A MANUAL OF TOXICOLOGY A CONCISE PRESENTATION OF THE PRIN- CIPAL FACTS RELATING TO POISONS, WITH DETAILED DIRECTIONS FOR THE TREATMENT OF POISON- ING. ALSO A TABLE OF DOSES OF THS PRONGS PAL AND MAIM NEW remeSiSs By ALBERT H. BRUNDAGE, AM. M/D.. Phar.D. PROFESSOR OF TOXICOLOGY, PH YS1OLOGY AND HYGIENE IN THE BROOKLYN COLLEGE OF PHARMACY ; PROFESSOR OF TOXICOLOGY AND PHYSIOLOGY IN THE RHODE ISLAND COLLEGE OF PHARMACY AND ALLIED SCIENCES ; TOXICOLOGIST TO THE BUSHWICK HOSPITAL J WOW-PRESID ENT OF THE BOARD OF PHARMACY OF THE STATE OF NEW YORK, ALSO BOARD EXAMINER IN TOXK OLOGY AND POSOLOGY; FORMERLY PRESIDENT OF THE BROOKLYN MEDICAL SOCIETY, THE BROOKLYN COLLEGE OF PHARMACY, THE KINGS COUNTY PHARMACEUTICAL SOCIETY ; ETC. MEMBER OF THE AMERICAN MEDICAL ASSOCIATION, THE AMERICAN PHARMACEUTICAL ASSOCIATION, THE AMERICAN MICROSCOPICAL SOCIETY, &C. SECOND EDITION, DEVISED AND ENLARGED NEW YORK: THE HENRY HARRISON CO. Broadway & Gates Ave. (Brooklyn Borough) LONDON: BAILLIERE, TINDALL & COX 8 Henrietta Street, Covent Garden 1902 Copyright, 1901 By Albert H. Brundage Copyright, 1902 By Albert H. Brundage Registered at Stationers' Hall, London, England fiURR PRINTING HOUSE NEW YORK, U. S. A. DEDICATED TO THE MEMORY OF MY MOTHER, SARAH MERVINA BRUNDAGE, WHOSE ATTAINMENTS AND NOBILITY OF CHAR- ACTER HAVE BEEN THE INSPIRATION AND BENEDICTION OF MY LIFE. PREFACE TO SECOND EDITION. The exceedingly gratifying reception accorded the first edition of this book, has induced the author to attempt a second and somewhat enlarged edition. In the effort to make the book as serviceable as pos- sible, it has seemed to him desirable to associate some additional facts with those already offered in the previ- ous edition. He indulges the hope that these and a cer- tain rearrangement of some of the matter will com- mend themselves especially to those college teachers who have done the author the honor to adopt the book for the use of their classes. He feels that if physicians, pharmacists, and others, who have so generously mani- fested their favor, determine that the book is of in- creased value to them because of certain alterations and additions, his efforts will have been most compen- satingly fruitful. ALBERT H. BRUNDAGE. July 20, 1902. PREFACE TO FIRST EDITION. Toxicology is a subject of vital importance to the physician, the pharmacist, and the public. A life often depends upon a physician's thorough and ready knowledge of the subject. The public de- mand of the pharmacist such a knowledge of this subject as shall enable him to recognize and pro- tect against possible errors in prescriptions. They also expect him to be competent to afford prompt; intelligent, and efficient emergency treatment in cases of poisoning. Various medical and pharma- ceutical colleges, and boards of pharmacy, also re- quire a knowledge of Toxicology for their examina- tions. Although there are many excellent books upon Toxicology, providing invaluable means for study- ing it, and for extended investigations in it, never- theless none of them seem to have satisfactorily provided for the immediate and practical require- ments of students, pharmacists, and physicians. There seems to be a demand for a book which will serve as a ready means of review of the salient points of the subject, and as a convenient, con- densed emergency reference. This Manual of Tox- icology, which is intended by the author to replace the Toxicology-Memoranda which he originally prepared for the use of students in the Brooklyn College of Pharmacy and others, has, therefore, been prepared by him to provide for the apparent demand. Inasmuch as Toxicology is essentially and insep- arably associated with the subject of dosage, the VI PREFACE. author has introduced a table of doses of the prin- cipal and of many new remedies. There is a wide divergence of opinion as to what constitutes the proper minimum and maximum doses of various remedies, and the student is, there- fore, often in doubt as to what doses to adopt. In the effort to relieve him of this embarrassment, the author has reviewed the leading authorities on doses and has endeavored to offer to the student the opinion of the majority by the dose given in the Dose Table of this Manual. In the effort to emphasize important words and phrases for emergency and other purposes, capitals and bold-face type have been freely used throughout this book. The author desires hereby to express his appre- ciation of valued assistance afforded him by Prof. Elias H. Bartley, B.S., M.D., in the preparation of this book. In conclusion, the author entertains the hope that although his book may have many imperfections, it will nevertheless prove both useful and helpful. ALBERT H. BRUNDAGE. 1073 Bushwick Ave., Brooklyn-New York, N. Y. September 30, 1901. CONTENTS. PART I. PAGES General Considerations :- Definitions, Classifications, Descriptions, General Directions, etc 50 PART II. Poisons and Acute Poisoning:- History, Symptoms and Treatment in Detail.... 51-214 A Key to Treatment 215-218 PART III. The Indications of Various Symptoms 219-227 PART IV. Table of Identification Tests for Poisons 229-246 Chart for Detection of Metals 247 Chart for Detection of Acidulous Radicals 248 PART V. Outline of Procedure in Searching for Poisons 249-262 PART VI. The Signs of Death-Tests to Determine Death 263-264 PART VII. The Modes of Death:-Coma, Syncope, Asphyxia.... 265-268 PART VIII. Unconsciousness or Coma-Interpretation, Treatment. 269-272 VIII CONTENTS. PART IX. PAGES Guide to Post-Mortem Procedure (In Suspected Poi- soning) 273-274 Post-Mortem Appearances in Poisoning 275-293 Post-Mortem Key to Poison 294-296 PART X. Chronic Poisoning and Drug Habits:- Alcohol-Arsenic, Chloral, Cocaine, Ether, Lead, Mercury, Opium and Morphine, Paraldehyde, Phosphorus, Sulphonal, Wormwood - Ab- sinthe 299-321 APPENDIX. Dose Table (single Dose)... 323-340 [Prepared by comparing and averaging doses stated by leading American and European authorities.] Dose Table (Maximum Daily Doses) 341-342 Directions for Making Post Mortems 343-345 Key to Urinalysis (for Exclusion Purposes) 345-346 Tables of Weights and Measures 347-349 Temperature Equivalents 350 Table Showing Frequency of Respiration, at Various Ages, and of Pulse 350 Income and Expenditures of Life 350 Tables Showing Frequency of Poisoning by Various Poisons 351-352 Order of Eruption of Teeth 353 Eruptive Fevers 353'355 Table for Making Percentage Solutions 355 Epitome of Important Incompatibles 356 Freezing Mixtures 357 Laws Relating to Sales of Poisons 357 Questions for Self-Examination 358-366 A MANUAL - OF- TOXICOLOGY PART I. GENERAL CONSIDERATIONS. Toxicology is the science which treats of the nature, properties, effects, and detection of poisons, and the treatment of poisoning. A Poison may briefly be said to be: Any sub- stance which, independent of any mechanical action, uniformly causes disease or death when ap- plied to, introduced into, or developed within the body. Because a certain person is peculiarly susceptible to the action of a certain substance and has there- fore what is termed an idiosyncrasy regarding that substance, and is injuriously affected by it, or is diseased and consequently so affected, while others in health are not injuriously affected by it, that sub- stance is not on that account to be classed as a poi- son. Nor is it the avenue by which a poison enters the body (either the mouth, lungs, skin, ear, nose, or otherwise) which determines that it is a poison. Its effects, and uniform ones, are what cause it to be classed as a poison. A Corrosive Poison is one which causes local de- struction of tissue. Such poison, when swallowed, usually produces nausea, vomiting, and great local distress. A Corrosive Poison is not strictly a true poison. If the Corrosive Poison be highly diluted with water it ceases to be corrosive (e.g., Nitric Acid). 2 A MANUAL OF TOXICOLOGY. A True Poison, in the strictest sense, is one which, when absorbed by the system, uniformly causes dis- ease or death. No matter how highly diluted, it is still poisonous (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 Robert 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: Tn 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." 3 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- 4 A MANUAL OF TOXICOLOGY. 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 such as Lead, Mer- cury, Morphine, etc.). An Antidote (agent which acts directly upon or against the Poison) is any agent or measure which so alters a poison as to make it harmless, or me- chanically prevents its absorption, or removes it from the body. A Chemical or True Antidote is one which makes the poison harmless by chemically altering it. A Mechanical Antidote or Antidotal Measure is one which removes the poison unchanged, or so coats the stomach or mechanically suspends the poison that absorption is prevented. An Antagonist (or Physiological Antidote)- (agent which acts directly upon the functions of the body)-is an agent which so acts upon the sys- tem as to counteract, more or less completely, the effects of another substance. (For example, the administration of atropine counteracts to a certain ex- tent, the effects of morphine. An Antagonistic Measure is one which tends to overcome the remote systemic effects of a poison. (For example, artificial respiration; cold affusions; application of heat or cold, etc.) A Medicine is a substance administered to cor- rect a disordered or diseased state of the system. Posology treats of the quantity and form of medicine to be administered at one time, or within a certain period. A Dose is the quantity of medicine to be admin- istered at one time or within a certain period, usu- ally 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. EFFECTS OF POISONS. 5 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. 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. (Either two grains of arsenic or half an 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, com- monly 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 the cor- rosive effects produced upon the stomach and in- testines by the immediate contact of a concentrated mineral acid or caustic alkali; or the irritative, in- flammatory, or local specific effect of such sub- stances 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. 6 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 blood, that is, it must be absorbed into the general circulation, and be carried to dis- tant parts of the body, in order to produce its full effects upon the system. Some poisons are more rapidly taken into the general circulation than oth- ers. The corrosives often produce local effects so severe as to cause death. Poisoning cannot occur by nervous communica- tion or by simple approximation of tissue. We know that poisons are absorbed into the cir- culation because we find them in the blood, secre- tions, and various organs of the body, such as the kidneys, liver, spleen, brain, lungs, etc. Some poisons are absorbed without undergoing any change, and pass out of the circulation and body still unchanged. Some are chemically altered during absorption, or in the blood or organs, and thus de- stroyed. Some so alter the blood as to make it unfit to perform its functions. The statement that when a poison enters the blood it probably causes some change in that fluid, has been to a certain extent confirmed: According to Da Costa, the following effects of different poisons on the condition of the blood have been recognized: Substance. Alcohol, Effects. Anemia, often leukocytosis. EFFECTS OF POISONS. 7 Substance. Amyl nitrite, Acetanilid, Ammonium hydroxid, Antipyrin, Bromin, Chloral, Chromic acid, Ether, Guaiacol, Hydrogen cyanic, Illuminating gas, lodin, Lead, Nitrobenzene, Nitroglycerin, Phenacetin, Phosphorus, Potassium chlorate, Sodium nitrite, Poisonous mushrooms, Effects. Methemoglobinemia. Methemoglobinemia. Leukocytosis. Methemoglobinemia. Methemoglobinemia. Leukocytosis. Methemoglobinemia. Oligochromemia, Hemocytolysis, leukocytosis. Methemoglobinemia. Methemoglobinemia, polycythe- mia. Leukocytosis, methemoglobine- mia. Anemia, granularbasophilia, of- ten leukocytosis. Methemoglobinemia, megalo- blastic anemia. Methemoglobinemia. Methemoglobinemia. Polycythemia, occasionally leu- kocytosis. . Methemoglobinemia, anemia, leukocytosis. Methemoglobinemia. Hemoglobinemia. In toxicological examinations, it is important to find the poison in some of the secretions or organs of the body. 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.). 2. The character of the surface to which the poison is applied. 8 A MANUAL OF TOXICOLOGY. Poisons may enter the system through the skin, as by the use of washes and salves (e. g., such poisons as arsenic, tartar emetic, corrosive sublimate, opium, etc.). If the skin is removed beforehand, the absorption is of course more rapid. If the surface is rich in blood vessels and the intervening walls thin, the poison is likely to be very promptly taken up. When poisonous vapors or gases are inhaled, the effects are exceedingly prompt, be- cause of the rapidity of absorption in the respiratory tract. Poisons act more rapidly when given by the mouth than by the rectum; and still more so when given by hypoder- matic injection; when injected directly into the blood ves- sels of the body they have an almost instantaneous effect. A poison taken into the stomach when the latter is full of food usually acts very slowly, or may expend its power upon the contents (potassium permanganate introduced into a stomach containing much organic matter expends its oxidizing power upon such matter) ; but if the stomach is empty the action is usually very prompt, and apt to be directed against the walls of the stomach. 3. The quantity of blood in the blood vessels quite materially influences the rapidity of absorp- tion. 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 various experiments upon animals. As a poison, which has been absorbed into the blood, passes through the different organs of the body, some of it is at once separated by them and promptly removed in their secretions, such as the EFFECTS OF POISONS. 9 saliva, urine, sweat, bile, and pancreatic juice. The kidneys remove many poisons. 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 really this portion which produces the poisonous effects. That portion which is still in the stomach or other- wise unabsorbed, 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 is 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 is, for the time being, deposited in the organs, is harmless while there, but is never- theless a menace to life, as it may at any time be reabsorbed and thus become again active. It is therefore evident that a poison should be entirely re- moved from the system as soon and as completely as possible. The length of time required for the removal of an absorbed poison from the circulation, either by the secretions or by its being deposited in the organs or tissues, depends upon the poison and the state of the system. Potassium iodide, turpentine, antimony, and carbolic acid may often be found in the urine a 10 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. 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. 11 eral depression of the system Eke 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 action. 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, it is well known that dilute diuretics are more effective than concentrated ones; but saline purgatives are most ef- fective 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. A poison is absorbed more rapidly in the gaseous than in the solid or even liquid state; consequently it is most active in the gaseous, less active in the liquid, and least active in the solid state. A diseased or dis- ordered stomach may delay absorption of a poison or prove highly susceptible to the action of an irritant poison; or the acidity, alkalinity, or other character of its contents may determine the solution, absorption, destruction or intensity of action of a poison (e. g., an acid or alkali may be neutralized; mercurous chloride may be decomposed by an alkali thereby acting se- verely). Certain toxalbumins, such as snake venom, are almost or entirely inert when taken into the stomach, but very poisonous if introduced directly into the blood. Some poisons have a severe irritant effect in large doses. Although some substances are very irritant poisons 12 A MANUAL OF TOXICOLOGY. in large closes, small closes of them do not irritate, but if continued, gradually salivate (e. g., certain salts of mercury). As a rule, the larger the dose, the quicker and oftimes more emphatic the action. Some irritant substances, however, act as emetics in large doses, while small ones have no emetic effect, and consequently remain and poison; as, for instance, arsenic. A large dose of a poison may also cause death in a different way from a small dose. Oxalic acid in a large close quickly produces death by shock; in small closes, it slowly kills by its action upon the heart and nervous 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 modify the action upon the system as to obscure the symptoms, and even interfere with the chemical tests. As indicated in the foregoing, among others, such conditions and peculiarities of the system, as Habit, EFFECTS OF POISONS. 13 Idiosyncrasy, and Disease 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 that substance. 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 so- lutions of cocaine applied to the mucous membranes will cause severe symptoms of poisoning; opium pro- duces wakefulness; etc. 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, 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- 14 A MANUAL OF TOXICOLOGY. 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 paraly- sis, strychnine acts less readily. In typhoid fever, very large doses of alcohol are tolerated. Sleep usually diminishes or retards the action of poisons, owing to diminished vital functions (e. g., ar- senic, and other irritants). Exhaustion usually in- creases the susceptibility to certain poisons, particularly 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: J. 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 mo- tives for poisoning; the possession or purchase of the particular poison found ; previous attempts to poison; active efforts for secrecy regarding medicine used, or matters vomited; undue haste in burial, etc. 2. Symptomatic Evidence is that contributed by the symptoms. It may be subjective or objective. While it is very important in determining a poisoning, it is, nevertheless, only presumptive evidence of poi- soning. As is well known, there are no absolutely characteristic symptoms of any poison. If such were not the case, symptoms would be determinative evi- dence, and chemical investigation unnecessary. The local action of strong mineral acids and alkalies may, however, be considered 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, EFFECTS OF POISONS. 15 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 lias been vomited, or of material found in some part of the body, or in its excretions. The consideration of the physical properties of the suspected poison should be associated with the chemical investigation. Poison found in the stomach has in some cases been introduced there after death. Care must, therefore, be exercised to exclude such possibility. There is no known distinctive chemical test for certain poisons. Consequently those poisons cannot always be identified. Furthermore, the poison may have been decomposed in the blood or tissues, or so thoroughly eliminated or otherwise removed as not to be discoverable. The more unstable of the alkaloids and organic poisons are known to be oxidized while passing through the lungs. It is believed that many poisonous princi- ples, which enter the blood, are either destroyed or their effects neutralized by the white blood corpuscles. 16 A MANUAL OF TOXICOLOGY. Sometimes the chemical investigation is interfered with by the presence of certain ptomaines. Ptomaines (Animal Alkaloids, Cadaveric Alka- loids, or Putrefactive Alkaloids) are alkaloidal substances, resulting from the decomposition of albuminous materials under the influence of bac- teria. Some ptomaines are poisonous, the majority are not. Ptomaines have been found in mussels, oysters, eels, sausage, ham, canned meats, etc. Ty- rotoxicon is a ptomaine 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 a proteid substance with poisonous properties, or a mixture. The term toxin is usually restricted to poisonous proteid substances produced by disease producing microorganisms-as diph- theria toxin or tetanus toxin. Food Poisons: Certain foods, when undergoing decomposition, may become poisonous from the de- velopment of ptomaines or toxins. The symptoms of food poisoning are usually those of a gastro-in- testinal 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. 17 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 a post-mortem sign from the action of an irritant poison, or from disease, suffocation, drowning or strangulation. A deep red color of the stomach wall is sometimes caused by transulation of blood from the liver or spleen. Gravitation of blood, also, sometimes causes a similar appearance in the intes- tinal wall. Ante-mortem symptoms or some chemical evidence is therefore important. In ulceration of stomach from irritant poison mu- cous membrane usually 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, esophagus, etc., will invariably show effects of poison. Perforation may result from poison or disease, and follow corrosion or ulceration. In perforation from disease, opening is usually small, oval or rounded, with smooth edges; from acids, large and ragged. The diaphragm, stomach, spleen, liver and other viscera sometimes spontaneously soften. The preceding facts indicate necessity for caution in drawing conclusions from post-mortem appearances. 5. Experimental Evidence is evidence obtained by administering the suspected substance to some living animal and observing the effects. 18 A MANUAL OF TOXICOLOGY. But such facts as the following should not be overlooked: A rabbit can take more morphine than a man who weighs fifty times as much; amygdalin 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; the hedgehog is unaffected by the bite of the most venomous snake, and is not injured by large doses of hydrocyanic acid or of cantharides; although the frog is easily affected by the digitalis poisons, the toad is quite unaffected by them; dogs can take more morphine than most men; etc. THE CLASSIFICATION OF POISONS. It is almost impossible to arrange a satisfactory classification of poisons. An ideal classification would be one in which the same poison appeared but once, and in which the line between each poison was sharply drawn. Some writers upon toxicology classify poisons according to the kingdoms; that is, as animal, min- eral, and vegetable poisons. Poisons have also been classified as organic, mineral, and volatile poisons. But these classifications have proved un- satisfactory. Poisons may advantageously be classified either physiologically or chemically. Physiological classification is the usual and most satisfactory one, and is based upon the effects of poisons upon a healthy animal or upon the system when it is in a healthy condition. Chemical classification is a classification based upon chemical composition or chemical behavior. The author herewith presents a new physiological and also a new chemical classification which, he be- lieves, will be found useful. But for the reader's convenience, Tanner's, Blyth's, and Robert's classifi- cations are also introduced. THE CLASSIFICATION OF POISONS. 19 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; Ptomaines; Sa- vin; Trichina; Veratrum, etc. 1. IRRITANTS. True Irritants. Acetic, Carbolic, Chromic, Lactic, Oxalic and Salicylic Acids; The concentrated min- eral acids; Creosote; Corrosive Sublimate; Concentrated Lye; Potassium Chlorate; Po- tassium Nitrate; Potassium and Sodium Hy- droxides and Carbonates; Quick Lime; Soluble Salts of Barium; Water of Am- monia, etc. Corrosives. Alcohol; Apocynum; Bella- donna ; Chloral; Chloroform, Ether, etc. (Anesthetics); Car- bonic Oxide; Carbon Dioxide; Opium, etc. Cerebral. Narcotics. Nux Vomica, Strychnine, Bru- cine ; Ignatia; Thebaine, etc. Spinal. Tetanies. 2. NEUROTICS. Deliriants. Belladonna; Camphor; Cannabis Indica; Cocaine; Fishberries (Picrotoxin); Fungi; Hyoscya- mu's; Stramonium; Solanine, etc. Arnica ; Antipyrine ; Phenacetin, and many other Phenol and Benzene derivatives; Colchicum; Cocaine; Hemlock; Lobelia; Tobacco (Nicotine). Depressants. Cerebro- spinal. Aconite; Conium, Curare, Physostigma, Poke Root (Par- alyzants) ; Digitalis; Fishber- ries (Picrotoxin); Gelsemium; Hydrocyanic Acid; Nitro-Ben- zol; Pink Root; Potassium Cy- anide; Veratrum Viride; Animal and Insect Poisons, etc. Asthenics. 20 A MANUAL OF TOXICOLOGY. 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. IRRITANTS. 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 ieel- ing. Of these the opium group produce sleep; the belladonna group produce illusions and delirium; the alcohol group produce exhilaration succeeded by sleep or delirium. Anesthetics (General) are narcotics. THE CLASSIFICATION OF POISONS. 21 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, Hyoscyannes, Stramonium, Solanine, Co- caine, 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. Some poisons have the properties of both a cor- rosive or irritant and of a neurotic poison (e. g., Corrosive Sublimate, Arsenic, Carbolic Acid, etc.). The following-named drugs act directly upon the heart: Aconite, Antimony salts, Chloral, Hydro- cyanic Acid, Veratrum Viride, Digitalis, Sparteine, Strophanthus, etc. The first five decrease the number and force of the heart beats, the last three increase the force of the heart contractions. Poisons which affect the heart cause death by sud- den shock, collapse, or syncope. Among poisonous gases directly affecting the lungs are: Carbonic-Acid Gas, Chlorine, Illuminat- ing Gas, Muriatic-Acid fumes, Nitrous fumes, Sewer air, Sulpheretted Hydrogen, Sulphurous Oxide, etc. Neurotic symptoms are caused by poisonous gases, through the poisoning of the blood. 22 A MANUAL OF TOXICOLOGY. CHEMICAL CLASSIFICATION OF POISONS. Volatile Non-Metallic Poisons. Bromine; Chlorine; Iodine ; Fluorine; Phosphorus; Arseniuretted, Phosphoret- ted, and Sulphuretted Hydrogen; etc. 1. INORGANIC. Metallic Poisons. Antimony; Barium ; Copper; Lead ; Mer- cury ; 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, Bru- cine; Cocaine; Codeine; Colchicine; Coniine; Curarine ; Emetine ; Hyoscyamine; Morphine; Narceine; Narcotine; Nicotine; Physostigmine; Pilocarpine; Ptomaines; Sparteine; Strychnine; Veratrine, etc. 2. ORGANIC. Alkaloids. Bee, Wasp, and Hornet stings, and bites of various other insects or of animals. Venom of various snakes, such as the Co- bra, Copperhead, Rattlesnake, Mocassin, etc. Animal Poisons. Bacterial Poisons. Food Poisons; Ptomaines; Septic Poi- sons; Toxins. Glucosides. Digitalin; Salicin; Santonin; Solanin; Strophanthin, etc. Organic Acids. Acetic, Meconic, Oxalic, Salicylic, Tartaric, etc., Acids. THE CLASSIFICATION OF POISONS. 