PROTEINS 224c suffused and there is a copious flow of serum and mucus from the nose; there may be headache, flushed face, feverishness, a sense of fulness in the head and of constriction over the eyes. Later on there may be such swelling of the mucous membrane of the nasal passages as to almost completely block them, and the membrane may be very sen- sitive, even painful, also “water-soaked.” If the nasal discharge continues some time it may become distressingly profuse as well as sharp and irritating to the nasal openings and to the upper lip; this results in red- ness, sensitiveness, excoriation and cracking of the skin over which the fluid spreads, which is also aggravated by the frequent efforts to wipe it away. Breathing may be labored and the sufferer becomes impatient and irritable; he is more or less feeble and miserable, and finds himself quite unfit for the cares and responsibilities of daily life. Symptoms in “cat fear,” or “animal asthma,” etc.: Some persons experience much nervous excitement, with perhaps a choking or suf- focating sensation in the presence of certain domestic or other animals; this may occur even from merely entering a room or place recently occupied by such animal. It appears that the effects, either way, is due to the proteins of the epithelial scales, hair-scales, or other scales cast off by or issuing from the animal. These proteins floating in the air and inhaled or similarly incorporated by a sensitized person poison him. It then is not a hysteria but a nervous disturbance of a toxic character. 'Such a disturbance may also be referable to the scale-proteins from the feathers or skin of a bird, such as a parrot, or a canary, or a sparrow, etc., or to epidermal, hair-scale or other proteins from other creatures. The disturbance may range from a simple aroused conscious- ness or sense of aversion, antipathy and dread with excitement, to great irritability, roughened skin, chills, cold perspiration, nausea, vomiting, diminished heart action, difficult breathing, a sense of chok- ing or smothering, air-hunger, etc. TREATMENT Ordinarily, the most successful method of identifying the respective poisonous protein or proteins, and definitely treating the actual cause, is to vaccinate the afflicted individual with solutions or extracts of various suspected proteins until the wheal-like, inflammatory skin reactions indicate the poisonous protein or proteins. These vaccina- tions are made into the skin. When the identification is complete, the individual is therapeutically (hypodermically) inoculated with graded doses of an extract or solution of the pollen or other of- fending protein, given at certain intervals, usually one to three times a week, for several weeks. To determine the degree of sensitiveness scratches are made on the skin and to these is applied a 25%, 10% or even weaker dilution of the vaccine until just that dilution which gives r.o definite reaction is determined. That is to be the first phyodermic dose injecting a few drops only. Subsequent injections are of a few more drops and later a stronger dilution. These injections (therapeutic inoculations or vaccinations) stimulate the formation in the body of certain anti-bodies or neutralizing agents, which gradually become nu- merous and strong enough to successfully antagonize or overcome the assaults and injurious effects of the poisonous protein or proteins. Much skill and also good judgment is required in the successful in- terpretation of the various skin reactions and in the judicious em- A MANUAL OF TOXICOLOGY 224d ployment of the therapeutic or curative vaccinations. Commonly, in a pollen poisoning, it has been found advisable to repeat these therapeutic measures the next year, about two months before the beginning of the flowering season or pollination of the plant or plants causing the poison- ing, as a precaution against a return of the affection. In testing (by vaccinating) to determine the animal or bird protein causing the poisoning, the use of an emulsion or solution made from the dust of a room or place occupied by an animal or bird which it is suspected may be the cause, or made from the hand soilings resulting from stroking it, may afford the necessary information by showing whether such animal or bird is the source of the protein poisoning, i.e., of asthmatic-like attacks: and if so the necessary therapeutic (hypoder- mic) vaccination may then be instituted. The proper preparation of the various protein extracts requires much care and the best in the market is quite expensive. An antitoxic serum called pollantin has been prepared by injecting horses with pollen protein from certain plants. It is used by introducing one drop into the outer angle of each eye and one or two drops into each nostril each morning before rising. It has afforded temporary relief. Among other methods of relief in the “hay fever,” “summer cold,” “cold in the head” and asthmatic type of protein poisonings are the following: Various sprays of a neutralizing, alkaline, antiseptic or anodyne character, including boric acid, sodium salicylate, menthol, resorcin, hydrogen peroxide, Dobell’s, and Seiler’s solutions, etc. A solution of cocain, two to five grains, to the ounce of rose water, with or without ten grains of antipyrin, is helpful; but the cocain habit is easily induced. In uric acid conditions small doses daily of lithium and sodium, potassium, or magnesium salts, with dieting are beneficial. Hypercrophies, polypi, etc., must be remedied also. For excessive nasal secretion and obstruction, a spray of suprarenal extract, a dram in an ounce of Dobell’s solution. A mixture of the fluid extracts of white pine bark and witch hazel, two drams of each, and of calendula one dram, in two and one-half ounces of liquid albolene as a nasal spray, used every three or four hours, affords considerable relief. Camphor and menthol rubbed up together (without heat), each one dram, in liquid albolene, two and one-half ounces, used as a spray, likewise relieves. Capsules or tablets, each consisting of morphin 1/12 grain, atropin 1/500 to 1/300 grain and caffein 1/4 grain, given every two to four hours, relieve much. The morphin relieves the pain and irritability; both it and the atropin diminish the excessive secretions, and all three, improve the circulation and afford rest. Hoffman’s Ano- dyne, and spirit of chloroform, help some persons. A hypodermic in« jection of three to four minims each of adrenaline solution (1 to 1,000) and pituitrin, may be given if there is not too great vascular tension; i- usually affords prompt and intense relief. The inhaling of vaporized benzoin, camphor, etc., or inhaling the fumes of potassium nitrate, stramonium. or belladonna, lobelia, oolong tea or coffee each by itself or in combination with one or more of the others sometimes affordi; great relief in paroxysms. Various tonics and stimulants, arsenic, strychnin, etc., also various sedatives and oxygen, may be found useful, VENOM (See Snake). VIRUS (See Rabies). 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. If unfavorable symptoms occur, may be cramps in lower extremities; severe, persistent vomiting; collapse. SYMPTOMS: 1. 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- 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 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 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 min- utes, or %. teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every V2 to 2 hours), and Atropine Sulphate (1/120 grain hypodermically every )/2 to 2 hours), or Tincture of Belladonna (20 drops in water every J4 to 2 hours). Tincture of Digitalis (30 drops by mouth, or half as much hy- podermically, every 54 to 2 hours), or Digitalin TREATMENT: 226 A MANUAL OF TOXICOLOGY. (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), 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 — SABADIILA — CEVADIN — ZYGADEMUS (DEATH CAMAS). HISTORY s Usually taken by mistake. Veratrine sometimes used to commit murder. 1/16 grain Veratrine has caused dangerous symptoms. Death in 1 to 5 his. or several days. Recovery from 4 grs. Veratria. Death by paralysis of respiratory centres. 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; sight lost, 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 m 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 fill every io 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. 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 10 grains), or strong tea, or a decoction of oak bark (/4 oz.) ; or Pot. Permang. (10 to 15 grs. in a pint of water), to oxidize alkaloids. 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 % 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 y2 to 2 hours), Atropine Sulphate (1/120 grain hypodermically every x/2 to 2 hours), or Tincture of Belladonna (20 drops in water every y2 to 2 hours). Or to support: Tincture of Digitalis (30 drops by mouth, or half as much hypodermic- ally, every to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every y to I hour), and in- halations 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 by mouth or rectum help; also Strophanthin (hypod.) 1/120 grain. 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. Give Hyoscin with Opium (see 4) as a sedative, and Ergot (hypod.) to strengthen circulation. 4. Give Opium (Powdered Opium, 1 to 2 grains every y to 2 hours), or Laudanum (20 drops every y to 2 hours, or J/2 teaspoonful in gruel by rectum 228 A MANUAL OF TOXICOLOGY. as frequently), or Morphine Sulphate grain by mouth or hypodermically every /2 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). (See Arsenic, Phosphorus, Strychnine, Mercury, etc.). VERMIN KILLERS. VOLATILE OILS: OIL OF CEDAR, ETC. (Treat as in Savine poisoning.) WOORARA. (See Curare). WHITE PRECIPITATE. (See Mercury Compounds). WOUNDS, POISONOUS (POST MORTEM, s DISSECTING, ETC.). 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, 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 hrs. Infrequency of fatal result from Zinc Sulphate is 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. 1. 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 (1/10 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 (l/2 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 (p2 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. 1. 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. F. —Physostigma (Physostigma Venenosum); Calabar Bean; Ordeal Bean. I. 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. O.—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. 1. 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). n. Digitalis (Digitalis Purpurea) ; Purple or American Foxglove ; Lion’s Mouth; Fairy Fingers ; Dead Men’s Bells. N.—Gelsemium (Gelsemium Sempervirens); Yellow JasF\ine; Woodbine; Even- ing Trumpet Flower. 1. Branch (flowering). 2. Calyx and Pistil. 3. Corolla and Stamens. 4. Fruit. 5. Branch (fruiting). O"—Lobelia (Lobelia Inflata); Wild or Indian Tobacco; Fmetic 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 f'om 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 upp.rr pa«"t of stem of immature plant. 6. Same, of mature plant. 7. Four spores x 200 + . Fig. 8. Variety: Hortensis—immature plant. 9* Mature. 10. Four spores x 2004*. 1Poison Amanita, Death Cup (1 to 4. Amanita Phalloides). 1. Plant with whitish cap partly expanded. 2. Fully expanded. 3. Mature plant (vert. 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+. “• Nux Vomica (Strychnos Nux Vomica); Vomit or Poison Nut; Dog Poison ; a sbane, 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. I . Poke (Phytolacca Decandra); Poke Weed, etc. 1. Branch. 2. Fruit (single showing carpels). & . U.—Poppy, Opium Poppy (Papaver Somniferum); Thebaica. I. Ovary (with some stamens remaining). 2. Ripe Capsule. 3-4. Seeds. 5. Branch. 6. Capsule V.—Rhus i RJtu5 Radicans, ) Poison Ivy; Poison Oak.—(Rhus Ver- VV7 1 . us Toxicodendron f nix, Poison Sumach.) , ’ 1 °bacco (Nicotiana Tabacum). 1. Plant in flower. 2. Capsule. 3. Ripe capsule opening at top. 4. Capsule (transverse section). j: p‘. e,rfV"u,71 \ir*ie CVeratrum Viride); American Hellebore; Devil’s Bite; I11- dun Poke; flch Weed; Bugbane. .. Root. 2. Flower. fnnpne'rh Marilandica); Pink Root. 1 Flowering stem. 2. Corolla oneneHi Ovary with part of style. 4. Fruit and calyx. 5. Same (one cell opened). 6. Ovary (trans. sec.). 7. Root stock and stem. rophanthus (Strophanthus Hispidus). Illustration: seed with comose awn. PRINCIPAL POISONOUS PLANTS, ETC (Unaccompanied by names, as identification test). Referred to in foregoing. (See page 224.; 232 A MANUAL OP TOXICOLOGY PRINCIPAL POISONOUS PLANTS, ETC. 233 234 A MANUAL OF TOXICOLOGY. PRINCIPAL POISONOUS PLANTS, ETC. 235 236 A MANUAL OF TOXICOLOGY, PRINCIPAL POISONOUS PLANTS, ETC 237 238 A MANUAL OF TOXICOLOGY, PRINCIPAL POISONOUS PLANTS, ETC. 239 240 A MANUAL OF TOXICOLOGY. PRINCIPAL POISONOUS PLANTS, ETC. 241 242 A MANUAL OP TOXICOLOGY. PRINCIPAL POISONOUS PLANTS, ETC. 243 COBRA DE CAPEQ.O PER DE-LANCE 244 A MANUAL OF TOXICOLOGY. HEAD OF RATTLESNAKE ('ll®. 3Elf* JFfnA VjiPit 4poison ) RATTLESNAKE RATTLE OF RATTLESNAKE (SNAKE I4YR5 0LO) TARANTULA SCORPION SPANISH FLIES ENCYSTED ■TRICHINA KEY TO CONSTITUENTS 245 KEY TO CONSTITUENTS of Various Patent, Proprietary and General Preparations [Note! The KEY is indicative of the reported, reputed, proved or probable, 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, or otherwise reported by, or through the American Medical Association, the British Medical Association, The Druggists Circular, The American Druggist, The Western Druggist, The National Druggist, The Medical World, The Medical Record, The American Journal of Pharmacy, and other sources of information such as Beasley’s Druggists’ Receipt Book, Street’s Patent and Proprietary Medicines, Oleson’s Secret Nostrums and Systems of Medicine, Reports of the New York, Massachusetts, New Hampshire, Kansas, Indiana, Louisiana and other boards of health,_ etc., have been carefully consulted in this compilation; quite recently and most serviceably, also, Nostrums and Quackery, Vol. II. (pub. 1921), by Dr. Arthur J. Cramp, Director, Propaganda Department and Bureau of Investigation, of the Journal of the American Medical Association. 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- ing the ingredients; etc.) Upon reference to the Key it may be apparent that: certain preparations, commonly supposed to be potent, or harmful, are not so, at least not now, and perhaps were never found to be so; or, that a certain min- eral water or salt is chemically unsuited for use in the specific emergency; etc. The attendant upon a case of sup- posed poisoning must painstakingly determine if such a con- dition truly exists, and if so, its probable cause, then treat accordingly.] Anesthetics (Local).—They commonly contain or consist of 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. Agnew’s Catarrhal Powder [Anglo-American Catarrhal Powder] (cocain, boric acid, menthol, sodium benzoate, sodi- um bicarbonate). Ascatco (Opium-arsenic preparation, etc.) Az-Ma-Syde (cocain 4.5 gr. per fluid oz., odor of thymol, wintergreen, phenol). [Tablets: acetanilid.] Birney’s Catarrh Powder (cocain, hydrochl., 1%%; men- thol, eucalyptol; sodium benzoat; sodium bicarb.—Conn. Kept., 1909). A MANUAL OF TOXICOLOGY 246 Blosser’s Catarrh Remedy (chamomile flowers, aniseed, cubeb and pepper—1912.) Brodie’s Liniment for Asthma (oils of stillingla, cajeput, lobelia; alcohol). Electric Catarrh and Asthma Cure (cocain). Hair’s Asthma Cure (potassium iodid). Haye’s Asthma Cure [7 remedies] (“No. 781”: oils of tur- pentine, peppermint, etc.) ; (“T. I. Q.”: iodids). Himrod’s Asthma Cure [or Powder] (lobelia, 2 oz.; stra- monium leaves, 2 oz.; saltpeter, 2 oz.; black tea, 2 oz. All powdered).—Oleson 1903 (quoting “Covert”.) Jayne’s Asthma Remedy (saltpeter, powd. belladonna or stramonium leaves, veg. matter). Lane’s Catarrh Cure (phenol, salt). Lenox Catarrh Cure (alum, zinc sulphate, lead acetate; pot. permang.) Nyal’s Catarrhal Balm (chlorbutanol, 2 grs.; lanolin, menthol, oil eucalyptus—Idaho San. Insp. Rept., 1912.) Rexall Catarrh Jelly (mfr. claims camphor, menthol, euca- lyptol—Street.) Rexall Catarrh Tablets (mfr. claims: boric acid, thymol, menthol, eucalyptol, benzoic acid.—Street). Ruby Catarrh Powder (cocain—Mass. Bd. Hlth., 1908). Sage’s Catarrh Remedy (golden seal, borax, salt, phenol) Schiffman’s Asthma Remedy (pot. nitrate, leaves of stra- monium, belladonna, mullein, etc.) 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 Pastes,— (Commonly: arsenic, with or without zinc sulphate or chloride; or chromic acid; or antimony chloride). 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). .Curry Cancer Cure [14 preparations]. (Among them, a White Solution”—4% cocain; a “White Powder”—25% acetamlid; “Liquid Poppy”—opium; “Wash” & “Tonic(s)”— 9% to 20% alcohol.) Miller’s Cancer Cure (acetanilid). Mixer’s Cancer and Scrofula Syrup [In 7 packages] )„®yruP> potassium iodid, methyl salicylate, alcohol, etc.), ( Cancer Paste,” camphoraceous oils, hyoscyamus-like or belladonna-like substances). Cosmetics and Related Preparations. Absorbit (acid boric, magnes. carb., calcium carb., alum). Amarol (epsom salt, 90%; borax 10%). Anti-Freckle Lotion (corrosive sublimate, 1% %; alcohol, 2%; water, 96%%). intment (ammoniated mercury, 12%; zinc Bradford’s Enameline (zinc oxide). TY,k^ro'oi*r^/ s Face Bleach (corros. sublim., 23%%; com- mon salt, 9%%; magnes. sulph., 45%%). KEY TO CONSTITUENTS 247 Calocide Compound (alum, borax, tannic acid, common salt). Captol (chloral, tannic acid, tartaric acid). Cerol (borax, stearic acid). Dr. Charles Flesh Food (zinc oxid, 2%; acid stearic, 1 1/6 %; vaseline, 51%; starch, 38%%). Circassian Cream (corrosive sublimate). Clearola (sulphur). Complexion Powder (bismuth, subcarbonate). Curticle Acid (acid oxalic, 2%; alcohol 10%; water). Delol (barium sulphate and sulphide, sulphur, calc, carb., zinc oxid, starch—Ind. S. B. Hlth.) Eugenie’s Favorite (lead carbonate). Flake White (lead carbonate). Flowers of Oxzoin (zinc oxid, 15%%; glycerine, 16%%; rose water, 68%;—variations). Freckeless (ammoniated mercury) [white precipitate, “a powerful caustic poison”] (12% bism. subnit., 10% vaseline). French’s Grease Paint (calcium and zinc oxide). Gouraud’s Oriental Cream (calomel). Hagan’s Magnolia Balm (zinc oxide). Hill’s Freckle Lotion (corrosive sublimate). Kalydor (potash, mercuric chlorid). Kingsbery’s Freckle Lotion (corrosive sublimate). Kingsbery’s Freckle Remover (corros. sublim.) Kintho Beauty Cream (ammoniated mercury, bismuth subnitrate, borax). Lac Virginis (benzoin). Laird’s Bloom of Youth (calcium, zinc oxid). Magic Face Lotion (boric acid, alcohol, 6.4%). Malvina Lotion (corrosive sublimate, zinc carbonate, emulsion of almonds). May-A-Tone (borax 3 to 25%; epsom salt, 50 to 97%). Mercolized Wax (ammoniated mercury, 10%; zinc oxid, 10%; petrolatum or paraffin base, 80%). Mme. Ruppert’s Face Bleach (corrosive sublimate, 2/5%; benzoin; alcohol). Milk of Roses (mercuric chlorid). Neroxin (borax, 55%; soap, 25%). Othine (ammoniated mercury, 11.5 to 23%; bismuth sub- nitrate, 7%%). Pearl White (bismuth subnitrate). Perspiro [similar to the old Thiersche’s Powder] (acid salicylic, gr. 10; acid boric, dram 1%). Pimple Lotion (carbolic acid, tannic acid). Phillip’s Face Lotion (methyl, i.e., wood alcohol, 11%; ethyl, i.e., grain alcohol, 38%%; etc.) Rexall Tan and Freckle Lotion (corros. sublimate). Riker’s Face Powder (calcium, zinc carbonate). Saunder’s Face Powder (zinc oxid). Snow White Enamel (lead carbonate). Snow White Oriental Cream (lead carbonate). [Note: Many face powders are composed chiefly of a starch, such as rice, wheat or potato starch, and of a talcum powder; these are perfumed and tinted a rose color. Some contain zinc oxide or bismuth oxychloride or some other basic salt of bismuth. The coloring matters are carmine for pink or flesh tint; burnt umber, burnt sienna, bole, car- mine and yellow ochre for a Rachel or brunnette tint.] 248 A MANUAL OF TOXICOLOGY Stillman’s Freckle Cream (ammoniated mercury, 20%). Thompson’s Wrinkle Lotion (alum, glycerin, water). Tiz—Apparently approx.: alum, 60; acid tannic, 10; acid salicylic, 5; talcum, 5; starch, 20%). Cough “Cures,” Consumption “Cures”; etc. Allen’s Lung Balsam (opium, lobelia, blood root; etc.). Dr. Seth Arnold’s Cough Killer (morphin). Ayer’s Cherry Pectoral (approximately: morphin acetate, wines of antimony and ipecac; etc.—P.M.&S.J.) (“Non-alco- holic revised formula,” printed on label.) Barker’s Cough Remedy (pot. iodid, methyl, salicylate, creosote). Black’s Pulmonic Syrup (water—alcohol, sol., ichthyol, glcerin, sugar. Alcohol 15.2%—1916.) Bosanko’s Cough and Lung Syrup [formerly Cure] (chlor- oform, alcohol, morphin, ammonia, syrup of tar, honey—No. Dak. Bull., 1911.) Boschee’s German Syrup (“opium or morphin”). Brompton Consumption and Cough Specific (approx, liq. ext. ipecac, tr. opium, treacle, water.) Brown’s Bronchial Troches (conium, cubebs, acacia, licor- ice, sugar). Bull’s Cough Syrup (“morphin sulphate, gr. % in one ounce.” Another report: codein about % gr. to the ounce.). (Ammon, chloride, alcohol 5%—1914.) Cherry Balsam (a “consumption cure” labeled “harmless.” Analysis showed opium, alcohol, bitter almond oil). Child’s Cough Mixture (syr. squill,- wine of ipecac, tr. camph co.) Coe’s Cough Balsam [Lloyd’s Specific] (opium, ammon. chlorid, ipecac; salicyl. and benzoic acids; etc.) Crosby’s Balsamic Cough Elixir. (An analysis showed chloroform, sulphuric acid, acetic acid, etc.) DeWitt’s One Minute Cough Cure (salicylic acid, chloro- form). Dr. Drake’s German Croup Remedy (opium). Duket Consumption Cure (“A glycerine solution of guaia- col carb., ac. salicyl., sod. bicarb., pot. carb., and small am’t nitric acid—A.M.A., 1914). Gowan’s Pneumonia Cure (camphor, opium, carbolic acid, turpentine, quinin, stearin, lard). 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.) Jones’ Grip and Cold Tablets (acetanilid 2.44 grs. per tab- let, or 50%.—Conn. Rept., 1908). Keating’s Cough Lozenges (“morphin, ipecac”); or (“ipe- cac, lactucarium, squill, ext. licorice, sugar, mucilage of tragacanth”). Kennedy’s Laxative Cold Tablets (capsicum, camphor, podophyllin, cinchona—Kan. Bd. Hlth., 1913). King’s New Discovery for Consumption (morphin, chloro- form, pine tar). Kurakoffi (ac. salicyl., oil sassafras, turpentine). One Day Cough Cure (morphin, Indian hemp). .['so s Cure for Consumption (morphin, tartar emetic, chloroform, Indian hemp, lobelia, etc.—Oleson, 1903, quoting KEY TO CONSTITUENTS 248a New Idea.) [Later: Piso’s Cure. Piso’s Remedy for Coughs and Colds] (Indian hemp, chloroform). Sedatole (heroin, squill, sanguinaria, wild cherry, balm of Gilead buds—Drug. Circ., 1917). Sabine’s Indian Vegetable Cough Balsam (tar, resins, chloroform, alcohol, sugar, traces of alkaloids, flavored with aromatics-—A.M.A., 1920). Seelye’s Cough and La Grippe Remedy (alcohol, chloro- form, tar, sugar, syrup, plant material—A.M.A., 1919). Shiloh’s Consumption Cure (heroin % gr., chloroform 2y2 min.; per fluid ounce. Also glycerine, oil of tar, terpin hydrate, peppermint, ext. lobelia, ext. licorice; etc.—Analy. 1908.) Smith Bros. S. B. Cough Drops (essentially charcoal and sugar flavored with oil of sassafras—N. H. Bd. Hlth., 1913). St. Jame’s Society Opium Cure (morphin, caffein—Mass. Bd. Hlth., 1904). Stoke’s Expectorant (paregoric). Van Wert’s Balsam for the Lungs (morphin 0.18 gr. per fl. oz., ammon. chlorid, alcohol, chloroform—1916). Victor Lung Syrup (opium). White Pine compounds for coughs and colds (commonly morphin, chloroform, etc. Sometimes contain as many as 15 ingredients). Wistar’s Balsam of Wild Cherry (opium, ipecac, squill, tartar emetic). [Consumption “Cures”.—Commonly one or more of: Mor- phin, 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.] Zaegel’s Lung Balsam (alcohol, water, sugar, a laxative and oil of peppermint.—A.M.A., 1920). Hair Dyes, “Tonics,” etc. Various kinds of hair restora- tives contain lead. Absorbit (boric acid, magnes.carb., alum., calc. carb.—Ind. State Bd. Hlth.) A. D. S. Hair Reviver (alcohol 26%, glycerine, quinin, pilocarpin, salicylic acid, menthol). Allen’s World’s Hair [and Color] Restorer (lead, sulphur). Ambrosial Hair Tonic (wood alcohol 48%—Drug. Circ., 1915). Ayer’s Hair Vigor (lead acetate, sulphur). Ayer’s Recamier [Balm also “Cream”] (corrosive sublim., perhaps zinc oxid). Barbo Compound (lead acetate, sulphur, Glauber salt, calcium chlorid, salt, water—Conn., State Chemists, 1915). Bordet’s Hair Tonic (carbolic acid, tincture nux vomica). Cactico Hair Tonic (borax, capsicum, oil of rose, alcohol, glycerin). Canthrox (borax, baking soda, soap). Capillaris (Mansfield) (a salve of corros, sublim., sulphur, zinc oxid, borax and petrolatum—Drug, circ., 1915). Capitol (chloral, ac. tannic, ac. tartaric, fixed oil,—probably castor oil,—alcohol 65.9.—A. M. A., 1910). Chevalier’s Life for the Hair (“contains much lead”—Mass, Bd, Hlth.. 1902). 248b A MANUAL OF TOXICOLOGY Danderine (dil. alcohol—glycerin solution of boric acid, salicylic acid, resorcin, capsicum, perhaps cantharidin), Eau de Quinine Hair Tonic (alcohol 72; borates, large amount—No. Dak. Rept., 1905). Eau Sublime (similar to “Mrs. Potter’s Walnut Stain ” etc.) Echo Antiseptic Hair Tonic (grain and wood alcohols). Egyptian Hair Tonic and Dandruff Cure (large amount wood alcohol—1906). Exelento-Quinine Pomade (petroleum, liquid paraffin, sul- phur, trace of quinin, oil, wintergreen a trace). Parr’s Gray Hair Restorer (ammoniacal solution of silver equivalent to about 7 gr. silver nitrate to 3% ounces of the preparation). Goldman’s Gray Hair Color Restorer (silver nitrate). Green Mountain Hair Restorer (lead acetate, sulphur). Hall’S Vegetable Sicilian Hair Renewer (lead acetate, sul- phur—N. H. Bd. Hlth. 1907). Hays Hair Health (glycerin-water, sol. of lead acetate, with free sulphur—Conn. Agr. Experim. Sta., 1915). Kathairon (tr. canthar, oil bergamot, glycerin, aq. ammon., castor oil, oil cloves, alcohol (perhaps wood). La Creole Hair Dressing (lead acetate, sulphur, glycerin, alcohol and water—Analys. La. Chem.) La Tosca Hair Tonic (98.5% wood alcohol). Leslie Co.’s Hair Wash (common salt, 47; borax, 47; sod. salicyl., 6.