23 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: Corrosives. Strong Mineral Acids Sulphuric. Nitric. Hydrochloric. Vegetable Acids. . • • Organic Deriva- tives Oxalic. Carbolic Acid. Alkalies Strong Alkalies. Alkaline Carbonates, etc. Simple Irritants The above diluted. Lime. Zinc. Silver, etc. 24 A MANUAL OF TOXICOLOGY, Arsenic. Mercury. Antimony. Phosphorus. Iodine, etc. Specific Irritants .... Opium. Prussic Acid. Chloroform. Belladona. Aconite. Strychnin. Conium. Tobacco. Phenol, etc. Neurotics Corrosive Poisons are characterized by these three things: I. Immediate action. 2. Local effects, such as destruction of tissue and staining; and in many cases by, 3. Death from shock. Irritant Poisons give rise to- 1. Pain in the stomach and bowels. 2. Faintness and sick- ness; and 3. Purging with straining. 4. The evacuations are often tinged with blood. 5. The pulse is feeble and irregular; and 6. The skin is cold. Many of the substances of this class, from irritating the tissues with which they come in contact, produce a severe burning sensation in the mouth and oesophagus, as well as in the stomach. The degree of local destructive action produced will of course vary in proportion to the amount of the vehicle with which the noxious agent may be diluted. Irritants cause death by inducing collapse or convulsions, or by exciting severe inflammation; or, in some cases, after a variable inter- val, by leading to stricture of the oesophagus. The diseases which most resemble the action of irritants are, malignant cholera, severe diarrhoea, colic, cholera morbus, gastritis, en- teritis, rupture of the stomach or intestines, and obstruction of the bowels, mechanical or otherwise. Neurotic Poisons.-The symptoms of certain diseases bear a resemblance to those caused by some of the poisons of the neurotic class. Thus, belladonna gives rise to delirium with special illusions or convulsions. Sometimes there is tetanus, as in strychnine poisoning; sometimes coma (opium and car- bolic acid), or syncope (digitalis). Diseases of the brain and spinal chord, likely to be confounded with the effect of these poisons, are often very insidious in their progress, and hence mav suddenly give rise to suspicious symptoms. The history, THE CLASSIFICATION OF POISONS. 25 mode of attack, etc., will generally negative any suspicion of poisoning. The above facts show the necessity of extreme caution in diagnosing a poison from the symptoms exclusively. As may be observed in the foregoing table, Tanner places under his first group, " Corrosives," first, the "strong" or "concentrated mineral acids," such as sulphuric acid (oil of vitriol), nitric acid (aqua fortis), hydrochloric acid (muriatic acid, spirit of salt), and such "mixed acids" as nitro-muriatic (aqua regia), and nitro-sulphuric (aqua reginae), 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 26 A MANUAL OF TOXICOLOGY. known;" and also such "simple animal irritants" as poisonous fish, and poisonous meat, and such foods as milk and cheese which have undergone such changes as make them poisonous; 4th. Such "irritant gases" as chlorin, sulphurous acid, nitric oxid, hydrochloric acid gas, and ammonium hydroxid. Under his third group, "Specific Irritants," he places, 1st. Such "specific mineral irritants" as iodin and potassium iodid, bromin and potassium bro- mid; also phosphorus, arsenous acid (arsenic, white arsenic), hydrogen arsenid, copper arsenite (Scheele's, Brunswick, or mineral green), antimony chlorid (ter- chlorid or butter of antimony), tartar emetic (tartarized antimony, potassio-antimony tartrate), mercury and its compounds, such as corrosive sublimate, calomel, the red oxid (red precipitate), the red sulphid (cinna- bar or vermilion), the cyanid, the nitrates, and the subsulphate (turpeth mineral) ; also lead acetate (sugar of lead), lead subacetate (Goulard's extract), lead carbonate (white lead), copper sulphate (blue vitriol or bluestone), copper subacetate (verdigris), barium chlorid, barium nitrate, and barium acetate. 2d. Such "specific vegetable irritants" as laburnum, "cenanthe crocata, phellandrinum aquaticum, 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. 27 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 mix vomica, strychnin and brucin; "Paralysants (neurotics producing paralysis of the motor nerves)," in which he includes calabar bean and its active principle eserin, conium (common or spotted hemlock) and its alkaloid conin; "Hypos- thenisants or Syncopants (neurotics producing- death by syncope)," in which he includes aconite and its alkaloid aconitin, hydrogen cyanid (prussic acid), potassium cyanid, also gelsemium and its alka- loid gelsemin, etc.; "Depressants(neurotics producing marked depression of the heart's action)," in which he includes digitalis and its active principle digitalin, tobacco and its alkaloid nicotin, lobelia, colchicin, white hellebore and green hellebore and veratrine; "As- phyxiants (noxious gases, producing neurotic symp- toms by means of blood poisoning)," in which he in- cludes carbon monoxid, carbon dioxid (carbonic acid gas), hydrogen sulphid (sulphuretted hydrogen), and the so-called "coal gas;" "Abortives (substances pro- ducing abortion)," in which he includes ergot of rye, savin and its oil, oil of tansy, the yew, and extract of cotton root. To the foregoing, lay lor adds the following in the appendix of his book: I. " Bites of venomous reptiles," with chief ref- erence to the bites of such serpents as the cobra of India, the adder (or common viper) of England, the brown and black snake of Australia, also the tiger snake, the rattlesnake, the copperhead, etc. II. " Bites of rabid animals," such as mad dogs, etc. III. "The stings of bees, etc.," including those of bees, wasps, hornets, scorpion, etc.; also the bites of ants and other insects. 28 A MANUAL OF TOXICOLOGY. ROBERT'S CLASSIFICATION OP' POISONS. I. Poisons Which Cause Coarse Anatomical Changes of the Organs. A. Those which especially irritate the part to which they are applied. 1. Acids. 2. Caustic alkalies. 3. Caustic salts, especially those of the heavy metals. 4. Locally irritating organic substances, which neither can be classified as corrosive acids nor alkalies, nor as corrosive salts. Such are: Cantharidine, phrynine, and others in the animal kingdom, croton oil and savin in the vegetable kingdom; locally irritating colors, such as the aniline dyes. 5. Gases and vapors which cause local irritation when breathed, such as ammonia, chlorine, iodine, bro- mine, and sulphur dioxide. B. Those which have but little effect locally, but change anatomically other parts of the body, such as lead, phosphorus and others. II. Blood Poisons. 1. Blood poisons interfering with the circulation in a purely physical manner, such as peroxide of hydro- gen, ricine, abrine. 2. Poisons which have the property of dissolving the red blood corpuscle, such as the saponins. 3. Poisons which, with or without primary solution of the red blood corpuscles, produce in the blood methae- moglobin, such as potassic chlorate, hydrazine, nitro- benzene, aniline, picric acid, carbon disulphide. 4. Poisons having a peculiar action on the coloring mat- ter of the blood, or on its decomposition products, such as hydric sulphide, hydric cyanide, and the cyanides and carbon monoxide. HL 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. 29 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, senanthe, crocata, and camphor. 3. Convulsives. Almost every poison has been known to produce convulsive effects, but the only true convulsive poi- sons are the alkaloids of the strychnos class. 4. Complex Nervous Phenomena. Aconite, digitalis, hemlock, calabar bean, tobacco, lobelia inflata, and curara. A MANUAL OF TOXICOLOGY. 30 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. B. Acids and Alkalies. 1. Sulphuric acid. 2. Hydrochloric acid. 3. Nitric acid. 4. Potash. 5. Soda. 6. Ammonia. 7. Neutral sodium, potassium, and ammonium salts. THE CLASSIFICATION OF POISONS. 31 In nearly all cases of death from any of the above, the analyst, from the symptoms observed during life, from the surrounding circumstances, and from the pathological appear- ances and evident chemical reactions of the fluids submitted, is put at once on the right track, and has no difficulty in ob- taining decided results. 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 disulphide. 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, nico- tine, piturie, sparteine, aniline. * 2. The opium group of alkaloids. 3. The strychnine or tetanic group of alkaloids, strych- nine, brucine, igasurine. 4. The aconite group of .alkaloids. 5. The mydriatic group of alkaloids, atropine, hyoscya- mine, 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 32 A MANUAL OF TOXICOLOGY. suggests itself, the physiological action of which is the oppo- site of the strychnos class. Solanin (although classed as a mydriatic and put near to atropine), has much of the nature of a glucoside, and the same may be said of colchicin, so that, if the classification were made solely on chemical grounds, solanin would have followed colchicin, and thus have marked the transition from the alkaloids to the glucosides. Division II.-Glucosides. 1. The digitalis group. 2. Other poisonous glucosides acting on the heart. 3. Saponin. The glucosides, when fairly pure, are easily recognized; they are destitute of nitrogen, neutral in reaction, and split up into sugar and other compounds when submitted to the action of saponifying agents, such as boiling with dilute min- eral acids. Division III.-Certain Poisonous Anhydrides of the Organic Acids. 1. Santonin. 2. Mezerein. It is probable that this class will in a few years be ex- tended, 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, asthusa cynapium, cenanthe 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 I.-Poisons Secreted by the Living. 1. Poisonous amphibia. 2. Poison of the scorpion. 3. Poisonous fish. 4. Poisonous insects, spiders, wasps, bees, beetles, etc. 5. Snake poison. THE FATAL DOSE OF A POISON. 33 Division II.-Poisons Formed in Dead Animal Matters. 1. Ptomaines. 2. Poisoning by putrid or changed foods-sausage poi- soning. 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. THE FATAL DOSE OF A POISON. 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 in- fluence the effect and result. Even in some authenticated cases, the exact quantity 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. j/io; Digitaline gr. % 1 Hydrocyanic Acid gr. i; Strychnine gr. E2 5 etc., also some animal poisons, such as the venom of certain snakes, the bite of the tarantula, etc. Some of the toxins are exceed- ingly 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 pro- duce death. 34 A MANUAL OF TOXICOLOGY. PROMPT TREATMENT FOR POISONING, MODE OF PROCEDURE. When symptoms and circumstances indicate that a poison has been taken, the following course should be pursued: I. If there is a known chemical antidote and it is at hand, use it at once (either alone or in con- junction with an evacuent), 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, at once evacuate the stomach (i. e. re- sort to 2). Or where this is impossible or im- proper, promptly employ such mechanical antidotes as will coat the walls of the stomach, etc., mechanic- ally suspend the poison, or remove the latter by catharsis. 2. In absence of prohibitive caustic action of poison, evacuate and wash out the stomach by means of the stomach tube or stomach pump or emetics, and warm water. If a chemical antidote is now for the first time convenient, employ it. Demulcents should usually be employed after evac- uation of the 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 antagonist). Also encourage the natural processes of removal (i. e. urine, perspiration, etc.). 4. Employ the proper antagonistic measures to stimulate flagging organic functions. MECHANICAL ANTIDOTES. 35 ANTIDOTES. Antidotes affect a poison either mechanically or chemically, or both, so as to remove it from the body or alter its character before absorption and thus prevent its poisonous action upon the system. They act in the respiratory passages or alimentary canal and may be employed for vegetable or min- eral poisons, but have no effect upon medicines given hypodermically. Mechanical Antidotes include: the use of the stomach tube or pump; the employment of Emet- ics, Cathartics, Demulcents, Injections, Ligatures, Poultices, Washes, etc. Chemical Antidotes include: Oils, Soap, Milk, Acids, Albumin, Alkalies, Charcoal, Carbonates, Hydrates, Sulphates, Iodine, Potassium Perman- ganate, Sodium Chloride, Starch, Tannic Acid, Turpentine, preparations of Iron, etc. MECHANICAL ANTIDOTES. THE STOMACH TUBE AND THE STOMACH PUMP. When active measures are to be employed to evacuate the stomach, this is most readily accom- plished by means of the stomach tube, the stomach pump, or by emetics. The stomach tube is a long, rubber tube, shaped like a catheter, and having a funnel attached to one end. It is introduced into the stomach by forcibly keeping the poisoned person's mouth open, by means of a gag or of a knife handle wrapped in a handkerchief, and passing the tube down; the finger should be used to guide it in the mouth. Care should be exercised that the tube is not acci- dentally passed into the windpipe in front of the gullet. It is sometimes found necessary to intro- duce the tube through the nose instead of the mouth. Tepid water may be introduced into the stomach through the funnel and tube and by lower- ing the tube and turning the funnel down, the 36 A MANUAL OF TOXICOLOGY. stomach may be more or less emptied of fluid and poison by siphonage. The washing out process should be repeated until all poison has apparently been removed from the stomach. 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 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. EMETICS. LOCAL EMETICS. Alum-a tablespoonful in water, syrup or honey. (Unreliable.) Ammonium Carbonate-30 grains or more in water. Copper Sulphate-10 grains in water in one close; or 3 to 6 grains in water every 15 minutes. Mustard-2 to 4 teaspoonfuls in a cupful of warm water. (Good and stimulating). MECHANICAL ANTIDOTES. 37 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). Tepid Water--in quantity freely, (4 to 8 glasses). Tickling the Throat with feather or finger. (Good). Yellow Mercuric Sulphate (Turpeth Mineral)- 2 to 5 grains. (Unsafe unless it vomits.) Zinc Sulphate-20 to 30 grains in a wineglassful of water; repeat if necessary. Or 30 grains m 2 ounces of water, giving a tablespoonful every half hour. Considered prompt and safe. Children 5 grains. (This is the best emetic). SYSTEMIC OR GENERAL EMETICS. Antimony, Wine of-An ounce or more in water. Apomorphine Hydrochlorate-gr. 1/16 to hy- podermically when the use of emetics by the mouth is prevented by narcosis or otherwise. Emetine-gr. 1/12 to Ipecac, Fluid Extract of-54 to 1 teaspoonful. Ipecacuanha, Pulverized-30 grains or more in water. Does not irritate the mucous membrane of the stomach. Ipecac, Syrup of-1 to 4 teaspoonfuls, or a tea- spoonful every 10 minutes until vomiting is pro- duced. Ipecac, Wine of-1 or 2 tablespoonfuls in water. (Slow and unsatisfactory). Squill, Syrup of-A teaspoonful. 38 A MANUAL OF TOXICOLOGY. Squill, Compound Syrup of-% to teaspoonful. Tartar Emetic-1 to 3 grains. (Slow and de- pressing). 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 m doses of % to 4 ounces, in water. Such cathartics as Senna and Gamboge are often the best ones for narcotic .poisoning. CHEMICAL ANTIDOTES. 39 DEMULCENTS. Demulcents are substances which soothe and protect the parts to which they are applied. They include Almond, Olive, and other bland Oils, Aca- cia, Barley, Cetraria, Elm, Figs, Flaxseed, Gelatin, Glycerine, Honey, Isinglass, Liquorice Root, Marsh- mallow Root, Starch, Tragacanth, and White of Egg, each with or without water. CHEMICAL ANTIDOTES. OILS, ALBUMIN, TANNIN, ETC. Oils and Fats (almond, cotton seed, linseed and olive oils, melted butter, lard, etc.). Oils and fats are useful against the corrosive acids and alkalies, metallic oxides and salts; they are, however, con- sidered to be contra-indicated in poisoning by Can- tharis, Carbolic Acid, Creosote, Copper Salts and Phosphorus, because they encourage the absorp- tion of these poisons. Oils and fats unite with the caustic alkalies to form soaps ■ thus liberating gly- cerine. As antidotes to the metallic salts they are not as good as albumin. As antidotes to the alkalies they are inferior to acids, owing to their slow action. Soap (Castile Soap, etc.). Castile soap dissolved in four times its bulk of hot water to form "suds," and administered by the cupful, is an excellent antidote for corrosive acids and metallic salts, par- ticularly Corrosive Sublimate, Potassium Bichro- mate, and Tin and Zinc Salts; but Albumin is better for these last two. Soap is better than caus- tic alkalies for acids, because it has no corrosive action. It should not be used as an antidote to alkalies. Albumin.-An excellent Chemical Antidote, form- ing Compounds, more or less inert with most of the corrosive alkalies, metallic salts, mineral acids, Anilin, Bromine, Chlorine, Creosote, Iodine, and with alcoholic solutions of most of the alkaloids. 40 A MANUAL OF TOXICOLOGY. It is particularly valuable as an antidote to inor- ganic poisons and a good application for the bites and stings of insects. Albumin should, be well diluted when used (the whites of four eggs to one quart of tepid water). It is important to follow it first by an emetic and then by a cathartic, inasmuch as many of its compounds are soluble in an excess of albumin, or in acid or alka- line solutions. Milk.-The antidotal action of milk is similar to that of albumin and due to its albumin, casein and free alkali. Milk is a good substitute for albumin, and especially suitable for metallic salts, corrosive acids and alkalies (particularly Ammonia), and the alkaline earths. Owing to the fat in milk it is to be avoided when fatty antidotes are contra-indi- cated. White of egg and milk together are good anti- dotes to iodic preparations. 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. 41 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.-Alcohol is considered a valuable anti- dote in Carbolic Acid poisoning. Four or more ounces of equal parts of Alcohol and water 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 whisky 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. 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. 42 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. 43 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, ip2 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 employed as antidotes to Arsenic poisoning. 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 water, 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. 44 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. I, after which shake them together to a uniform smooth mixture. This should be given in large doses of an ounce or more, and frequently repeated. Sesqui-Oxide of Iron (freshly prepared), made by precipitating Tincture of Perchloride of Iron with Sodium Carbonate and filtering through a cloth, may be given as an antidote to Arsenic. It should be freely administered in hot water. Dialyzed Iron may be given in ounce doses or less, frequently repeated, for the same purpose. Magnesia (Calcined Magnesia; Magnesium Ox- ide; Mg. O.). Magnesia mixed with twenty-five times its weight of warm water gelatinizes, be- coming suited to antidotal use. It may be given in 1% to 2 ounce doses of such mixture, frequently 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. 45 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 30 to 60 grain doses in water. 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- 46 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 % 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 vinegat should be added to the antidote. Potassium Permanganate is promptly decomposed by Alcohol, and by the usual stomach contents, urine, etc. Locally, this antidote is good in sanke 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. 47 the resulting oxalates are soluble and almost as poisonous as the Acid itself. Potassium Iodide is administered in 5 to 30 grain doses three times a day in chronic poisoning by Arsenic, Mercury, or Lead, or their salts, to encourage their elimination from the system. 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. 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, producing com- pounds which are almost harmless. It has a slight antidotal action against corrosive acids, Corrosive Sublimate, Copper Sulphate, and Zinc Sulphate. Wheaten flour is also a good antidote to the fore- going. 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 prepara- tions, free vomiting or lavage should be encouraged as long 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 48 A MANUAL OF TOXICOLOGY. 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; the Tan- nates are nearly insoluble, but not absolutely inactive, being somewhat soluble in dilute hydrochloric acid of the gastric juice, also readily soluble in dilute alcohol, and emetics and active purgatives should be employed for their prompt removal from the alimentary canal. Tannin renders Tartar Emetic harmless (but albumin does not) by forming an insoluble 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 fifteen minutes. By combining about ten per cent, of its weight of Iodine with it, its efficacy as an antidote to vegetable poisons is increased, but not over ten grains of such mixture should then be given. When Tannin is not at hand, resort may be had to decoctions or infusions of Tea, Coffee, Nut-galls, Kino, Rhatany, Catechu, Oak, Willow or Cinchona barks, or other substances which contain 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 Tur- pentine is of doubtful value as an antidote to Phosphorus poisoning, but Oil of Turpentine which has 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, and it should be given in hot water or alone (floated on the water or in capsules) immediately after the Phosphorus is taken, or as soon thereafter as pos- sible. The antidote is considered valueless if not given within twelve hours. Do not give it with an CHEMICAL ANTIDOTES. 49 oil, soup, milk, white of egg or other albuminous substance; nor should mucilaginous or alcoholic drinks be allowed with it; nothing but the capsule or hot water. If it cannot be determined what quan- tity of Phosphorus has been taken, the Oil of Tur- pentine may be given in four doses of % drachm (2 cc.) each, at 15 minute intervals. If the stomach will not retain the Turpentine it has been recommended to 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 Turpentine, 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 by means of the stomach tube is now resorted to in nearly all cases of poisoning. It should, however, be remembered that in Sulphuric Acid poisoning the introduction of water is inadvisable, at least when 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. Inas- much as emetics are usually administered in water, it may be remarked in this connection that other- wise an emetic may be given in poisoning by Oxalic Acid, 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. 50 A MANUAL OF TOX1COL.OGY. 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: Equal parts of Magnesia, Charcoal, and the Hy- drated Oxide of Iron, mixed and freely given in plenty of water. (The Magnesia is given to neu- tralize 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). The following antidotal preparation delays the action of the salts of Copper, Morphine, and Strych- nine. It has also some effect on compounds of Mercury. It is a perfect antidote to Arsenic, Digi- talin, Zinc, etc., but it is of no value against Mer- curic Cyanide, Hydrocyanic Acid, the caustic Alka- lies, Tartar Emetic, or Phosphorus. The prepara- tion is as follows: Liquor Ferri Sulphatis (specific gravity 1.45) 2^4 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 1% to 3 ounces, frequently repeated. PART II. POISONS AND ACUTE POISONING: HISTORY, SYMPTOMS AND TREATMENT. N. B.-It is to be understood that the doses in this chapter are for adults, and are to be modified ac- cording to the urgency of the symptoms, and dis- continued or reduced when the symptoms are re- lieved. The author has endeavored to place together poisons exhibiting similar phenomena or for which the same treatment is applicable. The symptoms of those poisons which, in the opinion of the author, even the pharmacist should be familiar with, 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 is always justifiable, and the neglect to do so may be censurable. ACETANILID (ANTIFEBRIN) - ANILIN - ANTIPYRINE - EXALGIN - PHE- NACETIN. HISTORY: All of these drugs are more or less dangerous. Probably Acetanilid and Antipyrine the^most un- safe. z 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 52 A MANUAL OF TOXICOLOGY. of Anilin, has caused death within 12 hours. Anilin is an oily fluid having a peculiar and distinctive odor. The fatal dose of Anilin is considered to be about 6 grammes, but recovery has occurred after 10 grammes. Poisoning has resulted from 7 grains of Antipyrine; also from 3^ -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. In chronic poisoning by Anilin the per- spiration has a reddish color.] TREATMENT: 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). 2. Stimulate with Aromatic Spirit of Ammonia ACID ACETIC. 53 teaspoonful doses in water every 10 to 15 min- utes), or Brandy or Whisky (in teaspoonful doses every 10 to 15 minutes), or give either of these three hypodermically. Encourage respiration by giving Strychnine Sul- phate (in 1/60 to 1/20 grain doses every % to 2 hours, according to effect). Sustain blood pressure by Atropine Sulphate (1/120 to 1/60 grain doses hypodermically every % to 2 hours, according to effect). 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: 1 ounce of Acetic Acid in concen- trated state. The symptoms and treatment are similar to those for the Mineral Acids. ACID CARBOLIC (PHENOL, PHENIC ACID) - CREOSOTE. 