—1915). Magic Hair Tonic (common salt, alcohol). Parker’s Hair Balsam (lead acetate, sulphur). Pinau'd’s Eau de Quinine (alcohol (by vol.) 67; solids (chiefly resin, similar to benzoin) 0.18; quin, sulph., minute trace; essential oils, very small amount.—Hiss. Thesaurus of Prop. Prep., 1899). (Alcohol (by vol.) 66; quin, or cin- chona alkaloids, 0.02.—Journ. A. M. A., 1913). Porto Rican Hair Growing and Dandruff Removing Co- coanut Oil (essentially cotton seed oil colored with caramel —La. Quart. Bull., 1916). Mrs. Potter’s Walnut Juice Hair Stain [later—“Hair Tint”] (active principle of the dye a pbenolic compound—con- formed to tests for paraphenylene diamin—a poisonous and dangerous chemical). Rexal Hair Tonic (boric acid, wood alcohol—Ind. Bd. Hlth. Rept., 1913). Seven Sutherland Sister’s Hair Grower (borax, quinin, al- cohol). Skinner’s Dandruff Mixture (chloral). Well’s Hair Balsam (lead acetate, sulphur, glycerine). Westphaul’s Auxiliator (borax, wood alcohol (by vol.) 10.96, alcohol total, 54.8; solids largely glycerin 3.56.—N. H. Bull. Hlth., 1907). (Conn. Rept., 1914, similar.) Wyeth’s Sage and Sulphur Hair Remedy (lead acetate—La. analys.) Headache Preparations, etc.—Headache powders common- ly contain: acetanilid or antipyrin, or phenacetin, or aspirin or some other analgesic, perhaps cocain; and such frequent- ly . associated with caffein or camphor monobromate, an«ri tncarbonate of soda, or sodium salicylate. In fact “headache cures” and “anti-pain” “remedies” in general depend for their results on “one or another of the coal-tar drugs, acentanilid, acetphenetidin (or phenacetin), antipyrm, etc., which depress the heart.” They “injure the blood and produce a habit.” Samuel Hopkins Adams, in the Collier crusade, advised the ,® regarding the “drug-store-vended ‘headache cures’ anti-paui remedies,” containing acetanilid, as follows: t;~aKe na nostrum of this class without a doctor’s prescrip- are sure contains no acetanilid Make you- •He is responsible. A suit for dam- f(vn nil^L.recently heen won against a New York drug store lp„„, Linimeni; (turpentine, caustic soda, essential oils, KEY TO CONSTITUENTS 248e Classe’s Great Penetrating Liniment (alcoholic solution of: ammonia, chloroform, opium, camphor, oils of sassafras, or- ganum and thuja; alcohol 64%; chloroform 35.3 min. per fl. oz.) Fluid Lightning (aconite); (another of the reputed form- ulas: oil of mustard, cajeput, cloves and sassafras each 2 fluid drams, ether 1 fluid ounce, laudanum iy2 fluid ounces, alcohol 20 fluid ounces). Dr. Grove’s Anodyne for Infants (essentially a sugar syrup, flavored with oil of spearmint and containing 1-7 gr. morphin sulph. to each fid. oz.—A.M.A., 1919). 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). Jones’ Liniment (essentially, gasoline solution of oleoresin capsicum, oil sassafras, methyl salicylate, volatile oil, mus- tard.—1916). Liniment of Opium (Brit.) (tincture of opium and soap liniment equal parts). “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.) Parson’s Liniment (tar oil, kerosene). Sloan’s Liniment (essentially: turpentine, a light oil sim- ilar charac. as kerosene or coal oil, oil sassafras, oleores. capsicum, and appar. pine oil.—N. & Q.—Cramp, 1918. Thomas’s Electric Oil (chloroform, camphor, catechu, opium, oils of hemlock, wintergreen, origanum, sassafras and turpentine; alcohol). Thompson’s Liniment (menthol, camphor, oil turpentine, oil eucalyptus, chloroform tr. capsicum, methyl, salicyl., liqd. petrolatum). 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). Pain Preparations. Caldwell’s Anti-Pain Tablets (acetanilid 51.4; caffein, 12.3; corn starch 23.2; and camphor—1912). . Chlorodyne or Chloranodyne (an old formula: Chloroform 1 dram, morphin 5 grains, ether y2 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 formulas 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 y2 fluid dram, oil peppermint 12 minims, chloroform 1 fluid ounce, dilute hydrocyanic acid 2 fluid drams, glycerine enough to make 8 fluid ounces. Mix. Dexter’s Headache and Antipain Powders (acetanilid, caf- fein, sodium salicylate). Fosgate’s Anodyne Cordial (paregoric, ginger, rhatany. rhubarb). Green Mountain Oil (Magic Pain Destroyer) (oils sassa- fras, turpentine, thuja?, camphor?, linseed oil). Lindsey’s Pain Cure (capsicum, camphor, chloral, chloro- form, ether, oils of hemlock, cinnamon, sassafras, cloves, cedar, origanum, wintergreen. 248f A MANUAL OF TOXICOLOGY Miles’ Anti-Pain Pills (acetanilid 1.96 grs. and caffein 0.32 gr per pill; sod. bicarb., starch). Monroe’s Neuralgia Tablets (sod. brom., acetanilid, morph, sulph., gelsemium—Kan. Bd. Hlth., 1910). ptr?yEDlvis^sC Pain-Killer (opium, camphor, capsicum) ; or tSot camphor, tr. capsicum, tr. guaiac, tr. myrrh, alcohol). Po'pe?s Cure for Neuralgia (conium, potassium xodid). TinrtwaVs Ready Relief (ammonia, capsicum). Scholnfeld* PaTn Relief (chiefly kerosene with some oils of sassafras and mustard; cayenne pepper. Kan. Bd. Hlth., 1912). Vermifuges. , .. Brown’s Male-Fern Vermifuge (FI. ext. male fern, oil W Worm Syrup (santonin, cascara, sod. bicarb., oil of anFaetaeCstock’sReVermhuge (reputed ingredients: oils of wormseed, anise and turpentine; tincture of myrrh, and cas- tor oil). . Freeman’s Vermifuge Oil (pink root, oils of wormseed and turpentine; hydrastin, castor oil, syrup of peppermint). Hand’s Worm Elixir (santonin, emodin, oil peppermint, alcohol, 10.2.—Conn. Rept., 1914). Jayne’s Tonic Vermifuge (sodium santonate, pink root, jalap, erigeron, turpentine—Oleson). Kennedy’s Worm lyrup (santonin). Kennkle’s Vegetable Worm Syrup (santonin, pink root). Kickapoo Indian Worm Killer (0.5 gr. santonin per tablet). Low’s Worm Syrup (santonin 4.2 gr. per fl. oz.; genna?; alcohol 11%). Notkin’s Worm Syrup (santonin, senna, alcohol). Nyal’s Worm Syrup (santonin). Pleasant Worm Syrup (santonin, cascara sagrada, sod. bicarb., alcohol). Proctor’s Vermifuge (santonin, pink root). Rexall Worm Syrup (santonin, pink root, senna, potass, hydroxid, oil wintergreen, glycerin, water—Street). Vermin Killers. Battle’s Vermin Killer (“23% strychnin, Prussian blue, sugar, and flour). Butler's Vermin Killer (strychnin 5%, soot and flour). Gibson’s Vermin Killer (% grain strychnin in each pack- age). Simpson’s Vermin Killer (arsenous acid 40%, mixed with malt and starch). [Some vermin killers contain phosphorus or arsenic with or without ground glass.] Miscellaneous. “A. C. E. Mixture” (alcohol 1, chloroform 2, ether 3, parts). Abernethy’s Pills (blue pill 2 gr., co.ext. colocynth, 3 gr.) A. D. S. Fruit Laxative (phenolphthalein, tamarind pulp, cassia fistula, fig pulp, gingerin, aromatics). . Aletris Cordial (alcohol 28%, aletns, helomas, scrophu- laria). Alkalol (pot. chlor., pot. bicarb., eucalyptus, spearmint, cinnamon, vanilla, acid salicylic, acid boric). Allan’s Anti Fat (pot. iod., salicyl. acid, glycerin, fL ext- bladderwrack). KEY TO CONSTITUENTS 248g Allan’s Restorative Tonic (alcohol 33%). Alophen Pills (aloin, strychnin, ext. belladon. leaves, powd. ipecac, phenolphthalein). Alpha-Lax (magnes. sulph., pot. chlorid, acid tartar., sod. bicarb.) Alypin (“local anesthetic;” “closely related to stovaine;” “claimed to be equal to cocain.” Used externally in 10% sol.; hypoderm. 1 to 4% sol. Has poisoned.) Ambition Pills (iron, aloes). Anadol (acetanilid, 79; caffein; sod. bicarb., 20—A. M. A., 1910). Analgine Tablets (aicetanilid). oxydendron, arboreum, abbucus canadensis, urginea scilla.df Anasarcin (Winchester, Tenn.) (Tablets: claimed to con- tain active principles of oxydendron arboreum, sambucus canadensis, urginea scilla. Elixir: claimed to contain active principles of oxydendron, sambucus, hepatica, and potassium nitrate—A. M. A., 1907). Anedemin (Chattanooga, Tenn.) (claimed to contain Iso- lated active principles of strophanthus, apocynum, squill and sambucus chemically combined.—Similar to "Anasarcin”— 1907). Anticalculina Ebrey (essentially, alcohol 28.8% by vol., colchicin, ammonium salts, vegetable extractives, water— A.M.A., 1920). Antidipso (pot. brom.) Anti-Grippine (acetanilid 1.77 gr. per tablet.—Ind. Bd. Hlth., 1915). Anti-Growl (acetanilid). Antineurasthin (“A mixture of egg yolk, milk sugar and gluten, with small amounts of starch, dextrin and aromat- ics.”) Antiphlogistine (a clay poultice practically identical with Cataplasma Kaolini, U. S. P. The official poultice contains kaolin, boric acid, thymol, methyl salicylate, oil peppermint, glycerin). Anti-Plug—Appar., bruised gentian and licorice roots, bound together into plugs with tobacco leaves by means of pressure—Oleson, 1903, quoting from “Western Drug.”) Aphlegmatol (appears, upon analysis, to be merely a con- centrated solution of glucose—1920). Arthur’s Sexual Tablets (iron, calc, carb., podophyllin-like drug, aloes, buchu, pepper, capsicum, cinnamon, small amount pepsin—1917). Ascatco (opium, arsenic, pot. cinnamate). Athlophoros (pot. acetate, sod. salieyl.) Ayer’s Ague Remedy (“non-alcoholic revised formula” contains quinin, ginger, cinnamon, cloves, peppermint, orange peel, glycerine, water). Ayet’ S Pills (aloes, ginger, jalap, colocynth, podophyllin, gamboge, oils of peppermint and spearmint). Aspirin [Acetylsalicylic Acid]. Acts like salicylic acid and salicylates. Often used in doses of 5 to 15 grs. repeated once in 3 hrs. until ears ring, producing its full effects. Atwood’s Jaundice Bitters (22% alcohol). Ayer’s Recamier Moth and Freckle Lotion (corrosive sub- limate). Ayer’s Vita Nuova (cocain, alcohol—Oleson quoting Drug. Circ.) Ayer’s Sarsaparilla (“FI. exts. sarsaparilla, stillingia, yel- low dock, May apple; potassium iodid 3.4 grains per fluid ounce; iron iodid, glycerine or sugar”.). New formula on label. 248h A MANUAL OP TOXICOLOGY Baby’s Soothing- Syrup (morphin 1/20 gr. per fl. oz., alcohol, 10%.—N. H. Bd. Hlth., 1916). Bacterol (cresols 50%, potash soap). Ballard’s Wonderful Golden Oil (oil peppermint, 2.9; methyl salicyl 0.95, linseed oil 96.15, veratrin—1916). Balm of Figs Compound (ichthyol, alum, boric acid). Balsam of Life (Cook’s) (camphor, borax, water, etc.— Drug. Circ., 1916). Bateman’s, Pectoral Drops (tinctures of opium, opium ben- zoated, and Canada castor with ground cochineal ), (or, like “Pectoral Tincture, N. F.”) Bactley’s Solution (50% stronger than laudanum). Beecham’s Pills (aloes, ginger, soap.—Anal., 1914). Bell’s Pa-pay-ans [Bell-Ans] (Essentially ginger, char- coal, sodium bicarb., saccharin, oil wintergreen). Bengue’s Balsam [Baume Analgesique Bengue] (menthol 18, methyl salicyl, 20, lanolin 54, lard 8.) Betul-Ol (menthol, 2%; 2% of chloral in methyl salicyl- ate). Big G 'Injection (similar to berberin hydrochl. 15 gr.; zinc acetate, 15 grs.; glycerin 14 dr.; water q. s., 8 oz.—Drug Circ.) (Essentially a watery sol. of boric acid and berberin —A.M.A., 1919). Bile Beans (aloin, cardamon, perhaps colocynth). Black Cloud Healing Mixture (corros. sublim, loz.; oil of tar, 1 gal.; turpentine, 1.5 oz.; phenol 5 oz.; wood alcohol, 1 g-al.—No. Dak. Kept., 1911). Black Drop (Brit.) (4 times as strong as laudanum). Blair’s Pills (Gout and Rheumatism) . (Colchicum, alum). Bloodine Blood and Kidney Tablets (methylene blue, hexa- methylenamin and salicylates.—1916). Blue Bell Bright Sunshine Tablets (arsenic, damiana, zinc phosphide, nux vomica, cantharides, glycerine, corn starch). Boracetine similar to Antiseptic Solution (N.F.) with “a dash of formaldehyde.” Bowden’s Indian Balm (lard, tallow, cocoanut oil, rape oil, oil eucalyptus, ess. oil camphor, ess. oil lemon, lanolin, bal- sam Peru,terebene, sol. ammon.) Boys’ Friend (solution—zinc sulph., boric acid, hydrastin, Pills.—iron oxide, powd. cubebs.—Ind. Bd. Hlth., 1913). Brandreth’s Pills (“Ext. colocynth, aloes, soap, oils of pep- cinnamon, gum arabic and alcohol.”) Break-Up-The-Grip” Tablets (acetanilid). (on? 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 y8 gram, extract hyoscyamus % grain). 1916)OWn S 0od Treatment (pot. iod., a mercury comp’d.— Re^t°Win906)TeethinS Syrup (morphin, oil anise—No. Dak. ?71iiedy r Seasickness (sod. brom., 14.94 grs.; citric acid 2.71 grs. in 100 c.c.—A. M. A., 1909.) ®yrup ( iodide of mercury, potassium io- e-rqUtn1nt* Sc,Di?.inleci.11ns Flui strychnin, brucin.—No. Dak. Nerve Restorer (bromides of ammonium KEY TO CONSTITUENTS 248m Koenig’s Nerve Tonic (pot. brom., 30 sod. brom., 30; ammon. brom., 10; ext. vibum, prunif., 10; co. tr. valer., 130; glycerin, 30; water, 430 parts). Koko (borax, glycerin, formaldehyd, alcohol). Kopp’s Baby’s Friend (analysis showed % grs. morphin in 1 fluid ounce of the preparation—Analys., 1905. “Alcohol 8.5%. morph, sulph. % gr. to oz.”—1916. Kornol (collodion with ac. salicyl in alcohol and ether.—• Dr. Wiley). Kutnow’s Improved Effervescent Powder (claims to be composed of ingredients of celebrated Carlsbad spring— tartaric acid not present in natural Carlsbad water. A Ger- man analysis of Kutnow’s: Tartaric acid, 43.60; carbon di- oxid, 14.27; sulphuric anhydrid, 4.27; sodium oxid, 20.39; po- tassium oxid, 8.89; chlorin, 1.82.—A. M. A., 1907). Laird’s Rheumatism Formula (pot. iod., 120 grs.; sod. salicyl., 60 grs.; Rochelle salt, 1 oz.; wine colch. seed, 1 oz.; tinct. guaiac, 1 oz.; water 4 oz.—A. M. A., 1915). Lambert’s Wine of Coca (cocain). Lane’s Brain Relief (acetanilid, alcohol). Laudanum (Brit.) (Strength 1 gr. in 14 min.) Laxaphen (phenolphthalein, acid salicyl.) Laxative Bromo Quinine (phenacetin 2.19 grs. per tablet. —Ind. Bd. Hlth, 1915). Laxative Quinine Tablets (contain acetanilid). Laxatol (phenolphthalein). Lightning Hot Drops (chloroform (48 drops to the oz.), ether, capsicum, alcohol 60%—Report Journ., A. M. A., 1916-18). Lindley’s Golden Remedy (ammon. potass., and sodium bromids). Liquid Extract of Opium (Brit.) (22 gr. ext. opium in an ounce). Listerine (similar to Liquor Antisepticus, TJ. S. P.—boric acid, benzoic acid, thymol, eucalyptol, oil peppermint, oil wintergreen, oil thyme, alcohol, purif. talc., water). Louisenbad Reduction Salt (Queen of Beauty) (2/3 sod. sulph., 1/3 common salt.—Drug. Circ., 1915). Luxor (zinc oxid, boric acid). Lysol “Marketed in 1889; (obtained by boiling a mixture of heavy tar oils with fat or, resin and an alkali. It there- fore contains the alkali compds. of the cresols and of their superior homologues along with soaps.”—Witthaus.) Magic Eye Salve (zinc oxid, benzoic acid, petrolatum—• A.M.A., 1918). Magic Toothache Gum (chloral, phenol, oil of cloves, wax, cotton, etc.—No. Dak. Rept., 1908). Make-Man Tablets (strychnin, arsenic, aloes, potassium sulphate, iron). Manola (alcohol (by vol) 18.00; sugar, glycerine, traces calcium, magnes., iron, sodium, arsenic.—A. M. A., 1913.) McCorrison’s Famous Diamond Lotion (corros. sublimate). McGraw’s Liquid Herbs of Youth (essentially: epsom salt, senna, red pepper, quassia, alcohol, water, wintergreen flavor —A.M.A., 1920). Methylene or Bichloride of Methylene (anesthetic of chlor- oform, and methylic alcohol 20%). Mendenhall’s Number 40 for the Blood (pot. iodid, ammon. acet., cathartic resins, licorice, glycerin, sugar, alcohol, water—A.M.A., 1920). Mexican Oil (opium). Mile’s Restorative Nervine (bromids, benzoic acid). Modoc Oil (approx., benzine, 75 c.c.; methyl salicyl, 4.5 c.c.; oil sassafras, 6 c.c.; chloroform 0.2 c.c.; oil turpentine q. s. to make 100 c.c.—No. Dak. Rept., 1912). Mother’s Friend (opium); another, of Atlanta (soap, oil). 248n A MANUAL OF TOXICOLOGY Muller’s Famous Prescription (potass iodid, colchicin—1917). Munyon’s Kidney Cure [pills] (found to contain nothing but ordinary white sugar—A. M. A., Journ., 1907). Munyon’s Special Liquid Blood Cure (corros. sublim., 0.42; pot. iodid, 50.78). Musterole (oil of mustard 1.67; menthol; appar. camphor. A fatty base such as lard 89.17.—Conn. Rept., 1915-16).— (“Apparently contains wool fat as fatty base.”) Nepenthe (of about same strength as laudanum, and said to contain glucose and sherry wine). Neurosine (Mfr. claims for each fl. ounce: bromides of potassium, sodium, ammonium each 40 grs.; zinc bromid, 1 gr.; ext. lupulin, 32 gr.; fl. ext. cascara sag., 40 min.; ext. henbane, 0.075 gr.; ext. bellad., 0.075 gr.; ext. cannab. Ind., 0.600 gr.; oil bitter almonds, 0.060 gr.; aromatic elixirs—A. M. A., 1915). Newbro’s Herpiclde (wood alcohol, 44% to 52%; salicyl. acid, borax.—No. Dak. Bull., 1916). Newell Rheumatic Tablets (common salt, 20; sal ammon- iac, 80) , New Skin (flexible collodion with amyl, acetate.—Wiley, 1914). No-To-Bac (possibly licorice, gentian, ammon. chlorid and ginger made into mass with glycerin, tragacanth and syrup. —Oleson, 1903). Novocaine (“Local anesthetic similar in action to cocaine but said to be less toxic than other cocaine substitutes.” For infiltration anesthesia, 4 grains in 3 1/5 ounces normal salt sol., with 5 drops of 1:1,000, epinephrine sol. added se- cures sustained anesthetic effect.) (See Procain.) Nurito (phenolphthalein, 6; pyramidon, 60; milk sugar, 34. —A. M. A., 1912). Nuxated Iron (iron 1/100 gr., nux vomica alkaloids 1/1000 gr. in one tablet; aromatics). Nyal’s Coca Wine (contained cocain.—Mass. Bd. Hlth., 1907). Nyal’s Compound Extract of Damiana (contained cocain—• 1910). Nyal’s Compound Laxative Fig Syrup (epsom salt, veget. extractives). Nval’s Soothing Syrup (sod. bromid 16 grs. per fl. oz.; lupulin, ext. fennel?). Oil of Life (Joy of the World) (raw linseed oil, with oils of sassafras, hemlock, origanum, cedar, and gum camphor in solution.—No. Dak. Rept., 1910). Osborne’s Mixture for Epilepsy (pot. brom., 166 grs. in 1 oz.—Brit. Med. Assn.) Paine’s Celery Compound (alcohol 19% to 21% and vari- ous seeds, roots, barks, leaves; chamomile flowers, pot. ni- trate, glycerine, sugar). Palpebrine (morph, sulph., zinc sulph., corros. sublim., boric acid, salicylic acid). Pantopon (mixture of hydrochlorids of various opium al- kaloids). Pape’s Cold Compound (acetanilid, 13.1; phenolphthalein, 15.1). Paregoric (Paregoric Elixir—Brit.); 1 gr. in about y2 oz.) Petit’s Eye Salve (morphin). KEY TO CONSTITUENTS 248o Peacock’s Bromides (mfr. states: bromids of potassium, sodium, ammonium, calcium, lithium 15 grs. per fl. drm.; al- cohol 10%). Pebeco Tooth Paste (pot. chlorate, calc, carb., soap, methyl salicyl., menthol.—Wiley). Peeble’s Brain Restorative for Epilepsy (“Solution of am- monium, sodium and potassium bromids, combined with an alcoholic preparation of valerian, flavored with oil of bitter almond.”—1911). Perfection Cold Tablets (camphor, salicyl. acid, aloes, qui- nin.—Kan. Bd. Hlth., 1910). Perry’s Magic Remedy for Rheumatism (water, alcohol, solution of oil wintergreen and pot. iodid). Perspiro (Ac. salicyl., ac. boric.—A. M. A. 1908). Perspi-No. (boric acid, 20; ac. salicyl, 22; calc, carb., 10; talc., 42). ky). In 1906 owner notified to put some medicine in the preparation, or it could be sold only where liquor license was carried. A laxative was added; but that appeared to have materially injured its sale. Therefore later announced: “Old Peruna (now called Ka-tar-no) and sold as an alcoholic beverage.” [Alcoholic strengths: whiskey, bottled in bond, 50%; champagne 9 to 12%; claret 5 to 12%; beer 2% to 5, etc. %.] Pheno-Bromate (acetanilid, 50; pot. bromid, 50). Pike’s Liver, Kidney and Stomach Remedy (an acid astrin- gent solution; essentially: Epsom salt, ferric chloride, arsen- ous acid, hydrochloric acid, coloring matter, water.—A. M. A., July, 1920). Pink Pills (iron sulphate, sodium or potassium, carbonate, licorice). Pierce’s Favorite Prescription (opium, digitalis, savin). Pierce’s Golden Medical Discovery (opium, podophyllin. guaiac) or, (mfr. claims: golden seal root, queen’s root, stone root, black cherry bark, blood root, mandrake root, glycerin, borax, water). Pierce’s Smart Weed (opium). Pinkham’s (Lydia) Vegetable Compound (Said to closely resemble infusion or decoction of “life everlasting” plant; 15 to 20% alcohol). (Alcohol 16.32% by vol.), glycerin, lovage or angelica and possibly aloes or aloin and tansy: etc.—Conn. Rept., 1916). Plant Juice (alcohol (by vol.) 20%; glucose, aloes, licor- ice and possibly small amounts cascara or senna; etc.—A. M. A., 1916. Plantation Sarsaparilla (pot. iod., alcohol—A.M.A., 1918). Platt’s Chlorides (approximately: chlorides of aluminum, calcium, hydrogen, lead, mercury, sodium, zinc and alumi- num sulphate). Pluto Concentrated Spring Water (sulphates of calcium, magnesium, sodium; common salt, magnes. carb.) Poslam (zinc oxid, sulphur, acid salicylic, oil of tar, men- thol, corn starch, and probably petrolatum; perhaps lanolin and soft paraffin). Procain (Novocaine) commonly used in 1% sol., etc., as local anesthetic). Prunoids (phenolphthalein, cascara sagrada, slight quan. prunes, de-emetinized ipecac). Pulmonol (potassium guaiacol sulphonate, 5.7; sod. ben- zoat, 2.1; strych. sulph., 0.008). Queen Bee Injection ,cocain, zinc, magnesium, sulphates, traces potassium and sodium, glycerin.—La. Bd. Hlth. Rept., 1914-15). 248p A MANUAL OF TOXICOLOGY Radway’s Ready Relief (watery alcoholic solution of oleoresin, capsicum, camphor and ammonia. Radway’s Renovating' Resolvent (potassium iodid). Rat Exterminator (barium chloride, calcium sulphate, corn meal, or similar starchy meal—Ewe, in Amer. Druggist.) Ree’s Cholera Mixture (opium, chloroform, cloves). Reave’s Embrocation (olive oil, aqua ammonia, oil origan- um, Goulard’s lead extract). , _ Rexall Cold Tablets (phenacetin, 1 gr. per tablet.—Ind. B. H„ 1915). . , , Rexall Dyspepsia Tablets (mfr. claims pepsin, rhubarb, magnesia, bismuth, oil of cassia.—Street). Rexall Gastric Tablets (mfr. claims aloin, gentian and capsicum.—Street). Rheumacide (antipyrin, salol, citric acid, aspirin). Richie Drug Habit Cure (morphin, sulph., salicyl. acid, pepsin). Rival Herb Tablets (essentially: aloes, podophyllum res- ins. capsicum, buchu and plant extractives; coated with cal- cium carbonate and sugar although labeled “chocolate coated.”—A. M. A., Aug., 1920.) Roche’s Embrocation (oils of cloves, lemon, amber, olives); (also: “asafetida, alkanet, olive oil; oils of caraway, turpen- tine, wintergreen, pine needles, bergamot.”) Sabine’s Indian Vegetable Tea (similar to Green Mountain Herb Tea). Sage’s Catarrh Remedy (golden seal, borax, salt). St. Jacob’s Oil (chloral 1 oz., chloroform 1 oz., ether 1 oz., tr. opium %oz., camphor 1 oz., oils of origanum and sassa- fras % oz. each, alcohol % gal.), or, (ether, turpentine, car- bolic acid, capsicum, aconite, origanum, alcohol). 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.) Said to be intended to imi- tate Carlsbad salt. Sal-Sano (essentially :table salt, sod. phos., baking soda, Glauber’s salt—-A.M.A., 1920). Sanatogen (“Casein makes up about 95% of the prepara- tion.” Casein is commonly known as the curd, in milk, or as cottage cheese.) Sanford’s Woman’s Friend (pot. permang., alum, zinc sulph.; lead acetate?). Sanitas Disinfecting Fluid (terpenes, hydrogen dioxid present; chlorides, trace.-—No. Dak. Bull., 1913). Sanitol (An analysis showed salol, menthol, alcohol, for- maldehyd; perhaps common plantain present). Saprol (“contains 40% of cresols”—Witthaus). Schenck’s Pulmonic Syrup (wormwood, catnip, tansy, hoarhound, hops, hyssop, chamomile, comfrey, elecampane, senega—wintergreen). Scotch Oats Essence (morphine 2 gr. to bottle; 35% alcohol). Scotch Paregoric (ammoniated tincture of opium), (90 min. equivalent to 1 gr. opium). Sealeaf Emulson (cod liver oil, malt extract, chocolate, alcohol, aromatics, water—A.M.A., 1920). Seawright Water (“the water consisted in part of a filthy and decomposed vegetable substance."—A.M.A., 1919). Sfeelye’s Laxa-Tena (essentially laxative plant material, sugar, alcohol, water—A.M.A., 1919). . Seelye’s Wasa-Tusa (ammonia, chloroform, camphor, cap- sicum, aromatics, alcohol, water—A.M.A., 1919). KEY TO CONSTITUENTS 248q Seigel’s (Mother) Curative Syrup (aloes, capsicum, dil, acid hydrochlor, molasses, water.—Br. Med. Assn., 1909). Seven Seals, or Golden Wonder (ether 4, chloroform 6, camphor 4, tr. capsicum 35, oil peppermint 32, alcohol 50- 90%). Silex (sand 98.5%, baking soda, cayenne pepper.—Kan. Bd. Hlth. Bull., 1910). Simpson’s Rat Paste (40% arsenous acid). Skin Success Ointment (red mercuric oxid.—Mass. Bd. Hlth. Rept., 1898). Steedman’s Soothing Powders (calomel 27; sugar 22; corn starch 50.5.—Brit. Med. Assn., 1909). Stuart’s Specific Drops (a turpentine solution of camphor, alcohol and mercuric iodid). Sukro-Serum (“not a ‘serum’ in the ordinary sense, but apparently it is a solution of ordinary sugar (sucrose)”— A.M.A., 1920). Swift’s Syphilitic (or “Sure”) Specific (S. S. S.) (cupric sulphate, roots of the fringe tree, prickly ash, white sumac, red sumac and sarsaparilla); alcohol 15%. Syrup Cocillana Compound (heroin hydrochl., etc.), or, (mfs. claim per fl. oz.; Tr. euphorb. pilulif., 120 min.; syr. wild lettuce, 120 min., tr. cocillana, 40 min., syr. squill co., 24 min., cascarin. 8 grs.; heroin hydrochl., 8/24 gr.; menthol, 8/100 gr.—See Pk. Davis & Co.). Syrup of Pigs (Purging action due to senna and not to figs. Found to be 25% an elixir of senna and 6% of alcohol. In U. 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.) Syrup of Poppies (British); (originally a preparation from poppy capsules; now usually a variable mixture of laudanum and syrup). Tanlac (formerly “Cooper’s New Discovery”) (A wine to which has been added gentian, buckthorn (or rhubarb or cascara), a berberin bearing drug, glycyrrhizic acid and glycerin, flavored with wild cherry, alcohol (by vol.) 15.70.” “Berberin emodin, licorice, gentian and glycerine present; tartaric acid small amount.