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. It is the poison most commonly used for 54 A MANUAL OF TOXICOLOGY. suicidal purposes, but is rarely used as a means of committing murder. A Carbolic lotion has been fatally administered by mistake for medicine. Poi- soning sometimes results from the use of too strong an injection, from a spray, from a strong salve rubbed into the skin to cure itch or other skin affections, or from absorption when used as an anti- septic in surgical dressings. If the urine becomes dark colored or smoky in using Carbolic Acid, discontinue use. When fatal, death usually occurs in from *4 to 4 hours after the poison has been taken. The short- est time has been in 10 minutes, the longest time 60 hours. Fatal dose: From a drachm up; usually % to 2 ounces. Half an ounce is as a rule fatal ; 6 or 7 grains have caused dangerous symptoms. Death is due to cardiac and respiratory paralysis. If prompt, death may result from syncope; if pro- longed, from apnoea. SYMPTOMS: Usually, but not always, an immediate burning pain from mouth to stomach, accompanied some- times by vomiting; there is usually a whitening of the lips and mouth, also of the esophagus and stom- ach; the breathing is labored; as. a rule there is dizziness and later loss of consciousness; low tem- perature ; diminished and greenish, brownish or black urine, the urine and breath having the char- acteristic odor of Carbolic Acid or of Creosote; pupils contracted; collapse. TREATMENT: Death usually occurs so soon that treatment must be prompt to be effective. Do not treat as for an acid. Remember that Car- bolic Acid, although so called, is not an acid, but belongs to the class of bodies known as phenols, and has but feeble acid properties. ACID CARBOLIC. 55 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 the absence of extreme damage tq the mucosa of the stomach (as indicated by small quantity of poison taken, or its not being in the pure state, or pain not being very severe), the stomach-tube may, as a rule, safely be introduced. When not safe, omit evacuent treatment, and limit alcohol to 4 ounces, well diluted. Avoid the use of oils and glycerine, 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 (equal parts) and at once remove it with the stomach-tube, if possible, syphoning it out. If the stomach-tube is not at hand, may use Mustard (a tablespoonful in a small cupful of water), or much better, Apomor- phine Hydrochlorate, hypodermically (1/10 grain). The Alcohol protects the stomach from the corro- sive effects of the Carbolic Acid and also acts as a stimulant. The Apomorphine not only has a prompt emetic effect upon the more or less paralyzed stom- ach, but also controls any inclination to acute alco- holism. (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 15 minutes, from 4 to 8 times, according to the severity of the poisoning. Washing out freely with much water is also good secondary treatment. In the absence of Alcohol, a very dilute Acetic Acid has been employed. 56 A MANUAL OF TOXICOLOGY. 2. Administer one of the soluble sulphates next, such as Sodium or Magnesium Sulphate (in y2 to 2 ounce, or i to 2 tablespoonful, doses in a cupful of water) to hasten the elimination of such portion of the Carbolic 'Acid as may have entered the circula- tion. Half a pint of suclf solution. % the strength, should be left in the stomach for continued ab- sorption. 3. Stimulate heart, circulation, and respiration by Atropine Sulphate (1/120 to 1/60 grain hypoder- mically every JZ to 2 hours), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief, using one every 15 to 30 minutes). A hypodermic injection of Sulphuric Ether (15 min- ims) may be employed. A hypodermic injection of Strychnine Sulphate (1/60 to 1/20 grain every % to 2 hours), or Tincture of Digitalis (5 to 10 drops), or Digitalin (t/roo grain) every % to 2 hours, may be helpful. 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 vegetable demulcents (as flaxseed, or elm tea, gruel), or white of egg, or magnesia in water, may be given in the absence of other agents, or as an after treatment, to soothe and protect the mucous membrane. 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. 6. May give Opium (Powdered Opium, 1 or 2 grains every JZ to 2 hours), or Laudanum (20 drops every to 2 hours by mouth, or )Z teaspoonful in gruel by rectum as frequently), or Morphine Sul- phate grain by mouth or hypodermically every ACID CARBONIC. 57 % to 2 hours), to relieve pain and nervous irrita- bility if present and severe. The treatment for poisoning by Creosote 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, are efficient dress- ings in external injury or corrosion. ACID CARBONIC [GAS] (CARBON DIOXIDE, CHOKE DAMP). 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. Fatal dose: io 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. 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, 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 58 A MANUAL OF TOXICOLOGY. the heart does not begin to beat soon after begin- ning artificial respiration, the jugular vein may be opened (avoid entrance of air) to relieve distention of the right ventricle. [The jugular is selected be- cause there are no important valves between it and the heart], 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). HISTORY: 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 y2 ounce ha's 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. SYMPTOMS: Pain in the stomach; colic; cramps in legs; vom- iting; purging; dilated pupils; great depressionj col- lapse. Chromic Acid vomit produces yellow stain on cloth. TREATMENT: 1. Evacuate the stomach. In poisoning by the acid employ stomach-tube and much water to sy- ACID CHROMIC. 59 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, of 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 JZ to 2 hours), and by inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief, using one every 15 to 30 minutes). A hypodermic injection of Sulphuric Ether (15 min- ims) may be employed. A hypodermic injection of Strychnine Sulphate (1/60 to 1/20 grain every % to 2 hours) may be helpful. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or, stove-lids, heated, applied to the feet and sides of the body) to main- tain bodily temperature. 4. Protect the mucosa of the stomach by admin- istering demulcents (such as milk, gruel, flaxseed or elm tea). 6. Give Opium (Powdered Opium, 1 or 2 grains every JZ to 2 hours), or Laudanum (20 drops every )Z to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every to 2 hours), to relieve pain and nervous irritability if present and severe. 60 A MANUAL OF TOXICOLOGY. ACID HYDROCYANIC (PRUSSIC ACID) - BITTER ALMONDS, AND THEIR OIL - CHERRY LAUREL WATER-SCHEELE'S ACID - ETC. HISTORY: Poisoning may be the result of accident, suicidal intentions, or the effort to commit murder. It has resulted from inhaling the vapor of the anhydrous acid, from the use of the cyanides, from the acid itself, or from vegetable substances containing amygdalin. This latter substance readily under- goes decomposition, resulting in Hydrocyanic Acid and other products. Hydrocyanic Acid is a con- stituent of bitter almonds, cherry laurel, cherry, peach and plum pits. The Dilute Hydrocyanic Acid should contain 2 per cent, of the anhydrous acid. Oil of Bitter Almonds contains io 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 the centres of respi- ration. Fatal dose: 9/10 grain of the anhydrous Acid; 40 minims of Dilute Hydrocyanic Acid (U. S. P.) ; re- covery after 1 drachm of Scheele's Acid (equal to 22/5 grains of the anhydrous acid) ; 80 almonds fatal; 4 to 6 will poison a child. Death after 17 drops of Oil of Bitter Almonds; also recovery after 4 drachms; but 20 drops is considered a fatal dose. SYMPTOMS: The symptoms come on in the very act of swal- lowing or almost immediately. The breath has the ACID HYDROCYANIC. 61 characteristic odor of Bitter Almonds. Respiration difficult and expiration prolonged; pulse impercept- ible ; eyes glassy and prominent; pupils dilated ; wild cries; involuntary urination and defecation; con- vulsions ; asphyxia; cyanosis; paralysis; general collapse; coma ; death. TREATMENT: There is no known, altogether reliable, antidote, although Ferrous Sulphate (in 5 to 10 grain doses) has been claimed to be a good chemical antidote. The following has been recommended because it results in forming Prussian Blue: Give Magnesia (1 teaspoonful) stirred up in water; then in water 16 drops of Perchloride of Iron and 12^2 grains of Ferrous Sulphate. Cobalt Nitrate has proved effi- cacious in many cases. Put the patient in a horizontal position out in the air. Resort to artificial respiration, usually necessary. The most serviceable methods in great emergency are the use of Ammonia, diluted, by inhalation, hy- podermically and by mouth; 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 the resort to artificial respiration. A mixture of the Ferrous and Ferric Sulphates as an antidote , to be followed by a solution of Potas- sium or Sodium Carbonate, or Hydroxide, the com- bination producing the inert Prussian Blue in the stomach, has been highly recommended. If there is time to do anything besides resorting to artificial respiration and stimulation, give the iron preparation and employ the following meas- ures : 1. Evacuate the stomach (after the antidote), with stomach-tube, or tickle fauces with a feather, or press finger down throat, or give an emetic of Mus- tard (tablespoonful in a wineglassful of water), or 62 A MANUAL OF TOXICOLOGY. Zinc Sulphate (20 grains in a tablespoonful of water). Wash the stomach out with a dilute solu- tion of Hydrogen Peroxide; or may give Potassium Carbonate (20 grains in a wineglassful of water), immediately followed by Copperas (10 grains) and Tincture of Iron (1 teaspoonful in 2 tablespoonfuls of water) ; or may give Javelle Water (1 teaspoon- ful in a cupful of water), or Chlorine Water (a table- spoonful in a cupful of water), or use a Chlorine spray. May give a hypodermic injection of the ordinary solution of Hydrogen Peroxide •(% of a teaspoonful every 5 minutes until respiration and circulation improve, then occasionally). Also stim- ulate with hypodermic injections of Atropine Sul- phate (1/120 to 1/60 grain doses), or may use Chloric Ether (15 minims) hypodermically. 2. Employ douches; pour cold water on face, and alternately hot and cold water on chest. 3. Stimulate. Give inhalations of Ammonia. Also give Aromatic- Spirit of Ammonia, Brandy or Whisky (1 teaspoonful in a little water every 2 or 3 minutes by mouth, or in double quantity by rectum, or in half quantity hypodermically). 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. Apply electricity. Employ a faradic current, applying it to the chest walls, particularly over the heart. ACIDS MINERAL. 63 ACIDS MINERAL (CONCENTRATED): HY- DROCHLORIC (MURIATIC ACID, SPIRIT 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 accident or attempted suicide. Poisoning by Sul- phuric Acid is usually the result of mistaking it for a beverage or attempted suicide. Although the primary effects of these acids may be recovered from, the secondary effects, consisting of stricture of the esophagus or stomach, or perforation of the esophagus, resulting in death, is apt to occur in a year or two. The dangerous qualities of Sulphuric Acid are in proportion to its degree of concentra- tion rather than to the quantity taken. Fatal dose: Hydrochloric Acid, % ounce; usually, i ounce; recovery has occurred from more than an ounce; shortest fatal period, 2 hours. Nitric Acid, 2 drachms; % ounce has been recov- ered from; shortest fatal period, 1^4 hours. Sulphuric Acid, 1 drachm ; greatly depends upon the quantity of food in the stomach ; recovery has taken place after 2 ounces; average fatal period, 16 to 24 hours; shortest period, 1^4 hours. Death from Concentrated Mineral Acids by as- phyxia or collapse or perforation of the. stomach. Death usually occurs withirj 24 hours. SYMPTOMS: Pain throughout digestive tract; thirst intense; swallowing difficult; vomit dark-colored and con- taining mucous shreds, parts of membrane of eso- 64 A MANUAL OF • TOXICOLOGY. phagus and stomach, and perhaps blood; feeble pulse ; clammy skin ; collapse ; cough ; difficult res- piration ; sometimes constipation; white on lips. Hydrochloric Acid produces on dark cloth first a bright red color, which after some days becomes a reddish-brown or yellow. No stains on the skin. Mucous membrane of mouth and tongue is gray or white. Nitric and Nitrohydrochloric Acids produce first white, then yellow, and finally brownish-red stains on lips and skin. Stain clothing yellow. Sul- phuric Acid produces black stains and corrosion on lips, and chars clothing, or stains dark cloth red or brownish-red; stains. other colored materials a bright reddish or yellowish. TREATMENT: Do not use stomach-tube, stomach-pump, or emetics with concentrated acids, lest the former perforate the wall of the esophagus or stomach, or the latter rupture the stomach. Chalk, Potassium, or Sodium Carbonate or Bicarbonate, although anti- dotes, should not be used, lest the gas generated rupture the weakened wall of the stomach. Avoid water in poisoning by Sulphuric Acid, as it generates heat, and thus increases the injury to the stomach. Antidotes: Magnesia, soap, albumin, lime water, whiting, plaster from wall, and demulcents. i. Give Calcined Magnesia in frequent doses (2 tablespoonfuls in a cupful of tepid water or milk). Lime water ad libitum. Soap suds (as castile soap, dissolved in 4 times its bulk of hot water), given by the cupful until the stomach is soothed, give excel- lent results. 2. Give demulcents (such as white of egg, 1 in % cupful of water; barley water, flour, flaxseed tea, gruel, starch water, olive oil, or milk, given freely) to soothe and protect. 3. May give Opium, or Morphine Sulphate (a hy- podermic injection of % or % grain), or Deodorized ACID OXALIC. 65 Tincture of Opium (io to 15 drops) by mouth, to relieve the pain. Stimulants may be used hypodermically. Apply heat to body. Oil enemata benefit. External parts injured by these acids are benefited by bathing with soap and water, and treating like burns. ACID OXALIC (ACID OF SUGAR) - The Acid POTASSIUM OXALATES (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 also has been taken for Epsom Salt, owing to similarity in appearance. Fatal dose: i drachm of the solid acid has killed; usually ^2 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 ef- fect 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. Although the soluble salts of Oxalic Acid are almost as poisonous as the acid itself, they are not as corrosive. Death has occurred in io minutes, but usually occurs in about an hour. Death has occurred as late as the fifth day. Death by paralysis of respiration and heart. The time of death is not dependent upon the amount and concentration of the poison. 66 A MANUAL OF TOXICOLOGY. SYMPTOMS: A hot acrid or intensely sour taste in mouth; burning sensation in esophagus and stomach; in- tense thirst; distressing cough; severe pain in head, abdomen, and back; tongue swollen; sense of suffo- cation; usually vomiting of highly acid, greenish, blackish-brown or bloody mucus; black and blue colored face; cold skin; coma; collapse; sometimes convulsions; urine contains crystals of Oxalate of Lime, albumin, and tube casts. Oxalic Acid, in substance or in strong solution, acts locally as a corrosive upon the tissue with which it comes in contact, and also acts as a true poison. Upon the concentration of the solution de- pends the predominance of either action. Oxalic Acid in a large dose, and dissolved in a small quan- tity of water, produces immediate and severe symp- toms. In the reverse state the symptoms are de- layed and less severe. Death may be caused by dilute solutions without either pain or vomiting hav- ing been present, the symptoms being similar to those produced by narcotic poisoning. TREATMENT: Treatment must be prompt. The chemical anti- dote is Lime in any form (such as lime water, chalk, whiting, or wall plaster, given freely in water). i. Give at once Lime Water, or Lime Water with an equal quantity of pure water or Oil, freely, or the Saccharated Solution of Lime, or some soluble Salt of Calcium, or Magnesium, either suspended or dis- solved in a very small quantity of water, or in some demulcent, as milk, mucilage, or oil. Carbonate of Calcium, in the form of prepared chalk (2 teaspoon- fuls at a dose), or Precipitated Carbonate of Cal- cium (2 teaspoonfuls at a dose) is very satisfactory, as with Oxalic Acid it forms the Oxalate of Calcium, an inert substance. Ordinary chalk, plaster from the wall, whiting, or even powdered oyster shells, may be substituted when the preceding are not read- ACID OXALIC. 67 ily obtainable. Magnesia (2 tablespoonfuls in a gill of milk) may be given, as it forms an insoluble ox- alate. 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, followed by pure water. Milk of Magnesia 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- 68 A MANUAL OF TOXICOLOGY. sium Sulphate (1 to 2 tablespoonfuls in a cupful of water), to clear out the intestines. When water is admissable, much should be given to encourage elimination of the poison by the kid- neys. Apply poultices to the abdomen, and hot fomenta- tions to the loins. 4. Employ stimulants freely upon signs of col- lapse (such as Brandy or Whisky (in tablespoonful doses in a little water), but only per rectum). 5. Give Opium (Powdered Opium, 1 to 2 grains), or Laudanum (20 to 30 drops at a dose), or give Morphine Sulphate, hypodermically (% grain every % to 2. hours), if pain is severe. 6. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, or flour and water, or crushed bananas), to soothe and protect the irritated and inflamed surface, as an after treatment. ACID SALICYLIC - SALOL. HISTORY: Salicylic Acid is used as a preservative for keep- ing cream, wine, lager beer, cider, jams, etc. Death in poisoning results from paralysis of res- piration. SYMPTOMS: Dilated pupils; quick, deep respirations; dys- pnoea ; flushed face ; ringing in ears; deafness; de- lirium ; may be nose-bleed. TREATMENT: i. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to 10 minutes until ACID SULPHURIC 69 it acts), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 min- utes until vomiting results), or Apomorphine Hy- drochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective. After emetic, always give plenty of luke-warm water to encourage vomiting. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypoder- mically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently); also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every p2 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 *4 to 2 hours), or Digitalin (1/100 grain hypodermically every )4 to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary) may be used for the same purposes. Draughts of strong coffee may also be given. 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. (See Acid Hydrocyanic). ACID, SCHEELE'S. ACID SULPHURIC. (See Acids Mineral). A MANUAL OF TOXICOLOGY. 70 . HISTORY: Taken by mistake for an aperient. Fatal dose: i ounce. SYMPTOMS: Abdominal pain ; vomiting; prostration ; convul- sions ; collapse; death. Antidote: Lime or chalk. i. Give Lime Water freely; or Prepared Chalk (in 2 teaspoonful doses in a small cupful of water every 15 to 30 minutes), or Magnesia (2 tablespoon- ful doses in a small cupful of water, repeated every 10 to 15 minutes), or may give with benefit soap suds, or Carbonate or Bicarbonate of Sodium or Potassium in water. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and protect the irritated and inflamed surfaces. 3. Give Castor Oil (2 tablespoonfuls) to clear out the intestines. 4. Stimulate if necessary (as described under Jalap (q. v.). ACID TARTARIC. ACIDS, VEGETABLE (CORROSIVE) : ACETIC -OXALIC-TARTARIC. Symptoms and treatment under their respective heads (q. v.). ACONITE (MONKSHOOD, WOLFSBANE) - ACONITINE. 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. 71 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; j/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. SYMPTOMS: Tingling in mouth, throat and extremities; anes- thesia of surface; muscular weakness, hence stag- gering; dizziness; burning pain in stomach or ab- domen; dilated pupils; slow, weak, irregular pulse; voice suppressed; skin covered with cold sweat; shallow, slow, feeble respiration; face pale; sight often poor; eyes fixed and staring; deafness; vomit- ing not common, but may begin in an hour, and is then severe; syncope. Patient often conscious to the last. TREATMENT: Put the patient in a horizontal position, the head lower than the feet, to prevent syncope. Maintain absolute quiet. If there is time to do more than employ artificial respiration and stimulation, resort to the following: 72 A MANUAL OF TOXICOLOGY. I. Endeavor to wash out the stomach, syphoning with a stomach-tube and much water. It is usually advisable to avoid emetics, as they act poorly and exhaust the patient. If given, give cautiously. Give Tannic Acid as an antidote (in 5 grain doses), followed by water, or Animal Charcoal (powdered and stirred up in water), or the follow- ing mixture may be given, to arrest the solubility of the poison: Iodine, £4 grain; Potassium Iodide, 2 grains; water, 1 ounce. Give a dose of Castor Oil. ■ 2. Stimulate heart, circulation, and respiration with hypodermic injections of Ether (10 minims every 10 to 30 minutes), or with Brandy or Whisky (in 2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently) ; also with Ammonia inhalations or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes by mouth, or % teaspoonful hypodermically as frequently) ; also with Strych- nine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every 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 % to 1 hour), should be given. Caffein Citrate (1 to 4 grains every % to 1 hour), may be used for supporting purposes. Draughts of strong coffee may be given. Also Nitroglycerine. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature 4. May give Opium (Powdered Opium, 1 or 2 grains every to 2 hours), or Laudanum (20 drops every % to 2 hours by mouth, or *4 teaspoonful in gruel by rectum as frequently) or Morphine Sul- phate (% grain by mouth or hypodermically every ALCOHOL. 73 y to 2 hours), to relieve pain and nervous irrita- bility. Apply a mustard paste to the pericardium, and rub the back and legs with hot towels. Resort to artificial respiration if necessary (rhyth- mically raising and lowering arms from straight at sides to up ovgr 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: i. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little 74 A MANUAL OF TOXICOLOGY. water every 10 to 15 minutes, or y 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 % 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 *4 to 2 hours), or Digitalin (1/100 grain hypodermically every y to 1 hour), or Caffein Citrate (t to 4 grains every X to i 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 purposes. Draughts of strong coffee may also be given. ALCOHOL, ETHYL OR GRAIN - BRANDY - WHISKY - GIN - RUM - WINES - BEER - CIDER. HISTORY: Symptoms of poisoning usually appear within an hour. The fatal dose of Alcohol varies. 2*4 ounces killed a boy of 9 and a girl of 5 years of age. 4 ounces of Brandy killed a child of 7. From 2*4 to 5 ounces of Absolute Alcohol contained in Brandy, Gin, etc., may be considered the toxic dose for adults. 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 *4 pint of Gin and from 2 ounces of Gin. Recovery from 3 ounces of Rum. Death by paralysis of heart in hours or days. "Absolute Alcohol'' is Alcohol free from water. "Proof Spirit" is a mixture of spirit and water, con- taining 49.24 per cent, of Alcohol, i. e., about half and half. "Methylated Spirit", is spirit mixed with ALCOHOL. 75 io 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; hallucinations; stupor; anesthesia; coma; pulse rapid, weak, ' compressible; skin cool and moist; pupils usually dilated; face ghastly or bloated; temperature reduced; lips livid; conjunc- tivae red ; breathing noisy ; may be convulsions. The symptoms of Alcohol poisoning often resemble apo- plexy, concusssion of brain, and Opium poisoning. There is an odor of Alcohol on the breath; may be bloody froth on lips. An important diagnostic sign is that the patient may usually be aroused for a short time. (See chart at end of book). TREATMENT: 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). Ammonium Chloride (30 grains in pint of water given at one draught) sometimes remarkably restores. 2. Support. Give Strychnine Nitrate (1/60 to 1/20 grain every ^4 to 2 hours hypodermically). To counteract the stupor give Aromatic Spirit of Am- monia (in % 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- 76 A MANUAL OF TOXICOLOGY. haled, using one every 15 to 30 minutes), to encour- age respiration. Also give Atropine Sulphate, hy- podermically (in 1/120 grain doses every ^4 to 2 hours), or Tincture of Belladonna (in 20 drop doses) every J4 to 2 hours). Give Cafein Citrate (in 1 to 4 grain doses every to 2 hours), or strong coffee pint). 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. For asphyxia employ the galvanic current. A distended bladder should be catheterized ALCOHOL, METHYL (WOOD SPIRIT, WOOD ALCOHOL). HISTORY: The swallowing-, or even exposure to the fumes of Wood Spirit, has produced very serious results. The drinking of Bay Rum, Essence of Ginger and other preparations, which had been made from AVood Spirit, have produced violent symptoms and even permanent blindness. When swallowed. Wood Spirit with remarkable uniformity selects the optic nerve and retina for attack. From a drachm to an ounce or more of Wood Spirit usually produces severe symptoms and often results in blindness. Bathing in water containing Wood Spirit has sometimes injured. SYMPTOMS: The symptoms usually appear about the second or third day, unless the dose is large enough to pro- duce coma. The principal symptoms are nausea, vomiting and headache. Disturbance of vision does not as a rule appear until the third, fourth, or even fifth day. Total blindness then occurs in from 12 to 48 hours, ALKALIES. 77 if at all. In a few days slight vision is restored but soon again lost. There may be excitement, coma, semi-coma, depression, a sense of the coming and going of sight, eyeballs sensitive to pressure and rotation. TREATMENT: Pilocarpine Hydrochlorate (in % to J4 grain doses) is the best remedy, but should be begun early in the poisoning. The remainder of the treatment is similar to that for Ethyl Alcohol. 