—A. M. A., 1915.) Taylor’s Horehound Balsam (codeia sulph., methyl sal- icyl., chloroform, camphor). Teething Powders (usually contain calomel 1 grain, Dov- er’s powder 2 grains, milk sugar 3 grains). Thieleman’s Cholera Mixture (opium, chloroform, ether, ipecac, peppermint, alcohol). Thompson’s Eye Water (copper and zinc sulphates, spirit camphor, tincture saffron). Toilet Bowl Cleaner (sodium bisulphate and sodium chloride in molec. propors. Added to water in bowl liber- ates Hcl. from Nacl. and cleanses bowl.—Ewe in Amer. Druggist). Sulphuric acid does it well.—A. H. B. Tongaline (essentially sod. salicyl. mixture). Tousley’s Sneezeless Snuff (morphin, menthol, borax, qui- nin.—Kan. H. B.) Trafton’s Balm of Life (potassium iodid, opium). Tucker’s Fever Drops (alcohol 29%; camphor, glycerin, tinct. opium 1.7 min. per fl. oz.; .1 min. ipecac). Tutt’s Pills (calomel, aloes, starch, sugar). Unguentine (zinc oxid, aluminum acetate, phenol, aromatic oils, petrolatum). 248r A MANUAL OF TOXICOLOGY Unguentum Mirabile (red mercuric oxide, camphor, boric acid, etheral oil of beech, petrolatum, spermaceti, olive oil— Rept. de Pharm., in Amer. Druggist). Van Buskirk’s Sozodont (soap, red sanders, oil winter- green, water, alcohol). Vapo Cresolene (appears to be “essentially cresols and cor- responds in every respect to cresol of the U. S. P.”—A.M.A. 1908). Var-ne-sis (alcoholic sol. [15-18%] containing less than 1% of vegetable drug extracts, chiefly derived from emodin-yielding (laxative) drugs and capsicum.—Conn, Rpt., etc., 1915-18.) Varnesis “Extra Laxative” (Mag. Sulph. 15.07 reducing sugars, licorice and rhubarb or cascar.—N. H. Bd. Hlth., 1916.) Verandah Chem. Co.—Aspirin Tablets [“Acetyl. Salicylic Acid, Aspirin”] [“Aspirin 5 gr.”] (Containing no aspirin; contained ac. salicylic, corn starch, talc, milk sugar, calc, earb., and a small amount of sod. citrat.—A.M.A., 1919). Veronal Tablets (should be dissolved before being admin- istered). Fatal effects from as little as 15 grains of the drug. Vin Mariani (cocain.—Mass. Bd. Hlth, 1907). (A mixture of Bordeaux wine and an alcoholic extract of decocainized coca leaves.—Conn. Rept., 1915). Vinol (alcohol ,by vol.), 18.69; oxids of iron, sodium and potassium; phosphoric acid; dextrose; glycerin., etc.—Conn. Rept., 1914.) Walker’s Vinegar Bitters (golden seal 1 oz., cape aloes V2 oz., water 16 oz.; also reported 61% alcohol). Warner’s Safe Cure [or Remedy] (salt petre, liverwort, wintergreen, bugle weed, alcohol, glycerine, etc.). Waterman Institute Morphine Cure (alcohol, morph, sulph., 13.7 gr. to 16 grs. per fl. ounce.—1912). Watkin’s Anodyne (heroin). White’s Elixir (tartar emetic, camphor, opium). Wilson’s Compound Sarsaparilla (5.1% alcohol; molasses). [Journal Amer. Med. Ass’n, (May, 1912): “It is extremely improbable that there is any therapeutic value in sarsapar- illa.”] Wilson’s Original Wahoo Bitters (Epsom salt, salicyl. acid, sassafras, gentian, prickly ash-—1917). Wilson’s Solution Anti Flu (oil of euclaptus, methyl sali- cyl. and a small amount of thymol or oil of thyme.—A. M. A., Aug., 1920.) Mrs. Winslow’s Soothing Syrup (morphin, essence of anise, syrup of balsam of tolu, etc.) “No longer contains opiates. Now apparently a mixture of carminatives and laxatives.” “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.) Woodbury’s Standard Rheumatic Salts (aspirin). Wooley’s Cure for Alcoholism (morphin). Wright’s Instant Relief (opium). Zaegel’s Essence (alcohol, water, sugar, a laxative and a saponin—A.A.M., 1920). Zemo (alcohol (by vol.) 28.35%, methyl salicyl, thymol, borax, tannic acid, glycerin, menthol, phenol-like bodies present.—A. M. A. Journ., 1915). KEY—SUPPLEMENT 248s Absorbit (Boric acid, 18 parts; magnes carb.» 40 parts; alum, 10 parts; calcium carb., 22 parts.—Ind. State Bd Hlth.) “Andrews’ Wine of Life Root or Female Regulator’’ (fed- eral chem. analys. = 14% alcohol, sugar, methyl salicyl., tannin); and the “Annex Powders” (“composed of almost equal parts of common salt and baking soda with a small amount of washing soda”). Apothesine Local anesthetic similar to procaine (which is similar in action to cocaine but less and feebly toxic and having unsustained action, which is remedied by injecting epinephrine simultaneously), but slower in action. Used with 1 to 100,000 epinephrine usually; on cornea or by injection or anesthesia, in 1 to 2%. Subcutaneously, for complete anesthesia, in 4% sol. Is practically non-toxic and not injured by boiling solutions. Bad-Em-Salz (salt, Glauber salt, baking soda, tartaric acid.—Anal, federal chemists.) Black’s Pulmonic Syrup (water-alcohol sol. of ichthyol, glycerin and sugar.—Govt, analysis, 1916.) Bovinine (a blood preparation containing 11% alcohol and over 6% glycerin.—A. M. A., 1917-1918). Calocide (salt, borax, alum, tannin.—State Chemists, Conn.) Calocide (common salt, about 22.44%; borax, about 37.58%; alum, about 39.35%; tannin, a small amount. Chichester’s English Pennyroyal Pills (now called Chi- chester’s Diamond Brand Pills) (appar. aloes and iron sul- phate.—Journ. A. M. A.; 1911). Collargol (colloidal silver); (used as germicide and antiseptic in gonorrhoeal ophthalmia, etc. Constituents: Common principal constituents of certain varieties of patent medicines are: “Headache cures: Acetanilid, antipyrin, phenacetin, or some similar drug. “Female weakness cures”; also various “tonics”: Alcohol; perhaps an alkaloid of nux vomica, or some vegetable bitter; frequently, also colored and flavored. “Epilepsy cures”: Bromids. “Diuretics: Often with some disease-aggravating kidney irri- tant, for the self treatment of kidney disease; also for diabetes— with endeavor to foster the common fallacy that diabetes is a kidney disease instead of a nutritional affection. D. D. D. (chloral hydrate, 2 gr.; [= chloral rash?] alcohol 28%, to oz.—U. S.). (ac. salicyl 0.75; ac. carbol 1.18; ol. gaulth, 1.00; glycerin 9.28; alcohol 65.10; water 22.69.—Chemists, Brit. Med. Assn.) Dial “Ciba.” Action similar to barbital (veronal), as sedative and hypnotic. Dose not to exceed 7 grs. in 24 hrs. Disinfectant Krelos-Mulford (a sol. of cresols and rosin soap). Doan’s Kidney Pills (oil of juniper, pot. nitrate, hemlock pitch, powd. fenugreek, etc.—Anal, chemists, Brit. Med. Assn.) Doan’s Kidney Pills ("oil of juniper, potassium nitrate; powdered fenugreek seeds and wheat and maize (corn) starches.”—From analysis by British Medical Ass’n.) Dr. Carter’s K. & B. Tea (senna, liverwort, wintergreen leaves, juniper berries, with buchu. and boneset leaves, and possibly uva ursi.-—Anal., N. & Q.—Cramp). KEY—SUPPLEMENT 248t A MANUAL OF TOXICOLOGY Dr. D. Kennedy’s Favorite Remedy (alcohol 18%, sugar 50%, pot. acetate, methyl salicy, aloes, licorice, oil sassafras. —Analys., federal chemists). Dr. Grove’s Anodyne for Infants (Essentially a sugar syrup, flavored with oil of spearmint and containing 1-7 gr. morphin sulph. to each fid. oz.—A. M. A., 1919). Dr. Gunn’s Pain Expeller (alcohol 50-60% and 1% to 1% grs. opium to oz.; camphor and capsicum.—N. Dakato Agric. Experm. Sta., 1911). Dr. Gun’s Pain Expeller (opium.—Col. State Bd. Hlth., 1909). (Alcohol, 50-60%, 1 y5 to 1% grs. opium to the ounce; camphor and capsicum present.—N. Dakota Agric. Exp’mt. Station, 1911; N. & Q.—Cramp). Dr. Pierce’s Anuric Tablets (acetate, carbonate, chlorid, iodld, phosphate, salicylate, ammonia, calcium, iron, potas- sium, sodium, emodin, aloin, quinin, hexamethylenamin and sugar—apparently also Canadian hemp, queen of the meadow; etc.—Chem, Lab. Journal, A. M. A.—1917.) “Alcohol for Kidney Diseases: Of course is contra-indicated in inflammatory diseases of the kidney. Potassium is a kidney irritant and it would tend to aggravate any inflammation that might exist.” “The popular idea that urinary sediments and pain in the lower part of the back mean kidney diseases, while false, is assiduously cultivated by certain patent medicine makers, to frighten and sell.” Duffy’s Malt Whiskey (“Alcohol, syrup for smoothness and coloring matter”; or, “whiskey of a very poor quality”; or, “whiskey, with a little cane sugar added to it.”—Anal, rept., 1912). E-Lep-Tine (sod. and pot. bromides 16%, alcohol 6%, ammon. valerate.—Indiana State Bd. Hlth.) Enteronol (“essentially: alum, camphor, ginger, red pep- per, tannic acid and phenolphthalein.”) Exelento-Quinine Pomade (petrolatum—“vaseline”) 91.84%; liquid paraffin with trace of oil of gaultheria 6.18%; sulphur 1.29%—other subs., including trace of quinin, 0.098%.—La. state chemists—circ. 1918). Father John’s Medicine (essentially a cod liver oil emul- sion.—Conn. State Chems., 1911). Fruitatives (appar. similar char, and action as aloes strych., and belladoin—laxative pills.—Mod. from Journ. A. M. A.. 1917). Garfield Tea (essent. senna leaf and triticum, valva— mallow—flowers and fruits and mint stems—perhaps manna. —Anal., A. M. A. Journ.—N. & Q.—Cramp, 1921). Gem Balsam (85% cottonseed oil, 15% oil of turpentine.— Anal. Bureau of Chem., U. S.) Get Slim (essentially: sugar colored pink; tartaric acid colored pink; baking soda, a white powder.—Lab. Jour. A. M. A.) (1914). Giles’ Germicide (analys. indie., oily mixt. of chiefly lin- seed oil, ether and camphor.—A. M. A., 1918; N. & Q.— Cramp.) igGiles’ Germicide (linseed oil, ether, camphor.—Journ. A. M. A., ..Green Mountain Oil or Magic Pain Destroyer ("essentially linseed oil 95%, with oil of sassafras, oil of thuja and oil St turpentine, with possibly small amounts of camphor.”— N. & Q.—Cramp; Med. Journ., A. M. A., 1915.) KEY—SUPPLEMENT 248u Greenhalgh Diphtheria Remedy (essent. mixt. of “sulphur, borax, trace of starch, plant tissue carrying berberin, iron, aluminum and potassium, as sulphates and nitrates, with charcoal and traces of manganese dioxiod indicated.”— Analys., N. & Q.—Cramp.) Gregory’s Antiseptic Oil (approx, kerosene oil 89%, with small amounts of oil of cloves, cassia and sassafras and a trace of camphor and pepper resins.—Anal., Bureau Chem.— N. & Q.—Cramp.—Journ., A. M. A., 1920). “Gonorrhea and Gleet 3-Day Cure” (analys. indie, sol. zinc sulph. and sulphocarbolate, boric acid, opium and hydrastin. —N. & Q.—Cramp.) Homenta (essent. menthol, thymol, ammonia, sugar 61% +, alcohol 4.6%, water.—Journ. A. M. A., 1918—N. & Q.—Cramp). H. G. C. (aq. sol. borax and berberin. sulph.—Anal. U. S. Gov’t Chems.; N. & Q.—Cramp), Humphrey’s Pile Ointment Witch Hazel Oil (Compound). (“Essent. a camphor ointment on a lard base.”—Jour. A. M. A.—N. & Q. Cramp). Ice Mint (Borax, oil of peppermint or menthol.—Dab. Analys.— Report N. Y. Tribune in Ad-visor Dept., 1917). Jacob’s Liver Salt (sod. phosph., sodium sulphate, common salt with mixture washing soda and citric acid). Analys.— U. S. Gov’t reports). Kathairon (said to consist of: “Castor oil, 1 fl. oz.; Tr. Cantharides, 1 fl. dram.; Oil of Bergamot, % dram.; stronger ammonia water, 1 drop, alcohol enough to make 3 fl. ozs.; Oleson, 1903 quoting New Idea”); or, (oil of cloves and glycerin, with some methyl alcohol present in the mixture.—Prom Ind. Bd. of Health Report, 1913.) Kay’s Linseed Compound (chloroform, 1.07; alcohol, 4.30; sugar, 48; mucilage of decoction of linseed, 19; oil of anise, present; tolu and squill, small amounts; ipecacuanha alkaloids, O. morphin alkaloid, 0.021.—Seer. Rem., 1909, 12.) Keller’s Plaxseedine (alcohol 4.6 per cent., gum and plant extracts, appar. syrup, flaxseed, molasses and senna.—Anal. Bur. Chem., 1914-15.) Keene’s One Night Cold Cure (“sugar-coated tablets colored with ferric oxid. Pill mass contains cinchonin sulphate 0.21 gr.; acetanilid, 0.32 gr.; calcium carbonate, 0.25; gr.; starch, 0.34 gr.; extractive and excipient, 0.87 gr. Manufacturer claims cascara, bromid, quinin, ipecac, camphor and bryonia. No bromid found, no quinin (except merest traces), no camphor, not more than a trace of cascara (if any), no ipecacuanha alkaloids; extract of bryonia may be present.—Seer. Rem., 1909, 6.”) Kennedy’s Laxative Honey and Tar (“alcohol, sugar, syrup, pine, tar, codein, croton oil, salicylic acid, chloroform, oil of peppermint and oil of sassafras.”—Minn. D. and P. Dept. Rept., 1907, 614, and No. Dak. Expt., Stat. Rept., 1906, pt. 2, 157). Kennedy’s Medical Discovery (“alcohol (by volume), 44.0; solids, 2.5; mandrake or similar drug, present.—No. Dak. Expt. Stat. Rept., 1907, p.. 2, 148.”) Kennedy’s Pinus Canadensis, Light. (“Later called ‘Abican.’ Claimed to be a non-alcoholic extract of Pinus Canadensis, to each fl. oz. of which is added 24 grs. each of potash alum and zinc sulphate, and 0.48 gr. of thymol. Analysis showed no tannin.—Jour. A. M. A., Feb. 13, 1915, 608.”) 248v A MANUAL OP TOXICOLOGY Kennedy’s Pinus Canadensis, Dark. (“Later called ‘Darpin.’ Claimed to be a non-alcoholic extract of Pinus Canadensis, to each fl. oz. of which is added 0.48 gr. of thymol. Analysis showed tannin.”—Jour. A. M. A., 1915.) Kora-Konia (Mennen). (“Contains zinc stearate, 44%; talc., 48%' magnesium carbonate, 5%; boric acid, 3%. —Jour. A. M. A., 1916.) Kosine (approx., antipyrin 11 gr., ammon. brom. 100 gr., sod. brom. 31 gr.—Conn. S. A. Sta., 1914). Kroy Wen Ointment (Mfrs. formula claims carbolic acid (phenol), witch hazel, arnica, menthol, thymol, zinc ozid, oil of hemlock, oil of cajaput, oil of cade, sulphur, boric acid and base.—Conn. Kept., 1914, 302.”) Kulux Compound (zinc oxid, 7%; bism. subcarb., 5%; glycerin, 10%; water, 78%.—Ind. State Bd. Hlth.) Lafayette Mixture (“Formula: copaiba, 125 c.c.; Spt. nitrous ether 125 c.c.; comp, tinct. lavender, 125 c.c.; sol. potassium hydroxid, 32 c.c.; syrup, 300 c.c.; acacia mucilage quan. suf. to make 1,000 c.c.”—Jour. A. M. A., 1917.) La Sage Complexion Treatment [tablets and capsules to be used as wash] (essentially a weak sol. of soda, and borax; phenolphthalein to color.—From Lab. Analys.; Jour. A. M. A.—1914). Laxative Quinine Tablets (acetanilid 1.9 gr. per tablet; also quinin, caffein, tannic acid and veget. cath. drug.—From Analys. U. S. Bureau of Chemistry. Leonard Bar Oil (liquid petrolatum, ammonium oleate (soft soap) oleic acid, camphor, eucalyptol, alcohol, water.— Dept, of Hlth., City of N. Y., 1917-18). Leonard Ear Oil (“to all intenes and purposes liquid petro- latum with camphor, eucalyptol, etc., emulsified by aid of a soft soap produced from ammonia and oleic acid.”—From an analys., Dept. Hlth., City of N. Y.) Lepso (bromids equiv to about 6.8 pot. brom in each fl. oz. = abt. 51 gr. pot. brom. to a dose.—A. M. A. Lab.— Joum., 1915). Lucile Kimball home obesity treatment (Pink Pills = prin. red pepper, menthol and bitters). (Brown Tablets = aloin type of cathartic pill). (Powder = soap, Epsom salt, and washing soda.—Dr. Wiley, Report, 1914). MacDonald’s Atlas Compound Famous Specific No. 18 [pills] [“essentially: sodium sulphate (Glauber’s salt), sodium bicarbonate (baking soda), a laxative plant drug) (appar- ently aloes), ginger, small amount of phosphate, a trace of alkaloid and talc.” “The pills coated with starch, calcium carb. and sugar, and coating colored with fluorescin.”—Anal, federal chemists, 1916-17]. Marmola (approx, dried thyroid gland, phenolphthalein, sod. chlorid., powd. bladder-wrack, “extractive,” and oil of peppermint a trace.—From analyses—Br. Med. Journ.; Journ. A. M. A., 1909). Mayrs Stomach Remedy [essent. olive oil: Rochelle salt (or Epsom salt)]. [“Gall stones = principally a mixture of fatty acids and soap” (sodium salt of fatty acids)—“pro- duced by the action of the alkaline intestinal fluids on the large amount of oil taken.”—Journ. A. M. A.; 1911]. Medinal (barbital sodium). Mendenhall’s No. 40 for the Blood (“essentially: pot. iod., cathartic resins, ammon, acet., licorice, glycerin, alcohol, sugar and water.”—N. & Q.—Cramp.) KEY—SUPPLEMENT 248w Mentholatum (essent. petrolatum and 5% boric acid, 10% menthol, and camphor,.—Jour. A. M.A., 1918; N. & Q.—Cramp.) Mentholatum (“essentially: petrolatum with about 5% boric acid and 10% menthol and camphor.”—N. & Q.—Cramp.) Mother Hart’s Baby Syrup (“opium 3 gr. to oz., and al- cohol 10%.”) Mrs. Edward’s Infant Syrup (morphin and alcohol.—Jour. A. M. A.—N. & Q.—Cramp). Mu-col (common salt and borax equal parts, and aromatics. —Journ. A. M. A., 1914). Nature’s Remedy Tablets (“essentially: aloes or aloin, cascara and belladonna with probably podophyllin.”—A. H. Clark in Journ. A. M. A.; etc.). Odor-O-No (practically a 33% of aluminum chlorid (hydrous). Phenoco (“A mixture of coal tar cresote and higher phenol homologues—phenols containing two or more methyl groups—in soap solution”). (Is said to contain coal tar creosote, 20%; phenol homologues, 50%; and soap, 30%.) Is 16 to 16 times stronger than phenol but claimed to be non-caustic, non-irritant and only half as toxic as phenol. Used in 1 to 5% or more solutions. Is incompatible with strong alkalies and acids. Phenol Sodique (phenol.—1918; N. & Q.—Cramp). Resinol (an antiseptic prep., appar. quite similar to Resorcin Co. Oint (N.P.), but minus bismuth and perhaps wool-fat). Resorbin (a mixture of soap, wax, oil, gelatin and sheeps- wool oil.) Salvitae (federal analys. about 1920 = essentially citric and tartaric acids with sulphates, carbonates or bicarbo- nates and phosphates of magnesium, sodium, potassium, and lithium, with a trace of hexamethylenamine.—N. & Q.— Cramp). Sedatole (Heroin, tolu, blood root, squill, wild cherry, balm of Gilead buds.—Drug. Cir., 1917). Sevetol (“An emulsion of fats—14.1% of oil”). Samaritan Nervine (abt. 19% pot. brom.; and indications of atropin—1917). Swamp Root (essentially: alcohol, about 9%; sugar, water and flavoring matter with a slight laxative principle”). Terraline (liquid petrolatum). Three Chlorides (Henry). “Mfr. claims (per fl. drm.) mer- curic bichlorid, 1/72 gr.; arsenic chlorid, 1/40 gr.; iron proto- chlorid 2/25 gr.; in a cordial of calisaya alkaloids.”—Jour. A. M. A., 1915.) Tiz (appar. similar tab. = “alum 60%, tannic acid 10%, salicylic acid 5%, talcum 5%, starch, 20%.”—Journ. A. M. A., 1911). Tri-Iodides (Henry). (“Formula 1910: Colchicin 1/20 gr.; phytolaccin, 1/10 gr.; solanin, % gr.; sodium salicylate, 10 grs.; iodic acid (= to iodin), 7/32 gr.; in 2 fl. drm. of aromatic cordial.”) (“Formula 1914;: In 2 fl. drm.= colchicin, 1/200 gr.; phytolaccin, 1.2 grs; mydriatic alkaloids, 1/500 gr., sodium salicylate, 3.5 grs.; iodic acid (= iodin, 7/125 gr) Tutt’s Pills (aloes, calomel, starch, sugar.—Federal anal. —1915). Veril (areca nut, vermifuge). Vick’s Vap-O-Rub (yellow vaseline %+ part; camphor, menthol, oils of thyme, eucalyptus and turpentine = % part. —La. chems.; also Jour. A. M. A., 1918). 248x A MANUAL OF TOXICOLOGY. Williams’ Pink Pills [“for pale people”] (Sugar, iron sulph., pot. carb., starch; a veg. subs., strych., talc.—Anal, fed. Chem.—1914). Williams’ Pink Pills for Pale People (appar.: ferrous sulph.; potass, carb.; trace of strych.; starch; talc; sugar). Wilson’s Patent Ring Worm Cure [or “Dethblo.”] (Ferrous sulphate; glacial acetic acid). KEY TO TREATMENT (A digest arranged from the preceding pages of Parc II.) POISON. TREATMENT. ‘mSS™!.’*.”? Physiological. ACETANILID. ANILIN. ANTIPYRINE. EXALGIN. PHENACETIN. Evacuate the stomach. Recumbent position. Artificial respiration. Caffeine Citrate. Digitalis. Strychnine. Oxygen. Heat. ACID- ACETIC. —Mineral Acid*— HYDROCHLORIC. PHOSPHORIC. NITRIC. SULPHURIC. Magnesia. Albumin. Lime-Water. Soap, Demulcents. Avoid emetics and stom- ach pump if acid concen- trated. Stimulants. Opium. External heat. (VCID— 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.I. 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 also the varkxrt cardiac and respiratory stimulants, such as Ammonia, Digitalis, CaSckts, Strych- nine, Nitroglycerine, Atropine, etc. 250 A MANUAL OF TOXICOLOGY. POISON. TREATMENT. CM«h«'ioVi? Physiological. 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 s 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. Opium 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. CANNABIC- AMERICAN ot INDIAN HEMP. Tannic Acid. Evacuate stomach. Stimulants. External heat. KEY TO TREATMENT, 251 POISON. TREATMENT. Chemical and Mechanical. Physiological. CHLORAL. CHLORALAMID. Evacuate stomach. (Is well to siphon out stomach with tea or coffee.) Liquor Potass® ( 3 in water 5 viii.) 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. _ Artificial 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. Artifir'.a' heat. Opium. 252 A MANUAL OF TOXICOLOGY. POISON. TREATMENT, 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. 253 INDICATIONS OF VARIOUS SYMPTOMS. PART III. THE INDICATIONS OF VARIOUS SYMPTOMS IN POISONING. (an aid to diagnosis of the poison)* BLINDNESS. Suspect: Wood Alcohol, Barium, Digitalis, Qui- nine, Nicotine, etc. BREATH (Specific Odor of Breath). Suspect: Acid Hydrocyanic, Alcohol, all ethereal oils, 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.) Suspect: Concentrated corrosive acids or alka- lies, Antimonial preparations, Arsenic, Colchicine Aconite, Nicotine. COLLAPSE. 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. COMA, PROFOUND. *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. CYANOSIS. Suspect: Anilin, Acetanilid, Benzocoll, Exalgin, Nitrobenzene, Phenacetin, Toluidin. DEAFNESS AND BLINDNESS (More or Less Complete). Suspect: Aconite, Belladonna, Cocaine, Conium. DEATH, QUICK AND SUDDEN. Suspect: Acid Hydrocyanic, Acid Carbolic, Car- bon Dioxide, Creosote, Potassium Cyanide or other cyanides. Strong Ammonia, Oxalic Acid. 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, Nicotine, 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 cof- rosives. ERUPTION (Acne) Suspect: Bromides, compounds of or substances which contain Antimony, arsenicals, Emetine, iodides. 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. GUMS (Dark Line or Border on Gums). Suspect: Bismuth, Copper (green), Lead (blue), Mercury (bluish), Silver, Boric Acid (gray). HEARING. Suspect: (Impaired or Lost) Aconite, Barium, Bromism, Cinchonism, Conium, Lead, Mercury, Opium, Quinin, Salicylates, Salol, etc. (Intensified) Hydro- phobia, Strychnin, etc. (Buzzing) Salicylates. (Ringing) Quinin, Tobacco, toxemias, food poisonings, Ergot, etc. Suspect: Absinthe, Opium and Morphine, Co- caine, etc. ILLUSIONS, VISIONS, ETC. MANIA OR DELIRIUM (Raving Mania, Raging Delirium, or Mental Excitation). Suspect: Alcoholism (chronic), Atropine, Cam- phor, Cannabis, Hyoscyamus, Cocaine, Physostigmine, Stramonium, Veratrine. MISCARRIAGE OR ABORTION. May be due to: Cotton Root Bark, Cornutin, Pennyroyal, Phosphorus, Rue, Savine, Tansy, etc. INDICATIONS OP VARIOUS SYMPTOMS. 257 (EDEMA (of Glottis). Suspect: All the corrosive poisons. (EDEMA (Pulmonary), Suspect: Ammonia, Morphine, Muscarine, Pilo» carpine. PAIN. Colic: Arsenic, Colocynth, Copper, Lead Cramp: Antimony, Arsenic, Lead. Neuritic: Chronic arsenical poisoning. Suspect: Aconite, Arsenic, Colchicine, Coniine, Curare, Ergotinic Acid, Gelsemium, Guachamaca- poison, Lead. PARALYSIS (As a rule, ascending). Suspect: Aconite, Acetanilid, Antipyrine, Exal- gin, Phenacetin, Sulfonal, etc. PERSPIRATION (PROFUSE). PRIAPISM. Suspect: Cantharidin, etc. PULSE (Greatly Accelerated). Suspect: Atropine, Hyoscyamine, Scopolamine, etc. PULSE (Particularly Slow), Suspect: All narcotics, Baryta, Lead, Morphine, Muscarine, Nicotine (later rapid and irregular), Opium, Physostigmine, Pilocarpine (later rapid and irregular), substances of the Digitalin group (later rapid pulse). PULSE, WIRY. Suspect: Baryta, Lead, substances of the Digi- tali.n group. 258 A MANUAL OF TOXICOLOGY. PUPILS, CONTRACTED. Suspect: Codeine, Morphine (Opium), Musca- 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, Crytisin, Mercury, Muscarine, Nicotine, Physostigmine, Pilocarpine, Saponin substance, etc. SKIN, MOUTH AND PHARYNX, VERY DRY. Suspect: Atropine, certain parts of Belladonna, Hyoscyamus, Thorn-apple, Allantotoxin (from de- caying fish), Hyoscin, Hyoscyamine, Scopolamin, etc. Suspect: Aconitine, Alcohol, Antimony, Lobelin, Morphine, Muscarine, Nicotine, Opium, Physostig- mine, Pilocarpine. SKIN, MOIST. SKIN, YELLOW. SKIN, BLUE. Suspect: Picric Acid and its salts. Silver Salts. SPEECH. Suspect: (Garrulous) Opium or its alkaloids. (Thick) Alcohol. TACTILE SENSE. Anesthesia (surface). Suspect: Aconite, Alcohols, Bromides, Cannabis, Opium, Physostigma; etc. Hyperaesthesia (surface). Suspect: Alcohol, Opium, (habits), Arsenic. Variation in temperature-sense (surface). Suspect: Aconite, Alcohol, Cannabis; etc. TASTE, FOUL Suspect: Arsenic, Copper, Lead, Mercury, Po- tassium Todide, 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- sons, Chrysarobin, Potassium Chlorate, Pyrogallol, Sodium Nitrite. URINE (That Reduces Fehling’s Solution). Suspect: Benzaldehyde (Bitter Almond) Oil, Carbon Monoxide, Chloral, Chloroform, Formic Acid, Oxalic Acid and its salts, Phloridcin, Pyro- gaflol, Uranium salts. 260 A MANUAL OF TOXICOLOGY. URINE (Very Odorous). Suspect: Ammonia, asparagus, Tellurium, Tur- pentine Oil (violets), and other ethereal oils; also auto- intoxication. Urine (Red) Suspect: Uric acid, blood, etc. Urine (Blue; etc.) Suspect: A methyl. URINE (Unnatural Scantiness or Suppression). Suspect: Cantharidin, Corrosive Sublimate and other mercurial preparations, Oxalic Acid, Oxa- mic Acid, Potassium Oxalate. VISION. Amblyopia (Loss of acuteness of sight; feeble or blurred sight, with fundus or base of eye unchanged). Suspect: Tobacco, tea or coffee used in excess. A variety of amaurosis, a temporary blindness, may be caused by abuse of tobacco, by excessive use of Alcohol, Quinin or Salicin; may occur in Iodoform or Lead poisoning. Amblyopia, or Amaurosis (more or less complete loss of sight—pupils may be unchanged). Suspect: Aconite, Alcohol, botulism, Caffein, Gelsemium, Methanol, Tobacco, Veratrum, etc. Amblyopia with more or less deficient accommo- dation only. Suspect: Alcohol, Coniin, Conium, Methanol, etc. Amblyopia, with more or less dilated, or contracted pupils. Suspect: Aconite, Alcohol, Cocain, Coniin, Conium, Digitalin, Dinitrobenze, Eserin (contracted), Gelsemium, (Gelsemin), Loco Weed, Nitrobenzene, Quinin, or Veratrin; botulism, ptomain-poisoning—food poisonings; chronic Anilin or Nicotin poisoning; etc. Diplopia (Double Vision). Suspect: Belladonna, Conium, Gelsemium, ptomain-poisoning, various food poisonings; etc. VISION. 260a Double vision, or dimness of vision; more or less paralysis of accommodation. Astigmatism. Perhaps a total blindness. Suspect: Aconite, Belladonna, Hy- oscyamus, Methyl Alcohol (sudden blindness), Stram- onium; etc. (Usually pupils are dilated, but sometimes normal, unsymmetrical, or contracted.)* Mydriasis (extreme dilatation of pupil) with par- alysis of accommodation. Suspect: Alcohols, the atropa ; Belladonna, (Atropine, Homatropine, etc.), Duboisin, Gelsemium, Hyoscyamus, Mandrake, (Scopolamin), Stramonium; ptomain-poisoning; etc.* Myosis (Contracted pupil; or, Pin-Hole, or Pin-Point Pupil). Suspect: (Aconite 1st stage?), Amyl Alcohol, Opium, Morphin, Physostigmin; etc. Some ill-defined disturbance of vision (with per- haps slight pupillary dilatation). Suspect: Belladonna or Atropin combined with Opium or Morphin, pos- sibly with Codein; also a botulism; food poisoning; etc. Blue. Suspect: Alcoholism; etc. Brownish. Suspect: Coffee, etc. Green. Suspect: Cinchona or Santonin; etc. Red. Suspect: Duboisin ; etc. Yellow. Suspect: Gelsemium, or Santonin, etc. Photophobia, (Intolerance of light). Suspect: Cinchonism, or Arsenic poisoning. If an object appears larger or smaller than it should: Suspect: Poisoning by Cannabis Indica.* (Memo) : Atropin, Homatropin, Cocain and Scopo- lamin dilate the pupil of the eye. First two and Scopo- lamin paralyze accommodation; Cocain only slightly impairs it. First two used in eye 2 grs or more to oz. (Apply one or more drops) ; Cocain in 2 to 4% sol. (Apply a few drops) ; Scopolamin, Hydrobromid, use in 1/10 to y5 of one per cent solution. (Apply 6 or 7 drops). Eserine contracts the pupil. (One drop of a one per cent solution used in the eye.) [Delirium (toxic)—illusions, hallucinations, etc— Suspect: Alcoholism (acute or chronic). “Nearly all poisons, notably the vegetable narcotics, and narcotico- 260b A MANUAL OF TOXICOLOGY. acrids, are apt to produce delirium:”—Woodman and Tidy. Dread: Alcohol, hydrophobia, sometimes Opium, Cocain ; etc.]. [Delusions, illusions, hallucinations. (Without actual delirium.) Suspect: Alcohol, cocain, hyoscyamus, hyoscin, wormwood; etc.]. [Visions; “Spectres”—such as rats, mice, beetles, animals, “devils,” “ghosts,” etc. Suspect: Alcohol, Lead, Mercury, etc.]. *[See charts for tests] VOICE. (Loss of) In Barium, Lead paralysis, Trichinosis, etc. (Rough) Belladonna, etc. VOMITING. Suspect: Aconite, Ammonia (stringy saliva, perhaps blood), Antimony (mucus-white, stringy, perhaps bloody), Arsenic (brown, with blood), Colchicum, Colocynth, Digitalis (grass-green vomit), Phos- phorus (vomit luminous in dark), Antimony, Zinc (incessant vomiting). VOMITING AND PURGING. 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, WITHOUT DIARRHCEA. Suspect: Apomorphine, Cytisin, Lobelin, Nar- cissin, etc. VISION TESTS. me PART III*. THE SPECIAL SENSES. DETERMINATION OF THEIR CONDITION FOR RECOGNITION OF THE TOXIC EFFECTS OF CERTAIN POISONS (See pages 253 to 260b) VISION TESTS NB. At the indicated distances, these test types of Brun- dage’s Manual of Toxicology, 14th edition, copyrighted, 1923, by the Henry Harrison Co., afford a person quite definite information as to whether his sight is normal or abnormal. [Test your eyesight! Ascertain if you are being poisoned by excessive use of coffee or tea, etc. By employing the tests and the references above indicated, supplemented in some instances by other tests logically indicated and else- where provided, those persons who have been in the habit of using very freely either coffee, tobacco, or alcoholic beverage, quinine, or one of the common nerve or heart sedatives or stimulants, or some very insidiously dele- terious substances, may discover they are unconsciously optically suffering from the injurious effects of such ex- cessive use, or from a chronic auto-intoxication from over- eating or from eating wrong food, and need medical treat- ment or eyeglasses or both.] In reading each of the series, the respective type being read should be placed or hung nearly on a level with the eyes, and in a strong, preferably natural light. Care should be taken to avoid shadows. Each eye should be tested separately, one eye being covered—but not pressed upon—with a card, black paper, or the cupped-palm, held closely in front of it, while the other eye is being tested. Diminution in Vision: De Guret averages usual diminution in acuteness of vision as follows: At 50 years of age the acute- ness is diminished one-fifth; at 60 years one-fourth; at 70 years one-third; at 80 years one-half.] The pupil is 4 mm. in diam- eter in the average adult; smaller in old age. The visual center is in the cuneus of the occipital lobes. 260d A MANUAL OF TOXICOLOGY. For Nearby Readings B ' m vu iwt bM teJ? to aftffTCfr the chiefs of (he ©ppoeition when they set forth thi danger of breaking Atm tG l&rLLoa which Mpemttm the function* of the legislator fro* Ihoee of the judge. " This nuta." it we* said. 'e»y be a UJ Englishman | and yet his tony be the cause of all good Englishmen. Only lest year we poeoed aa Act to regulate the proaedure of the ordinary oourte in case* of treaaon. We paeeed that Art because we thought that, la thoee courts the life of a eubject obnoxious to the government was not then sufficiently secured. Yet the life of a sabjeel obnoxious to the gorernmeiit was than far more aocum than it will be if Una Bouos take* At D-0.25 meter—25 centimeters—(4 diopters). (Normally read at about 10 inches) R If placed in a good light, these words should bo read, by the normal eye, at about 16 inches from the eye. [Refer to pages 263 to 260b of Brundage’s Manual of Toxicology, indicating effects on vision produced by certain poisons.] At D-0.40 meter (2.5 diopters). (Normally read at about 16 inches) u CELT CLIFFS DEEP SELLS tool ghoteudlasic holed FELT CLOTHE SEAL CRIED COLD LODGER BALL BOOTS At D-0.50 meter (2 diopters). (Normally read at about 20 inches) bet let fat foes rod deohsudtl rode SEE SET LEE TELL COD HOD COO TOED N At D—0.75 meter (1.25 diopters) (Normally read at about 30 inches) D DLSTUEOHCF °ELL SOLE FELL ROOT H OCEFSDUTL FLOG POLE CELL GOLD RUDE BEET At D-I.oo meter (1 diopter) (1 meter = 39.3701 inches). (Normally read at about 40 inches) A told sled lfsdceutoh BATH feud meters (.50 diopters). (Normslljr read at about 80 iuebes) VISION TESTS. 260e KEY. 1— orbital bone. 2— eyelid. 3— muscle which moves eyeball. 4— —sclerotic. 2—retina—corresponds to photographic plate of a camera. 6—iris or colored curtain. Variable hole in center (for light) is called the pupil. 7— crystalline lens. 8— cornea (transparent tissue which admits light to retina). 9— vitreous humor. 10— ciliary muscle—controls shape of lens. 11— aqueous humor. 12— optic nerve—divides into fine threads ending in rods in retina. f—Myopic or short-sighted eye. (Has a long diameter.) I—Hyperopic or hypermetropic or far- sighted eye. (Has a short diam- eter.) lotted lines indicate normal eye, Insert illustrates way in which normal lens accommodates itself to near and far objects: D—shape of lens when viewing distant (D) objects. N—shape of lens when viewing near (N) objects. A MANUAL OF TOXICOLOGY 260f For Distant Readings M TDRPLAEOF 26836 058394 At D-3.00 mfters (Normally read at about 10 feet) Horizontals For Astigmatism Tests. (Test at about 10 ft. in strong light or at 8 ft. in fair light.) fuzzy "sides” orSTt rndf13111 (an/fs the lines will appear hazy, or together All en(^s» u°r. °f different widths or spacings, or run and 160° are leasf aflwJSi ,,I^lsJinct but usually those between 90° ' • ar? 13. ppt’. /Calcium. Dissolve the ppt. in Acetic Acid and add KaCr04. Yellow ppt. = Ba- rium. If no ppt. add Ha S04. Dilutee White ppt. on stand- ing or shaking = Strontium. No ppt. add Ama cao4. White ppt. = Cal- cium. Add to original solu- tion NaaHP04. 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. A mmonia. Heat with KHO, gas evolved. (Nessler’s test.) 296 “ CHART FOR THE DETECTION OF ACIDULOUS RADICALS OF SALTS IN SOLUTION,” (THOMPSON.) DISSOLVE THE SALT IN WATER, AND RENDER IT NEUTRAL, IF NECESSARY. Group I. H2S04. Decomposes. Group ID BaClj. Precipitates. Group III. CaCl2 Precipitates. Group IV. AgNOs. Precipitates. Group V. Fe2Cl„. Precipitates. Group VI. H2S04+FeS04. Forms a black colouration. Sulphites. Sulphides. Carbonates. Cyanides. Acetates. Oxalates, White. Tartrates “ Citrates “ Sulphates “ Phosphates “ Oxalates, White. Tartrates “ Citrates “ Phosphates “ Chlorides, Whitt. Tartrates “ Bromides, Yellowish White. Iodides, Yellow. Phosphates “ Chromates, Red. Arseniates, Chocolates. Arsenites, Yellow. Ferrocyanides, Blue. Borates, Yellowish. Nitrates. Group I. H2S04 | Apply heat, and notice any odour which may be evolved. Sulphides give off H2S (sulphuretted hydrogen). Confirm. Sulphites give off S02 (sulphurous acid gas). Confirm. Carbonates effervesce and give off C02 (carbonic acid gas). Confirm. Cyanides give off the odour of HCy (hydrocyanic acid). Confirm. Acetates give off the odour of acetic acid. Confirm. Group II. BaCljj i Should the precipitates produced by this reagent be insoluble in HN03, a sulphate is indicated. Should the precipitate be soluble, pass on to Group III. Group III. CaClj 1 Should the precipitate produced by this reagent be insoluble in acetic acid, but 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. Group IV. AgNOs ■ The colour of the precipitates by this reagent is very characteristic. If the precipitate is white and insoluble in HNOs, but soluble in dilute solution of ammonia, the presence of a chloride is indicated. Confirm. Group V. FeaClg A yellowish precipitate indicates a borate. Confirm. Group VI. H2S04 4- FeSO* Should the previous reagents give no precipitate, add a crystal of sulphate of iron and a few drops of strong sulphuric acid. The formation of a black colour indicates a nitrate. Confirm. 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 other preservative fluid should be added. When is 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 in 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 organ 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 orifice, 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 a 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, 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 forpreliminary 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 orwater, accordingto their abil- 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 of 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, stomacli 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 and 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 of solids, liquids or gases. Others are arrayed in varied colors, in crystalline shapes, or volatilized in flame and viewed by the achromatic or apochromatic lenses 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 of 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 of ozone for the purple-color reaction for strychnine, or 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 poison may be resolved into two principal procedures: i. An- alysis for volatile and inorganic poisons. 2. Analysis for non-volatile organic poisons. Having reduced the materials to be examined to a uniform mixture by means of thorough division, and, if necessary, also by dilution, a small and carefully weighed portion may be taken for the application of simple preliminary tests. Then the remaining portion may be divided into either three or four parts: one 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. Each part should be carefully marked. The part pro- 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. The delivery tube is connected with a glass condenser, and the mixture distilled over a water-bath for about half 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 sul- 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 free 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 small 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 contents. 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- rin, 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-'?'*, 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. _ TheTiltrate 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. 1 he 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- mately 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 a 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- ide; it may also contain a trace of copper oxide. 1 he melt is cooled, dissolved in a little water, and sodium bicarbonate added so as to change any caus- tic soda remaining into carbonate, and to decompose the small amount of sodic stannate; the liquid is then filtered. T. he filtrate will contain the arsenic as sodic ar- senate, while on the filter there will be pyro-anti- monate of soda, tin oxide, and, possibly, a little copper oxide. 308 A MANUAL OF TOXICOLOGY. The recognition of these substances now (by) chemical methods) is not difficult. INVESTIGATION OF THE SULPHIDES INSOLUBLE IN 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. 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 sul- 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. This 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. 1. 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. 1. A feather lightly suspended near the mouth or nose remaining unmoved indicates death has oc- curred. 2. Hold a bright mirror over the mouth and nose of 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 death, although certain injuries of the brain, etc., produce the same condition. 5. The conjunctive 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- TESTS. 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 to flow if death has occurred. 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. 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: 1. 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 of internal organs: as heart, spleen, distended bladder, pregnant uterus, or other organ in 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 oedema of glottis or larynx, etc. CAUSES OF DEATH. MODES OF DEATH. The actual or immediate cause of sudden death is obviously dependent upon one or other of the three (Partly adapted from Bichat and Herold). 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:— 1— Death beginning at brain, coma. (See p. 328.) 2— Death beginning at heart, syncope. (See p. 328.) 3— Death beginning at lungs, asphyxia or apncea. The immediate c?use 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 are engorged. 316 A MANUAL OF TOXICOLOGY. ASPHYXIA (Apncea). 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 haemo- globin into methaemoglobin, (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 venae 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 ot brain, lungs or other organs, especially if asphyxn 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 and 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 certain animals, and the measures which are most successful in 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- siderations. The animals most suitable for the study and demonstration of 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 four 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 notab'e differ- ences in animal phenomena, calling for an intimate knowledge of 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- fully recorded: The date, name of the observer or observers, the place, the kind of animal, its color, markings, condition, sex, apparent age, weight, etc. The preliminary measures em- ployed (such as anesthesia, etc.). The name, condition and form 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 pf each as regards vomiting 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, seventy, 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 demonstrations 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 the 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 im- mediate fall of arterial blood pressure. Depression of res- piratory center, diminished oxygen-carrying power of the blood, and paralysis of peripheral motor nerves. Formation of methemoglobin. Hemolysis may occur. There is loss of heat through vaso-dilatation from the central action. On frogs it seems to paralyze motor nerve endings. When convulsions occur in animals, such are sometimes of spinal 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. x kg. by mouth. Anilin. On frog: 2 drops in mouth producing convulsions, 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; heart stops in diastole. Arterial tension reduced. Stimulation of center and periphery of vagi. Depression followed by paralysis of respiration from depression of centers. Carbolic acid is absorbed from the stomach particularly when associated with alcohol; and it readily diffuses into the blood, where it probably exists as an alkaline carbolate. Although it is eliminated by all the secretions, such occurs mainly through the lungs and kidneys. In the urine it appears as salts of sulphocarbolic and glvcuronic acids, etc., but considerable of the phenol is elim- inated without being changed. There is diminished heat pro- duction and increased heat dissipation. Fall in blood pressure through paralysis of vasomotor center. In collapse from phenol all the medullary centers and the cardiac muscle are 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 gm. x kg. hypoderm., toxic and fatal. Cat: 0.1 to 0.2 gm. x kg. (in solution) hypoderm., toxic and fatal. Rabbit: 0.1 to 0.2 gm. 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 dyspnoea, 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 in 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 or 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, rabbit, 1.5 mg. x kg. hypodermically. Guinea pig, 2 mg. x kg. Pigeon, .06 mg. x kg. Frog, 0.2 mg. x kg. hypodermically. 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 b’ood is drawn from the general circulation by the distention of the splanchnic area, thus re- acting upon other organs, and a paralysis of the 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 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), I 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 owung 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, o.x 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 it. 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 fata!. 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. Rabbit, 60 to 70 mg. x kg. by mouth, toxic; 100 to 500 mg. x 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 of 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 fatal. Frog, 10 to 15 mg. x gm., toxic and fatal. Hyoscyamine: Cat, 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 occurs in the form of iodides, and promptly appears in all of the body secretions. Most of it is removed in the urine in the form of iodides. Iodides in the blood are supposed to be con- verted into sodium iodide without affecting the composi- tion of the blood. It is supposed that they form a loose combination with proteids. It is asserted that potassium iodide dilates the blood vessels, thus increasing the secre- tion of glands. Dose: Dog (anesthetized), tincture of iodine 4 cc. hypoderm., toxic. Rabbit (anesthetized), 0.1 to 1.0 gm. x kg. hypoderm., toxic and fatal. Ipecac (Emetine). Reduction of temperature by poisonous doses. In dogs very large doses produce cardiac paralysis, es- pecially if injected into the jugular vein. Dose: Dog, emetine, 1 to 2 mg. x kg. hypoderm., emetic. Dog, cat, rabbit, 0.1 to 0.2 gm. 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- derm., toxic, paralysis, fatal. Mercury (Corrosive Sublimate). The soluble salts of mer- cury 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 large doses. Dose: Dog corrosive sublimate, 1 to 2 ounces of one per cent, solution by mouth toxic, producing more or less corrosion of alimentary canal. In rabbit same dosage fatal, with alimentary canal corrosion. Methylene Blue. There is a strong affinity between the axis cylinders of nerves and methylene blue. Dose: Dog (anes- thetized), 0.1 to 0.2 gm. in solution into femoral vein, toxic and 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: Dog, 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 ganglia 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. Peristalsis is stimulated in toxic doses, the inhibitory nerves being paralyzed. The pupils are contracted through stimulation of 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-stimplation, and consequent exhaustion of the vasomotor center and vagi, produces a rapid and weak pulse. 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- 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 to 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 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 con- 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 and 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 and rabbit, 2 to 4 mg. x kg. hypoderm., toxic and fatal. Guinea pig, 4 to 6 mg. x kg. hypoderm., toxic and fatal. Frog, 0.5 to 0.8 mg. hypodermic, toxic and fatal. Dog (anesthetized), 0.5 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. Finally 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- vulsive periods the frog often appears to be paralyzed. Smce in 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 such 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 its exact location thus noted. In poisoning of a frog by picrotoxin it is seen to be located in the medulla; by strych- nine 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 15 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 muscarine. 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, but 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, in toxic doses, 'first an extension of the forearms, finally also of the hind legs. Dose: Dog and rabbit, a few drops of the alkaloid 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. Frog, 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- traction. Ultimately the muscles become paralyzed. Depres- sion 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- tem more or less generally. In rabbits one of its common toxic effects is to make the animal “buck.” It is corrosive. Frequently causes dizziness and blindness from its superior central action. Dose. Veratrine Sulphate: Rabbit, 2 to 3 mg. x kg. hypoderm. causes convulsions; 1 cc. of 1 per cent, solu- tion by mouth causes corrosion of stomach. Rabbit (anes- thetized), 8 to 10 mg. hypoderm. paralyzes heart. Frog, 1 mg. hypoderm., toxic and fatal, as a rule; Vi 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- theria, tetanus, etc., when administered for such purpose. Hirschlaff claims to have been successful in producing an anti- toxic serum capable of counteracting poisoning by morphine. He injected 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 the 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. Further 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 free 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 quan- tity is unknown, and in others the strength of the preparation used is not stated. Some poisons are exceedingly active or deadly in very small doses. Among these are Aconitine gr. i/io; Digitaline gr. % 1 Hydrocyanic Acid gr. i; Strychnine gr. ]/2 ; etc., also some animal poisons, such as the venom of certain snakes, the bite of the tarantula, etc. Some of the toxines are exceedingly poisonous. The toxin of diphtheria is so poisonous 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 re- duction in body temperature; by hemorrhage due to corrosive perforation of blood vessels; by severe 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 be found in the blood, in the viscera or other tissues 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 mother, 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, Wormwood, etc.) ; also Garlic, Turpentine, and Co- paiba; the purgative principles of Rhubarb, Senna, Castor Oil, and Scammony, etc.; also Opium, Iodine, Iodides, Antimony, Arsenic, Bromides, Quinine, Sul- phur, Hexamethylenamin, Bismuth, Iron, Lead, Mercury, and Zinc. Therefore, the actions of certain drugs administered to the mother may be observed in and may even poison her child; among such are Opium, Arsenic, Potassium Iodid, Mercury, etc.; Senna, Castor Oil and some other purgatives may act 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- beb, Emetin, Ergot, Iodine and Iodides, certain es- sential oils and aromatic substances, such as Cloves, Pennyroyal, Peppermint, etc.; also Hexamethylena- min, Elyoscyamus, Morphine, Opium, Mustard, Phenol, Quinin, Salol, Salicylic Acid, Sulphonal, Tar, shell fish, currants, red berries, tomatoes, pickles, cheese, etc. Also food proteins, and synthetic com- pounds. 330 MANUAL OF TOXICOLOGY SUBSTANCES ALTERING COLOR OF URINE Dark green, or brown—Phenol. Bluish green—Methylene Blue. (If acid.) Brown or greenish-brown—Phosphorus, Phenol, Lead, Mercury, etc. Yellow or yellowish—Phallin, Phosphorus, Diamin, Rhubarb, Santonin. (If urine acid.) Salol, To- luene, Senna, etc. (If urine alkaline.) Purple—Santonin. (If urine alkaline.) Yellow. (Acid). 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), va- rious ethereal (essential, volatile) oils, and their vegetable sources, Turpentine, Cubeb, Asparagus, Gin, etc. SUBSTANCES ALTERING COLOR OF FECES Deeper color—Purgatives. Black or dark gray—Bismuth salts, Iron, Lead, Manganese, etc. Green or greenish—Colchicum, Mercury (as Calo- mel, etc.), etc. SUSPICIOUS SYMPTOMS. 