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 similar way. Caustic Potash is rarely taken except by accident. Fatal dose: 2 drachms of strong solution of Am- monia may be fatal; 4 drachms is usually fatal, but an ounce has been recovered from. SYMPTOMS: Burning pain from mouth to stomach; difficulty in swallowing; vomiting; may be vomiting and purging of mucous and blood; skin cold and clam- my; pulse feeble; rapid exhaustion; symptoms of suffocation; convulsions; stupor or coma may be developed. , (Excessive inhalations of Ammonia are poisonous or fatal by the resulting bronchitis). (Baryta Muriate and Carbonate produce also headache, deafness, and dimness of sight). TREATMENT: i. As antidotes, give diluted acids, especially vege- table acids: Vinegar and water, equal parts; Acetic 78 A MANUAL OF TOXICOLOGY. Acid, diluted (a teaspoonful in y2 pint of water) ; Citric Acid or Tartaric Acid (% to 2 drachms in a pint of water), or clear lemon juice, or orange juice, freely. The fixed oils (such as Castor, Cod Liver, Lin- seed, Almond, and Olive) form soaps with the free alkalies, and consequently destroy their caustic effects. If there are signs of corrosion, as indicated by se- vere pain, collapse, etc., do not use stomach-pump, stomach-tube, or emetics, for fear of perforation or rupture. Assist vomiting by copious draughts of tepid 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 or inflamed surfaces. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hypoder- mically as frequently) ; also with Strychnine Sul- phate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/20 grain hy- podermically every y 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 y2 to 2 hours), or Digitalin (1/100 grain hypodermicallly every y2 to 1 hour), or Caf- fein Citrate (1 to 4 grains every y^ to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every y2 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, ALKALOIDS. 79 applied to the feet and sides of the body), to main- tain bodily temperature. 4 Give Opium (Powdered Opium, i 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, tracheotomy should instantly be performed. When a dangerous quantity of Ammonia has been inhaled, give inhala- tions of Acetic Acid, Hydrochloric Acid, Chlorine Water, or Vinegar. ALKALOIDS. HISTORY: Tannin forms a comparatively insoluble tannate with alkaloids. Potassium Permanganate is useful for some of the alkaloids. TREATMENT: Give Albumin, Iodine, Charcoal, emetics and cathartics. For symptoms and treatment in detail see each alkaloid under respective title. ALOES - BRYONIA - COLOCYNTH - ELA- TERIUM (SQUIRTING CUCUMBER) - ELATERIN - EUPHORBIUM - GAM- BOGE - "HIERAPICRA" - JALAP (q. v.) - MEZEREON - PHYSIC NUT - SCAM- MON Y, and Similar Vegetable Irritants. HISTORY: One grain of Elaterium has produced violent effects. SYMPTOMS: Severe irritation of the intestinal canal, causing pain, vomiting and purging; cold sweats; usually great prostration; sometimes convulsions; col- lapse. 80 A MANUAL OF TOXICOLOGY. TREATMENT: I. Evacuate the stomach; syphon out the stomach with a stomach-tube, using water freely. If the stomach-tube is not at hand, or the poisonous substance is too large to be removed by it, use Zinc Sulphate (20 grains in a tablespoonful of water, re- peated in 10 to 15 minutes if necessary), or Apomor- phine 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, a purgative, such as Castor Oil (1 to 2 tablespoonfuls), or Epsom Salt (1 to2 tablespoon- fuls) 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 J4 teaspoonful as often hypodermically). 4. Give Opium (Powdered Opium, in 1 to 2 grain doses every to 2 hours), or Laudanum (to to 20 drops in water every to 2 hours), or Morphine Sulphate grain hypodermically or by mouth every % to 2 hours), to relieve' the pain and quiet the nervous system. 5. Maintain the body heat (by applying hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to body and extremities). Apply hot fo- mentations to the abdomen. ALUM. TREATMENT: Administer Ammonium or Potassium Carbonate or Bicarbonate as an antidote. AMYL NITRITE. 81 AMYL NITRITE - NITRITE OF ETHYL - NITRITE OF POTASSIUM - NITRITE OF SODIUM. 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. i. If the poison has been swallowed, evacuate the stomach; syphon out stomach with a sfiomach-tube, or use a hypodermic injection of Apomorphine Hy- drochlorate (i/io grain). 2. Support. Give Brandy or Whisky (in table- spoonful doses every 5 to 10 minutes, or % tea- spoonful doses hypodermically every 5 to 10 min- utes). Give Strychnine Sulphate, hypodermically (1/60 to 1/20 grain every % to 2 hours). Aid heart by Tincture of Digitalis (15 drops every 10 to 20 minutes), or give Digitalin (1/100 grain every to 2 hours). 3. Douche. Use alternate hot and cold dou'ches to the chest. 4. Resort to artificial respiration if necessary (rhythmically raise and lower arms from straight 82 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. 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 impossible. 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 2% ounces by mouth in adult. Probable fatal dose of Ether by mouth, 1 ounce. 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. 83 Nitrous Oxide (Laughing Gas) : A prominent symptom, usually, is delirious laughter. TREATMENT: When inhaled: i. Remove anesthetic; invert patient; draw tongue well forward with forceps ; maintain inverted position until pulse and respiration are good; expose patient to a current of pure air, or give Oxygen. Dash, alternately, 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 en- courage the action of the diaphragm ; one pole on the pit of the stomach, other on the larynx. 2. Give hypodermic injection of Atropine Sulphate (1/120 grain, repeated every % t° 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 or Nitroglyce-r rine 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. May arouse by slapping with a 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. Dash Ether on chest and abdomen for shock stim- ulation. Also give inhalations of Amyl Nitrite (a 84 A MANUAL OF TOXICOLOGY. 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every y2 to i hour if necessary), or inhalations of Ammonia. As relapse may occur, do not leave patient for some time after apparent recovery. When swallowed: If Chloroform or Ether have been swallowed. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using water freely, or tickle fauces with a feather, or give Mustard (a tablespoonful in a wincglassful of water and repeat in 15 minutes if necessary), or give Apomorphine Hydrochlorate, hypodermically (in 1/10 grain doses). Give copious draughts of water containing 1 to 2 teaspoonfuls of Sodium Bicarbonate or Carbonate- as antidote. Demulcents may be necessary. 4. Give Opium, to relieve pain when necessary.- (Powdered Opium, 1 or 2 grains every y2 to 2 hours), or Laudanum (20 drops every y2 to 2 hours by mouth, or y2 teaspoonfui in gruel by rectum as frequently) or Morphine Sulphate (y grain by mouth or hypodermically every % to 2 hours), to relieve pain and nervous irritability. Remainder of treatment as in poisoning by in- halation. ANILIN INK OR DYES. (See Acetanilid, etc.). ANTIMONY AND ITS COMPOUNDS: AN- TIMONIAL WINE -TARTAR EMETIC - ETC. HISTORY: Antimony has been taken by mistake for Epsom Salt, also for Sodium Carbonate. Has also been considerably used for secret poisoning and murder. The ointment has poisoned externally applied. The ANTIMONY AND ITS COMPOUNDS. 85 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 treatment is highly important. Fatal dose: Tartar Emetic, % grain has caused serious symptoms; )4 grain killed a child in an hour; 2 grains have proved fatal in an adult; y2 ounce has been recovered from. Death is due to 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 of Tannin (10 to 30 grains to the pint of water). 86 A MANUAL OF TOXICOLOGY. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas), to soothe and protect the irritated or inflamed surfaces. 3. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body), to main- tain bodily temperature.- 4. Give Opium (Powdered Opium, 1 to 2 grains every % to 2 hours), or Laudanum (20 drops every to 2 hours by mouth, or half a teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every % to 2 hours), to relieve pain and nervous irritability. 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 *4 teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every ^2 to 2 hours), or Tincture of Belladonna (20 drops in water every J/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 purposes. Draughts of strong coffee may also be given, ANTIPYRINE. (See Acetanilid). 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. 87 HISTORY: Arsenic in one form or another is quite a common poison. It 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, and various uses in the arts. It is a con- stituent of various insecticides and used to destroy vermin and various weeds, and is used in stuffing birds and animals. Is used 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 Subli- mate. Fatal dose: Usually a dose of 3 grains of Arsenic is fatal, but recovery is quite probable when only I grain has been taken, and also when a large dose produces prompt and copious vomiting; 2^ grains have caused death; % ounce of Fowler's Solution has been fatal. Death usually occurs within 24 hours. SYMPTOMS: Burning pain in the esophagus and stomach; pain in stomach is increased by pressure, soon spreads over abdomen; there is frontal headache; 88 A MANUAL OF TOXICOLOGY. colicky pains; sense of constriction in throat, and irritating metallic taste in mouth; more or less vio- lent, often bloody vomiting and purging; rejected matters, first mucus, then bilious, of a yellowish, brownish, or greenish color; stools may become serous or bloody; pulse is small, feeble, and fre- quent ; breathing difficult 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 pustular skin eruption in protracted cases. [Symptoms usually come on within >4 hour, but may not appear for 2 or 3 hours |. TREATMENT: 1. 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 tcaspoonful every 10 to 15 minutes until vomiting results) ; or give a hypodermic injection of Apomorphine Hydro- chlorate (i/io grain repeated every 15 minutes un- til effective). The chemical antidote should be given before or when evacuating the stomach. The chemical antidote is Hydrated Sesquioxide of Iron. In an emergency this may be prepared by adding Aqua Ammonia to Tincture of the Chloride of Iron, and washing the precipitate with water; or Monsell's Solution or Dialyzed Iron may be used in place of the Tincture. (See Iron in Part I.). Ferri Oxidum Hydratum cum Magnesia-the official antidote-made by precipitating the solution of the Tersulphate of Iron by Magnesia, is usually ARSENIC. 89 considered the best antidote. It should be given in teaspoonful doses or more. The Dialyzed Iron may itself be given (in 30 minim doses or more every 2 to 4 hours). Follow by a tablespoonful of Castor Oil. In absence of other antidotes may use freely raw eggs beaten up in milk. 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. Give Opium (Powdered Opium, 1 or 2 grains every to 2 hours), or Laudanum (10 to 20 drops every to 2 hours by mouth, or JA teaspoonful in gruel by rectum as frequently), or Morphine Sul- phate (% grain by mouth or hypodermically every % to 2 hours), to relieve pain and nervous irrita- bility. 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 *4 teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every J4 to 2 hours), or Tincture of Belladonna (20 drops in water every *4 to 2 hours), to prevent col- lapse. Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every /2 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 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 cofifee may also be* given. 5. Employ artificial heat (such as hot water 90 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. 6. Give large draughts of water containing Sweet Spirit of Nitre (2 to 4 teaspoonfuls), to relieve the tendency to suppression of urine. ATROPINE. (See Belladonna). AUTO-INTOXICATION, OR AUTO-INFEC- TION (SELF-POISONING). HISTORY: Auto-infection is perhaps best defined to be the result of an unnatural general metabolism or of an unnatural decomposition in the digestive tract. It seems probable that there are substances in the excretions of all plants and animals, which are poi- sonous to them. If we drank none but the purest water and took only that food which was absolutely void of adulteration and infection, and respired only pure air, yet our excretions would undoubtedly con- tain poisons. The bacteria which are always present in the natural contents of the intestines doubtless originate some of these poisons, which are truly ptomaines. Constipation interferes with elimination and as a natural consequence a more or less serious train of symptoms frequently results. SYMPTOMS: The common symptoms are: more or less head- ache; coated tongue; offensive breath; sense of stupor and languor; etc. TREATMENT: A brisk cathartic, followed by a bitter tonic, and a temporary reduction in the nitrogenous foods is usually all that is required. BARIUM AND ITS COMPOUNDS. BARIUM AND ITS COMPOUNDS: BARIUM ACETATE - BARIUM CHLORIDE - BARIUM NITRATE - BARIUM OXIDE (BARYTA)-ETC. 91 HISTORY: Barium Chloride is sometimes mistaken for Ep- som Salt. Barium Nitrate has been mistaken for Sulphur. Fatal dose: Death has resulted from 100 grains of Barium Chloride in i 5 hours; death has resulted from a drachm of Barium Carbonate; half an ounce of Barium Chloride has been fatal in 2 hours; half an ounce of the Nitrate of Baryta killed a man in 6^2 hours. SYMPTOMS: Abdominal pains; cramps; purging; vomiting; feeble pulse; labored and short respiration; dilated pupils; excessive urination ; loss of voice, sight or hearing; convulsions; collapse; death. TREATMENT: i. Evacuate the stomaclY; 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 ^2 wineglassful of water), or inject Apomorphine Hydrochlorate, hypodermically (1/10 grain). Repeat in 15 minutes if necessary. As an antidote, give Dilute Sulphuric Acid (% to 1 teaspoonful in a wineglassful of water), or give Aromatic Sulphuric Acid (same amount), or Mag- nesium or Sodium Sulphate (% to 1 ounce, or 1 to 2 tablespoonfuls, in a cupful of water, or all three may be given together in much water. The purpose in such treatment is to produce the insoluble Ba- rium Sulphate. May give Pulverized Alum (1 drachm in )Z cupful of 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 92 A MANUAL OF TOXICOLOGY. even crushed bananas), to soothe and protect the irritated and inHamed surfaces. 3. Stimulate, if there are signs of collapse, with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or y. teaspoonful doses hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in'a little wafer every 10 to 15 min- utes, or y^ teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every )A to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every JA to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours), to prevent col- lapse. Tincture; of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically every % to I 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 % to I hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. 4. Give Opium (Powdered Opium, t or 2 grains every )A 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 y2 to 2 hours), to relieve pain and nervous irritability. 5. Apply poultices, a mustard paste or a hot water bag, or cloths wrung out in hot water, to the ab- domen. BELLADONNA (DEADLY NIGHT SHADE) - ATROPINE - HOMATROPINE - HY- OSCYAMUS - HYOSCYAMINE - HYOS- CINE - STRAMONIUM - DATURINE - DULCAMARA - SOLANINE. HISTORY: Belladonna: Belladonna berries are sometimes eaten by mistake. Infusion of leaves, and extract BELLADONNA. 93 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 mixe'd 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. The extract of Stramonium has been accidentally substituted for an extract of Sar- saparilla. 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 2^4 hours; also recovery from 3 drachms of it. Children will take almost as much as adults, as a rule. 100 Stramonium seeds killed a 2-year-old child. Death from 1/30 grain Atropine subcutane- ously; also from 1/12 grain by mouth, and death is likely when 1 grain has been taken and no treatment follows. When death takes place it may occur in an hour or two, but it usually occurs within 15 hours. Death by cardiac paralysis. 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 94 A MANUAL OF TOXICOLOGY. inability to urinate. Face sometimes red and swollen. The symptoms usually appear in from % to 2 hours after taking the poison. 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. 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. Then, 10 or 15 minutes afterwards, empty the stomach. 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 % to 2 hours), or Laudanum (15 to 20 drops every to 2 hours), or Morphine Sulphate (in to Yi grain doses hypodermically every % to 2 hours), or Eserine (in 1/60 to 1/30 grain doses every to 2 hours), to quiet the brain. Morphine is the best antagonist to the effects of Atropine on the cerebrum, kidneys, heart, pupils, respiration and arterial tension. Muscarine is probably the best general antagonist (in doses of % to 1 grain). BENZENE-BENZOL. 95 3. Draw the urine. 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 the chest. 5. Stimulate. Give 15 to 30 drop doses of Aro- matic Spirit of Ammonia, and Brandy or Whisky (a teaspoonful in water by mouth, or % 'teaspoonful hypodermically every % to 1 hour). Hold Am- monia Water to the nostrils. 6. Employ artificial respiration if respiration is interfered with (rhythmically raise and lower arms from sides to up over head and back again, 18 to 20 times per minute). BENZENE - BENZOL. HISTORY: Used in dyeing, cleaning and as a cough medi- cine. Death in 17 hours from 3 drachms of Ben- zene. SYMPTOMS: Nausea; gastro-intestinal distress; dizziness. TREATMENT: 1. 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 (i/io grain hypodermically, repeated every 15 minutes until effective). After giving an emetic give plenty of luke-warm water to encourage vomiting. Sodium or Potassium Carbonate or Bicarbonate may be administered as'an antidote. 1. When inhaled, provide much fresh air. Arti- ficial respiration should be resorted to if necessary 96 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 )Z 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). BROMIDES. SYMPTOMS: Nervous system greatly depressed; force and frequency of heart beat much lessened; reduction in temperature, and in number of respirations; mus- cular weakness, semi-somnolent state or maniacal excitement.-, (Bromides are eliminated by the kidneys, skin, slaliva, bronchial and intestinal mucous mem- branes, and in milk). TREATMENT: i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to ro minutes until it acts), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effec- BROMINE. 97 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 Opium (Powdered Opium in 1 to 2 grain doses every 1 to 3 hours), or Morphine Sulphate (in % grain doses every 1 to 3 hours by mouth or hypodermically) to combat mental symptoms. 3. Support and stimulate. Give Caffein Citrate (in 1 to 5 grain doses every % to 2 hours) to com- bat depression. Administer Tincture of Digi- talis (in 10 to 20 drop doses every 1 to 3 hours) to sustain and regulate the heart. Fluid Extract of Ergot (in 15 minim doses every 1 to 3 hours), or Atropine Sulphate (1/120 to 1/60 grain hypodermically every to 2 hours) or Tincture of Belladonna (in 10 to 20 drop doses) to stimulate heart, etc. Brandy or Whisky (in teaspoonful doses by mouth or % teaspoonful hypodermically every % to 1 hour) may be given with the Opium, as a nervous stimulant. BROMINE. HISTORY: An ounce on an empty stomach caused death in 7 hours. SYMPTOMS: Inhaled, its vapor greatly irritates the respi- ratory mucous membrane and the eyes, causing distressing cough, hoarseness, and dyspnoea. Swallowed, its action is that of an -active cor- rosive poison. It causes violent gastritis, rapid prostration, great anxiety, rapid pulse, trembling of hands, collapse. 98 A MANUAL OF TOXICOLOGY. TREATMENT: When Inhaled, provide fresh air; give inhala- tions of Ammonia or steam; stimulate by Aro- matic Spirit of Ammonia (% teaspoonful in a wineglassful of water every J4 to 2 hours). Give Caffein Citrate (in 1 to 5 grain doses every Jd to 2 hours). 1. When Swallowed, evacuate the stomach: syphon out the stomach with a stomach-tube, or produce vomiting by Apomorphine Hydrochlorate (hypodermically in 1/10 grain doses). Give Mag- nesia 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 Jd 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. BRUCINE. (See Strychnine.) BRYONIA. (See Aloes). CAFFEINE. HISTORY: Recovery after 200 grains. SYMPTOMS: Burning pain in throat; giddiness; faintness; nausea ; numbness ; pain in abdomen ; dry tongue ; great thirst; trembling of extremities; free diu- resis ; cold skin; weak pulse; collapse. CAFFEINE. 99 TREATMENT: i. Evacuate the stomach.: syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to 10 minutes until it acts), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effec- tive), or Ipecacuanha (Powdered Ipecacuanha 30 grains, or Syrup of Ipecac a teaspoonful every 10 to 15 mjnutes 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 34 teaspoonful hypo- dermically as frequently) ; also wrth Strychnine Sulphate (1/60 to 1/20 grain hypodermically every 34 to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every 34 to 2 hours), or Tincture of Belladonna (20 drops in water every 34 to 2 hours), or 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 I hour), or Caffein Citrate (1 to 4 grains every 34 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 I hour if neces- sary) may be used for the same purpose. 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, 100 A MANUAL OF TOXICOLOGY. applied to the feet and sides of the body) to main- tain bodily temperature. CALABAR BEAN (PHYSOSTIGMA, THE WESTERN AFRICA ORDEAL BEAN) - PHYSOSTIGMINE (ESERINE).. HISTORY: Poisoning occurs from beans eaten by children. The bean is used in decoction by the natives of the west coast of Africa as the ordeal test for witch- craft. They believe the innocent will vomit it, the guilty retain it and die. Fatal dose: Six beans caused death in boy of 6 years. The fatal dose of Physostigmine is consid- erably less than 3 grains. Death results from respiratory paralysis. SYMPTOMS: Effects are opposite to those produced by Strych- nine. Tumultuous heart action; complete muscular re- laxation and tremors ; giddiness ; contracted pupils ; respiration irregular and slow; reflexes lost; may be vomiting and purging. TREATMENT: 1. 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 CAMPHOR.-CAMPHORATED OIL. 101 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 % 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 34 to 2 hours, as preceding). If this treatment is ineffec- tive, give Chloral (in 10 grain doses every % to 1 hour in syrup and water by mouth, or in water by irectum). Give Strychnine Nitrate, hypodermic- ally (1/60 to 1/20 grain every y2 to 2 hours), or Tincture of Nux Vomica (10 to 20 drops). 3. Stimulate: Give Brandy or Whisky (in tea- spoonful doses every 15 to 30 minutes), or Alcohol (% teaspoonful in tablespoonful of water every 15 to 30 minutes). Coffee may be beneficial. 4. Artificial Respiration.-If respiration becomes labored, raise patient's stretched out arms, ryth- mically, from sides of body to up over head, and back to sides again, 20 times a minute, with tongue kept forward. CALCIUM. (See Lime, also Alkalies). CAMPHOR.-CAMPHORATED OIL- SPIRIT OF CAMPHOR. HISTORY: A popular household remedy, occasionally taken by rpistake. May cause very severe symptoms but 102 A MANUAL OF TOXICOLOGY. rarely fatal. (Spirit of Camphor is i to io; Cam- phorated Oil i to 5 in strength). Fatal dose: 30 grains. Recovery after 200 grains. Dangerous symptoms from 20 grains and from 15 minims of the strong solution. Death asphyxia. SYMPTOMS: Camphor odor; languor; giddiness;, clammy skin; headache; smarting in urinary organs; pulse quick and weak; delirium; convulsions; collapse. No purging, vomiting or pa'in, unless dose very large, when may be burning pain along esophagus and at pit of stomach, and vomiting. TREATMENT: 1. Promptly give water to precipitate the Cam- phor, if in alcoholic solution. 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 2 tablespoonfuls of Castor Oil.-Some authorities favor giving Al- cohol or Brandy (in teaspoonful doses) by mouth; others fear these may aid in the solution and ab- sorption of the Camphor.. If given, is better to give hypodermically. 3. Allow patient to inhale Ether to check in- clination to convulsions. Relieve cramps with CANNABIS, AMERICAN. 103 alternate hot and cold douches. May give Aco- nite (Tincture of Aconite, 1 drop every 1 to 2 hours), Potassium Bromide (in 10 grain doses every % to 1 hour), or Opium (Powdered Opium 1 or 2 grains every to 2 hours), or Laudanum (20 drops in water every to 2 hours) to relieve the convulsions. 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. CANNABIS, AMERICAN (CANNABIS AMERI- CANA, AMERICAN HEMP)-CANNABIS, INDIAN (CANNABIS INDICA, INDIAN HEMP) - HASCHISCH - GUNJAH OR GANGA OR GANZA - CHURRUS OR CHARAS-BHANG OR SIDDHI. SYMPTOMS: Sense of exhilaration; pleasurable intoxication; peculiar prolongation of time; sense of double con- sciousness followed by drowsiness; anesthesia; loss of-power, particularly of lower extremities; pupils dilated ; pulse rapid; respiration slow; may cause increased sexual desire; catalepsy; some- times convulsions. TREATMENT: Caustic Alkalies are incompatible. i. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoon- fuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipe- 104 A MANUAL OF lOXTCOLOGY. cacuanha, 30 grains; or Syrup of Ipecac, a tea- spoonful every 10 to 15 minutes until vomiting re- sults), or Apomorphine Hydrochlorate, hypo- dermically (1/10 grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke-warm water to encourage vomiting. Give strong tea freely; or Tannic Acid, or Gallic Acid (30 grains in ^2 wineglassful of water). Give Sweet Spirit of Nitre (in teaspoonful doses every % to I hour) to encourage excretion by kid- neys. 2. Stimulate: give draughts of strong coffee, or Caffein Citrate (in 2 or 3 grain doses every 1 to 3 hours), Atropine Sulphate (in 1/120 grain doses hypodermically every 1 to 3 hours)$ or Tincture of Belladonna (10 to 15 drops every 15 minutes, for 2 or 3 doses) as antagonists; Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled) to stimulate circulation. If respiration is embarrassed, resort to artificial respiration. May apply electricity to the chest muscles. CANTHARIDES (SPANISH FLIES) - CAN THARIDIN. 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. HISTORY: SYMPTOMS: A violent gastro-enteritis, with abdominal tenderness; burning sensation in pharynx and eso- phagus ; sense of constriction of throat; burning pain in hade, bladder, and urethra; frequently CANTHARIDES. 105 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. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not 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 tQ 2 grains every *4 to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or )4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth, or hypodermically every J4 to 2 hours) to relieve pain and irritation. 4. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every to to 15 minutes, or teaspoonful doses hypo- dermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every to to 15 minutes, or J4 teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate 106 A MANUAL OF TOXICOLOGY. (1/60 grain hypodermically every y2 to 2 hours) and Atropine Sulphate (1/120 grain hypodermic- ally every % to 2 hours), er Tincture of Belladonna (20 drops every y2 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 y^ to 1 hour), 01 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 yA to I hour if necessary) may be used for the same purposes. Draughts of strong coffee may also be given. 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. N. B.-Employ anesthetics, if necessary, to re- lieve convulsions, etc. CARBON MONOXIDE (CARBONIC OXIDE) - CHARCOAL FUMES - ETC. 1 his is a combustible, colorless,^transparent, odor- less, taxless, but very poisonous gas. It burns readily in air with a blue flame. When cast-iron plates are red hot it readily diffuses through them ; thus the gas may pass into the air of a room heated by a stove. Open charcoal or stove coal fires, de- fective stove pipes or furnace flues and escaping illuminating gas are among its sources. This gas enters the blood, combining with the hemoglobin of the red corpuscles and displacing the oxygen. After the blood has been saturated with this gas recovery is almost impossible. The blood of those poisoned by this gas is of a persistent fluidity and bright, cherry red. Air containing i per cent, of this gas will kill a dog in a minute and HISTORY: 107 CARBON MONOXIDE. a half. The gas is a narcotic poison. When pa- tient has been exposed to gas over 8 hours and coma exists, the chances of recovery are slight. If opposite exists, may expect recovery. Other things being equal, the chances of recovery or permanence of injury is in proportion to the length of time the blood has been exposed to the gas and the degree of saturation with the gas. Carbon monoxide is the chief constituent of coal gas and poisoning by the latter is mainly due to it. But suffocation by coal gas is not to be confused with the poisonous effects of coal gas. SYMPTOMS: In Poisoning:- Dizziness; severe headache; weakness; may be nausea, vomiting and convulsions; face', as a rule, livid ; pupils dilated. When the poisoning is very slow, the symptoms are languor, debility, anorexia, headache, and maybe a dry cough. Symptoms re- semble those of malaria. In Suffocation:- Symptoms arc choking; gasping; suffused eyes; congested face; collaps'e. TREATMENT: I. Promptly provide plenty of fresh air. Make cold wet applications to the head and neck. Employ artificial respiration if necessary (by rhythmically raising and lowering arms from ex- tended at sides to up over head and back again, 18 or 20 times per minute). 2. Give Oxygen, also Ammonia inhalations; 3. Douche face and chest with hot and cold water, alternated. 4. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth, or % teaspoonful hypodermically every 10 to 15 minutes), or with Aromatic Spirit of Am- monia (a teaspoonful in a little water every 10 to 15 A MANUAL OF TOXICOLOGY. 108 minutes, or % teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every y\ to 2 hours), and Atropine Sulphate (1/120 to 1/60 grain hypoderm- ically every % to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypo- dermically, every *4 to 2 hours), or Digitalin (1/100 grain hypodermically every y^ to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to r hour if necessary), may also be em- ployed for the same purposes. Draughts of strong coffee or rectal injections of coffee may be given. Give lime water, milk or flour mixed in water. May advantageously give Camphor (2 grains dis- solved in a little almond oil), every 2, 3 or 4 hours, as required. 5. Transfusion of blood has been recommended, also the intravenous injection of a sterilized salt solution (7/10 per cent.). CASTOR OIL BEANS. The activity of the plant is supposed to be due to Ricin, a poisonous toxalbumin from the seed of the castor oil plant. Ricinin, a crystallizable alka- loid from the plant. Fatal dose: 3 seeds were fatal to an adult male in 46 hours; 20 seeds killed an adult female in 5 days. HISTORY: SYMPTOMS: Abdominal pain; cramps; prostration; vomiting; intense thirst; severe griping, purging, and tenes- mus; collapse. 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, TREATMENT: CHLORAL. 109 such as Zinc Sulphate (20 grains in 2 tablespoon- fuls of water, repeated in 15 minutes if vomiting is not produced) ; or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains, or Syrup of Ipecac, a teaspoonful every 15 minutes until vomiting results), or Apomorphine HydrOchlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective). After giv- ing emetic, always give plenty of luke-warm water to encourage vomiting. 2. Give demulcents (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas) to soothe and protect the irritated and inflamed surfaces. 3. Employ artificial heat (such as hot water bottles, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body) to maintain bodily temperature. 4. Give Opium (Powdered Opium, 1 to 2 grains every JZ to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or *4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate grain by mouth or hypodermically every to 2 hours), to relieve pain, griping, and tenesmus. CHERRY LAUREL WATER. (See Acid Hydrocyanic). CHLORAL. HISTORY: Quite frequently injudiciously used by the public to quiet nerves and induce sleep. Is sometimes used for suicidal purposes. In frequent doses it may accumulate and kill by paralyzing the heart. A dose should very rarely exceed 20 grains and should not be repeated as often as hourly more than 3 times. It appears to be a cumulative poi- 110 A MANUAL OF TOXICOLOGY. son. 10 grains have caused alarming symptoms, 20 and 30 grains have each caused death ; but as much as 460 grains have been recovered from, and it is believed that most persons would recover from any dose under 2 drachms if proper treatment were given. 3 grains killed a child, a year old, in 10 hours. In some persons large doses temporarily suspend some of the mental faculties without pro- ducing apparent unconsciousness. Children bear Chloral proportionately better than adults. Old persons, and particularly those with weak hearts or inclined to apoplexy, are easily affected. 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 contracted during sleep, dilated upon awakening; body-temperature greatly reduced. SYMPTOMS: TREATMENT: Put in horizontal position and elevate feet. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube; or give Mustard (a table- spoonful in a small cupful of water, repeated in 15 minutes if not effective), or Zinc Sulphate (in 20 grain doses every 10 to 15 minutes), or Apomor- phine Hydrochlorate, hypodermically (in 1/10 grain doses every 10 to 15 minutes, until vomiting results), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes, until vomiting is produced). After giving an emetic, always give plenty of luke-warm water to encourage vomiting. Liquor Potassae (2 teaspoonfuls in a cupful of water) is said to decompose 20 grains of Chloral in the blood; it should be given hourly. 2. Stimulate: give draughts of strong coffee by mouth, or introduce it into rectum through tube ; CHLORINE. 111 dr give Citrate Caffein (in 5 to io grain doses every % to 3 hours). Give Strychnine Sulphate, hypo- dermically (in 1/60 grain doses every *4 to 2 hours); or give Picrotoxin (in 1/100 to 1/50 grain doses, repeated every J4 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 I hour,if necessary), and Brandy or Whisky, hypo- dermically (% teaspoonful every 10 to 15 minutes). Keep patient awake, overcoming stupor by shaking, shouting, flagellation, or by shocks of electricity. Give inhalations of oxygen. 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 body) to maintain bodily temperature. Apply cold to head, and Ammonia to nostrils. Resort to artificial respiration, upon respiration be- coming more labored. CHLORATE OF POTASH (See Potassium Chlorate). CHLORINE - CHLORINATED LIME - JA- VELLE WATER - LABARRAQUE'S SOLUTION. SYMPTOMS: Chlorine inhaled causes extreme laryngeal irrita- tion, and may even cause oedema, resulting in asphyxia. Black eschars on the tongue and phar- ynx may be produced. There is usually cough, a sense of tightness 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. 112 A MANUAL OF TOXICOLOGY. TREATMENT: When Chlorine vapor has been inhaled, the pa- tient should inhale Ammonia vapor to form Am- monium Chloride. Provide much fresh air, steam inhalations, or inhalations of Ether or Chloroform. When Chlorine preparations have been taken into the stomach, albumin is the.proper antidote. i. Evacuate the stomach. When Chlorine prepa- rations have been swallowed, the stomach should be gently washed out by means of a stomach-tube, or use an emetic, such as Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 min- utes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), .or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes 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 (% 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 % 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 *4 to 2 hours), or Tinc- ture of Belladonna (20 drops every *4 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 CHLORODYNE. 113 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to i hour if necessary) may be used for the* same purposes. Draughts of strong coffee may also be given. Give lime water, milk, or flour mixed in water. 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 *4 wine- glassful of water). 5. Give Opium (Powdered Opium, 1 to 2 grains every p2 to 2 hours; or Laudanum, 20 drops every % to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every )4 to 2 hours), to relieve pain 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 poisoning. CHLOROFORM. (See Anesthetics). CHOKE DAMP. (See Acid Carbonic). CHROMATE - BICHROMATE. (See Acid Chromic). (See Illuminating Gas). COAL GAS. 114 A MANUAL OF TOXICOLOGY. COCAINE-EUCAINE. HISTORY: 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 is rare, but % grain taken in- ternally has caused death; 22 grains by mouth caused death within an hour; 7/10 of a grain killed a child; 23 grains, also 32 grains,. have been recov- ered from; also 14 grains hypodermically; 1/20 of a grain hypodermically caused dangerous symp- toms in a girl 12 years old; 4)4 grains swallowed have produced very alarming symptoms. A solu- tion applied to the eye or mucous membrane may produce suddenly serious symptoms; 7 or 8 min- ims of a 4 per cent, solution in the eye have pro- duced spasm and unconsciousness; 20 to 30 drops of a 4 per cent, solution applied to the teeth and gums have produced serious symptoms. Taken subcutaneously or applied to the mucous membrane Cocaine acts very rapidly. Death has occurred in 40 seconds and has been delayed also to 4 minutes. Recovery is quite certain after 30 minutes. Death usually occurs from apnoea or heart failure. 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 early delirium and unconsciousness or almost no symptoms except those of asphyxia. COCAINE. 115 TREATMENT: Fresh air; put patient in horizontal position. Resort to artificial respiration if necessary. Employ stimulants and electricity; also the re- mainder of the following treatment if possible and required: If Cocaine was introduced hypodermically, give stimulants of Brandy or Whisky (2 to 4 teaspoon- fuls in water by mouth every 5 to 10 minutes, or 15 to 30'minims hypodermically every 5 to 10 min- utes), or Aromatic Spirit of Ammonia (1 teaspoon- ful in water by mouth, or % teaspoonful hypoder- mically every ten minutes), or Ether in 15 minim doses hypodermically; also Strychnine Sulphate (1/60 grain hypodermically), and Atropine Sulphate (1/120 to 1/60 grain hypodermically), or Tincture of Belladonna (20 drops). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypo- dermically), or Digitalin (1/100 grain hypoder- mically), or Caffein Citrate (1 to 4 grains), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled), may be used for the same purposes. Draughts of strong coffee may also be given. Nitroglycerine has been recommended. 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 Apo- morphine 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 116 A MANUAL OF TOXICOLOGY. of oak bark (i ounce to a small cdpful of hot water) ; or may give Iodine (i grain) and Potas- sium Iodide (io grains) in J4 wineglassful of water. Then use stomach-tube or emetic again. Give in- halations of Amyl Nitrite (3 or 5 minim pearls) to support heart. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 5 to 15 minutes, or % teaspoonful doses hypo- dermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every .5 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 grain hypodermic- ally), or Tincture of Belladonna (20 drops). Tinc- ture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically), or Digitalin (1/100 grain hypodermically), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to I hour, if necessary) may be used for the same purposes. Draughts of strong coffee may also be given. Relieve inclination to asphyxia by oxygen inhala- tions. 3. Give Opium, if necessary. To relieve nervous excitement or delirium, when present, give Mor- phine Sulphate, hypodermically (% grain doses every to 2 hours), or Laudanum (20 drops every to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently). 4. Artificial respiration if required (rhythmically raising and lowering extended arms from sides to over head, 18 times a minute). Electricity may be required. Chloral (in 40 to 60 grain doses) may be helpful. Nitroglycerine, hypodermically (in 1/100 grain doses) has been recommended. COCCULUS INDICUS. 117 COCCULUS INDICUS (LEVANT NUT, IN- DIAN BERRY, FISH BERRIES),-PICRO- TOXIN. HISTORY: Picrotoxin is used as a fish poison, also as a bird poison, as a medicine, and sometimes to adulterate beer. P>eer extract containing Picrotoxin is fatal to flies. Picrotoxin poisoning produces an extra- ordinary swelling of the abdomen in frogs, which Strychnine does not. SYMPTOMS: Nausea; vomiting; muscular weakness; drowsi- ness; sometimes convulsions; may be scarlet-fever- like rash. Fatal dose: 2 to 3 grains of Picrotoxin is consid- ered to be a dangerous dose. Death from paraly- sis of heart in diastole. TREATMENT: Treat as in poisoning by Strychnine (q. v.). CODEINE. (See Opium). 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 3^ drachms, and an ounce of the Tincture. 1^2 ounces has caused death; an ounce has been recovered from. The fatal dose of the alkaloid is less than J/2 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. 118 A MANUAL OF TOXICOLOGY. SYMPTOMS: Burning pain in throat, esophagus, and stomach; great thirst; soreness ; vomiting; violent purging ; griping; intense abdominal pain; urine suppressed; face pinched; pupils dilated; profuse salivation; pulse rapid, then slow; great weakness; skin cold, pale, and covered with sweat; frequent spasms; sometimes muscular pains and convulsions; con- sciousness present until the last; collapse. TREATMENT: There is no altogether satisfactory known anti- dote. i. Evacuate the stomach: syphon out the stom- ach with stomach-tube, or, if vomiting has not oc- curred, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, re- peated in 15 minutes if not effective), or Ipe- cacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective. After giving emetic, always give plenty of luke-warm water to encourage vomiting. Give Tannic Acid (in 30 grain doses) or Gallic Acid (in 30 grain doses, in % wine- glassful of water), or a decoction of oak bark, or strong tea. 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. 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. 119 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 34 to 2 hours by mouth, or % 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. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or 34 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) and Atropine Sulphate (1/120 grain hy- podermically every 34 to 2 hours), or Tincture of Belladonna (20 drops every 34 to 2 hours). Tinc- ture of Digitalis (15 to 3Q 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 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). COLOCYNTH. (See Aloes). CONIUM (HEMLOCK, COMMON OR SPOTTED HEMLOCK) - CONIINE. HISTORY: Has a mousy odor. Has been eaten for parsley, and eaten in salad and soup. Serious results from 75 grain of Coniine. 120 A MANUAL OF TOXICOLOGY. Fatal dose of Coniine is about 23/10 grains. One drop may cause bad symptoms. SYMPTOMS: 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. TREATMENT: Keep head low. I. Evacuate the stomach' syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effec- tive), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until 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 p2 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 even crushed bananas), to soothe and protect the irritated and inflamed surfaces. Then give Castor Oil (a tablespoonful). CONVALLARIA. 121 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful doses hy- podermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every io to 15 minutes, or % 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 % to 2 hours), or Digitalin 1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl' Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary) may' be used for the same purposes. 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. If breathing becomes labored, resort to artificial respiration (rhythmically raise arms from side to up over head and back again, 20 times per minute). CONVALLARIA (LILY OF THE VALLEY). HISTORY: The common preparations-the extract and fluid extract-contain the two active principles Con- vallarin and Convallamarin. The former is a pur- gative, while the latter is a heart poison, quite sim- ilar in action to Digitalin. Symptoms and treatment similar to Digitalis (q. v.). 122 A MANUAL OF TOXICOLOGY. COPPER AND ITS COMPOUNDS: COPPER SULPHATE (BLUE STONE, BLUE VIT- RIOL)-VERDIGRIS (COPPER SUBACE- TATE) - ETC. HISTORY: Copper is taken by accident or for the purpose of abortion, suicide, or murder. Commonest cause of poisoning is the use of copper vessels in cook- ing. Chronic poisoning may result from using copper to give a green color to pickles, preserved peas, and sweets; the use of green wrappers for foods; copper used in the manufacture of artificial flowers; the keeping of drugs in copper vessels; from working in copper or bronze, etc. Fatal dose: death from an ounce of Copper Sul- phate; and also a recovery. Death from an ounce of Verdigris. 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. i. Give the chemical antidote, Potassium Ferro- cyanide (Yellow Prussiate of Potash, in 5 to 15 grain doses in water) ; or give albumin and milk, mixed with sugar; or Magnesia. If eggs are not at hand, give a thin paste of flour and water; then 2. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as COPPER AND ITS COMPOUNDS. 123 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. 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 (Powdered Opium, every to 2 hours; or Laudanum, 20 drops every ^4 to 2 hours by mouth, or *4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every / to 2 hours), to relieve pain and nervous irritability. 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 % teaspoonful doses hypo- dermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hypo- dermically every to 2 hours), or Tincture of 124 A MANUAL OF TOXICOLOGY. Belladonna (20 drops every % to 2 hours). Tinc- ture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically every to 2 hours), or Digitalin 1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee are good. 7. Saturate the system with Potassium Iodide (in 3 to 10 grain doses in water). CORROSIVE SUBLIMATE. (See Mercury Compounds). CREOSOTE. (See Acid Carbolic). CROTON OIL (CROTON TIGLIUM). HISTORY: The oil and also the liniment have each been taken for Castor Oil by mistake. Fatal dose: 20 drops. Half a drachm has been recovered from. SYMPTOMS: Severe abdominal pain; vomiting; purging; fluid stools; pulse small and thready; skin moist; face pinched ; prostration ; collapse ; death. TREATMENT: 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 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 CROTON OIL. 125 not effective), or Ipecacuanha (Pulverized Ipecacu- anha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (l/io grain, repeated every 15 minutes until effective). After giving emetic, always give plenty of luke- warm 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 (Powdered Opium, every % to 2 hours; or Laudanum, 20 drops every *4 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 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 y 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 % to 2 hours) and Atropine Sulphate (1 /120 to 1/60 grain hypodermically every % to 2 hours), or Tincture of Belladonna'(10 to 20 drops in water ev^ry y2 to 2 hours).' Tincture of 126 A MANUAL OF TOXICOLOGY. Digitalis (15 to 30 drops by mouth, or half as much hypodermically every to 2 hours), or Digitalin 1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour)-, and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary, may be used for the same purpose. Draughts of strong coffee may also be given. CURARE (WOORARI, SOUTH AMERICAN "INDIAN ARROW POISON") - CUR- ARINE. HISTORY: Death by asphyxia. SYMPTOMS: 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. TREATMENT: I. The poison* is usually introduced through a wound. If there is a wound ligate above it; incise the part freely and endeavor to suck out the poison; wash the wound with a weak solution of Potassium Permanganate. Give Spirit of Nitrous Ether (i to 2 teaspoonfuls in a wineglassful of water; repeat in io to 20 minutes). Employ artificial respiration as the most efficient antagonist (rhythmically raise extended arms from sides up to over head and back 18 times a minute) until poison is eliminated. The poison usually passes off rapidly. Evacuate the bladder frequently, to prevent reabsorption., 2. Stimulate the heart, circulation, and respira- tion with Brandy or Whisky (2 teaspoonfuls every 10 to 15 minutes, in a little water). Strychnine Sul- phate (1/60 grain hypodermically every ^2 to 2 CYANIDE OF MERCURY. 127 hours) has an antagonistic action upon the heart and respiration, and Atropine Sulphate (1/120 to i/6o grain hypodermically every *4 to 2 hours), or Tincture of Belladonna (10 to 20 drops in water every J4 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 and Treatment, according to most authorities, same as for Acid Hydrocyanic; accord- ing to some authorities, same as for Corrosive Sub- limate. CYANIDE OF POTASSIUM (POTASSIC CYANIDE). HISTORY: Potassium Cyanide is used in electro silvering and gilding, in photography, to clean lace, and also for the purposes of suicide and murder. 2*4 grains arc ecpiivalent to i grain of the Anhydrous Prussic Acid. Fatal dose: about 2*4 grains is considered to be the fatal dose. Usually 5 grains is a fatal dose. SYMPTOMS: 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 128 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. TREATMENT: Treat as in poisoning by Acid Hydrocyanic (q.v.) ; also employ demulcents if caustic action has been severe. CYANIDE OF SILVER (SILVER CYANIDE). SYMPTOMS: The action is similar to that of Hydrocyanic Acid, but weaker. TREATMENT: Give large draughts of Ferrous Sulphate (Green Vitriol, ^2 to 2 grains in much water). Then treat as for poisoning by Hydrocyanic Acid. DIGITALIS 129 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. HISTORY: 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, 4% 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 ounces have been recovered from. 10 grains of the powdered leaves have been fatal. 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 type, the others act quite sim- ilarly). Vomiting of matter of a grass green color, mucous an,d bile; purging with severe pain; severe head- ache ; pupils usually dilated, sometimes contracted; eveballs bulging; sclerotic blue colored; vision dis- 130 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. TREATMENT: Put in horizontal position during and for. some time after symptoms subside, to prevent fatal syncope. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if not effective), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacu- anha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 min- utes until effective). After giving an emetic, al- ways give plenty of luke-warm water to encourage vomiting. While emptying the stomach, give Tan- nic Acid or Gallic Acid (30 grains in a cupful of water, then in 10 minutes again evacuate the stom- ach). If Tannic or Gallic Acid is not convenient, give plenty of strong tea, or a decoction of oak bark (1 ounce to a small cupful of hot water), or give Potassium Iodide (10 grains) and Iodine (1 grain, in half a wineglassful of water). 2. Then give Epsom Salt (1 to 2 tablespoonfuls in a teacupful of water), or Rochelle Salt (2 tea- spoonfuls in a small cupful of water), then plenty of water. 3. Then give Fluid Extract of Quillaja (10 drops in a tablespoonful of water), or Fluid Extract of Senega (10 drops in water). For the effects of ERGOT. 131 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. 4. Stimulate with Brandy or Whisky (2 to 4 tea- spoonfuls in water every % to 1 hour), or with Aro- matic Spirit of Ammonia (a teaspoonful every y2 to 3 hours). 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. DOG BITE. (See Saliva). DULCAMARA. (As in Belladonna, q. v.). ELATERIUM. (See Aloes). ERGOT. HISTORY: Given or taken to produce abortion. 15 to 60 grains of Ergot have produced very seri- ous symptoms. SYMPTOMS: Not very definite as a rule. More or less gastric disturbance; vomiting; thirst; diarrhoea; burning pain in feet; tingling in fingers; cramps in extremities; pupils dilated; dizzi- ness; pulse small, feeble; weakness; coldness of surface; sometimes convulsions; abortion or mis- carriage in pregnant women. 132 A MANUAL OF TOXICOLOGY. TREATMENT: , Recumbent position. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of wa?er, 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 hypodermically as frequently), or with Aromatic Spirit of Am- monia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 grain hypodermically every y2 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 20 drops by mouth, or half as much hypo- FORMALDEHYDE. 