331 SUSPICIOUS SYMPTOMS OF POISONING. (GENERAL HINTS) . When a person apparently in good health suddenly becomes lck, vomiting or purging or both, or showing symptoms of :reat vasomotor disturbance, or marked cerebral symptoms, me should suspect the invasion of some acute disease, the 'resence of a severe gastro-intestinal irritant, or the action of ome active poison, in the absence of a history of shock If everal persons are affected in the same way a food poisoning hould be suspected. Convulsions, if present, might be due to acute disease, some :astro-intestinal irritant, or such poison as one of the alkalies, If strychnine, etc. Vomiting and purging might be due to lisease or to such poison as ptomains, salts of the metals, conite, alkalies, arsenic, or corrosive sublimate, etc. As a rule, when vomiting and purging occur they are lature s methods of removing that which is a menace to the ndividual. and they should be judiciously encouraged. Great disturbance of heart action or of respiration, marked hange in the color or appearance of the skin, a quick, feeble 'Ulse, hyperesthesia, anesthesia, prickling sensations, pupillary peech, and temperature changes, stupor and coma, are phe- lomena which may point to acute disease or to a powerful rntant narcotic or depressant poison. Inquire as to the patient’s recent experiences, such as .istory of fall, exposure to elements or contagion, etc. • also egarding medicines, food and drink taken, and observe source nd any remnants of them. Test them, if necessary. Care- ully inspect the vomit and excretions, noting color, odor, re- ction and presence of foreign substances, such as undis- olved poison, parts of poisonous plants, etc. A peach-like or itter almond odor of breath or vomit would cause one to uspect hydrocyanic acid poisoning; the peculiar odors of lcohol, ether, formaldehyde, opium, lysol, phenol, etc are naractenstic of the respective poison and should guide to onnrmation by other evidences than odor. Observation of e urine as to its appearance and color may reveal the red olor of antipynne or fuchsine, or the greenish of methylin ue, phenol or mercury, etc. Often in suspicious cases it 5 wise to remove and subject to prompt chemical and micro- copical tests not only vomited matters and the first stomach /asnings, but also medicine and food remnants. As it is very humiliating to a physician to have others dis- over that what he had taken for disease was a plain case of oisomng, it behooves him to be on his guard and painstak- igly 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- is somewhat indefinite, 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 hemoglobin 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.” '• If not of the same “group” as that of the patient it may prove i effective if not actually harmful. ON UNCONSCIOUSNESS.—To tell if person is unconscious, raise eyelid and touch white of eye.patiencwill ? 1* Observe state and position of patient’s body. Place patient on back, head to one side, so that tongue or vomited • , .°^^ windpipe. If face be pale, keep head low; if flushed, elevate it. Loosen clothing about neck, chest and .f1'r1 e,nf arm.s a°d legs. Place away from objects of injury. Test eyes for condition of pupils, squinting, response to iignt and touch. If pupils equally contracted, probably poisoned by opium; if unequally contracted, probably injury to brain- if W6 to touch probably no injury to brain. If face drawn to one side, probably apoplexy or compression of brain;’ if flushed and bloated, probably alcoholism. May detect odor of alcohol or opium on breath. Examine mouth and tongue; bite on ongue ana froth in mouth indicate fits. Observe surface of body; very cold skin indicates fainting, collapse, freezing, severe shock, or intoxication; hot skin indicates great fever or sunstroke. Observe breathing; if slow, indicates shock or other depression; * tef.tor°us, indicates opium poisoning or brain affection. Observe the pulse; if rapid, indicates sunstroke or fever; if slow, brain aitection; if thready and rapid, indicates shock or some depressing effect. Raise successively each extremity and allow to drop: if rails lifelessly, suspect paralysis. If patient in convulsion, suspect hysterical, ursemic, epileptic or such convulsions. Examine body and extremities for fractures. J PART X.— Its Interpretation and Treatment. KIND OF COMA. ETIOLOGY. DEVELOPMENT. CHARACTER. CONVULSIONS. PARALYSIS RESPIRATION. TEMPERATURE. i y~' .. pupils. PULSE. SKIN. „ STOMACH AND BOWELS. ODOR OF BREATH, ETC URINE. Alcohol. Alcoholism. Delirium. Coma lasts for hours; gradually lessens. Aroused by ammonia or shaking, but is incoherent. No convulsions. No paralysis. “Steamboat.” Stertorous. / .ieavy. Low. Falls progrej’" sively from 1° to 6 below normal. ■I but ed as a rule L^l—ay be nor W light 'Sensible to fi^4Kunctiva Full and strong; later feeble. Is strong in Can- nabis Indica. First moist and warm, then cold. Vomiting, usually. Breath alcoholic. But alcohol may have caused ruptured cere bral blood vessels in By analysis alco hoi. 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. k'Uted. Much in- -, creased. Hot and dry. Urine retained. Emetics or wash out stom- ach; inject Pilocarpine and stimulants subcutaneouslv. Chloral. Chloral, etc. Profound coma. Can- not be aroused. Diminished, sigh- ing or stertorous; then shallow and feeble. As low as 94° F. 1 even 91° F. awaf' Slow, or very weak and quick. Later lost. Very cold. Fi- nally urticaria. Douches; Opium. 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. N°t re’ light. Imperceptible. Cpld, covered with clammy perspiration. Odor of bitter al- monds. Stimulants; Ammonia m- ha ations. 1-50 grain Atropine hypodermically. Artificial Opium. Opium, etc. Developed gradually. Aroused by noise, not by shaking. When aroused is coherent. No paralysis. hirst 8 to 10 per min., but deep; then 4 to 5 and long pauses. Shal- low. j s b>e Insen- J hSht- As 1, aPProaches, |S-— Strong. Slow and lull till late in poison- ing. First dry, per- haps warm ; later cold, clammy sweat. Opium in breath. Opium. respiration. Battery. Wash stomach; one pint strong coffee into rectum; Battery; keep moving; Atro- | Pine subcutaneously; artifi- Asphyxia. Exposure to gas or foul air. Cannot be aroused. convulsions fol- lowing distress- ed breathing. Difficult owing to oedema of lungs. Low. 1 Small. Rapid. Weak. Surface dry and hot. Much CO or C02 in breath. ciul respiration. Pot. Permang. 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 wrist. Cold and per- spiring. Lower head; stimulants; smelling salts; cold water tary ligation of artery. Hysterical. Trance. (2) Hypnotic. (3) males mostly.) Consciousness suddenly lost. Hypnotized. Developed suddenly. Coma alternates with hysterical delirium. No stertor; may be weak. 1 Usually lowci* L [ Ho jV,:ML c ll8ht bensitive •eeble, and requent. Flushed and hot. (2) Skin old. (3) Limbs , remain as jlaced. Vo vomiting. Vo diarrhoea. Vo odor. [ ncontinent>e. -old applications. Give Arom. 3pt. Ammon. 2) Watch; nourish. i 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 and 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, 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. 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. HEART. FEEDING IN POISONING 338a PART Xa FEEDING IN POISONING. Various Recuperative Measures in Debility When a person is poisoned it is important that he be given only such foods as are strictly suitable. Cer- tain foods are harmful in certain poisonings. In some poisonings no food should be given by mouth, if at all, for some time; and it may be necessary to observe some food restrictions until complete recovery occurs. The menace to health and to life is serious enough ordinarily, in a severe poisoning, to demand one’s best efforts, without having also to contend against the damaging, perhaps destructive, effects of unsuited foods being given. The food supplied should be sup- portive and reconstructive, energy-producing and tis- sue-building, fortifying against the shock and other serious effects of the poisoning—not an added evil, perhaps even an insurmountable, crushing handicap. If the mother of a nursing baby be poisoned, it may be necessary to discontinue giving the baby her breast milk for a time at least; such conditions as the fol- lowing demand such action: If the mother be so severely affected by the poison as to make the nursing too great a tax upon her vitality, or, as to seriously disturb the baby’s digestion, or to otherwise injuriously affect it, or even to menace its well being; also, al- though the mother does not yet evidence serious effects from the poison taken, if the poison be one of those known to be excreted through the breast milk and the dose taken be large enough to be deemed dangerous, the feeding of the mother’s milk to the baby should 3383 A MANUAL OF TOXICOLOGY be promptly suspended. In suspending the feeding of the breast milk of the mother, or in providing for a de- ficiency in its quantity or quality, resort must be had to the milk of a wet nurse, or to some kind of arti- ficial feeding, such as a modified cow’s milk, or to some other substitute for human milk. Suitable adapta- tion of the artificial feeding, as of cow’s milk, to a baby, is a very difficult matter; and it is considered by many physicians the greatest problem in medical prac- tice, inasmuch as there is no true substitute for the milk of the human mother, and each mother and her baby commonly have their associated peculiarities. Babies differ greatly at the same age, in condition as well as in adaptability to formulae of cow’s milk, etc.; they differ also in sensitiveness to the various sugars, cereals, vegetable and animal proteins, fruit juices, etc. Consequently authorities differ more or less widely as to what constitute suitable formulae for the feeding of cow’s milk to infants (by bottle or otherwise) at the various ages; also as to what aux- iliary foods—such as cereals, toast, crackers, bread, vegetables or their juices (potato, carrot, spinach, pea, asparagus tips, etc.), egg, etc.—may best be given, and at what age the feeding of them may wisely be in- augurated. Because of the difficulties commonly encountered in providing suitable bottle-feedings, and other kinds of food for babies, the author has incorporated in this chapter suggestions on such feedings and foods. It may be of interest to know that these suggestions are based upon his personal experience in 38 years of medical practice, his advisory service at Baby Health Stations of the Bureau of Child Hygiene of the De- partment of Health of the City of New York, his nursery service, and upon a review, by him, of the opinions and the methods, in such matters, of many of the leading American experts on infant feeding and the care and treatment of children. (See section on Infant Feeding.) FEEDING IN POISONING 338^ Feeding in Shock from Poisoning.—If not pro- hibited by the condition of some part of the alimentary canal—as of the stomach, from the severe effects of a highly irritant or corrosive poison, or of the stomach or intestine or both from an existing highly fermenta- tive or putrefactive condition, or if not prevented by local or other blood conditions—such foods as the following may well be given by mouth; Milk; fluid, highly nutritious broths; strong meat soup (con- somme) ; or albumin water; gruels; coffee, tea, cocoa or other beverages (hot), or stimulants; etc. When not proper by mouth, such foods may be given as nutrient enemata, when suitably prepared. (See Feeding (Rectal) in Rabies.) Feeding in Acute Gastritis (Especially that caused by an irritant or corrosive poison).—If there be cor- rosion or severe irritation of the upper part of the ali- mentary canal do not feed by mouth—it is not likely to digest but to irritate and to poison more instead. No food should be given by mouth for a day or two ex- cept possibly diluted or peptonized milk. Then weak tea, albumin, strained rice, barley, or oatmeal water; thin, milk and egg custard. If readily taken, feed by nutrient enemata as outlined in section on Feeding in Poisoning by Rabic Virus. Milk and water with soft bread in it. When the severe symptoms are much re- duced, give with or without soft bread in it; try some yolk of egg, barley or oatmeal gruel, rice soup, soft egg, raw oysters, soft egg, gruel, zwieback, farina, oatmeal, custard, krumbles, cornflakes, etc., given gradually more and more as acute condition subsides. Drink freely of water. Saline and aperient waters maye be well borne, try them cautiously, except in pois- oning by mercury or in a nephritis or edema. Feeding in Poisoning by Rabic Virus.—During the early symptoms of rabic poisoning, soft, semi-fluid food may be quite readily taken—such food as a thick soup of chicken, lamb, mutton, beef or a broth from a concentrated meat extract; also milk with or without 338^ A MANUAL OF TOXICOLOGY a cereal, custard, jellies, jello, etc., or a malt extract. If swallowing is painful or difficult, it may be necessary to apply a 4 per cent cocain, procain, or similar local anesthetic solution to the throat to facilitate the process ; if swallowing still be difficult or cause severe general convulsions, it may be necessary to give inhalations of chloroform to the extent of a primary anesthesia, or even to feed by stomach tube or catheter introduced into the stomach, with or without anesthesia. If rigid- ity of the jaws should interfere with the introduction of the tube or catheter and a front or side tooth be absent, a soft catheter may be passed through such opening, aided by swallowing motions, or by a weak local anesthetic spray; or the tube may be passed through the nostril if necessary. Through the catheter, with small funnel connected, thin, fluid foods of the same general character may be given. In feed- ing by catheter larger quantities of food may be given usually, but at longer intervals, even a pint of thin gruel, predigested milk, panopeptone, liquid pepton- oids, soup or broth, etc. When it seems necessary to resort to rectal feeding the rectum should be well cleansed before introducing the food. Flush it with at least a quart of warm soap- suds (castile or ivory soap) with half a level teaspoon- ful of table salt to the pint of fluid, or twice as much bicarbonate of soda and salt to the quart. The patient should be on the left side with the hips on a pillow and the shoulder low. If there be much mucus or the rectum prove irritable, put in one-half to one teaspoon- ful of saturated solution of boric acid to the quart of flushing fluid. The rectal alimentation (nutrient enema) should be given through a rectal tube or through a flexible depressed-eye or “velvet-eyed,” long, rubber catheter (size 12 to 14 for a child; No. 15 to 23 for an adult.) The tube should not be so flexible as to bend easily, nor to double back upon itself after in- sertion, nor so stiff as to damage the rectal wall should it catch in a fold of it. It should be dipped in warmed vaseline or , in sweet oil and gently inserted to the FEEDING IN POISONING 338e sigmoid flexure, about 3 to 10 inches for children, according to age and size, and 12 to 24 inches for adults. It is important that the tube should be car- ried well up the rectal canal that the nutrient material may be retained more easily, and that it cover consid- erable absorbing surface; also, that, being delivered in the upper part of the rectum, it be taken up by tributaries of the portal vein and thus be carried di- rectly to the liver for the highly important assimilative processes which occur there; whereas, if the nutrient material be delivered at the lower part of the rectum and absorbed there, it is diverted from the course to the liver and goes directly to the heart through the vena cava. A glass or hard rubber funnel or a perco- lator-like wall-tank or can, large enough to readily con- tain all of the food at one time, if desired, should be attached to the tube inserted into the rectum. It is better than a fountain syringe and than one with a piston. The whole apparatus should be so managed that no air enters the bowel with the nutrient enemia. A little of the fluid should be allowed to run from the tip of the tube, (after filling it, and a part of the funnel, with the fluid), in order to exclude all air from the tube, which should then be pinched tightly, low down, and inserted. That which flows out may be poured into the funnel so as not to be wasted. For a young baby the tube should be inserted 3 to 4 inches; for an older child, 6 to 10 inches, ordinarily for an adult about 18 inches. The funnel bottom should be held only 4 to 8 inches above the rectum for a baby, 6 to 10 inches for an older child and t° 2 feet for an adult. In introducing the nutrient enema or food, the patient should lie on the left side, (or in Sim’s ’position) with knees drawn up, and the hip on a pillow; the left shoulder should be low but the head may be on a low pillow. Valuable aid in the retention may be had, by applying and pressing a wad of cotton or clean waste or several folds of gauze about the size of a walnut, against the anus, and then holding it there 20 or 30 minutes, or applying a towel or napkin 338f A MANUAL OF TOXICOLOGY like a baby’s napkin. By turning the patient on the back or upon the right side, as soon as all of the fluid has been introduced, and keeping in that position for a time, retention is favored. It may be necessary to elevate the hips or hip a little more. Quietly diverting the patient’s mind from the stress of retention to in- teresting, not too amusing, matters, may help. In case of great rectal intolerance, inject into the rectum by means of a small syringe, 5 to 10 drops of Tincture of Opium or of Tincture of Belladonna in half a teaspoonful or more of water, one-half to one hour before the nutrient enema is given. It should not be used when avoidable, as, although it encourages retention by soothing the nerves and reducing peristalsis, and also helps prevent general convulsions, there is a tendency to depend upon it too much, and it also tends to interfere with the absorption of the nutrient material. Although the nutrient enemata may be retained with great difficulty the first few times used, or for the first few days, or even rejected, as a rule, by persisting with them, they are soon quite well borne. When an intolerance to the enemata develops after quite a period of successful use, a period of rest from such injections, lasting one or two days if neces- sary, often will restore local tone and tolerance. It has been found that patients may be nourished quite well, even six or seven weeks, by the judicious employ- ment of this nutrition method, without causing a mucus diarrhoea or severe or protracted local disturbance. Nutrient Enemata.—As enemata, only such starches as have been predigested and converted into dextrin and maltose or glucose, are likely to be absorbed, even in small quantity. Fats and oils, usually, mechan- ically interfere with absorption, by acting as an envelope surrounding the absorbable foods, or by coating over the absorbing surface. Even when emulsified, saponified or otherwise prepared they appear to be of doubtful utility. Food which is not readily absorbed is apt to irritate the rectal wall as it is nature’s inclination there to remove waste or that which FEEDING IN POISONING 338g irritates. Proteins which have been more or less com- pletely predigested or pancreatinized, are more absorb- able than those which have not, but they must be well diluted. Pancreatin or pancreatic extract, or pepsin, may be used in the preparation of beef juice or of milk for absorption, but the pepsin is less satisfactory. A good way to procure the beef juice is by using a meat squeezer upon a round steak which is without fat and cut thick; the meat should be seasoned with pepper and salt, broiled over a lively fire, cut into two inch squares, and squeezed well. This furnishes about half a pint of juice for each pound of meat used. Although the juice is better when freshly expressed, when cold it may be re-warmed by putting its container in hot water. It may be pancreatinized in the same way as milk. Milk may be pancreatinized by adding a pint of fresh milk to four ounces of cold water; to this add a tubeful of Fairchild’s Peptonizing Powder (pancre- actic extract 5 grains and sodium bicarbonate, 15 grains) or one to two teaspoonfuls of Parke Davis & Co.’s Pancreatic Solution; then stir well. Stand the mixture in warm (not hot) water for half an hour. Then boil the mixture two or three minutes to stop further digestive processes; if the boiling be postponed much longer than 30 minutes the protein will be com- pletely digested—(while not objectionable in peptoniz- ing for rectal use, it would be for oral administration as it makes the mixture more or less intensely bitter). After being thus prepared, the mixture may well be kept on ice for 6 to-12 hours. A mixture of 2 ounces each of beef juice and of milk, both pancreatinized, or 4 ounces of pancreatin- ized milk and the whites of two eggs, either raw or pancreatinized, and 2 level teaspoonfuls of milk sugar, has proved very serviceable as favored by Dr. W. G. Thompson. Also, a mixture of peptonized milk, one- half pint, 1 or 2 level tablespoonfuls of milk sugar, or of dextrimaltose, and the whites of 1 or 2 eggs, raw or pancreatinized, and 1 tablespoonful of malted 338h A MANUAL OF TOXICOLOGY milk makes a good mixture. (Yolk of egg contains too much fat to be useful, usually, for such enema.) Bovinine, after being pancreatized like milk, may be found serviceable as a temporary substitute for the foregoing; freshly prepared, nutrient enemata, if given per rectum in one ounce doses; Panopeptone (pre- digested wheat starch and beef), and Liquid Peptonoids are predigested preparations which may be similarly used. Valentine’s Meat Juice—one ounce said to rep- resent the condensed essence of nine ounces of natural expressed beef juice, and to contain hemaglobin and some albumin—is quite often given by mouth in one- half to 2 teaspoonful doses in i to 4 tablespoonfuls of cold water, wine or cold or warm tea; it may also be given per rectum; so may also other, somewhat similar, meat preparations. It may be necessary to considerably dilute them. They should be introduced warm but should not be boiled. Another satisfactory mixture is made by beating up the whites of 2 eggs and mixing in J4 pint of milk; warm to 100 degrees F. and add the contents of a Fair- child’s peptonizing tube. Stand the mixture in a warm place for an hour then place on ice. A portion of this may be used as required, with or without 1 ounce of starch, strained oatmeal, barley or flour gruel, to each 4 or 6 ounces of it, as desired. In some conditions 1 or 2 tablespoon fulls of whisky is added, as in a severe debility or slow convalescence, but such is not suitable in rabies. Malted milk (3 or 4 heaping teaspoonfuls of the powder in 6 to 8 ounces of water), adding x/2 level teaspoonful of salt and the white of one egg if desired, is also used. By adding 5 grams of pancreation and the same amount of sodium bicarbonate to 8 ounces of a thick well cooked gruel of oatmeal, cornmeal, barley, arrow root or other farinaceous substance and keeping the mixture at ioo°F. for about 10 minutes it becomes pancreatinized. By this process the gruel has been FEEDING IN POISONING 338i thinned and made more digestible, the starch having been converted into dextrin and a sugar. If malt flour (commonly, barley soaked well heated, allowed to germinate, dried and ground) one part, and oatmeal 6 or 8 parts, be made into a thin porridge, it is a conveinent nourishing food for mouth or rectal administration. Maltine (made from wheat, oats and barley) is rich in the vegetable digestant or ferment known as diastase. It may be used alone or in raw peptonized milk; or it may be added to an equal part of well boiled wheat flour or barley flour, which it partly digests, and used thus as a convenient food, or added to milk to dilute the latter. Various malt extracts and malt preparations are serviceable foods. Mellin’s Food contains (wheat, flour and malt). It is dextrinized and quite rich in sugar, but not in fat. It is readily added to milk and hot water as a tem- porary or auxiliary food by mouth or rectum. Malted Milk is a preparation of milk with malted barley and wheat extracts whose starch has been changed into dextrin. It resembles Mellin’s Food, but also is of rather low fat content. It is particularly serviceable in severe alimentary disturbances and often may be used satisfactorily for a time as a substitute for breast milk in infant feeding. Feeding, in Poisoning by Mercury.—Take milk, more or less diluted. Gruels, thin well-done toast, soft puddings (without eggs) ; all vegetables except peas, beans, raddishes, cabbages. Drink water, postum. Avoid tea and coffee. In convalescence, cautiously clear broths. Fruits not very sour. Feeding by nutrient enemato may be necessary. (See under feeding in poisoning by rabic virus). Feeding, in Acute Gastritis.—In a gastritis resulting from the action of an irritant or corrosive poison, no feeding by mouth may be possible for some time— rectal feeding only. (See nutrient enemata, under feeding in poisoning by rabic virus). 338j A MANUAL OF TOXICOLOGY When feeding by the mouth can be employed, strained barley water, rice water, albumin water, milk and water, bread and water (warm), the various gruels as improvement ensues; also soft egg, gradually add bread and butter, raw oysters, thickened but simple broths and soup. Dry cereals plain vebetables, tea and coffee, peptonized foods. Feeding in Debility.—Give by mouth rich cream soups—chicken, lamb, clam or beef broth, with or without chopped meat or cereal thickening; fresh fish (boiled or broiled), broiled or crisp bacon, boiled tender ham, chicken, mutton or beef, lamb chops or cutlets, as able: tender, juicy steaks or chipped beef or ham- burger steak to chew; coddled (8 minutes in standing, boiling hot water, or put on in cold water and boiled 2 minutes), shirred, poached or other soft cooked egg; crisp toast, with or without butter, milk or cream; corn- bread, graham bread or malted bread, triskets, gluten bread, shredded wheat, graham, Wheatsworth or other dry crackers or biscuits with or without butter; also other crackers or biscuits and rolls that may agree and appeal to taste; also tapioca, rice and other cereals as corn flakes, krumbles, corn and oat meal, cream of wheat, wheatena, etc., as agree. Strictly fresh and well cooked vegetables that agree; custards, corn starch and bread puddings, junkets, calf’s foot jelly, gelatine, cooked (not very acid nor sweet) fruits, especially apples, prunes, peaches, pears, apricots, figs and dates. As drinks: water, malted milk, tea or coffee, Phillips or Epps cocoa, perhaps others and chocolate; albuminous drinks panopepton, hot or cold milk (easier digested if diluted, or better if peptonized; diluted (peptonize judiciously) unfer- mented grape juice or orange juice. Avoid most other foods and drinks until quite convalesced. Insomnia or sleeplessness, so often a disturbing ele- ment in debility, may often be helped by a glass of hot (somewhat diluted) milk or malted milk, taken shortly before retiring. When able, a short walk at FEEDING IN POISONING 338k bed time, or light calesthenic exercise, may help. Sleeping out of doors favors sleep, if not afraid. Take a hot sponge or tub bath, with cold, wet cloth on head, and followed by application of cool or cold water and brisk rubbing; then at once to bed, with head high, comfortable garb and bed clothing; wet, cold cloth to head, and heat to feet if weather not too warm; then by relaxing and composing mind, sleep is encouraged or induced without drugs. Feeding in Intestinal Auto-intoxication, Alimen- tary Toxemia; Auto-intoxication, Auto-toxemia- (Not true ptomain poisoning, nor spoiled, putrefied, etc., meat, fish or milk, etc., poisoning).—In poison- ing by toxins produced within the body, and while still active, diffused through the circulation, instead of be- ing directly removed in the excreta or neutralized be- fore being absorbed, the digestive and food absorptive functions are more or less seriously interfered with. Consequently the vital force so dependent upon these functions for its maintenance, is immediately men- aced. Pending removal or destruction of the toxins, or suspension of their production and of their toxic effects, the tax upon these functions must be reduced to a minimum. Therefore, foods which have been pre- digested and are highly absorbable and nutritious, and not contributory to the toxin nor toxic processes, are desirable. (See Pancreatinizing under Nutrient Enemata.) In the light of present knowledge and commonly ac- cepted chemical and other determinations and interpre- tations it seems best to reserve the term Food-Poison- ing for those poisonings resulting from the ingestion of foods already in a state of decomposition or in some way poisoned or poisonous before being taken as food. Although ptomain poisoning, so-called, commonly is in- cluded in this definition, doubtless such poisoning may be the result of an intestinal putrefactive process, orig- inating in the alimentary canal, and producing an auto- intoxication and toxemia strictly alimentary in its 338l A MANUAL OF TOXICOLOGY origin; hence an intestinal auto-intoxication, rather than a true food poisoning, or poisoning by food unfit for ordinary human consumption before it was in- gested. In the food-poisoning class would be placed meat, fish, milk, etc., whose proteins were in an unfit condition, or of a deleterious character before they were ingested. Feeding in Fermentation Auto-intoxication.— When a severe fermentative condition or the effects of such exists in some part of the alimentary canal, car- bohydrates—starches, sugars, all sweets and their prod- ucts, are to be avoided or taken very sparingly. Diluted or pasteurized milk, custard, soft egg, clear broth and various meat juices—hot and free from grease and pre- ferably, pasteurized—and plain carrots, asparagus, string beans, celery, etc., may be given cautiously when well borne, albumin water helps, drink water freely, or sip hot water or hot weak tea. Eat but little butter. Try some yellow corn meal, fish, chicken broths, eggs, chopped or scraped beef, boiled ham (sliced very thin), chipped or smoked beef (to be well chewed and residue discarded) ; oysters (raw, stewed or steamed). Trisket, slowly toasted wholewheat bread; shredded wheat bis- cuit, hominy tapioca, asparagus tips, small peas or string beans, or stringless string beans, cooked celery, spinach, squash, okra, lettuce, parsnips, etc. Roast beef or steak, veal, mutton chop (very tender) ; thin crisp fried bacon; lamb or beef tongue, boiled or roast, tender, not fat ham; cautiously; stewed fruit, jello or gelatine, custard. Also oranges, prunes, bananas, apples, peaches, pears, plums and olives. Buttermilk, but little butter. Tea or coffee with a saccharin tablet instead of sugar (no cream) ; skimmed milk and water. Aperient waters and much water between meals, alone if but little atony or loss of tone in bowels. Feeding in Putrefaction Auto-intoxication.— When a severe putrefactive condition, or the effects of such, exists in some part of the alimentary canal, pro- teins, both animal and vegetable, are to be avoided or FEEDING IN POISONING 338m to be eaten very sparingly at least. Carbohydrates may be given cautiously when well borne. Milk, diluted or pasteurized, such dry cereals as corn flakes, krumbles, puffed rice, well toasted bread, corn muffins, shredded wheat biscuits, triskets, graham and arrow root crackers, etc. Vegetable soups; strained thin meat- soups (cautiously, late in convalescence); asparagus; corn, lima, butter and string beans; small tender peas; perhaps small onions boiled ; small tender beets; lettuce, celery, spinach, pumpkin, squash, parsnip, tomato, po- tato, egg plant, etc. Bacon—crisp snappy (as con- valescence progresses) ; boiled or broiled fish—as weak fish, whiting, flounder, bass, trout—once or twice a week only. Most of the cereals—tapioca, sago, mac- aroni and spaghetti—no cheese, rice, cornmeal, oat- meal, graham or whole-wheat bread or crackers (crisp) —butter very sparingly, (about y2 ounce daily). Fresh fruit (raw and cooked) ; no sugar or cocoa until late in convalescence. Drink water freely and aperient waters; tea, coffee or cocoa (sparingly; skimmed milk and water—not other milk foods and early tender, small peas, string beans, asparagus, cooked celery, lettuce, tomatoes; strained vegetables soups without potato; perhaps a few very crisp potato chips. Crisp zwieback, or whole wheat bread slowly toasted and made snappy; then wet with hot water if with—(no butter) ; shredded wheat biscuit trisket graham crackers (unsweetened preferred), arrow-root or wheatworth crackers, aerated bread— (soft bread, charged with C02;). Boiled ham (in latter part of convalescence cautiously) ; crisp bacon; broiled or boiled lean chicken; fresh weakfish, whitefish, butterfish or flounder—eat chicken and fish occasionally, sparingly and very cautiously—mainly in latter part of convalescence. Only y2 ounce of butter daily if at all. Drink water freely, also orange juice with water; black coffee with one 2-grain saccharin tablet (no sugar) ; weak black tea with thin slice of lemon. No alcoholics nor ferments. In feeding in many or all of the auto-intoxications and in food poisonings, even in quite advanced con- 338n A MANUAL OF TOXICOLOGY valescence, only plain foods should be eaten; rich highly-seasoned or irritant foods are quite unsuited to due recovery processes. One should avoid trying to eat a large quantity or great variety of food, eat perhaps a little oftener but considerably less each time than formerly. Drink water freely, saline waters and the true aperients often are beneficial. Each case has its mandatory peculiarities, and these will rule and must be the real guide, with due observance of variety of foods and sufficient of food calories in feeding. Feeding in Food Poisonings.—Feed practically on the basis of Putrefaction-Auto-intoxication, modifying as indications arise. In treating any toxemia, or form of blood poisoning, the functional activity of the liver should be very care- fully maintained to insure the benefits of its bacteri- cidal and eliminative action. INFANT FEEDING If the mother of a nursing baby be poisoned suddenly, or a poisoned condition of her blood develop, it may be necessary to provide a wet-nurse for the baby or to resort to artificial feeding of it. In either case the frequency in feeding, the duration of each feeding, and the general principles to be ob- served are the same as in nursings by the mother. In selecting a wet-nurse it is desirable to secure one between twenty and thirty years of age, and who has had more than one child (because of the advantage of experience in the suck- ling and the general care of such), and whose nursing baby is about the same age as the one to be wet-nursed; however, the wet-nurse whose baby is less than six months old can, as a rule, properly suckle one at any age under that, although less difference between the ages is desirable. Usually a change from one wet-nurse to another is not harmful to a baby, and sometimes several wet nurses must be tried before one is found whose breast milk agrees. A woman of good develop- ment, rather broad-shouldered, of a gentle and happy dispo- sition, rather than one who is temperamental, nervous, hys- terical or neurasthenic, is much to be preferred; the char- acter of the milk secreted may be considerably influenced by anervous instability. The breasts of the wet-nurse in prospect should be examined to determine the quantity of milk present. INFANT FEE.DING 338o By light, but firm, manipulation of the breasts, well behind the nipples, using both hands on one breast at a time, the size and functional activity of their glands may be determined. By firmly but gently taking hold of one breast with both hands well behind the nipples, and expressing outward (as in empty- ing an infant syringe with one hand) the quantity and freedom of flow of the milk may be determined; it should spurt out with considerable force and in several streams, if the pressure is maintained for about half a minute. If it be difficult to express it without much massaging or pumping of the breast, such wet-nurse is ill-suited to the nursing of a premature, marasmic, or otherwise enfeebled or ill-nourished baby. Such babies require a plentiful supply of milk, the milk flowing with- out much sucking effort. In the normal breast a manual ex- pressing should not cause pain. Drawing the milk by a thumb and finger explusion process or by a stripping process, to feed the baby or to relieve the breast of over supply, is favored by some, and others use a breast pump. The lungs of the wet-nurse should be examined to determine that she is free from tuberculosis; the skin and throat ex- amined and the blood tested by the Wasserman test, to deter- mine she is free from syphilis; her eyes examined to be sure she has no trachoma; her nipples inspected to determine the absence of fissures, also that they are sufficiently prominent to insure a good seizure in the nursing. The vagmal and urethral secretions should be tested to determine the absence of gonorrhea and of puss cells. By exercising these precautions the baby should be quite well protected against a blood poison- ing or infection by the wet-nurse. The baby of the wet-nurse should be inspected to determine that it is well nourished by the mother, and appears to be free from conveyable disease. Also that the milk of the mother seems to be sufficient to supply both babies adequately. If the wet-nurse does not directly nurse the alien or wet-nurse baby, but sends her milk to be taken from a bottle or spoon, deter- mine that her milk is or will be properly drawn, received in a clean container, carried and kept for the purpose. The milk for the alien baby should be expressed first from one of the wet-nurse’s breasts, then her own baby should empty that breast and draw some from the other breast it necessary. At the next feeding the same course should be pursued beginning with the breast only partly emptied. If the milk of the wet- nurse is to be sent to the alien baby, it should be put on ice when received until time to feed, then warmed to blood heat and given. The writer has been much gratified by results obtained in his Health Stations’ work by following some of the methods advised by the celebrated Dr. L. Emmett Holt of New York. Some of his points are worthy of emphasis, such as: 338/ A MANUAL OF TOXICOLOGY “A simple method of calculating a milk formula for an average healthy infant on the basis of caloric requirements is to start with the daily amount of protein of cow’s milk needed. This by experience has been found to be furnished in approxi- I II Ill IV V VI VII VIII IX X Milk (ounces) 6 7 8 9 10 11 12 1 1 13 14 15 Water (ounces) 14 13 12 11 10 9 7 1 s 1 0 1 1 2 5 5 Sugarf (even table- 1 spoonfuls) 2>4 2J4 2*4 2/4 2/4 2/4 2 1 1*4 1 1 Total 20 20 20 20 20 20 20 , 20 20 20 Fat (per cent) 1.20 1.40 1.60 1.80 2.00 2.20 2.40 i 2.60 2.80 3.00 Sugar (per cent) 5.70 6.00 6.00 6.50 6.50 6.50 6.00 | 5.50 5.50 5.00 .40 .80 2.00 2.00 Protein per cent) 1.00 1.20 1.40 1.60 1.75 1.90 2.10 1 2.25 2.40 2.60 Calories (per oz.)) 11.5 12.5 13.5 14.5 15.5 16.5 17.0 18.0 20.0 21.0 Approx, age indication. 2 dys. 1 wk. 2 wks . 2 mos. 3 mos. 4 mos. 5 mos. 6 mos. 8 mos. 9-11 mos. *The gruel here indicated is made in the proportion of 1 oz. of flour by volume to 10 oz. of water. tMillc sugar is here indicated; of cane sugar use two scant tablespoonfuls instead of two and a half, and one instead of one and a half, etc. Maltose may be used in the same amounts as milk sugar. FORMULAS FROM WHOLE (4 PER CENT) MILK Giving Approximate Percentage Composition and Calories Value INFANT FEEDING 338q mately 1 y2 ounces of milk for each pound of body weight. An infant weighing 10 pounds will thus require 15 ounces of milk. If his caloric needs be calculated at 45 per pound they will be 450 calories. Of this there will be furnished in the milk (20 calories per ounce) 300 calories, leaving 150 to be made up by carbohydrates—sugar or starch. One ounce of sugar will add 120 calories; or 1)4 ounces, 150 calories. This will give the food value for a day. There is still to be deter- mined the amount of diluent which will depend upon the in- fant’s daily need of fluid. This has been shown to be about 3 ounces for each pound of body weight in the early months, and 2 ounces for each pound in the later months; i. e., for a 10-pound infant it will be 30 ounces a day. There will need to be added, therefore, 15 ounces of water. The formula will then be: 15 ounces milk, giving 300 calories 1% “ sugar, giving 150 calories 15 “ water The 30 ounces of food could be divided into seven feedings of 4% ounces each, or into five feedings of 6 ounces each according to circumstances. The approximate percentage com- position of the formula, using 4 per cent, milk, would be: fat, 2.00; sugar, 6.00; protein, 1.75. Before this top-milk is removed the milk should stand in the bottle at least 4 hours, and the top-milk should be carefully removed with a milk dipper, not poured off.” SCHEDULE FOR HEALTHY INFANTS DURING THE FIRST YEAR Age Interval Between Feedings Night Feedings after 6 p.m. Feedings in 24 Hours Quantity for one Feeding Ounces Quantity for 24 Hours Ounces 2nd to 7th day. .. . 3 2 7 1 -2 7 -14 2nd, 3rd and 4th weeks 3 2 7 2J4-4 54 18 -32 2nd and 3rd months 3 2 7 354-5 24 -35 4th and 5th months 4 1 5 6 -7 30 -35 6th, 7th and 8th months 4 1 5 654-754 3254-3754 9th and 10th months 4 1 5 • 7 -8 35 -40 11 th and 12th months 4 1 5 ' 8 -9 40 -45 “A schedule like the following indicates the needs of a healthy- infant of average size, weight and activity. But no schedule can be closely followed with any given child. One cannot con- clude because an infant is six weeks old he is able to digest a certain amount of food and a certain other amount because he is six months old. To attempt to follow any schedule too closely is to violate the fundamental principle of intelligent 338r A MANUAL OF TOXICOLOGY feeding, which is to adapt the food to the child’s requirements and powers of digestion at the time. Because these figures represent averages they form a useful basis for feeding healthy children. Age Average Caloric Requirements Furnished in 1 month 400 7 feedings oz. of No. Ill 2 months SOO 7 feedings 4J4 oz. of No. IV 3 months 560 5 feedings 7 oz. of No. V 6 months 640 5 feedings 7y* oz. of No. Vlil 9 months 740 5 feedings 7J4 oz. of No. IX How and Where to Begin—With all young infants, even those having presumably normal digestion, it is desirable to begin with a weaker food than would be indicated by their caloric requirements, and gradually increase both the strength and quantity according to the child’s digestion. With small or feeble infants still weaker formulas should be used and the increase made more slowly. For a healthy child with normal digestion who has previously had no cow’s milk one should begin with a lower formula than would usually be given to a healthy child of his size and age, but may increase the strength and quantity of the food more rapidly than with a stronger infant. A stationary weight for a week or two, or even a loss of a few ounces, is of no importance, provided the change in diet can be effected without disturbing digestion; for as soon as a child becomes accustomed to cow’s milk the strength can be increased and progress is assured. Nothing is easier than to disturb the digestion in the beginning by the use of too strong food.” Prof. Roger H. Dennett, Professor of Diseases of Children and Director of the Department in the New York Post Gradu- ate Medical School, etc., in treating on the bottle feeding of babies, in his books, very properly calls it “the intricate sub- ject of infant feeding.” He further says: “Infant feeding is a science, not guess work;” and that “experimentation may prove disastrous.” “Physicians of large experience will readily subscribe to these sentiments. The writer has found Dr. Dennett’s methods and personal suggestions, and the methods of Dr. Louis Fitscher, of. the Willard Parker, Rive.rside and other hospitals of New York INFANT FEEDING 338s City, of great service in his private practice and advising mothers and directing the feeding of very many babies, in the writer’s clinical service in the Bureau of Child Hygiene of the Department of Health of the City of New York, etc. He has also found the practical ideas of Dr. S. Josephine Baker, Di- rector of the Bureau of Child Hygiene of the Department of Health of the City of New York, very helpful. Dr. Dennett claims regarding the requirements of bottle-fed infants that: The fat infant over four months of age needs forty to fifty calories per pound per day. The moderately thin infant over four months of age or the average infant under four months needs fifty to fifty-five calories per pound per day. The emaciated infant of any age needs sixty to sixty-five calories per pound per day. CALORIES STOMACH CAPACITY At birth, 1 ounce. At 1 month, 2y2 ounces. At 2 months, ounces. At 3 months, 4 to ounces. At 5 months, 5J/2 ounces. At 6 months, 6 ounces. At 9 months, 7y ounces. At 1 year, 9 ounces. If the baby is quiet, usually (crying only about feeding time), gains steadily and proportionately in weight, with well digested stools and no vomiting, or but little (and that not sour) the food is agreeing with it. If there be a little vomiting immedi- ately or very shortly after feeding it is probable the quantity given is too great, or the baby nurses too fast. The quantity given should be reduced; or the food given for about 5 min- utes, and then a 5 minutes’ interval introduced during which the baby should be placed with the face over the shoulder and gently patted to belch up any gas present in the stomach; then the food given again for 10 or 15 minutes with or without an- other adjusting interval. The milk mixture is made more di- gestible by heating for 2 or 3 minutes. Boil the milk or rather bringing it to a boil and then by re- ducing the heat (such as turning gas low), allowing it to merely simmer for 3 minutes. Moving it from over the fire and stirring it for 5 minutes, thus preventing a scum forming. Small soft curds being formed instead of large hard ones and vomiting often prevented by feeding the milk thus: Dr. Dennett gives the following approximate analysis of 338t A MANUAL OF TOXICOLOGY Dryco (a dry milk which serves well as a temporary food in malnutrition, indigestion, etc.) : At first it should usually be fed to y2 strength only, at first. 1 ounce by weight = 127 calories. 8 level tablespoonfuls = 1 ounce. 1 level tablespoonful = 16 calories. Per Cent Fat 12 Lactose ' 44 Protein 34 Salts 7 Moisture 3 Given 1 part to 8 by weight 100 With the larger quantities of dry milk the urine is apt to become ammoniacal and by increasing the calories with starch and sugar this excessive output in the urine can be avoided. Dr. Dennett declares that during the process of drying the milk is important the change which takes place in the case. The heat and the loss of water separates almost instantaneously the casein into minute particles which remain suspended in this finely divided state when water is later added for feeding purposes. In the stomach these separate particles do not unite to form large masses or curds such as are found when fresh cow’s milk is acted upon by the gastric juice. He states also that these separate particles, although they become swollen, do not unite to from large masses or curds, such as are found when fresh cow’s milk is acted upon by the gastric juice and are more easily digested in stomach and in the intestines and are digested much more readily than the large curds of fresh cow’s milk or even the small curds of boiled milk. The analysis stated by Dr. Dennett also shows to what he calls attention, i. e., that the Dryco contains a low fat and a larger per cent of free fatty acid than does fresh cow’s milk; and that: “These fatty acids react with the alkaline carbonates to form soaps and the soaps in turn form an emulsion which assists in the digestion of the fats. He calls attention to the fact that when the. Dryco is used alone mixed with water 1 part to 8 by weight (one level tablespoonful to one ounce of water) it gives a mixture containing about Sy2 per cent lactose, 1 y2 per cent fat and a little over 4 per cent protein; and, that “This high protein content makes it advisable to add sugar or gruels or both to the feedings of older infants, after the digestive dis- turbances have been controlled, but not usually until 4 or 5 ounces (30 to 40) tablespoonfuls of the dry milk product are consumed daily.” INFANT FEEDING 338u Dr. Dennett says: “The food must be made fresh at each feeding by dissolving the proper quantity of the dry milk powder in the proper quantity of hot water. In order to furnish 50 calories per pound per day give 3 tablespoonfuls, leveled with a knife, of dry milk for every pound of the body weight, since a tablespoonful has 16 calories. Only very poorly nourished infants need as many as 50 calories per pound of dry milk. Well-nourished or fat babies gain progressively on 40 calories per pound per day (or ever less) which can be fur- nished in 2)4 tablespoonfuls for each pound of the body weight. The maximum strength of the food is one tablespoonful to the ounce of water, weaker solutions always being used at first. Begin with one tablespoonful ()4 of an ounce by weight) in 2 to 4 ounces of water, according to the age and size of the infant. In 24 hours 2 tablespoonfuls to each feeding may be used and a day or two later 3 tablespoonfuls, and so on until the caloric requirements are fulfilled. An infant of average size and weight may have at each feeding one or two more ounces of food than the number of months of its age, with a minimum quantity of 3 ounces and a maximum of eight ounces. Undersized or vomiting infants must have less.” “Begin orange juice in all kinds of bottle feedings at 6 weeks old to eliminate possibility of scurvy.”—Dr. Dennet. “Therefore, all of my cases are put on orange juice after 2 or 3 weeks.” He begins on cases of simple intestinal indigestion with a mixture of about l/$ milk and 2/z water boiled. He uses boiled feedings more or less for months even from birth through the bottle period. (Scum on top of boiled milk = fat and protein.) Crozer and Griffith give the following as the approximately gain in weight, by a baby during the first year: The first month, 7 ounces a week; third and fourth month. 5)4 ounces a week; fifth and sixth month, 4% ounces a week; dur- ing the remainder of the year 3)4 ounces a week. Some pedi- atrists anticipate considerable less average gain, at various periods, than in above, while others look for more. The aver- age gain seems to be about that indicated in the feeding chart arranged by the author. Vegetables and cereals may be added gradually and care- fully to a baby’s diet usually at about 8 months as an introduc- tion to table-feeding. A new food of a mixture (soft) of a meat substance, dried milk and a prepared cereal is being found very helpful in malnutrition cases (infants) and prob- ably will soon be marketed. There is an increasing tendency to feed babies of all ages only once in 4 hours. It seems to pro- duce the best results. 