133 dermically every to 2 hours), or Digitalin (1/100 grain hypodermically every % to I hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 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. ETHER. EXALGIN. (See Acetanilid.) (See Anesthetics.) EUPHORBIUM. FISH BERRIES. (See Aloes.) (See Cocculus Indicus.) FLY PAPER, POISONOUS. Commonly contains Arsenic (q. v.). FORMALDEHYDE-FORMALIN. HISTORY : Formaldehyde is a powerfully disinfectant gas. It is employed as a disinfectant for clothing, rooms, etc. Formalin is a 40 per cent, solution of gaseous Formaldehyde, and is used as an antiseptic and dis- infectant in solutions ranging from 1 to 2,000 to 1 to 200. When swallowed it has a caustic effect. SYMPTOMS : From inhalation: Intense irritation of eyes and nose; dyspnoea; throb- bing pain in head; sense of suffocation. From swallowing a Formaldehyde solution (com- monly a 4, 10, or 40 per cent, solution). Pain in stomach; nausea or vomiting; vomit may be bloody; dyspnoea; vertigo; intense anxiety; pulse rapid and 134 A MANUAL OF TOXICOLOGY. small; urine suppressed; may be diarrhoea; coma; collapse. TREATMENT: When inhaled : Fresh air; gentle stimulation if necessary. When swallowed : 1. Ammonia is considered the best antidote, form- ing a harmless hexamethylene amine. Three vol- umes of Spirit of Mindererus should be administered for every volume of 40 per cent. Formaldehyde solu- tion which has been swallowed. An alkaline mineral water may then be given, to neutralize the acetic acid resulting from the reaction. In the absence of other agents, white of egg stirred up in water may be given and the stomach then washed out or evacu- ated by Apomorphine Hydrochlorate (in 1-10 gr. doses). 2. Stimulate with hypodermic injections of Strych- nine, Digitalin, Amyl Nitrite, Aromatic Spirit of Ammonia, etc. 3. Give demulcents, as milk, barley water, etc. FOOD, POISONOUS. Poisonous Cheese, Poisonous Fish, Poisoned Meat, Poisoned Milk, Putrid Meat. Fungi (such as Poisonous Mushrooms, Toad- stools, Truffles, etc.). Also, Muscarine, Sausage Poison, etc. (Also see Ptomaines.) HISTORY: It is supposed that the symptoms of food-poison- ing are due either to toxins, or to several causes combined. Phallin, a toxalbumin from amanita phal- loides, breaks up red blood corpuscles. The only anti- dote is transfusing fresh blood or salt solution. SYMPTOMS : The symptoms are generally those of a powerful gastro-intestinal irritant. Usually there is a 2 to 6 hours incubation period. As a rule the symptoms are:-Nausea; sudden and severe retching; abdominal pain; dilated pupils; FUNGI. 135 reddened or scarlatina-like skin; great thirst; very offensive diarrhoeal discharges; elevated or reduced temperature; muscular twitchings; prostration and tendency to collapse. Poisonous Cheese usually causes retching, vomit- ing, purging, dyspnoea, dilated pupils, rapid pulse, and depression of temperature. Cheese poisoning is at- tributed to tyrotoxicon. (See Ptomaines.) Poisonous Fish (such as crawfish, land crab, yel- low-billed sprat, dolphin, gray snapper, conger eel, mussels, smooth bottle-fish, grooper, rock-fish, Por- tuguese man-of-war, king-fish, porgie, tunny, old wife, blower, etc.) causes symptoms of severe irrita- tion of the gastro-intestinal tract, somewhat resem- bling cholera morbus. Mussels frequently produce very alarming symptoms, due to a leukomain called mytilotoxine, the action of which resembles that of Curarine. When mussels are gathered from the bot- tom of a ship, in dock, they are apt to be contaminated with copper from the sheathing or with Arsenic from the paint. Pickled Salmon and Herrings sometimes produce poisonous symptoms. In some cases of poisoning by fish the symptoms are those of simple irritation, such as nausea, vomiting, purging, cramps, depression, etc. In other cases there are marked nervous symptoms, while the symptoms of gastro-enteric irritation are slight. The chief ner- vous symptoms are delirium, weakness, thirst, sense of heat about head and eyes, insensibility, dyspnoea, coma, and convulsions. Sometimes an eruption re- sembling nettlerash and associated with asthma appears. Poisoned Milk or Meat, such as that ,of birds or animals which have fed upon stramonium, laurel, or other poisonous plants or substances, produce the characteristic symptoms. Putrid or decaying meat produces symptoms of gastro-enteric irritation and also of a typhoid character, or septicaemia. (See Wounds, Poisonous.) Fungi: various forms of fungi, such as mush- 136 A MANUAL OF TOXICOLOGY. rooms, toadstools, truffles, etc., are directly poison- ous and produce symptoms of severe irritation of the gastro-intestinal tract. Poisonous Mushrooms, mistaken for edible varieties or through ignorance of their poisonous properties, produce such narcotic- irritant symptoms as violent vomiting, purging, anx- iety, thirst, abdominal pain, delirium, stupor, etc. The symptoms commonly occur within an hour and death usually within 24 hours. The gills and spores of the mushroom should be sought for in the stomach contents. Muscarine-a deadly alkaloid from various mush- rooms, as the Fly Fungus (Fly-Blown Agaric, False Orange). Fly Fungus is used in Kamschatka and Siberia to produce intoxication. Muscarine produces salivation; free perspiration; a desire to urinate; violent colic with thirst; slow, weak pulse; contracted pupils, dilating before death; dyspnoea; paralysis; death from the effect upon the heart. Distinguish poisonous from non-poisonous mush- rooms by the following: Gills of poisonous are white, cap is warty and the stem hollow. Gills of non-poison- ous are first pink, and then brownish purple, stalk cylindrical and solid. Reject mushrooms which have white gills or milky juice, or in which the color changes when they are broken or cut. Sausage Poison.-It is claimed that in uncured sausage-meat, a ptomaine is sometimes developed by bacterial growths, which causes symptoms of sausage poisoning. Recent discoveries, however, in- dicate the poison to be allied to the tetanus, diph- theria, and other toxins. Serious illness may be caused by eating sausage infected with trichina spi- ralis, a minute worm coiled up in an oval cyst. This is the most minute and numerous of the parasites. Its source is raw or imperfectly cooked pork or saus- ages. After entering the intestines it progresses to the muscular tissue of the body, where it lodges in the muscular-fibre sheaths. While enveloped in its capsule, the parasite is absolutely harmless. Trichinae produce malaise, anorexia, sleeplessness, FUNGI. 137 fever, severe muscular pains, swelling of the joints, sometimes contractions of the flexors of the ex- tremities, oedema of the face and eyelids, diarrhoea. Sometimes typhoid symptoms appear, and death in an unconscious state results. Death usually occurs within 30 days. Chemical and microscopical exami- nations of the suspected food or of a portion of the subject's muscle should indicate the nature of the poison. 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 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- ing, give, if at hand, Tannic Acid or Gallic Acid (30 grains in 2 tablespoonfuls of water), or liberal draughts of strong tea, or a decoction of oak bark (a teaspoonful to 2 wineglassfuls of hot water). Then evacuate the stomach again, unless vomiting continues. To relieve nausea after stomach has been emptied, give Lime Water and Creosote (put 2 drops of Creosote in a tablespoonful of Lime Water and give a teaspoonful of the mixture frequently). 2. Give Castor Oil (2 tablespoonfuls) and use an enema. In poisoning by Fungi, give Epsom Salt (2 tablespoonfuls in a small cupful of water), or Glauber Salt (2 teaspoonfuls in 4 tablespoonfuls of water). 3. Stimulate. If depression is very great, sup- port heart with Nitroglycerin (in 1/100 grain 138 A MANUAL OF TOXICOLOGY. doses), or stimulate with Brandy dr Whisky (a tea- spoonful dose by mouth every 10 to 15 minutes, or '4 teaspoonful doses hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % 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 to 2 hours), or Tinc- ture of Belladonna (20 drops in water every to 2 hours). Tincture of Digitalis (15 to 20 drops by mouth, or half as much hypodermically every % to 2 hours), or Digitalin (1/100 grain hypo- dermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to I hour if necessary), may be used for the same pur- pose. Draughts of strong coffee may also be given. 4. If body or feet are cold employ artificial heat (such as hot water bottles, or ordinary bottles con- taining hot water, or bags of salt, bricks, plates, or stove-lids, heated, applied to the feet and sides of the body). Also apply hot fomentations to the ab- domen. 5. Give Opium (Powdered Opium, 1 to 2 grains every % to 2 hours), or Laudanum (20 drops every % to 2 hours by mouth, or / teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every y2 to 2 hours), to relieve pain and nervous irritability. Also give Tincture of Capsicum (15 to 20 drops in % cupful of water). Give solution of Ammonium Acetate (in teaspoonful doses every y2 hour) to reduce fever and relieve kidneys. In fish poisoning, give Potassium Chlorate freely, or Spirit of Mindererus; also Capsicum and Chloro- form. In poisoning by the Fungi, give, as early as pos- sible, Atropine Sulphate, hypodermically (1/120 GASEOUS POISONS. 139 grain every % to 2 hours) as a specific antagonist; or after stomach has been emptied, Tincture of Belladonna (20 drops in water every ^2 to 2 hours by mouth) may be given instead of the Atropine. Atropine exactly opposes Muscarine. Antiseptics (such as Thymol, Salol, Naphthalin or Calomel) are recommended in the after treatment. There is no known remedy for trichinae. FUSEL OIL (AMYL ALCOHOL, q. v.). GAMBOGE. (See Aloes). GASEOUS POISONS. BROMINE (q. v.). CARBON DIOXIDE (see Carbonic Acid Gas). CARBON MONOXIDE (q. v.). CHLORINE (q. v.). FORMALDEHYDE (q. v.). MURIATIC ACID FUMES. NITROUS ACID FUMES. HYDROGEN ANTIMONIDE (STIBIN). HYDROGEN ARSENIDE (ARSENIURETTED HYDROGEN). HYDROGEN SULPHIDE (q. v. ). NITROGEN MONOXIDE (NITROUS OXIDE). (See Anes- thetics). PHOSPHINE (PHOSPHORETTED HYDROGEN). SULPHUR DIOXIDE (SULPHUROUS OXIDE). MIXED GASES, FUEL GAS (active ingredient Carbon Monoxide, q. v.; also Illuminating Gas). FURNACE GASES. ILLUMINATING GAS (Coal Gas, Water Gas-See Illumin- ating Gas). SEWER GAS AND CESSPOOL EMANATIONS (q. v.). SYMPTOMS: Regarding gaseous poisons it may in a general sense be said, that they cause dizziness, headache, nausea, sense of suffocation, exhaustion, and col- lapse. 140 A MANUAL OF TOXICOLOGY. TREATMENT: Fresh air, oxygen, rest, gentle stimulation and artificial respiration, as a rule. (See Petroleum). GASOLINE. GELSEMIUM (YELLOW JASMINE) - GEL- SEMINE. 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 2 also 3 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 7)4 hours. Death by paralysis of the respiratory centres. SYMPTOMS: Pain in brows and eyeballs; vision dim, some- times double; pupils dilated; ptosis; dropping of jaw; sense of langour; drowsiness; great muscular relaxation; staggering; pulse rapid, feeble; skin cold, moist; face anxious; voice lost; pain in chest; respiration slow, labored; sensibility diminished; suffocation; spasm; foaming at mouth; coma. TREATMENT: i. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacu- anha, 30 grains; or Syrup of Ipecac, a teaspoonful GELSEMIUM. 141 every io or 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically t1/10 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 Castor Oil (2 tablespoonfuls). 3. Stimulate. Belladonna or Atropine are good antagonists. Give Atropine Sulphate (1/120 to 1/60 grain hypodermically every J4 to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours). Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses, by mouth every 10 to 15 minutes, or % tea- spoonful doses hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or 14 tea- spoonful hypodermically as frequently; also with Strychnine Sulphate (1/60 to \/2.q> grain hypo- dermically every % to 2 hours). Tincture of Digi- talis (15 to 30 drops by mouth, or half as much hypodermically, every % to 2 hours), or Digitalin (1/100 grain hypodermically, every % to I hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every )4 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 % grain every to 2 hours). 5. Resort to electricity if necessary. Arouse by hot and cold water alternately douched on head and chest. 142 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. 7. If respiration ceases or is labored, resort to artificial respiration (rhythmically raise and lowei the extended arms from the sides up to over head and back again 18 times a minute). GOLD. SYMPTOMS: Irritant symptoms. It causes a pink stain upon the skin. TREATMENT: i. Give Albumin (white of egg) or flour (in water freely, and Sulphate of Iron (in i grain doses) promptly. 2. Evacuate the stomach without delay (either independent of or in conjunction with above) if free vomiting has not already begun. Syphon out the stomach with a stomach-tube, using plenty of water. 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. 143 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 % 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 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 % to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis (15 to 20 drops by mouth, or half as much hypodermically, every % to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled. using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. 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. HELLEBORE. (See under Veratrum). 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 insen- 144 A MANUAL OF TOXICOLOGY. 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. SYMPTOMS: 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. TREATMENT: I. 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 % 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 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). Tincture of Digitalis (30 drops by mouth, or half as much hypodermically, every y2 to 2 hours) , or Digitalin (1/100 grain hy- ILLUMINATING GAS. 145 podermically every % to i hour), or Caffein Citrate (i to 4 grains every % to I hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same pur- poses. Draughts of strong coffee may also be given. 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). HYOSCYAMUS. (Treat as for Belladonna, q. v.). ILLUMINATING GAS (COAL GAS, WATER GAS)-FUEL GAS. HISTORY: 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 perhaps so diluted as to be odorless, yet poisoning. The gas may be diffused through walls and parti- tions. Water Gas is more dangerous than Coal Gas. SYMPTOMS: Headache; confusion; dizziness; nausea; uncer- tain gait; weakness; loss of memory; unconscious- ness; asphyxia; death. May be convulsions. The patient may rouse up for a little while and seem in- telligent, and then again become unconscious or have convulsions. The symptoms vary in poisoning by Illuminating Gas, according to whether they are those of true asphyxia or of Carbonic Oxide poisoning. 146 A MANUAL OF TOXICOLOGY. Suffocation, due to an overflowing quantity of the gas stopping respiration, exhibits such characteris- tic symptoms as choking, gasping, suffused eyes, congested face, collapse. Asphyxia by Illuminating Gas (producing suffo- cation) is very different from poisoning resulting from breathing the diluted gas. Headache, dizziness, loss of appetite and malaise may be due to a slow poisoning from small amounts of gas present in the air of rooms. TREATMENT: No true antidote for poisoning by the gas is known. 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). INSECT POWDER, POISONOUS. (Treat as in Arsenic Poisoning, q. v.). INSECTS, POISONOUS. (The bite or sting). SYMPTOMS: Usually mainly local irritation. When by taran- tula or scorpion may be serious and consist of: pain; swelling; fever; erysipelas; suppuration; gan- grene ; death. TREATMENT: In mild cases apply a strong solution of Am- monium Chloride, or soap, strong soap suds, or other alkali to the affected part. If stinger left in extract it. In severe cases treat as for snake bite. (See Snake Bite). IODINE AND ITS COMPOUNDS. 147 IODINE AND ITS COMPOUNDS. HISTORY: Iodine is sometimes taken by mistake for harm- less mixtures or medicines. It is rarely used for suicide or murder. 20 grains has caused death. Recovery has occurred after taking drachms. 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: t. 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. 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- 148 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. 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. 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 % teaspoonful hypodermically as frequently) ; also with Strych- nine Sulphate (1/60 grain hypodermically every % 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 /I to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every % to 2 hours), or Digitalin (r/100 grain hypodermic- ally every % to'l 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 handker- chief 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 y2 to 2 hours), or Laudanum, 10 to 20 drops every *4 to 2 hours by mouth, or y2 teaspoonful in gruel by rectum as frequently), or Morphine Sul- phate ()4 grain by mouth or hypodermically, every IODOFORM. 149 / to 2 hours), to relieve pain and nervous irrita- bility. IODOFORM. HISTORY: 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. GENERAL SYMPTOMS: Drowsiness; slight delirium; emaciation; high temperature; rapid pulse; symptoms resemble men- ingitis. TREATMENT: 1. Wash the wound with the Oil of Eucalyptus. 2. Give stimulants if necessary. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 min- utes, or % teaspoonful doses hypodermically as fre- quently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypo- dermically every % to 2 hours) and Atropine Sul- phate (1/120 to 1/60 grain hypodermically, every 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 ^2 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 in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. IPECACUANHA. SYMPTOMS: Vomiting; hematemesis; hemoptysis. 150 A MANUAL OF TOXICOLOGY. TREATMENT: i. Wash out the stomach if possible. 2. Give vegetable acids, such as vinegar and water (equal parts), Acetic Acid, diluted (a teaspoonful in pint of water), Citric Acid or Tartaric Acid (% to 2 drachms in a pint of water), or clear lemon juice, or orange juice, freely. 3. Give stimulants if necessary. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses, by mouth every 10 to 15 min- utes, or teaspoonful doses hypodermically as fre- quently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or y teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypo- dermically every % to 2 hours) and Atropine Sul- phate (1/120 to 1/60 grain hypodermically, every ^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 hypo- dermically, every *4 to 2 hours), or Digitalin (1/100 grain hypodermically, every % to I hour), or Caffein Citrate (1 to 4 grains every X to I hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % t° 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. JABORANDI (PILOCARPUS) - PILOCAR- ' PINE. HISTORY: The dangerous dose of Pilocarpine is assumed to be 2 grains subcutaneously. SYMPTOMS: Profuse sweating; dizziness; salivation; vomit- ing; purging; tearing pain in eyeballs; contracted pupils; myopia. JABORANDI. 151 TREATMENT: i. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at- hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered 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 *4 to 2 hours by mouth). Very efficacious in arresting the symptoms. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every % to 2 (lours) 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). 152 A MANUAL OF TOXICOLOGY. Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically, every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and in- haled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 4. Morphine Sulphate (% grain every to 2 hours) to control nausea and vomiting. JALAP. SYMPTOMS: Large, watery stools ; tormina ; tenesmus. TREATMENT: i. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. 2. Give demulcents (such as white of egg, milk, oil, flaxseed or elm tea, barley, gum arabic or starch water, oatmeal gruel, gelatin, flour and water, or even crushed bananas) to soothe and protect the irritated or inflamed surfaces. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful LABURNUM. 153 doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a littie water every 10 to 15 minutes, or % 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 % to 2 hours), or Tincture of Belladonna (20 drops in water every to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically, every % to 1 hour), or Caffein Citrate (1 to 4 grains every y to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. (See Petroleum). KEROSENE. LABURNUM (THE SEEDS, WOOD, BARK, LEAVES, FLOWERS, PODS)- CYTISINE-ARNICA. HISTORY: All parts of Laburnum are poisonous, due to the presence of Cytisine, which is also contained in Arnica. Half an ounce of the Laburnum root has caused very serious symptoms. SYMPTOMS: Symptoms usually come on very rapidly; vomit- ing; purging; restlessness; drowsiness; twitchings; coma. i. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not 154 A MANUAL OF TOXICOLOGY. 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 (J4 to 1 ounce-1 to 2 table- spoonfuls-in a teacupful of water), or Rochelle Salt (2 teaspoonfuls in a small cupful of water). 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every to 2 hours), and Atropine Sulphate (1/120 grain hypo- dermically every ^2 to 2 hours), or Tincture of Belladonna (20 drops in water every ^2 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 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 *4 t° 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. 155 LACTUCARIUM. Symptoms somewhat similar to those of Opium. Treat as in Opium. LAUDANUM. (See Opium). LAUGHING GAS. (See Anesthetics). 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. 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 jG 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 day's after the patient is prostrated. SYMPTOMS: Throat dry; great thirst; sweet, metallic taste in mouth; colic, relieved by pressure; abdominal muscles very rigid; cramps in legs; paralysis of extremities ; vomited matters white ; stools black ; sometimes constipation; rapid, tense, cord-like pulse, becoming weak and relaxed; anxious, pinched, livid face; vertigo; anesthesia; stupor; muscular twitching; convulsions; coma; death. (In chronic lead poisoning there is a blue line at the margin of the gums). 156 A MANUAL OF TOXICOLOGY. TREATMENT: A soluble sulphate, such as Magnesium Sulphate, should be given, as it forms an insoluble Lead Sul- phate. Treat same as for poisoning by Barium com- pounds (q. v.). Alum is the best remedy for the colic. Put i)4 drachms Powdered Alum in a pint of boiling milk, separate curd, sweeten with sugar, and give a wineglassful every hour or two. Elim- inate poison by Potassium Iodide (10 to 20 grains in water every 2 to 4 hours), which renders it sol- uble. Elimination takes place by .bile, perspiration and urine. LIME. SYMPTOMS: Burning pain in the abdomen; intense thirst; obstinate constipation. TREATMENT: I. Give a vegetable acid: lemon juice or orange juice freely; or Citric Acid (t to 2 drachms to a pint of water), or Tartaric Acid (1 to 2 drachms to a pint of water), or Acetic Acid (a teaspoonful in % pint of water), or Vinegar (in )4 cupful doses, with water). The soluble sulphates, such as Mag- nesium or Sodium Sulphate (in 1 to 2 tablespoon- ful doses in water) have been recommended. 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 )4 to 2 hours), or Lau- danum (20 drops every to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth, or hypo- dermically every % to 2 hours.), to relieve pain and nervous irritability. LOBELIA. 157 LOBELIA (LOBELIA INFLATA, INDIAN TOBACCO). HISTORY: A drachm of the powdered leaves is considered a fatal dose. SYMPTOMS: Violent vomiting; severe depression and prostra- tion ; sometimes violent purging; cold sweat; pale skin ; feeble pulse ; giddiness; tremors; sometimes burning pain in fauces and esophagus; convulsions; coma; collapse; death. TREATMENT: Keep in recumbent position, even after acute symptoms are relieved. i. Evacuate the stomach, if free vomiting has not already occurred, i. e., syphon out the stomach with a stomach-tube, using plenty of water. If a stom- ach-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 pro- duced), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not 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 Castor Oil (2 tablespoonfuls). 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (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 158 A MANUAL OF TOXICOLOGY. every io to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every % to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 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 to 2 hours), or Laudanum, 20 drops every % to 2 hours by mouth, or J/2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (y grain by mouth, or hypodermically every to 2 hours), to relieve pain and nervous irritability. (See Silver Compounds). LUNAR CAUSTIC. MATCHES. (See Phosphorus). MERCURY AND ITS COMPOUNDS. Bichloride of Mercury (Corrosive Sublimate)-Red Precipitate (Red Oxide of Mercury) - White Precipitate (Ammoniated Mercury), etc. HISTORY: Corrosive Sublimate has been dispensed for Calo- mel. It is used to kill insects and vermin, to pre- MERCURY AND ITS COMPOUNDS. 159 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 grains to the ounce) applied to the scalp for ring worm killed a girl of 9 years. SYMPTOMS: !N. B.-The following symptoms refer especially to Corrosive Sublimate, but are in the main also characteristic of the others. Severe gastro-enteritis; acrid, metallic, coppery taste in mouth; sense of constriction in throat; burning heat in esophagus and stomach; colicky pains; mucous, bilious, bloody vomiting; mucous, serous, bloody, straining stools; lips and tongue white and swollen, perhaps shriveled; breath fetid; pulse small, frequent, irregular; face swollen and flushed or anxious and pinched; extremities cold; convulsions; coma; collapse; death. Pain may be absent. Skin eruption (Eczema Mercurial) if symptoms are protracted. Secondary symptoms are coppery taste in mouth; foul breath; swollen, tender, dark-red colored gums; hectic fever; teeth sticky; tongue swollen and thickly furred; breath offensive; salivation. In salivation the saliva may be increased from a pint to pints in a day. There may be a mercurial tremor. 