3387/ A MANUAL OF TOXICOLOGY Dr. S. Josephine Baker, so long Director of the Bureau of Child Hygiene, of New York City, has advised the following methods in Infant Feeding: MILK FORMULAE FOR FEEDING INFANTS PREPARED FOR THE AVERAGE BABY Bv S. Josephine Baker, M.D., Director, Bureau of Child Hygiene, Department of Health, New York City In L. H. Journal, September, 1922 Age W eight Amount of Milk Amount of W ater Amount of Milk Sugar Amount at Each Feeding Times of Feeding No. of Feed- ings Per Day Total Amount in 24 hours 1st week 6-654 lbs. 5 oz. 10 oz. 1 oz.* 2 oz. 7 14 oz. 2d week 7-754 lbs. 6 oz, 10 oz. 1 oz.* 2 oz. 2, 6, 9 a.m. 7 14 oz. 3-4 weeks 754 -854 lbs. 10 oz. 10 oz. 1 oz.* 254 oz. ■ 12, 3, 6, 10 p.m. 7 1754 oz. 2d month 10 lbs. 18 oz. 10 oz. 6 drams* 354 oz. 7 2454 o>z. 3d month 11 lbs. 18 oz. 10 oz. 5 drams* 4 oz. 7 28 oz. 4th month 12 lbs. 22 oz. 8 oz.t 5 drams* 5 oz. 6 and 9 a.m. 6 30 oz. 5th month 1354 lbs. 26 oz. 8 oz.t 4 drams* 554 oz. 12, 3, 6, 9 p.m. 6 33 oz. 6th month 15 lbs. 30 oz. 8 oz.t 4 drams* 7 oz. 5 35 oz. 7th month 16 lbs. 32 oz. 8 oz.t 3 drams* 8 oz. 5 40 oz. 8th month 17 lbs. 32 oz. 8 oz.t 3 drams* 8 oz. 5 40 oz. 9th month 18 lbs. 34 oz. 6 oz.t 2 drams* 8 oz. 6 and 10 a.m. 5 40 oz. 10th month 19 lbs. 34 oz. 6 oz.t 2 drams* 8 oz. 2, 6 and 10 p.m. 5 40 oz. 11th month 20 lbs. 36 oz. 4 oz.t 8 oz. 5 40 oz. 12th month 21 lbs. 40 oz. 0 oz. 8 oz. _ 5 40 oz. * ITse only half the amount of sugar indicated if cane sugar is substituted for milk sugar in these formulae. + Use barley water in making up formulae after three months of age. NOTE: One dram equals one teaspoonful DRY MILKS Dry milks are used for temporary digestive disturbances, for conveni- ence in traveling, etc. Among such dry milks are Diyco, Mammala, etc. To furnish 50 calories per pound per day of Dryco give three tablespoonfuls (level) for every pound of the body weight of a baby. One tablespoonful has 16 calories. Hence a 7-lb infant requires—7 x 50 calories = equals —350 calories (16 calories per tablespoonful = 21 -f- tablespoonfuls in 24 hours). Mix one tablespoonful to water 1 ounce == 1 to 8 by weight == mixture of 5)4% lactose, 1)4% fat and + 4% of protein. Indigestive disturbance or food injury begin low—one tablespoonful Dryco in 2 to 4 ozs. of water according to age and size of infant. It must be made fresh for each feeding. 8 level tablespoonfuls Dryco = 1 oz., 1 oz. — 127 calories. 8 level tablespoonfuls Dryco = l/» oz, or 16 calories, INFANT FEEDING 338w [The producers of Dryco have recommended the following in the use of Dryco: FEEDING TABLE FOR THE USE OF DRYCO Weight Amount Amount Number Intervals Total of baby of Dryco water each feedings of Calories in pounds each feeding level tbsp. feeding ounces per day feeding per day 5 2 254 7 3 hours 224 6 2/4 3 7 3 “ 280 7 3 354 7 3 “ 336 8 3 4 7 3 “ 336 9 354 454 7 3 “ 392 10 4 5 7 3 “ 448 11 4 5 7 3 " 448 12 5 6 6 3 “ 480 13 554 654 6 3 “ 528 14 6 7 6 3 “ 576 IS 654 754 6 3 “ 624 16 8 8 S 4 “ 640 17 8 8 5 4 “ 640 18 8 8 5 4 “ 640 1 oz. by weight—127 calories 8 level tablespoonfuls (leveled with a knife) — 1 oz. by weight 1 level tablespoonful (leveled with a knife)—16 calories The simplest general rule is to give 2 y2 level tablespoon- fuls per day for each pound of the infant’s weight. Dis- solve in one more ounce of water than there are table- spoonfuls of DRYCO per feeding. At 18 pounds, use barley gruel as dilutant and add sugar. Barley gruel may be made with 2 level tablespoonfuls of barley flour to the pint of water, boiled for 20 minutes, strained, and salted to taste. Cook enough barley for the full 24 hours and when mixing the food, dissolve the DRYCO in hot water, adding the barley gruel last. At first use 1 oz. of barley gruel to 7 ozs. of water and DRYCO, then 2 ozs. of barley gruel to 6 ozs. of water and DRYCO up to 4 ozs. of barley gruel to 4 oz. of the water and DRYCO mixture. Begin with one-half tea- spoonful of sugar in alternate bottles and gradually increase to one level teaspoonful to each bottle. Over 18-20 pounds feed well cooked cereals in addition to bottle feedings. CONSTIPATION—The treatment of constipation depends on the cause. One of the most frequent causes when DRYCO is used is underfeeding. Be sure that you are using 2l/2 level tablespoonfuls of DRYCO per day for every pound of the baby’s weight, as shown in the feeding table. Another cause of constipation is insufficient fluids. Give at each feed- ing at least one more ounce of water than the months of the baby’s age up to a maximum of 8 ozs. at 7 months. During the first 2 months 7 feedings of 3 to 4 ozs. are necessary. If these conditions are being fulfilled and the stools are constipated granulated (cane) sugar or Dextri- Maltose No. 3, may be given as much as a level teaspoonful in each feeding. Orange juice may be given once or twice a day an hour before feeding, beginning with a teaspoonful and increasing a teaspoonful every 3 to 4 days until the juice of a full orange is given daily. The Number of Feedinrs to be Given in a Day For babies up to 12 pounds—7 feedings. A.M. A.M. M P.M. P.M. P.M. A.M. 6 9 12 3 6 10 2 For babies 12-16 pounds—6 feedings: A.M. A.M. M P.M. P.M. P.M. 6 9 12 3 6 10 For babies above 16 pounds—5 feedings: A.M. A.M. P.M. P.M. P.M. 6 10 2 6 10 Fermentative diarrhea with frequent watery, acid stools, which often excoriate the buttocks, calls for a non-fermentative or protein food. This is best given in the form of fat free milk and Protolas so that the diarrhea may be controlled before starting DRYCO. Mix 2 packages of Protolac of 10 grams each in 16 ozs. of fat free PROTOLAC 338x A MANUAL OF TOXICOLOGY milk, boil this actively together for 10 minutes, then add 1 pint of cold water and bring to the boiling point again. Give the proper amount at the proper intervals for the age and weight as indicated in the table. After the stools have become good and firm change to DRYCO, using it as indicated above. The author has found Mead’s Dextri-Maltose of very great service as a carbohydrate and food in the feeding of infants. The company that produce the same recommend the following methods in its use. In intestenal disturbances or malnutrition they suggest the below stated measures: FEEDING TABLE NO. 1 Feeding Mixtures Suitable for the Average Well Baby Baby’s Age in Months Weight of Baby, Pounds Amount Cow’s Milk, Ounces Amount Boiled Water, Ounces Level Table- spoonfuls Dextri- Maltose Amount of Each Feeding Ounces Number Feedings in 24 hours 1 7 10 11 4 3 7 1 8 12 16 6 4 7 1 9 14 14 6 4 7 1 10 16 12 6 4 7 2 8 12 16 6 4 7 2 9 14 14 6 4 7 2 10 16 12 6 4 7 2 11 18 14 6 4^ 7 3 10 16 12 6 4 7 3 11 18 14 6 4J/2 7 3 12 20 IS 6 S 7 3 13 22 13 6 S 7 4 12 20 16 6 6 6 4 13 22 14 6 6 6 4 14 24 12 6 6 6 5 13 22 11 6 6^ 5 5 14 24 11 6 7 5 5 IS 26 9 6 7 5 6 13 22 13 6 7 5 6 14 24 11 6 7 5 6 IS 26 9 6 7 5 6 16 28 12 6 8 5 14 24 16 6 8 5 IS 26 14 6 8 5 7-8-9 16 28 12 • 6 8 s 17 30 10 6 8 5 18 32 8 6 8 5 19 34 6 6 8 5 20 36 4 6 8 5 21 38 2 6 8 5 10-11-12 22 40 0 4 8 s 23 40 0 4 8 5 24 40 0 4 8 5 When first starting a feeding of Dextri-Maltose, cow’s milk \i-,h wate»T , in^an,ts °J any age. use 4 level tablespoonfuls Dextri- maltose JNo. 1 in the feeding mixture. Then gradually increase the extn-Maltose to 6 level tablespoonfuls. Give plenty of cooled boiled water between feedings. In ordinary feeding cases use Dextri-Maltose ino. l; in constipated cases use Dextri-Maltose No. 3. INFANT FEEDING 338y HOURS TO FEED 10 per day— 6, 8, 10 12 A. M.; 2, 4, 6, 8, 10 P. M.; 2 A. M. 8 Times per day—6, 8:30, 11 A. M.; 1:30, 4, 6:30, 9 P.M.;2 A, M. 7 Times per day—6, 9, 12 A. M.; 3, 6, 9 F. M.; 2 A. M. 6 Times per day—6, 9, 12 A. M.; 3, 6, 9 P. M. 5 Times per day—6, 10 A. M.; 2, 6, 10 P. M. INTESTINAL. IN DIGESTION. DIARRHOEAS When baby is having Boose, Green or Yellowish Stools, containing mucus or curds, immediately omit Dextii-Maltose and boil the milk and water mixture 2 minutes. Then cool to blood heat and feed. As stools become normal, gradually add the Dextri-Maltose to the feeding until the prescribed quantity for well babies is reached. In the condition described above, but where the baby is having a temperature (infectious dirrhoeas), give a cathartic followed by a diet of Barley Water, prepared from Mead’s Barley Flour (without milk) for 12 hours. After 12 hours, omit the Barley water and feed milk and water boiled together for 2 minutes, without Dextri-Maltose, until the stools become normal; then gradually add the Dextri-Maltose No. 1 until the baby is taking a formula suited to its age and weight. When baby vomits or spits up shortly after feeding, boil the milk and water together for 2 minutes and reduce the amount of each feeding for a few days, returning to the regular feeding as soon as vomiting stops. Regurgitation is often prevented by placing the baby in an upright position immediately after he has finished nursing, with his head on the mother’s shoulder, patting him gently on the buttocks until he has expelled the air swallowed during nursing. . REGURGITATION. VOMITING Many cases of constipation in the bottle-fed baby are the result of a negative balance of the potassium and calcium salts. In such cases the use of Dextri-Maltose No. 3 in the same amount as Dextri-Maltose No. 1, will change this balance and will generally produce soft, normal stools. In some instances, especially in older infants, it is necessary to increase temporarily the amount of Dextri-Maltose No. 3 to 8 level tablespoonfuls, in order to obtain the desired results after which continue with 6 level tablespoonfuls of Dextri-Maltose No. 3. REGULATING THE DIET IN CONSTIPATION 338z A MANUAL OF TOXICOLOGY FEEDING TABLE NO. 2 Level Baby’s Weight Amount Amount Table- Amount Number Age of Cow’s Boiled spoonfuls of Each Feedings in Baby, Milk, Water, Dextri- Feeding in Months Pounds Ounces Ounces Maltose Ounces 24 hours 3 4 6 14 4 2 10 3 5 9 11 4 2 10 3 6 12 18 4 3 10 3 7 12 15 4 3 10 4 5 9 11 6 3 10 4 6 i 12 18 6 3 10 5 7 15 25 6 4 10 5 8 18 22 4 4 10 6 7 15 25 6 5 8~ 6 8 18 22 6 5 8 6 9 21 20 4 5 8 7 8 18 24 6 7 6 7 9 21 21 6 7 6 7 10 24 24 4 8 6 8 10 24 24 6 8 6 8 11 27 21 4 8 6 9 11 27 21 6 8 6 9 12 30 18 6 8 6 10 13 33 15 6 8 6 11 14 36 20 6 8 7 12 15 39 17 6 8 7 12 16 42 14 6 8 7 Feeding Mixtures for Marasmic (Malnourished) Babies* ♦First Feedings of Marasmic (Malnourished) Infant3 During the first few days of feeding a marasmic infant, use one-half the amount of milk prescribed in table No. 2 for an infant of the same age and weight. Then for each ounce of milk less than that prescribed, add 1 ounce of water to the amount of water called for in the formula. Boil the milk and water together for 2 minutes. Use Dextri-Maltose No. 1 in the same quantity as the formula calls for. Gradually increase the amount of milk in the feeding (about 1 oz. every other day), reducing the water in like amount, until the baby is taking the full table feedings, after which, stop boiling feedings. HOW TO PREPARE BOILED FEEDINGS Boiled feedings should be prepared as follows: After the proper quan- tities of milk and water are measured separately, pour them together and place on the stove, allowing them to come to an active boil, and boil for about 2 minutes, stirring constantly in order to avoid a scum forming, remove from stove—then gradually add the Dextri-Maltose No. 1, stirring until same is completely dissolved. The milk and water should always be boiled together. The same results are not obtained when these ingredients are boiled separately. Dissolve Dextri-Maltose thoroughly. INFANT FEEDING 339 FACTS ON FEEDING BABIES, ETC. FEEDING QANTITIES In feeding a baby the quantities to be given are usually about as follows: The first two days little-:'?.', Water, 3 or 4 teaspoonfuls every 2 to 4 hours. Then an ounce of milk and water about % or j/j cow’s milk, or the mother’s breast-milk, every (2?) 3 or 4 hours. At 1 month old 2 ounces every 3 or 4 hours. At 3 months old 3 ounces every 3 hours or a little more every 4 hours. At 5 months old Al/2 or 5 ounces the same way. At 9 months old 6 ounces every 4 hours. At 1 year old y2 pint 3 times a day and a little table food. (Starchy food.) All night feedings are stopped beginning at the age of 4 months. The carbohydrates come mostly from the vegetable foods, the starches and sugars, the cereals, etc., peas, beans, potatoes, etc. The sugars are the cane sugars (sucroses) and the glu- coses (grape sugars). The carbohydrates do not repair tissue, but produce energy or muscular power. Any excess of the carbohydrate is changed into fat and stored in the body as such. It is also stored in the body as animal starch (glycogen). Some of the glycogen is continuously distributed to the body between feedings to supply energy and heat. Fats used by the body as food come from both the animal and the vegetable kingdoms. They also produce heat and energy. Cream and bacon are the most digestible and service- able fats. Fat in excess is stored in the body as such for use in indisposition, etc. (e. g., bears live upon their fat in winter) certain elements called v itamins have been found necessary to prevent soft bent bones in babies. Deficiency in v itamins produces marc-s.ffils, scurv y and rickets. Oranges, lemons and vegetables added to the diet promptly will help correct the evil. Babies which have been given sterilized milk or some of the poorer proprietary foods need such at once. In fact any bot- tle-fed baby should have orange juice daily, a teaspoonful or more clear or in water. Three times a day between such number of feedings to pre- vent rickets, etc. 339a A MANUAL OF TOXICOLOGY The caloric value of foodstuffs is commonly calculated to be: 1 gram of protein = 4.0 calories 1 gram of carbohydrate = 4.0 calories 1 gram fat — 8.9 calories Body constituents are carbon, hydrogen, oxygen, nitrogen, principally, also chlorin, lime, magnesia, phosphorus, sulphur, etc. There are also mineral elements in the form of so-called salts. They are combined with various acids making phos- phates, chlorids, sulphates, etc. The materials we call food, which regenerates and develops the body, we call food or foodstuffs. They are water* (H20) protein (hydrogen, oxygen, nitrogen and carbon) carbohydrates (hydrogen, oxygen and carbon). Fat or hydrocarbon (oxygen, hydrogen and carbon in the form of fatty acids) as oleic, stearic, palmitic, in combination with glycerine, which serves as a base for such. There are also mineral salts of lime, phosphate, sodium, iron, etc., for structural purposes. All animal food and many vege- table foods such as vegetables and the cereals contain protein we well know. Protein is the great repairer of the tissues of the body. Whatever protein is not thus used by the body goes with various other foods to furnish body heat and muscular power. The food of an individual, we well know, whether of a baby or of a grown person cannot be used for the body in the con- dition in which it is taken into it. It must be prepared for the body tissues. The proteins or nitrogenous foods must be changed into soluble peptones. INFANT FEEDING 339b DIET FOR YOUNG CHILDREN DIET—Suggested by Department of Health of the City of New York—(Charts of 1921) [Author’s Note.—* or [ ] herein, indicates informa- tion introduced, or the usual modification or detailed method employed by the author of this book in feed- ing the average well child, at the respective age. In feeding the sick—child, especially in the poisoning of a child, of such age, it is well to select, from these normal feedings, a non-conflicting diet in conformity with the restrictions previously outlined and indicated in this chapter, by the author, as suitable feedings for an adult, in a similar poisoning]. Bureau of Child Hygiene [At this age the average child requires 850 to 1200 calories daily] DIET (12 to 18 Months of Age) [Juice of one half to one orange, or two tablespoonfuls prune juice, or two tablespoonfuls pineapple or tomato juice. Little or no sugar in it; perhaps with water.] 6.00 TO 6.30 OR 9.00 A. M.— 7.00 TO 7.30 A. M.— Two to three tablespoonfuls of cereal such as oatmeal, hominy, farina, corn flakes, puffed rice, krumbles, tapico, cream of wheat or wheatena, made very thin and served with milk and one teaspoonful of sugar. Glass of milk (eight ounces.) Clear, or, with 1 or 2 ounces of water, to reduce the size of the curd and to soften it. Glass of milk (eight ounces). Cracker or piece of zwieback or piece of stale bread with crust. 11 A. M.— 1.30 TO 2.00 P. M.— One article to be selected from each of the following groups: 1. Beef juice, two to four tablespoonfuls; coddled egg; scraped beef, one tablespoonful; mutton or chicken broth, one cupful; minced chicken, one tablespoonful; vegetable soup, one cupful. 2. Bread, zwieback, [toasted bread], or cracker. 3. Baked or mashed potato, rice. 5:30 TO 6.00 P. M — Cereal and milk. Zwieback or stale bread toasted, [or Graham, Arrow- root, Wheatsworth, or “Baby” cracker.] Glass of milk (eight ounces). [With or without 1 or 2 oz. of water.] Raw fruit juice should not be given to young children at the same meal with milk. It should be given one-half hour before, or at least one-half after a meal. Give egg at only one meal a day, mid-day preferred. If fat digestion poor, avoid much yolk. If getting much other protein, give egg only two to four times a week. 10 P. M.— 339c A MANUAL OF TOXICOLOGY DIET (18 to 24 Months of Age) [Requires 900 to 1200 calories daily] [One to] two ounces of orange juice, or pulp of six stewed prunes, or two tablespoonfuls baked apple (stiained), or two tablespoonfuls pine- apple juice, [raw or cooked tomato juice]. 6.00 TO 6.20 A. M.— Three tablespoon fuls of Cereal with milk and small amount of sugar. Glass of milk (eight ounces). Piece of toast or bread, buttered. 7.00 TO 8.00 A. M.— Milk (eight ounces).* Cracker, zwieback, toast, or bread.* 11 A. M.— One article to be selected from each of the following groups: 1. Beef juice, two to four tablespoonfuls, with bread; egg, soft boiled, poached or coddled; scraped beef, one tablespconful; mutton, chicken or beef broth, one cupful; minced chicken, two tablespoonfuls; vege- table soup, one cupful; lamb chop. 2. Bread, zwieback or cracker.* 3. Boiled rice, small, baked potato, spinach, well cooked carrots, [fresh or canned peas, asparagus, stringless string beans]. 4. Cornstarch pudding with milk, rice pudding, baked [or boiled] custard junket, [whey], two tablespoonfuls pulp of baked apple or pulp of six prunes. 1.30 TO 2.00 P. M — 5.30 TO 6.00 P. M.— Cereal and milk. "Zwieback or stale bread, buttered. *Stewed fruits. 10.00 P. M.— Milk (eight ounces).* •Also as for younger child. DIET (2 to 4 Years of Age) [Requires 1,000 to 1,400 calories daily] NOTE—A cupful of milk and bread or a cracker may be given in mid-afternoon or at bedtime, if the child seems hungry. 7.00 A. M.— Juice of one orange, or pulp of six stewed prunes, or two table- spoonfuls of baked apple, or two tablespoonfuls pineapple juice. Cereal of medium thickness, four tablespoonfuls, with milk and one [level], teaspoonful sugar. Egg, soft boiled, poached or coddled. Toast or stale bread, (buttered).* Glass of milk or cup of cocoa.* 8.00 A. M.— Glass of milk (eight ounces.) * One slice of bread, cracker or zwieback.* 10.30 A. M.— 1.30 P. M.— One article each from groups 1, 3, 4 and 5 OR 2, 3, 4 and S: 1. Chicken or beef broth, vegetable soup, milk soup made with a little potato or celery. 2. Egg (poached, coddled, boiled or scrambled), tablespoonful minced beefsteak* lamb chop, roast beef, broiled steak, INFANT FEEDING 339d chicken, fresh broiled or boiled fish. 3. Baked, oiled, creamed or mashed potato, rice, marcaroni. 4. Two tablespoonfuls of fresh or canned vegetables such as peas, string beans, spinach, asparagus tips, squash, stewed celery, cauliflower. All these vegetables should be well cooked. Rice [jelly, jam] or bread pudding, junket whey* or custard, apple sauce or baked apple. Two tablespoonful (once a week), or plain vanilla ice cream. 5.30 TO 6.00 P. M.— Cereal with milk toast or stale bread, lightly buttered. Egg (poached, soft boiled or coddled). One cup of milk or cocoa made with milk. Custard or stewed fruit. [Requires 1,300 to 1,600 calories daily] DIET (4 to 6 Years of Age) 7 A. M. Juice of one orange. Baked apple, or stewed prunes. (Fresh fruit may be given in season except raw apples, which should only be eaten later in the day. Fresh berries in small amounts may be given.) Cereal with milk and one teaspoonful sugar. Glass of milk* or cup of cocoa, made entirely with milk. Bread or toast with butter. Egg (soft boiled, poached, coddled, scrambled or omelet.) 7.30* A. M.— Glass of milk (eight ounces)* and bread. 10.30 A. M.— 1.30 P. M.— Select one article from each of groups 1, 3, 4, 5 and 6 OR 2, 3, 4, S and 6: 1. Chicken beef or mutton broth, vegetable, pea or bean soups or thick milk soups, strained before using. 2. Chicken, lamb, lamb chop, roast beef, beefsteak, minced beef, fish broiled, boiled or baked, egg (poached, soft boiled or coddled). 3. Vegetables in season except green corn, egg plant or raw vegetables such as radishes, cucumbers or tomatoes. 4. Potato baked, boiled lightly mashed. 5. Bread and butter. 6. Stewed fruit (peaches, prunes, apricots or apples) [strawberries, rasp- berries, or grapes if anemic] cookies or ginger snaps, plain cake, rice, tapioca, cornstarch or bread pudding, junkets [whey], or custards, ice cream (not oftener than once a week), jam, jelly, honey, dates or figs. 5.30 TO 6.00* P. M.— Cereal with milk and sugar, or milk toast, or thick soup such as pea or cream of celery, or egg (coddled, poached, boiled or scrambled). Cocoa made with milk, or glass of milk (eight ounces). Bread and butter [peanut butter, jelly]. Plain pudding, cookie or [relishes, ginger bread], ginger snap, stewed fruit. Apricot, banana, cherry, peach, pear, prune and watermelon each con- tain malic acid. Apple contains malic and gallic acids. Currant and gooseberry contain malic and citric acids. Citron, lemon, orange, limes and grape fruit contain chiefly citric acid; cantaloupe, rhubarb and lettuce also contain it. Cranberry contains malic, citric and benzoic acids. Grape contains tartaric acid. Spinach and tomato contain oxalic acid. Apple, banana, peach, pear and prune are less acid than most fruits. Apple, lemon, limes and orange contain patassium, calcium and magnesius. Salts are valuable as antiscorbutics. Apple contains a sodium salt and iron also. Calcic and potassic oxalates are found in asparagus, rhubarb, sorrel, spinach and tomato. Prunes are about 32 per cent sugar. Acids Contained In Various Fruits 340 A MANUAL OF TOXICOLOGY TOP MILK (“GRAVITY CREAM”) AVERAGES Result of milk standing undisturbed for 6 hours or more QUANTITY Approximate contained per cent of: Fat Sugar Protein Top 22 y2 21 y2 21 4 254 4 254 4 254 20 4 2)4 18)4 17 4 3 <1 4 3 it 15)4 14 4 3 it 4)4 4)4 3 it 12)4 11)4 3 it 4)4 3 a 4)4 3 it it “ 16 ounces ()4 bottle, or 1 pint) 6% 5 y5 4)4 4 4)4 454 4 54 3 3)4 tf 3% 454 454 3% The 32 ounces (or whole bottle or 1 quart... 3% Top milk formulas are not very well suited to the average baby unless the baby is over 6 months old or is unusually robust. AMOUNT OF SLEEP IN 24 HOURS, USUALLY REQUIRED AT DIFFERENT AGES Compiled by Albert H. Brukdage, M.D. Age Hours Birth to 6 Months 6 Months to 1 Year 1 to 2 Years 2 to 4 Years 4 to 6 Years 6 to 9 Years 9 to 12 Years 12 to 60 Years In old age there should be more sleep, to compensate better for readier waste and exhaustion, but usually sleep is more or less fitful and diminished; sometimes mainly a series of drowsing, dozings, or nappings. An unnatural tendency to sleep is indicative of some disturbance of metabolism with degeneracy of the nervous tissue; may be due to im- proper eating, severe heat or cold, anxiety or mental excitement, over- - to \%% From 1 up to 2 Weeks (During) Fifth and Sixth Day (During) Third and Fourth Day (During) First and Second Day AGE DAYS WEEKS MONTHS to to to to *-*■ to >— o to to to t— to t— o CO tOHMI—• OCOOOS CO 00 “vl 05 00*M05 0i 05 Cn t* CO Cli co to ►—* CONOCO 3 1 00 © 05^J OO "*4 05 C71 00 -d 05 d CO OO 05 | Pounds height. 321 321 to OO to 24- 25- 26- 27- 22-28 23- 24- 25- 20-26 21- 22- 23-29 to 1—* t—‘ ‘ cpoo-p1 to to to to 14- 15- 16- 18-24 9- 10- (6-10) 6-11 6-12 7- 8- 05 Ounces of Milk or a suitable Milk- 'd ixture. (Provides for 24 hrs.) 05 % OO % 10(-8-0) o o to 05 ???? OO OO CO ►—1 3 O to 05 1* 05 OO CO to to to to oooo to to to to 0000 0- S\2? , 1 Si 1 Cn Ounces 1 Amount of boiled Water (ordinarily) for a suitable Milk-Mix- ture (24-hr. Mixture). 2 toO 4 to 2 6 to 3 (s)6 to 3 I* o’ 05 May give o’ C5 milk sugar ►* o’ 05 instead in 1* S' 05 ibout V2 th »* o’ 05 e quantity, -E* £1 oryl [■XXX U or Vh- 5 None None Level 'ablespoonfuls Maximum amount of Dextri Maltose for a 24-hr. Milk-Mixture. 5 (or 4) 5 (or 4) 5 (or 4) 5 (or 4) Oi Oi 6 (or 5) 05 7) P - -<1 feedings 1 Number of Feedings in j 24 hours. Feed every 4 Hours. May Omit Late Evening Feeding. Omit 2 A.M. Feeding fi toiP.M. From 6 P.M. to Feed Every 4 1 6 A.M. ours. Sours Feeding Intervals. OO 00 OO OO 7 to 8(b) 7 to 8(a) 05 S’ Cn s 03 5 to 6 to r* O 2 to 3 O to 1 to 2 O to Ounces of suitable Milk-Mix" ture actually required for one feeding. (Ordinarily) 32 f CO to CO 321 37 to 42 f 38 to 44 37 to 43 36 to 42 35 to 42 39 to 45 39 to 45 38 to 44 37 to 43 37 to 43 38 to 44 39 to 45 41 to 47 34 to 40 35 to 41 36 to 42 38 to 44 i c c u 24 to 30 26 to 31 21 to 20 21 to 26 22 to 28 24 to 30 26 to 32 to to O to 0 0 O 3 s Quantity of suitable Milk-Mixture to be prepared for 24 hours Feedings. cO CO CO O 05 CO o 00^0 OOfOCO CO 00 1*001 Cw'oC 00 OO OO 00 OCOKfOl O OI o o -vite 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. Granulated corpuscles. With diluted acetic acid, show 3 to 5 nuclei, 'Red or yellow discs, biconcave; sometimes irregular in outline, Blood-cells. Albumin present, .... Pus. Albumin absent, Mucous corpus- cles. Cellular Elements. 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. k Fungi, yeast, hairs, threads, etc., etc. • Extraneous matters. 414 A MANUAL OF TOXICOLOGY. KEY TO URANALYSIS. (Continued.) Color«d Deposit. Visibly crystalline (red), Uric acid. Pale, easily soluble by heat, Urates. Deep-colored, slowly soluble by heat, Acid urates with uroerythrin. Red, insoluble by heat, alkalies, or acids, . . . Blood. Amorphous, With a clean pipette draw off a small portion of the sediment, transfer to a clean glass slide, and examine with a or %-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 orNaOH light—Sodium urate. dark —A mmonium urate. Permanent on adding KOH or NaOH, Calcium carbonate (rare). 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. 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. APPROXIMATE MEASURES. 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 Vo fluid ounce “ “ 1 tablespoonful (cochleax mag- num) ; 2 “ •• •• 1 wineglassful (cyathus vinarius); 4 •* •« 44 1 small teacupful or gill; teacup (poculum); 6 “ •* " 1 ordinary teacupful; 8 “ 44 44 1 coffee cupful pt.), 1 tum- blerful ; 1 pint 44 44 1 pound (of water); pound (libra); 2 pints 44 44 1 liter or kilogram of water. 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 1^ 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. 20 grains make one scruple ; 3 scruples “ drachm (60 grains) ; 8 drachms “ ounce (480 grains) ; 12 ounces “ pound (5760 grains). APOTHECARIES WEIGHT. 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)4 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 weigh* 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 (British) equals 20 fluid ounces. I quart—wine measure (32 fluid ozs.) equals 58.30 cu. in. I 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. 1 milliliter (mil.) equals 1 cubic centimeter; equals the measure of one gram of water. METRIC MEASURES, 417 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 METRIC MEASURES. LENGTH. 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. WEIGHT. 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. * About 34 oz. MEASURE. METRIC EQUIVALENTS Troy Metric gm. gr. 1 0.06S 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 15.432 To convert grammes into ounces, avoirdupois.. X 0.03527 To convert kilogrammes into pounds X 2.2046 To convert grains into grammes X 0.0648 To convert avoirdupois ounces into grammes . X 28.35 To convert troy ounces into grammes X 31.104 To convert cubic centimetres into U.S.A. fluid ounces... X 0.0338 To convert litres into U.S.A. fluid ounces X 33.814 To convert fluid ounces into cubic centimetres X 29.57 Tio convert pints into litres X 0.4732 To convert metres into inches X 39.37^ To convert inches into metres X 0.0254 C 1 inch equals 2.54 centimeters. C.1 foot equals 34.48 “ The above tables give metric equivalents of Troy measures. 418 A MANUAL OF TOXICOLOGY. 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; or, multiply by 2, deduct 1/10 of this product and add 32. TEMPERATURE EQUIVALENTS PULSE TABLE. 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 whera the action of the heart is feeble. No. Resps. per Min. First year 35 Second year 25 RESPIRATION AT VARIOUS AGES. No. Resps. per Min, At puberty 20 Adult age 18 to 20 INCOME AND EXPENDITURES OF LIFE. Income. Grains. Solid food 8,000 Water 37,650 Oxygen 13,000 Total 58,650 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, 23 pounds; minerals, 8.3 pounds. Food must construct this frame and must repair whatever losses it sustains. INKS. 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.” [Constituents of the body viewed from another angle:—Ac- cording to the Babylon Leader: “A scientist says each man contains the following ingredients: Fat enough for sevpn bars of soap. Iron enough for a medium-sized nail. Sugar enough to fill a shaker. Lime enough to whitewash a chicken coop. Phosphorus enough to make 220 matches.”—[Neverthe- less, some men make a poor match; so do some women.]— “Magnesium enough for a dose of magnesia. Potassium enough to explode a toy cannon. Sulphur enough to rid a, dog of fleas. The whole collection is worth 98 cents. Even that is a high price to put on some men.”—[Probably a wo- man would be “worth two cents” more, at least, i. e., an even dollar, as she is commonly assumed to be of a finer nature.—] INKS Black Ink usually consists chiefly of a decoction of nutgalls mixed with a solution of copperas; or, of a mixture of gallate or tannate of iron and a few drops of acetic or hydrochloric acid or phenol to prevent precipitation or mold, and a solution of indigo-carmine or logwood extract to insure visibility; per- haps a gum to make it adhere without spreading. If the ink is concentrated, and glycerine, sugar, dextrin, etc., is added (to keep it moist), also much gum, it becomes a copying ink. Some black inks contain extract of logwood and potas- sium chromate, or sumac; others contain such blue or violet dye as an indulin (one of the quinone derivatives), or a nigrosin (produced by heating nitrobenze, or a nitrophenol, with an amin substance derived from ammonia) ; the latter variety, having no sediment, is much used for fountain pens. (Stains by these inks are quite readily removed, as a rule, by solutions of oxalic acid, chlorine or hydrochloric acid; but if India ink has been added, as is done sometimes, they are irremovably fixed). Aniline inks are now much used. The In- delible Inks (for marking clothes; etc.) are: Silver nitrate preparations (not quite indelible; removable by washing, after using potassium cyanide strong solution—very poisonous) ; an India Ink (Chinese or Japanese Ink) consisting commonly of a mixture of lamp black or burnt cork, gelatine and water; another India Ink is similar, but made from the ink of the cuttlefish, treated with caustic alkalies—a sepia; an ink con- sisting of a decoction of nutgalls with ammonium vanadate; and an ink, a mixture of gluten (from wheat) dissolved in vinegar and rubbed with lamp black (soot), or with India ink (Chlorine causes this ink to lose its color, but does not remove it from goods or paper). Marking ink for hand bags, etc.: Shellac 3 ozs., resin 8 ozs., dissolved in alcohol 1 pint, by 419a A MANUAL OF TOXICOLOGY gentle heat for 14 hrs., while in closed bottle in water-bath. Shake well and stir in Frankfort black, or other color, 6/2 ozs. Blue Ink commonly consists chiefly of Prussian blue (an iron salt combined with a solution of potassium ferrocyanide), with oxalic acid and water in varying proportions; also of a sodium or potassium salt of indigo extract, with water. Yellow Ink may be produced by boiling saffron, or gamboge. Green Ink is made, often, by mixing indigo-carmine with picric acid; or use chrome green, or aniline. Red Ink is made, usually, from the soluble (East India or tropical America) redwoods, or similar dye wood commonly known as Brazil wood. It is prepared by boiling the wood with alum, tartar (from grapes), and water, then adding tinc- ture of cochineal and gum arabic. Sometimes, to make red ink: Brazil wood is boiled with stannous chloride, and gum arabic added; or, Brazil wood, vinegar and alum are combined; or, carmine is dissolved in caustic ammonia (1 to 120) and gum arabic is added. Printing Ink is composed, commonly, of a mixture of yel- low soap, boiled linseed oil, or hempseed oil, lamp black and varnish (or such drier as lead acetate, manganese borate or dioxide, or litharge). To secure other colors of printer’s ink: Lead chromate for a yellow ink, vermilion for a red ink, or an ultramarine for a blue or purple ink, may replace the lamp black. Lithographic Ink contains equal parts of soap, shellac, wax, tallow and pitch. Tbe Sympathetic or Invisible Inks often consist of a color- less vegetable juice, or lemon juice, to be made visible by press- ing the writing with a hot iron; milk, visible upon rubbing with soot; or a weak solution made from nutgalls, to be made visible (black or brown) by a solution of copperas; or, a solution of cobalt chloride, with or without nickel chloride, to be made visible by heat—with nickel chloride, turns green; without, turns blue; or, a weak aqueous solution of gold chloride or silver nitrate, to be made visible (blackish or pur- plish) by exposure to light and the application of heat—these must be kept from the light until time to be read. Solutions of lead acetate and of cobalt salts are used, also. The stain of the ordinary black or blue ink containing iron, or an iron rust, may be removed, usually, from cloth, by using a warm 10% to 20% watery solution of acetic acid mixed with about an equal amount of a (one dram to the pint) watery solution of oxalic acid, then freely washing with water. Sometimes the stain will yield to the following method: Apply common table salt; then rub with the juice of a freshly cut lemon; then hold it in the steam of a tea kettle nozzle; apply blotting paper to absorb the ink. Repeat the whole process if necessary, and wash freely. Laundrymen, cleaners, dyers, and others have worked out or confirmed many of the following facts:—(Most of the large city laundries, including, to the author’s personal knowl- edge, his own family’s laundry, pursue the same general meth- STAINS STAINS. 419b ods in removing stains. The whole matter is largely one of familiarity with chemical action, associated with a fair knowl- edge of fabrics.) Silver nitrate stains are best removed from cotton or linen, by immersing the goods in a saturated solution of sodium hyposulphite (photographers’ film-fixing salt), or in Javelle water and then removing the resulting silver chloride with weak ammonia water. From silk and wool the stain may be removed by using sodium or potas- sium cyanide solution (a dram to the pint) and thoroughly rinsing the fabric with warm water; but the cyanide poison is too dangerous and deadly for ordinary domestic use. To remove stains of aniline inks, dyes and blueing (from linen or cotton) use Javelle water or Labarraque’s solution; or, a potassium permanganate solution (1 oz. to the gallon). Sodium bisulphite (saturated solution) and powdered zinc oxide (used together but put in separate bags to prevent the sodium settling on and staining the goods) will sometimes re- move aniline stains when other measures fail. To remove such stains (from silk or wool) use the perman- ganate solution or hydrogen peroxide solution. Javelle water is a strong bleaching agent and should be used, usually, with an equal quantity of hot water. At it will remove the dye from colored goods it should not be used on such articles; and it should not be used on silk or wool as it will destroy the fibers. It will remove stains on cotton and linen resulting from cor- rosive sublimate mixtures. In using it, the stained part of the article should be immersed in it for a few minutes; the stain should then fade out. The article should then be rinsed in several waters to get out all of the Javelle water; put a few drops of ammonia in the next to the last rinsing, then rinse in much clear water. The standard washing process of the national laundrymen’s organization it appears usually removes aniline stains, ultra- marine blueing, indelible pencil (in cotton or linen) egg or other albumin, medicines of an organic nature, grease, grass (in cotton or linen), fruit or tobacco (in cotton or linen), cream and ice cream, mildew, mud, syrup, tea, coffee and some other stains. Stains from medicines containing iron or silver, first treated as of such alone are then best well washed. The standard, and similar washing processes seem to consist mainly of a series of baths, in conjunction with salts and solutions, about as follows: Treatment for Cotton and Linen:—“1st bath: Luke warm water. 2d bath: Hot water and soap solution (25 lbs. soap, 8 lbs. soda ash [washing soda], water to make 100 gals.). 3rd bath: Repeat 2d. 4th bath: Hot water and soda ash. 5th bath: Hot water. 6th bath: Hot water, rinse. (If white goods, add Javelle bath.) 7th bath: Hot water and acetic acid (5% to 20% solution). 8th bath: Hot water, blueing. 9th bath: Cold, water, rinse. For Woolens:—Nearly same temperature to be used throughout— 1st bath: Luke warm soap bath. 2d bath: Luke warm water; rince. For Silks:—Neutral soap, and water not over 100°F. No soda ash or Javelle water. If white goods, sodium bisulphite, also acetic acid (5 to 20% solution), may be used. 420 A MANUAL OF TOXICOLOGY. (When a straining substance has been dissolved or loosened by a reagent, it should be absorbed promptly by thick muslin or blotting paper placed in contact with it.) After employing such a washing process as the standard referred to, to remove blood stains, the remaining hemoglobin stain may be removed by Javelle water or ammonia water (1 part of a 10% solution to 9 parts of water), or hydrogen peroxide. After using such wash- ing process to remove ultramarine blueing, any remaining spots of it may be dissolved out by using an oxalic solution (1 oz. to 1 gal. of distilled water). Prussian blue should be re- moved by clean water. Obstinate stains of cocoa, chocolate, cream or ice cream (in cotton or linen), usually yield to Ja- velle water; or, to borax and cold water, followed by hot water from a height; (in silk or wool), to hydrogen peroxide. If fruit stain still persists, (in silk or wool), use: Warm water, and acetic acid, or oxalic acid, or potassium permanganate fol- lowed by oxalic acid, or sodium bisulphite. For glue, use acetic acid (for cotton and linen) ; and 50% of ethyl alcohol and same of ethyl ether (for silk or wool). For grease, try to soften stain with lard and oleic acid mixture (oleic acid 2 parts and lard 98 parts) ; then again wash by standard proc- ess (for cotton or linen) ; (for silk and wool) try strong soap solution or gasoline, carbon tetrachloride, ether, chloro- form, or benzene. Try blotting paper with hot iron. For gum or resin try succesively: Turpentine, benzene, carbon tetra- chloride, chloroform, alcohol 95%, ether, kerosene, gasoline, carbon disulphide. Carbon tetrachloride will remove chewing gum. Candle or other wax, and paraffin, yield to a hot iron with white blotting paper above and below the goods; if candle was colored, follow by soaking in denatured alcohol. Stains by fruit, tea, or coffee often yield to a deluge of hot water from a height. For oil stains in paper, apply wet pipe clay for 6 hours; or, Fuller’s earth lightly. Restore white of paper with ether. For iodin apply alcohol. The standard or similar washing process may remove India ink, also printers ink, if lard is rubbed, previously, into the stain. Pure grain alcohol removes phenol stains if applied promptly. Javelle water, or potassium permanganate followed by a solu- tion of oxalic acid, removes remnants of indelible pencil (in cotton or linen), after such as the standard process, 95% alcohol is substituted for Javelle water, if silk or wool goods. Weak ammonia water followed by hot water, or use of chloroform or ether, will remove iodine stains. Paint, tar and varnish stains usually yield to turpentine, benzene, chloroform or carbon tetrachloride. Methlyene, blue, picric acid, etc., stains yield to a weak ammonia solution and washings with water. IMPORTANT FACTS Be cautious in giving atropia to flaxen-haired, light-com- pexioned, 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 bycontact 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 8th 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 18th 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,) Disease—Scarlet Fever (Scarlatina). 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. .Danger of Contagion. As long as desquamation continues oi a uurulent discharge from the ear or an abscess keeps up- THE ERUPTIVE FEVERS. 422 A MANUAL OF TOXICOLOGY. indefinitely in clothing, toys, books, etc., which have not been disinfected. Disease—Measles (Morbilli, Rubeola). Period of Incubation. Four to fourteen 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. One to 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 .Disease —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 • Grains for Approximate Amount Per cent. Exact Solution required to make 4 fl. 0 z. 1-10 of 1% 1.82 grains grains tt 1/ / of 1% 2.28 << 2/ 1-6 of 1% 3.03 « ft 3 N / of 1% 4.55 n a 4/ ° / of 1% 6.06 ft ft 6 « / of 1% 9.10 if tt 9 '* 1% 18.20 ft it 18/ 1 2% 36.40 ft a 36/2 | 2/% 45.50 tt ft 45/ * 3% 54.60 ft ft 54/ 2 4% 72.80 tt drachms 1 ft 12/ « 5% 91.00 tt “ 1/ cr 6% 109.20 a “ 1 ft 49 ft 7% 127.40 tt “ 2 tt 7 * 8% 145.60 tt “ 2 ft 25 & 10% 182.00 it “ 3 ft 2 T3 12% 218.40 a “ 3 tt 38 ~ 15% 273.00 tt “ 4 tt 33 ~ 20% 364.00 tt “ 6 ft 4 Q 25% 455.00 tt “ 7 a 35 TO MAKE FOUR FLUID OUNCES OF THE SOLUTION. 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. For 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 AN EPITOME OF IMPORTANT INCOMPATIBLES. Aacia (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 oxidiz- able substance. Potassium (iodide of), with all strong acids and acid salts. (See Corrosive Sublimate.) Spirit of nitrous ether, with antipyrin, sulphate of iron, tincture of guaiacum, and most carbonates. Vegetable preparations holding tannic acid, with salts of iron and lead. Alkaloids are precipitated or destroyed by tannic acid, alkalies, iodin or iodides, and chlorinous compounds. Tinctures of gums or resins, with water. Dr. Tasker Howard says that for young people, up to 30 years of age, the maximal or systolic pressure may be con- sidered as normal at: The age plus 110. Between 30 and SO years, the age plus 100. Also that although Osier and French state that after 50 years of age 150 and 160 may be quite normal, the life insurance companies reject these fig- ures. He says the minimal or diastolic pressure should be about Yz lower than these figures; and that the blood pres- sure in women averages about 10 points lower than in men. BLOOD PRESSURE. FREEZING MIXTURES. 425 FREEZING MIXTURES. (THOMPSON.) Ingredients. Parts by Weight. Temperature reduced from 10° C. or 50° F. to Hydrochloric Acid 8 - 17° C. = + 1° F. Sulphate of Sodium . 5 Snow or Fine shaved Ice . Chloride of Sodium 2 fa © 1! d oo TH 1 Dilute Nitric Acid 2 - 19° C. = - 2° F. Sulphate of Sodium . 3 Dilute Nitric Acid 4 Nitrate of Ammonium 5 - 26° C. = - 15° F. Sulphate of Sodium . 6 Dilute Nitric Acid 4 - 29° C. = - 20° F. Phosphate of Sodium . 9 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 arid 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 poisqns. The new Harrison Law of 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.) 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). 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? 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? 10. What precautions should be observed in selling poisons? 11. 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? 1. 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. 4. 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? 1. 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? 11. 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? 13. What is the dose of Mild Mercurous Chloride, Sodium Benzoate, Strophanthin, Urethane? 14. 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. 1. 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? 10. 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? 1. 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 emergenc} 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. io. What are the principal effects of the habitual use of Cocaine? <_a) Of Morphine? 1. 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, srarch, 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? io. 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. 1. 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) Forpoisoningby Chloral and what does 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. B Heroin, gr. 2i Codeinae Sulph. Ext Hyoscyami, aa gr. 10 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? 10. 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, 4O, 73, 247, 274, 346. Hydrocyanic, 29, 32, 43, 70, 247, 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, 4i. Opium Group, 41. Oxidation of, 26. Strychnos Class, 39, 41. Vegetable, 41. Veratriries, 41. Allantotoxin, 254, 258. Almonds, Bitter arid 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. Ink, 62. 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. Physiolog. 60, a, b. 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. Arrow, 96. 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, ?84 353 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, 82, 111, 118. 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. Cevadin, 223. 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. 149. Chlorodyne, 123. Chlorodynomania, 381. Chloroform, 29, 32, 38, 39, 41, 92, 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. and Zinc, Search for, 308. Chrysarobin, 260. Churrus, 113. Cicuta, Maculata 129. Cicuta, Virosa, 129. Cicutoxin, 123, 254. Cider, 84. Cinchona, 256. Cinchonism, 256. Classification, Chemical, 28, 32. Physiological, 28, 34. Tanners, 28, 33. Blyth, 28, 29. Robert, 28, 38. Coagulation, Venous, 311. Coal Gas, 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, 3SS. Antumnale, 236. Colic, 24. Colored Plate, 16. Collapse, 2S3. 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. Deafness, 2S4. 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. 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. Eucalyptus, 143. Euphorbium, 89. Eupator. Ager., 143 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. Feeding, 338a. Fats, Melted, 47. Feces, Color Changes, 330. Ferri, Oxidum Hydratum, 53. Cum. Magnesia, 54. Fevers, Eruptive, 421. Fish Berries, 29, 127. Fish, Poisonous, 145. Fluorine, 32. Fly Paper, Poisonous, 97. 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, 2SS. 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. Golden Rod, 169. Grain, 82. Growth, 344. Guachamaca Poison, 257. Guaiacol, 17, 63. Guanidin, 254. Guide to Post-Mortem Procedure, 339. Gums, 256. Gunjah, 113. H Habit, 21, 23. The Cocaine, 374. The Morphine, 380. The 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 Picra, 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. H.ydric, 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 ef, 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, 61. Inks, 419. 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. lodol, 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, 60. 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. Laurel, 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. x. Inflata, 39, 173, 238. Lobelin, 258, 260. Loco 174. Lolium Temulentum, 39. Lungs Poisonous Gases Affecting, 31. Lye, Concentrated, 29. Lysol, 63. M Magnesia, 54, 60. Magnesium Sulphate, 48, 51, 55. Male Fern, 174. Mania, 24, 256. Matches, 193. Marihnana. 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 14. Time 60b 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, 86, 226. Methylguanidin, 191. Mezereon, 89. Milk, 26, SO. Drug Excretion in, 329. Mother’s, 329. Poisonous, 26,. 14S. 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, 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, 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. Picrotoxin, 29, 42, 127, 197, 254. Pigeon Berry, 190. Pilocarpine, 32, 41, 166, 197, 255, 257, 258, 260 Pilocarpus, 166. Pinkroot, 29, 197, 21S. Plan of Analysis, 298, 300. Plant Susceptibility, 23. Plants, Poisonous, Key to, 230, 244 Plumbism, 378. Plumbum, 288. Poison, 11. Absorbed, 16, 19, 21. Ante-Mortem Introduction of, 26, 27. Arrow, 96. 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. Feeding in, 338a. 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, IS. 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, 94. Antagonistic Action of, 22. Blood, 38. Brain and Heart, 338. Causing Immediate Death, 39, 260. 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, 5 S S J 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- Priapism, 257. Principals, Vegetable, Poisonous,42. Privy Emanations, 210. Protein Poisons, 94, 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. Py rethrum, 162. 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. Protein, 94. Sale of, 425. Secreted by the Living, 42. Suicides, 260. Specific Effects of, 20. Vegetable, 19, 94. Volatile. 32. Poke, 195; 230, 249. 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. Q Quaker Buttons, 182. Quassia, 47. Quinine, 253, 256. Questions, for Self-Exam’n. 426. Q. V„ 63. Rabies, 204. Rat Paste, 97, 202. Poison, 193. Ratsbane, 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, R Potash, 40, 248. Acid, Oxalate, 350. Chlorate of, 121, 198, Caustic. 87. INDEX 443 Toxicodendron, 203. Venenata, 203. Ricine, 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. 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. Somnos, 119. Spanish Flies, 114, 244. Spartein, 32, 139. Spigelia, 215. Spirit, Methylated, 178 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. Stains, 420. 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- 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, 87, 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. Scilla, 139, 216. Scillitin, 139. Scillitoxin, 139. Scopa rin, 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. Senses, Special, 260c. Sewer Gass, 24. U9. 210. 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 Root, White, 143. Snake Bite, 213, 243, 244. Sneeze Weed, 215. Venom, 22, 32, 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 Cent. Sol., 423. Of Tests, Identification, 273. Tanacetum Vulgare, 219. Tansy, 29, 219. Tar, 256. 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. 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, 23, 24, Toludin, 254- 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, 2S6. Vapors, 18, 38. Vaselin, 47, 22S. Venous Coagulation, 311. Veratrine, 23, 32, 226, 256. Veratrum, 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. Zygademus, 228.