160 A MANUAL OF TOXICOLOGY. TREATMENT: I. Evacuate the stomach if vomiting has not already occurred; syphon out the stomach with a stomach-tube, using plenty of water. If stom- ach-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 io 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. Stir up white of egg in water or milk (whites of 4 eggs to 1 quart) and give when begin to wash out the stomach. If poisoned by Corrosive Subli- mate, avoid excess of albumin, as the Albuminate of Mercury formed by the white of egg becomes soluble in an excess of the latter, also in the alkaline contents of the intestines, and may be absorbed. Give the white of 1 egg for every 4 grains of Cor- rosive Sublimate taken. If eggs are not at hand, give finely chopped raw lean meat, mixed up in milk or water. Flour may be mixed in water and given, if eggs, meat or milk are not at hand. After giving the albumin, again evacuate the stomach, washing out thoroughly if possible. Give Potassium Iodide (10 to 20 grains in 2 table- spoonfuls of water every 2 to 4 hours). 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically, every NAPHTHALIN. 161 % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically, every to 2 hours), or Tincture of Belladonna (5 to 10 drops in water every 2 to 6 hours) lessens the secretion in ptyal- ism. Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypodermically, every ^2 to 1 hour), or Caffem 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 *4 to I hour if necessary), may be used as stimulants. 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 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 y2 to 2 hours), to relieve pain and nervous irritability. 6. Bismuth, Dilute Nitric Acid in water, or Tan- nin are useful as gargles and mouth washes for salivation. MORPHINE. (See Opium). (See Petroleum). NAPHTHA. NAPHTHALIN. SYMPTOMS: Depression; cyanosis; twitching; strangury; dark-brown changing to inky-black urine. 162 A MANUAL OF TOXICOLOGY. TREATMENT: i. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective). After giving the emetic, give plenty of luke-warm water to encourage vomiting. 2. Give demulcents (such as white of egg, milk, oil, flaxseed or elm tea, barley, gum arabic or starch water, oatmeal gruel, or even crushed bananas), to soothe and protect the irritated or inflamed sur- faces. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful hypodermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypo- dermically as frequently) ; also with Strychnine Sulphate (1/60 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every p2 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 (i/too 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 J4 to I hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. NITROBENZENE-NITROBENZOL. 163 NICOTINE. HISTORY: A liquid alkaloid obtained from tobacco. Has been used for suicide and murder. Is a very deadly poison, death occurring in some instances in a few minutes. The fatal dose of Nicotine for an adult not accus- tomed to tobacco is placed at about i/io of a drop. It is one of the most deadly poisons known, caus- ing death in 3 minutes; but death has been delayed lor hours. (See Tobacco). 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 is because of its odor some- times added to sweetmeats, liqueurs or pomades. Its fumes, swallowing it or only applying it to the skin, may poison. Those who work in analine-dyes are exposed to danger from handling it. It is a powerful narcotic; the effects are similar to those of Prussic Acid. Fatal dose: 8 or 9 drops is considered to be a fatal dose; or merely tasting the fluid. Death results from asphyxia. SYMPTOMS: The symptoms may not appear promptly, but may be strangely delayed for a day or two. Lan- guor; numb feeling in head; confusion of mind; nausea; anxiety; cyanosis; dark nails, lips, tongue and mouth; dilated pupils; convulsions. TREATMENT: When swallowed. 1. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If 164 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 (% to 1 tablespoonful in water every 2 to 4 hours). 2. 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 Aqua Ammonia teaspoonful in a cupful of water), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or y^ tea- spoonful hypodermically as frequently), or with Chloric Ether (y2 teaspoonful in water every 15 to 30 minutes), or give these as enema; also with Strychnine Sulphate (i/60 grain hypodermically every % 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 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 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 % to 1 hour if necessary), or inhalations of Ammonia may be given for the same purposes. Draughts of strong coffee may also be given. NITROGLYCERINE. 165 3. Employ alternate hot and cold douche to chest, pouring from a height. 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 inhalations. 6. Employ interrupted current of electricity over heart region and to chest walls. When inhaled, omit No. I. 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 the crude Nitro- glycerine caused death. 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 ; muscular weakness ; precordial pain ; dilated pupils; flushed face; anxiety.; scanty, pigmented urine; sudden collapse; sometimes nausea and loss of consciousness; also symptoms characteristic of the Nitrites. TREATMENT: Recumbent position. Apply to head, cloths con- taining ice or wrung out in ice-water. Give Brandy or Whisky (in I to 4 teaspoonful doses in water). 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 166 A MANUAL OF TOXICOLOGY. to 2 hours), or Tincture of Belladonna (20 drops in 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- peated in 15 to 30 minutes, by mouth, or half as much, or a grain of Ergotin, hypodermically). NITROUS OXIDE. (See Anesthetics). NUX VOMICA (STRYCHNOS NUX VOM- ICA, POISON NUT, QUAKER BUTTONS, RAT'S BANE) - STRYCHNOS IGNATII - STRYCHNINE - BRUCINE. HISTORY: Poisoning may result from swallowing a vermin killer containing meal or flour with strychnine, and perhaps arsenic also. Game killed with Strychnine may poison. The drug is used for both suicide and murder. It has been taken by mistake for Santo- nine, for Salicin, etc. Brucine may be physiologic- ally considered a Dilute Strychnine. Fatal dose: Powdered Nux Vomica, 30 grains. (The seeds weigh about 30 grains, sufficient to cause death). Extract of Nux Vomica, 3 grains. Death may occur from Nux Vomica in from 15 min- utes 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 alarm- ing symptoms. It is probable that 7/10 of a grain hypodermically would produce death; 1/16 of a grain by mouth killed a child 2 years old in 4 hours; a recovery in an adult from 20 grains after prompt emetic; Dr. Warner died in 20 minutes from % grain, taken by mistake. Death or recovery is usually speedy. There is hope of recovery if the patient lives over 5 or 6 hours. Fatal results have occurred in 5 minutes. NUX VOMICA. 167 There was death after 6 hours in a case where 6 grains of Strychnine were given with some Mor- phine. Death results from suffocation or exhaustion, usually in about I or 2 hours from the beginning of the symptoms. The taste of Strychnine is intensely bitter and a dilution of I part in 100,000 may still be recognized by its bitter taste. SYMPTOMS: 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). TREATMENT: N. B. - Put patient in horizontal position in a dark room, free from all noise. 1. Give animal charcoal (ad libitum), or Tannic Acid (30 grains in a small wineglassful of water), 168 A MANUAL OF TOXICOLOGY. which forms a very insoluble tannate; or Iodine (i to 2 grains) and Potassium Iodide (5 to 10 grains) in water (a small wineglassful), or strong tea, or a decoction of oak bark (^ ounce to a gill of water) ; 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. 2. Evacuate the stomach QUICKLY: Syphon out the stomach repeatedly with warm water, using a stomach-tube. 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 produced), or Mustard (a tablespoonful in a small cupful of water, re- peated in 15 minutes if not effective), or Ipecacu- anha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes un- til vomiting results), or Apomorphine Hydrochlor- ate, hypodermically 1/10 grain, repeated-every 15 minutes until effective). After giving an emetic, always give plenty of luke-warm water to encour- age vomiting. After tetanic symptoms have begun, any attempt to introduce a stomach-tube or use an emetic, would only bring on a paroxysm and be useless. 3. Give Spirit of Nitrous Ether (1 to 2 teaspoon- fuls in water). Also catheterize frequently to prevent reabsorp- tion. 4. Give inhalations of Chloroform or Ether to control the spasms; or give Chloral (20 to 30 grains in water by mouth or twice as much by rectum, every to 2 hours), or Potassium Bromide (1 to 2 drachms in water every % to 1 hour by mouth, or to 2 drachms by rectum), or both Chloral and Bromide, keeping the patient gently narcotized dur- ing several hours if necessary. Inhalations of Amyl OPIUM, LAUDANUM, ETC. 169 Nitrite (a 3 or 5 minim pearl crushed in a handker- chief and inhaled, using one every 10 to 15 minutes if necessary), Curare (in 1/20 to 1/6 grain doses hypodermically), Calabar Bean (in form of Physos- tigmine Sulphate, 1/100 to 1/50 grain every % to 2 hours), Paraldehyde (% to 1 teaspoonful in sweet- ened water every % to 2 hours) and Urethane (in 5 grain doses in water every % to 1 hour) have^also been highly recommended. Important! For threatened death from embar- rassed respiration, should promptly resort to arti- ficial 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, HEROINE-NARCEINE-POPPY; 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 larger doses have been recov- ered from ; Laudanum, 1 drachm ; Extract of Opium, 2% grains (equal to 5 grains of Opium) ; Morphine Hydrochlorate, 1 grain, t/6 to ^2 of a grain of Mor- phine subcutaneously produced fatal results. Recov- ery from even 4 or 5 ounces of Laudanum ; also from 2 drachms of Morphine. Infants have died from 170 A MANUAL OF TOXICOLOGY. such small closes as 1/90, 1/15 and 34 of a grain of Opium, or 2 or 3 drops of Laudanum ; 1 drop equivalent to about 1/12 grain of Opium, killed an infant 7 days old; 2 grains of Morphine Acetate sub- cutaneously injected in a man with rabies produced but little effect. Tetanus, Strychnine, convulsions, great pain, or Opium habit, make the nervous sys- tem very tolerant of Opium. De Quincey used 9 ounces of Laudanum daily (equal to 360 grains of solid Opium). In Opium poisoning, death, as a rule, usually takes place in from 7 to 12 hours. The shortest period recorded is % of an hour; the longest 48 hours. If the patient survives for 12 hours, the chances of recovery are considered good. The symptoms of Morphine poisoning appear in from to 1 hour, and a fatal result may occur in 24 of an hour, but as a rule not until 8 or 10 hours after the poison was taken. 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 perspira- tion are favorable symptoms. The prognosis is the less favorable the more strongly the pupils are contracted. [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 are frequently taken OPIUM, LAUDANUM, ETC. 171 ;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], TREATMENT: Immediately resort to artificial respiration and stimulation in the most urgent cases. i. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains, or Syrup of Ipecac, a teaspoonful, every 10 to 15 minutes until vomiting results), or Apo- morphine Hydrochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective), if narcosis has not set in. After giving the emetic, always give plenty of luke-warm water to encour- age vomiting. While syphoning the stomach, or when giving emetic, or even before, give Potassium Perman- ganate (10 grains in a pint of water, repeated in % hour; or i or 2 grains in a pint of water, repeated every % hour and 3 or 4 times), to oxidize the poi- 172 A MANUAL OF TOXICOLOGY. son. This drug has seemingly proved effective even when Morphine had been 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. The hypodermic injection of Potassium Per- manganate solution is believed to have proved bene- ficial in some cases. (Inject 15 minims of a grain to the % ounce solution every 15 minutes). When Potassium Permanganate has been intro- duced into the stomach in treatment, it should after- wards be removed by syphon or emetic. If Potas- sium Permanganate is not at hand, give Tannic Acid (30 grains in a wineglassful of water), or Gal- lic Acid (the same amount), or copious draughts of strong tea, to make all the alkaloids insoluble. Charcoal (a tablespoonful or more in water) may be given. 2. Administer Atropine Sulphate, hypodermic- ally (1/120 grain every 15 minutes, 3 times, or until the respirations number 8 per minute), or Tincture of Belladonna by mouth or hypodermically (10 to 15 drops in a little water every 15 to 30 min- utes, 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 Bella- donna should be given very cautiously in this kind of poisoning and not until the pupils dilate (there- fore not depending upon such effect as a guide), lest poisoning by either result. 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every OPIUM, LAUDANUM, ETC. 173 % to 2 hours), or Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every to2 hours), or Digitalin (1/100 grain hypo- dermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite are highly recommended (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. 4. 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. 5. Plenty of strong coffee should be given fre- quently-may be given by mouth, but an enema of a pint, introduced hot, is highly recommended. 6. Oxygen inhalations are frequently of great value; also faradization of the chest muscles (anode placed over root of phrenic nerve, cathode 3 inches below ensiform cartilage), or of the extremities. 7. The patient should be aroused and kept awake by means of shaking, pinching, slapping with a wet towel, dashing cold water on face and chest, or alter- nate hot and cold, over his head from a height, fre- quently repeated, drying patient in the intervals. Avoid applying so much cold water as to cause col- lapse. Alternately hot water and ice to the nape of the neck may be used. Walking between attend- ants often helps to arouse and stimulates lagging circulation, but avoid walking patient so much as to use up vitality. Tincture of Capsicum (1 to 2 tablespoonfuls in water by rectal injection sometimes almost instantly relieves the stupor. Vinegar and water, Lemon or Orange Juice, or Cream of Tatar in water, every 10 minutes, antagonizes the narcotism. 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, 174 A MANUAL OF TOXICOLOGY. applied to the feet and sides of the body), to main- tain bodily temperature. 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. PARALDEHYDE. HISTORY: Has been recommended as a substitute for Chloral. Odor of drug in breath and urine. Fatal dose: I drachm has produced serious symp- toms. Recovery from 3^ ounces. Unconscious- ness may last for more than 30 hours. Death by paralysis of respiratory centres. SYMPTOMS: Slight stimulation ; excited ; incoherent; muscular relaxation; rapid pulse; pupils contracted and in- sensible to light; insensibility; collapse. 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. Give Atropine (1/120 grain hypodermically every % to 1 hour, 2 or 3 times), or Tincture of PETROLEUM-ROCK OIL, ETC. 175 Belladonna (10 to 15 drops every % to 1 hour, for 2 or 3 doses), or Strychnine Sulphate (1/60 to 1/20 grain doses hypodermically every % 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,) to main- tain bodily temperature. PARIS GREEN. (See Arsenic). PEACH KERNELS. (See Hydrocyanic Acid). PETROLEUM - ROCK OIL - PARAFFIN OIL (KEROSENE, MINERAL OIL, COAL OIL) - GASOLINE - BENZINE --NAPH- THA-RHIGOLENE-ETC. HISTORY: Petroleum or the products of its distillation have been accidentally drunk 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 Paraffin. Poisoning easily recognized from smell of breath and vomited matters. The prognosis is good. SYMPTOMS: Severe burning in mouth and stomach ; stools cov- ered with oily layer; cold skin; feeble pulse; sighing respiration ; pale, anxious face; great thirst and rest- lessness at night; unconsciousness. TREATMENT: 1. Evacuate the stomach; syphon out the stom- ach with a stomach-tube, using plenty of water. If 176 A MANUAL OF TOXICOLOGY. a stomach-tube is not at hand, give an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 10 to 15 minutes if vomiting is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if 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 piouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 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 % 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, and friction of the skin resorted to. 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 PHOSPHORUS-"RATSBANE," ETC. 177 18 times a minute), if breathing stops or becomes very labored. Should be kept up for 2 hours if in doubt. 5. If pain is severe, give Opium (Powdered Opium, 1 or 2 grains every % to 2 hours; or Lau- danum, 20 drops every ^4 to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth, or hypoder- mically, every JX to 2 hours), to relieve pain and nervous irritability. PHENACETIN. (See Acetanilid). PHENOL. (Acid Carbolic). PHOSPHORUS - "RATSBANE" - "RAT POI- SON"- MATCHES. HISTORY: Yellow (common) Phosphorus is poisonous, lum- inous, and evolves a strong odor. Red Phosphorus is not poisonous, not luminous, and almost odorless. The former is used in rat-poison and both kinds for the ends of matches. The ordinary Phosphorus rat- paste consists of Phosphorus, fat and sugar; some also contain Prussian blue as a coloring matter; others contain Arsenic as well as Phosphorus, and a common rat-paste is said to have ground glass for one of its constituents. Some vermin killers con- tain Strychnine. Fatal dose: grains of Phosphorus; 1/9 grain has caused death. The chewing of two matches killed a child. Recovery after suck- ing 300 matches. 1/50 grain of Phosphorus killed a child; 1% grains killed a man, and % grain, a woman, inside of 12 hours. A child recovered after swallowing a drachm of rat-poison. Death occurs in from hour to 12 days; usually between the 178 A MANUAL OF TOXICOLOGY. third and seventh days. Recovery is rare. Death results from failure of circulation and respiration. Death frequently takes place suddenly. Phospho- rus is more likely to cause death if finely divided or in solution than if taken in solid form. SYMPTOMS: The symptoms may appear in an hour or not until 3 or 4 days after the poison has been taken. Breath smells of Phosphorus-is garlicky; Phos- phorus or garlic taste in mouth; eructation of Phos- phorus vapors and may be Phosphorus odor in breath; burning pain in esophagus, stomach and ab- domen ; inflammation of stomach and intestines; mucus, bile and blood vomited and are luminous in the dark; there may be purging or constipation; may be bloody, coffee-grounds vomit with suppres- sion of bile; jaundice, perhaps with nettle-rash; pain in region of and liver enlarged; pupils usually dilated; temperature low; abdomen distended; twitchings; headache; vertigo; delirium; tendency to hemorrhage ; albuminous, scanty urine; convul- sions ; coma; pseudo-menstrual discharge, abortion or miscarriage in women. The general symptoms are similar to yellow atrophy of the liver. (The symptoms may come on in an hour or not for 3 or 4 days). TREATMENT: Avoid oils and fats and substances containing them, such as milk, as they increase solution and absorption of the Phosphorus. There is no known chemical antidote. I. Evacuate the stomach by syphoning it out with a stomach-tube, using also, if possible, water, into which a teaspoonful of old Oil of Turpentine has been put. Wash thoroughly. If a stomach-tube 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 to minutes until vom- iting results). Then continue the Copper Sulphate in PHOSPHORUS-"RATSBANE." ETC. 179 I 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. 2. Give without delay old, resinified Oil of Tur-_J pentine, or better still, French Oil of Turpentine 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 Turpentine is said to be soluble in Ether and Al- cohol. Turpentine (old) forms with Phosphorus an almost insoluble mass, the so-called Turpen- tine-phosphoric Acid. (100 times as much Tur- pentine should be given as there was Phosphorus taken). It should be given in hot water or alone (floated on the water or in capsules) immediately after the Phosphorus is taken or as soon thereafter as possible. It is considered valueless if not given within 12 hours. It is said that, if at hand, Potassium Permanga- nate (given in 2/10 per cent, solution, freely) has proved a valuable antidote. 180 A MANUAL OF TOXICOLOGY. 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 say may give Gum Arabic, or Traga- canth in water to protect the stomach. 3. If the Turpentine does not freely purge, give Magnesium Sulphate (Epsom Salt, 2 tablespoonfuls in a small cupful of water) and Sweet Spirit of Nitre (a teaspoonful in water). 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 ^2 to 2 hours), or Laudanum (10 to 20 drops every *4 to 2 hours by mouth, or )4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypoder- mically every 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. PHYSOSTIGMA. (See Calabar Bean). PHYTOLACCA (POKE BERRY, POKE ROOT). SYMPTOMS: Nausea; vomiting; slowing of heart and respira- tion ; depression; convulsions. TREATMENT: I. Vomiting and purging are frequently produced by the poison, but syphoning out the stomach with stomach-tube and much water is desirable. If the PHYTOLACCA. 181 tube is not convenient, give Apomorphine Hydro- chlorate, hypodermically (i/io grain every io or 15 minutes until effective), or Mustard (a tablespoon- ful in a small cupful of water). 2. Stimulate. Give Brandy or Whisky (2 tea- spoonful doses by mouth every 10 to 15 minutes, or y teaspoonful doses hypodermically as frequently), or Aromatic Spirit of Ammonia (a teaspoonful in water every 10 to 15 minutes), or Compound Spirit of Ether (j4 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 % to2 hours). 3. Give Opium (Powdered Opium, 1 to 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. PICROTOXIN. (See Cocculus Indicus). PILOCARPINE. (See Jaborandi). PINK ROOT. (See Spigelia). (See Phytolacca). POKE. POISON OAK OR POISON VINE. (See Rhus). (See Opium). POPPY. POTASSIUM. (See Alkalies). 182 A MANUAL OF TOXICOLOGY. POTASSIUM CHLORATE (Chlorate of Potash). HISTORY: Fatal dose: from ounce upward. SYMPTOMS: Poisonous doses interfere with 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 chemical reaction unchanged. TREATMENT: I. Evacuate the stomach: syphon out the stom- ach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 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 giving 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, 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. PTOMAINES. 183 4. Give Opium (Powdered Opium, 1 to 2 grains every J4 to 2 hours; or Laudanum, 20 drops every to 2 hours by mouth, or J/2 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth, or hypodermically every ^2 to 2 hours), to relieve pain and nervous irritability. Employ inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to I hour if necessary). Avoid stimulants, or anything likely to increase the congestion of the kidneys. PRECIPITATE, RED OR WHITE. (See Mercury). PTOMAINES (PUTREFACTIVE, CADAVERIC OR ANIMAL ALKALOIDS). HISTORY: Ptomaines are alkaloidal or basic products of the putrid decomposition of animal or vegetable mat- ter. Many of the Ptomaines respond to most of the ordinary reactions of the vegetable alkaloids, thus leading to confusion or error in toxicological investi- gations. Not all Ptomaines are poisonous, and quite often that which is called Ptomaine-poison- ing is really due to a mixture of substances con- taining no recognized causative Ptomaine. Such poisoning should be considered as a food poison- ing (q. v.). The reactions of certain Ptomaines duplicate the actions of the following alkaloids: Atropine, Colchi- cine, Coniine, Delphinine, Digitalin, Nicotine, Strychnine and Veratrine. 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 putrid game. 184 A MANUAL OF TOXICOLOGY. They cause dryness of the mouth, great thirst, red and swollen gums, dilated pupils, drooping eyelids; occasionally loss of voice, great weakness; there may be chills, vomiting, diarrhoea, offensive, dark- colored stools, temperature ioi to 104, convulsions and even death from paralysis of the heart. Post mortem examinations may show congestion of brain, lungs and kidneys, etc. Oily, alkaline, volatile substances resembling Coniine.in their reactions have been discovered in decomposing animal tissues. The reactions and physiological effects of certain ptomaines from corn meal are somewhat similar to those of Strychnine. Digitalin-like substances have been discovered in liver sausage. A substance giving most of the reactions of Col- chicine has been found in beer. Poisons formed during putrefaction. Tyrotoxicon is said by some to be a poisonous proteid allied to the tetanus and diphtheria toxins; by others a ptomaine, and found at times in stale milk, cheese, ice-cream and certain milk products. Tyrotoxicon produces vomiting, purging, rapid pulse, dilated pupils, hurried breathing, depression of temperature, prostration, and death. Typhotoxine-a substance produced by the Eb- erth bacillus of typhoid fever, kills mice and guinea pigs.in a day or two. Mydaleine, found in decaying cadaveric liver, spleen, etc., causes increase in temperature when hy- podermically administered. Neurine, found in decomposing animal tissue, acts similar to Curare. Cancroin is believed to be similar to Neurine and the active agent in producing cancer. Susotoxine, Choline, Methylguanidine, Isoamylamine, Patoa- mine, Trimethylenediamine, Ethylidenediamine, etc., also cause more or less serious symptoms or death. PULSATILLA. 185 TREATMENT: Treat as in Poisonous Foods (q. v.). HISTORY: Death by paralysis of heart. 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 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. 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 % 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 tenesmus. PULSATILLA. 186 A MANUAL OF TOXICOLOGY. RAT PASTE - ROUGH ON RATS. (See Arsenic; also Phosphorus). RESORCIN. HISTORY: 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. TREATMENT: 1. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water 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 teaspoon- RHUS-RHUS RADICANS, ETC. 187 ful hypodermically as frequently) ; also with Strych- nine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every to 2 hours), or 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 *4 to 2 hours), or Digitalin (1/100 grain hypo- dermically every % to 1 hour), or Caffein Citrate (j 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 hcur 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 wrater, 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 ho.t 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. Also employ friction and use an interrupted elec- tric current if necessary. RHIGOLENE. (See Petroleum.) RHUS-RHUS RADICANS-RHUS TOXI- CODENDRON (POISON VINE, POISON OAK, POISON IVY)-RHUS VENENATA (SWAMP-SUMACH, POISON-SUMACH). SYMPTOMS : Itching; swelling; vesicular eruptions ; throat may be involved, causing cough; thirst; vomiting: col- icky pains, with fever and delirium. (Poisoning due to active principle, a non-volatile oil called toxicoden- drol.) 188 A MANUAL OF TOXICOLOGY. TREATMENT: 1. Apply lotion of Grindelia Robusta (Fluid Ex- tract of Grindelia Robusta 1 part, water 10 to 48 parts, mix), or Carron Oil (Linseed Oil and Lime water), or Lead water. Frequent washing with soap suds and hot water is good. Alcohol removes the poison. A 5 per cent, aqueous solution of Cocaine promptly relieves burning and itching when applied as a lotion. A 5 per cent solution of Carbolic Acid is also good. Infusion of Lobelia (1 ounce to the pint), also Corrosive Sublimate solution are good applications; also Aristol dusted on or Ichthyol applied. Give a simple diet. 2. Give Magnesium Sulphate (a tablespoonful in a small cupful of water). 3. Give Opium (Powdered Opium, 1 to 2 grains every | to 2 hours), or Laudanum, 20 drops every | to 2 hours by mouth, or | teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (| grain by mouth or hypodermically every | to 2 hours), to relieve pain and nervous irritability. SALIVA OF RABID ANIMALS-RABIES (HYDROPHOBIA.) (Infection by bite.) HISTORY: Hydrophobia may result from the bite of dog, cat, wolf, fox or other carnivorous animal. The disease is, as a rule, fatal, death resulting in from 2 to 5 days. Shortest period on record 24 hours. Long- est, 9 days. SYMPTOMS: Symptoms do not as a rule come on inside of 3 weeks after the bite (usually between the 20th and 120th day), and may not occur until after years, the wound being long since healed. Symptoms are: pain and uneasiness in the part bitten; restlessness; ma- laise; dyspnoea; difficult swallowing; fear of water; pain in the stomach, with bilious vomiting; severe con- vulsions ; swollen, often protruding, tongue; free flow of viscid saliva; distorted face. If the dog has an appetite after the fourth day, or dies without paralysis, rabies did not exist. SANGUINARIA. 189 TREATMENT: Preserve for observation the dog or other hydro- phobic animal known or suspected. Preventive treatment when bitten: Immediately ligate above the wound and apply Tincture of Iodine in and about the wound; wash with hot water and suck wound to remove virus; apply Carbolic Acid to or cauterize or excise bitten part. Inoculate with Pasteur's hydrophobia emulsion. TREATMENT FOR HYDROPHOBIA. Give Chloroform (5 to 30 drops) in sugar and water. Give Morphine hypodermically (% grain every 1 to 3 hours) until under influence. Rectal in- jections of Chloral or Potassium Bromide may be given. Spray throat with 4 per cent, solution of Cocaine. Feed per rectum with nutritive enemas and sup- positories. Put patient in a dark room and keep quiet and warm. Exclude all draughts. Inoculate with P.asteur's hydrophobia emulsion. SALT OF SORREL OR LEMON. (See Acid Oxalic). 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- duced temperature ; slow pulse ; great prostration ; intense,thirst; convulsions; collapse. 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 190 A MANUAL OF TOXICOLOGY. 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.- Tannic Acid (in 10 to 20 grain doses) is recom- mended. 2. Stimulate heart, circulation, and -respiration with Brandy or Whisky (2 teaspoonful doses by mouth every 10 to 15 minutes, or % teaspoonful doses hypodermically as frequently), or with Aro- matic Spirit of Ammonia (a teaspdonful in a little water every 10 to 15 minutes, or % teaspoonful hy- podermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypodermically every to 2 hours), or Tinc- ture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every )Z to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every %' to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to I hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 3. Give Opium (Powdered Opium, 1 to 2 grains every % to 2 hours), or Laudanum (20 drops every % to 2 hours by mouth or hypodermically every % to 2 hours), to relieve local irritant action. SANTONIN. 191 SANTONIN. HISTORY: About 2 grains of Santonin killed a boy y/2 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 3 grains, and for adults twice that quantity. Death by asphyxia. SYMPTOMS: Color vision is disturbed, objects first assuming a violet or bluish, then yellow tinge ; ringing in ears ; headache; dizziness; dilated pupils; sweating; weak pulse ; abdominal pain ; convulsions ; stupor. Santonin is excreted by the kidneys, coloring acid urine greenish-yellow, alkaline urine cherry-red or crimson. TREATMENT: i. Evacuate the stomach: syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, 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 (i/to 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 % 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- 192 A MANUAL OF TOXICOLOGY. podermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every % to 2 hours), and Atropine Sulphate (1/120 to 1/60 grain hypodermically everyto 2 hours), or Tinc- ture of Belladonna (20 drops in water every y to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or as much hypodermically, every y2 to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every y to 1 hour), and inhalations .of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purpose. Draughts of strong coffee may also be given. 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 vomiting of blood anesthesia, uter- ine hemorrhage, and abortion. TREATMENT: 1. If patient has not vomited freely, repeatedly syphon out the stomach with warm water, or give Apomorphine Hydrochlorate, hypodermically (1/10 SAVINE. 193 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 the bowels have freely moved. 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 Ct teaspoonful hypodermically as fre- quently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 grain hypodermically every p2 to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours), or Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour) and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. 5. Employ artificial heat (such as hot water bottles, or ordinary bottles containing hot water, or 194 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. 6. Give Opium (Powdered Opium, i to 2 grains every to 2 hours), or Laudanum (20 drops every to 2 hours by mouth, or % teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (*4 grain by mouth or hypodermically every % to 2 hours), to relieve pain and nervous irritability. SCHEELE'S GREEN. (See Arsenic). SCOPARIUS. (See Digitalis). 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. SYMPTOMS: 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 SILVER COMPOUNDS. 195 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. TREATMENT: No true antidote is known. If there is time to do anything, fresh air, stimula- tion with Ammonia to the nostrils, and Aromatic Spirit of Ammonia by mouth (% to I teaspoonful in water every io to 20 minutes), and Brandy or Whisky (in teaspoonful doses by mouth, or half as much hypodermically, every 10 to 20 minutes), and Strychnine Sulphate (1/60 to 1/20 grain hypoder- mically every % to 2 hours) will help. Rest is bene- ficial. Transfusion of blood and the introducing of a normal salt solution into the veins have proven advantageous. Chlorine water or Dilute Hydro- chloric Acid and Potassium Chlorate internally, are recommended. Give Oxygen inhalations. SILVER COMPOUNDS (SILVER NITRATE, LUNAR CAUSTIC) - ETC. HISTORY: Nitrate of Silver turns black when contaminated with organic matters. It acts principally as a cor- rosive poison when taken internally. Prolonged administration of the Silver Compounds produces a blue or gray-black indelible discoloration of the skin, beginning first around the nails and fingers. Acute poisoning is rare ; usually from accidentally swal- lowing a piece of Nitrate of Silver stick. Death commonly results from asphyxia. SYMPTOMS: Pain ; vomiting of a white cheesy matter, which in sunlight rapidly turns black; purging; cramps; diz- ziness; cardiac depression; respiratory disturbance; convulsions ; paralysis ; coma : collapse. 196 A MANUAL OF TOXICOLOGY. TREATMENT: i. Give Sodium Chloride-common salt-(a table- spoonful of salt to the pint of water or even milk) freely, as the chemical antidote. It 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), or Zinc Sulphate (20 grains in water, repeated in 10 to 15 minutes if vomiting is not produced), or Ipecacu- anha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, 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 (such as white of egg, milk, oil, gum arabic, flaxseed or elm tea, barley or starch water, oatmeal, gelatin, flour and water, or even crushed bananas), to soothe and protect the irri- tated or inflamed surfaces. 4. Give Opium (Powdered Opium, 1 to 2 grains every to 2 hours), or Laudanum (20 drops every % to 2 hours by mouth, or *4 teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every % to 2 hours), to relieve pain and nervous irritability. 5. If necessary, stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or % teaspoonful hy- podermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little wates every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every J4 to 2 hours), SNAKE VENOM. 197 and Atropine Sulphate (1/120 grain hypodermically every to 2 hours), or Tincture of Belladonna (20 drops in water every | to 2 hours). Tincture of Digitalis (15 to 30 drops by mouth, or half as much hypodermically, every 4 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 same purposes. Draughts of strong coffee may also be given. SNAKE VENOM-SNAKE BITE. (The Bite of Various Poisonous Serpents.) HISTORY: The venom of the viper contains albumin, albumoses and globulin, all poisonous. The venom of the coora contains albumin, globulin, and syntonin, all poisonous. One four millionth of the body weight of cobra venom causes death. Death by paralysis of cardiac and respiratory centres usually inside of 12 hours. If death occurs in a few minutes, due to thrombosis; if, under 24 hours, by par- alysis of cardiac and respiratory centres; if after 24 hours, by exhaustion or sepsis. In fatal cases the blood deteriorates and will not coagulate. Poisonous snakes are thicker than harmless ones, and the tail is shorter. They also appear rough, owing to the dorsal scales being keeled. The head is also tri- angular ; they have a peculiar pit or depression in the upper jaw between the eye and the nose, and they have elliptical pupils. The poison is secreted by glands corresponding to the parotids in man; it is a thin yellowish fluid, varying in quantity from one drop to a drachm, according to the variety and size of the snake. SYMPTOMS: Symptoms more or less severe. Intense thirst, skin clammy. Chief symptoms are: Intense shock; severe pain 198 A MANUAL OF TOXICOLOGY. in part bitten; area of pain rapidly increases; local partial paralysis; intense swelling of portion of body injured, which later becomes livid and gangrenous; fainting; vomiting; small, frequent, irregular pulse; hemorrhages; bloody stools and urine; lethargy; dif- ficult respiration; convulsions; death. It is thought the peptones in the venom deter- mine the amount of local edema, the convulsions and also the paralysis of respiration: the globulins are sup- posed to disorganize the blood and produce hemor- rhage. TREATMENT: i. Thoroughly suck or cup the wound; ligate above it, between the wound and the heart, using piece of rope, or even pocket-handkerchief; cut out the bitten part or cauterize it thoroughly with caustic, red hot iron or live coal, or apply strong Nitric Acid or a solu- tion of Potassium Permanganate, or even put on Gun- powder and set fire to it. Subcutaneous injection, if possible, in orifice made by fangs or application of Potassium Permanganate (5 to 10 grains to the pint of water) solution, has been highly recommended. Also the injection about the wound, of about 10 min- ims of a 10 per cent, solution of Calcium Hypochlorite, or solution of Aurum Chloride. Elimination may be aided by inducing free perspiration or salivation by Pilocarpine Hydrochlorate (1/100 to 1/60 grain hypodermically). The free application of Ammo- nia Water has proved efficacious. Washing wound thoroughly and then applying 25 per cent. Carbolic Acid solution recommended. Application of Tincture of Iodine advised. Also Galium Circaezans internally. Bleeding patient on bitten limb and transfus- ing blood by other limb is recommended when severely poisoned by cobra. Quite recently the administration, or hypodermic in- jection in 15 to 20 c.c. doses, of a serum called Anti- vene has saved the lives of various persons bitten by the cobra. It seems likely to prove a perfect anti- dote. Bile, or the water soluble portion of it, is said to be as good. 2. Encourage heart action and circulation by SPIGELIA. 199 weak interrupted galvanic currents applied to the chest in region of the heart. 3. Give Ammonia inhalations and stimulate with Brandy or Whisky very freely (2 to 8 teaspoonful doses or more every 10 to 15 minutes, or | teaspoon- ful doses hypodermically as frequently), and with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or | teaspoonful hypoder- mically as frequently, which, if possible, should be injected into the radial vein, with an equal volume of water). Strychnine Sulphate (1/60 to 1/20 grain hypodermically every 10 to 20 minutes if necessary for several doses). If respiration is seriously interfered with, resort to artificial respiration and maintain for several hours. Keep patient quiet and provide fresh air freely. Transfusion of healthy blood or intravenous injec- tion of normal salt solution may be required. Tn rattlesnake bite, Olive Oil freely, both externally and internally, is by some considered a specific. It is believed that snake-charmers render them- selves immune to venom by taking small doses by the mouth. SODA. (See Alkalies). SPIGELIA (PINK ROOT). SYMPTOMS: Vertigo; dimness of vision; dilated pupils; dry throat; convulsions ; delirium. TREATMENT: i. Evacuate the stomach: syphon out the stomach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such 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 200 A MANUAL OF TOXICOLOGY. 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 Sa vine on Page 193. SQUILL (SCILLA). (See Digitalis.) STRAMONIUM (JAMESTOWN WEED, THORN APPLE, DEVIL'S APPLE). HISTORY: 100 seeds killed a child 2 years old. Recovery after ounce of the leaves infused in boiling water. Symptoms and Treatment similar to Belladonna. STROPHANTHUS (KOMBE ARROW POI- SON)-STROPHANTHIN-OUABAIN. HISTORY: Fatal dose: Strophanthin is three times as poison- ous as 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). SYMPTOMS: Pulse weak; urine increased; muscular rigidity; spasms. TREATMENT: Recumbent position. i. Evacuate the stomach if just taken; syphon out the stomach with a stomach-tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 table- spoonfuls of water, repeated in 15 minutes if vomit- ing is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecac- STROPHANTHUS. 201 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 14 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 202 A MANUAL OF TOXICOLOGY. hypodermically) and Potassium Permanganate are recommended. Also ice to spine, and a tobacco gnema. For threatened death from embarrassed respira- tion, resort to artificial respiration (rhythmically raising and lowering arms from straight at sides to up over head and back again, 18 or 20 times a min- ute). „ SULFONAL - TRIONAL. HISTORY: Death in 40 hours from 2 15-grain doses taken in an hour and a quarter. Also death on fourth day from taking over an ounce. SYMPTOMS: Giddiness; weakness; tumbling and walking about unsteadily; cyanosis; suppressed urine; ptosis; may be papular skin eruption. TREATMENT: 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. 2. Give Spirit of Nitrous Ether (1 to 2 teaspoon- fuls in water every to 2 hours) and Magnesium Sulphate-Epsom Salt-(2 tablespoonfuls in a cup- TIN COMPOUNDS. 203 ful of water). Give Sodium Bicarbonate (a tea- spoonful in a gobletful of water). ' 3. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or Ct 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). 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. SULPHURETTED HYDROGEN. (See Hydrogen Sulphide). TANSY (TANACETUM VULGARE). HISTORY: Fatal dose: As a rule *4 ounce of the oil causes death ; i drachm of it has caused death. The dose of the oil is i minim. Death by paralysis of heart. SYMPTOMS: Characteristic tansy odor of breath ; convulsions ; unconsciousness; dilated pupils; hurried, stertorous breathing; full, gradually weakening pulse. TREATMENT: Treat same as in poisoning by Savine. TARTAR EMETIC. (See Antimony). TIN COMPOUNDS. SYMPTOMS: Metallic taste in mouth; vomiting; diarrhoea; pain ; diminished heart action. 204 A MANUAL OF TOXICOLOGY. TREATMENT: i. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not pro- duced), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 min- utes until vomiting results), or Apomorphine Hy- drochlorate, hypodermically (1/10 grain, repeated every 15 minutes until effective).' After giving emetic, always give plenty of luke-warm water to encourage vomiting. 2. Give milk or white of egg freely. 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 % 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 ^2 to 2 hours) to relieve pain and nervous irrita- bility. TOBACCO-NICOTINE. HISTORY: Pure Nicotine is a colorless oily liquid, and is rapidly fatal. Poisoning has resulted from mistak- ing infusion for coffee; from tobacco chewing and smoking; from giving for worms, or to induce abor- tion ; from children using old tobacco pipes to blow TOBACCO-NICOTINE. 205 soap bubbles; from local applications of tobacco, etc. Boys have- died as the result of smoking to- bacco. Death by paralysis of respiration or of heart. ✓ SYMPTOMS: Severe depression ; giddiness ; feeling of wretched- ness and weakness; nausea; vomiting; weak, rapid pulse; cold, clammy skin; pupils at first contracted, then dilated; dyspnoea; muscular tremblings; there may be convulsions. TREATMENT: Put patient in a horizontal position. i. If free vomiting does not occur, evacuate the stomach; syphon out the stomach with a stomach- tube, using plenty of water. If the stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 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 &very 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 (% 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 206 A MANUAL OF TOXICOLOGY. every % to 2 hours), or Tincture of Nux Vomica (30 minims in 2 tablespoonfuls of water by mouth), as an antagonist. Also stimulate with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or %' teaspoonful doses hypodermically as fre- quently), or give Chloroform (20 to 30 drops 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 the feet and sides of the body), to main- tain bodily temperature. TRIONAL. (See Sulfonal). TRUFFLES. (See Fungi). TURPENTINE-OIL OF TURPENTINE- (SPIRIT OF TURPENTINE). HISTORY: Usually given by mistake, or overdose when used to expel worms. A child died in 15 hours from % ounce of the oil; a teaspoonful killed a 5 months old infant; recovery in child under 2 years old after taking a tablespoonful. Death by paralysis of respiration. SYMPTOMS: 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; d*y, moist skin; feeble, rapid pulse; coma; collapse. Somewhat resembles poisoning by Opium TREATMENT: 1. Evacuate the stomach if seen promptly; sy- phon out the stomach thoroughly with a stomach- URETHAN. 207 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), to soothe and protect the irritated and inflamed surfaces. 4. Give Opium (Powdered Opium, 1 to 2 grains every p2 to 2 hours), or Laudanum (20 drops every to 2 hours by mouth, or teaspoonful in gruel by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypodermically every to 2 hours), to relieve pain and nervous irritability. (See Fish Poison and Ptomaines). TYROTOXICON. HISTORY: Death by asphyxia. SYMPTOMS: Vomiting; reduced temperature and heart action; muscular weakness; general anesthesia. URETHAN. 208 A MANUAL OF TOXICOLOGY. TREATMENT: i. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in two tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), or Cupric Sulphate (3 to 5 grains in 2 tablespoonfuls of water every 5 to 10 minutes until it acts), or Mustard (a tablespoonful in a small cup- ful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipecacuanha, 30 grains; or Syrup of Ipecac, a teaspoonful every 10 to 15 minutes until vomiting results), or Apomorphine Hydrochlorate, hypodermically (1/10 grain, re- peated every 15 minutes until effective). After giv- ing emetic, always give plenty of luke-warm water to encourage vomiting. 2. Stimulate heart, circulation, and respiration with Brandy or Whisky (2 teaspoonful doses every 10 to 15 minutes, or' % teaspoonful doses hypo- dermically as frequently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours) and Atropine Sulphate (1/120 to 1/60 grain hypo- dermically every *4 to 2 hours), or Tincture of Bella- donna (20 drops in water every )4 to 2 hours). Tinc- ture of Digitalis (30 drops by mouth, or half as much hypodermically, every J4 to 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every *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, VASELIN OR PETROLATUM. 209 VASELIN OR PETROLATUM. Vaselin or Petrolatum is sometimes taken or given to children for colds or various lung affec- tions. Large doses of the latter may produce un- favorable symptoms. SYMPTOMS: If unfavorable symptoms occur, may be cramps in lower extremities; severe, persistent vomiting; collapse. TREATMENT: i. Evacuate the stomach if vomiting is not free; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, repeated in 15 minutes if vomiting is not produced), Mustard (a tablespoon- 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 % 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 ^2 to 2 hours), and Atropine Sulphate (1/120 grain hypodermically every *4 to 2 hours), or Tincture of Belladonna (20 drops in water every % to 2 hours). Tincture of Digitalis (30 drops by mouth, or half as much hy- podermically, every to 2 hours), or Digitalin 210 A MANUAL OF TOXICOLOGY. (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and inhalations of Amyl Nitrite (a 3 or 5 minim pearl crushed in a handkerchief and inhaled, using one every % to 1 hour if necessary), may be used for the same purposes. Draughts of strong coffee may also be given. VERATRUM-VERATRUM ALBUM (WHITE VERATRUM, WHITE HELLEBORE)- VERATRUM VIRIDE (GREEN HELLE- BORE)-VERATRINE. HISTORY: Usually taken by mistake. Veratrine sometimes used to commit murder. 1/16 grain of Veratrine has caused dangerous symptoms. Death by paralysis of respiratory centres. SYMPTOMS: Burning and pain in alimentary canal; pro- nounced muscular relaxation ; inability to swallow ; nausea; vomiting; diarrhoea; palpitation pf heart; pulse slow, thready; respiration labored; pupils usually dilated; may be convulsions. TREATMENT: Keep patient in horizontal position, with head lowest, and provide plenty of fresh air. i. Evacuate the stomach unless vomiting has been free, from action of drug itself; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 table- spoonfuls of water, repeated in 15 minutes if vomit- ing is not produced), or Mustard (a tablespoonful in a small cupful of water, repeated in 15 minutes if not effective), or Ipecacuanha (Powdered Ipe- cacuanha, 30 grains; or Syrup of Ipecac, a teaspoon- VERATRUM, ETC. 211 ful 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) in water (2 tablespoonfuls), or give plenty of strong tea, or a decoction of oak bark (% ounce to a small cupful of water). 2. Stimulate with hypodermic injections of Sul- phuric Ether (10 to 15 minims), or with Brandy or Whisky (2 teaspoonful doses every 10 to 15 min- utes, or % teaspoonful doses hypodermically as fre- quently), or with Aromatic Spirit of Ammonia (a teaspoonful in a little water every 10 to 15 minutes, or % teaspoonful hypodermically as frequently) ; also-with Strychnine Sulphate (1/60 to 1/20 grain hypodermically every to 2 hours), and Atropine Sulphate (1/120 grain hypodermically every % to 2 hours), or Tincture of Belladonna (20 drops in water every *4 to 2 hours). Tincture, of Digitalis (30 drops by mouth, or half as much hypodermic- ally, every y2 td 2 hours), or Digitalin (1/100 grain hypodermically every % to 1 hour), or Caffein Citrate (1 to 4 grains every % to 1 hour), and in- halations of Amyl Nitrite (a 3 or 5 minim pearl crushed in 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. 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, 1 to 2 grains every ^2 to 2 hours), or Laudanum (20 drops every /2. to 2 hours, or % teaspoonful in gruel by rectum 212 A MANUAL OF TOXICOLOGY. as frequently), or Morphine .Sulphate (Ci grain by mouth or hypodermically every C 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). VERDIGRIS. (See Copper). (See Arsenic, Phosphorus, Strychnine). VERMIN KILLERS. WOORARA. (See Curare). WHITE PRECIPITATE. (See Mercury Compounds). WOUNDS, POISONOUS (POST MORTEM, DISSECTING, ETC.). SYMPTOMS: Pain; swelling; inflammation. 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 or Bichloride of Mercury solution. ZINC COMPOUNDS: ZINC CHLORIDE - ZINC SULPHATE (WHITE VITRIOL), ETC. HISTORY: The Chloride used in embalming, as disinfectant and by tinsmiths, is corrosive, and the commonest ZINC COMPOUNDS. 213 cause of dangerous symptoms. White Vitriol is the Sulphate. Fatal dose: 6 -grains of Chloride; % to I ounce of the Sulphate. Fatal results from the Chloride in 4 hours. The infrequency of fatal result from Zinc Sulphate is due to its being almost always ex- pelled by vomiting. 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. TREATMENT: Antidotes: Albumin, soap, alkaline carbonates, and mucilage. i. Evacuate the stomach; syphon out the stomach with a stomach-tube, using plenty of water. If a stomach-tube is not at hand, use an emetic, such as Zinc Sulphate (20 grains in 2 tablespoonfuls of water, 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. The stomach-pump may be used if necessary. Put Sodium or Potassium Carbonate or Bicar- bonate (% ounce) in water used in syphoning, or give in water after emetic to assist emetic action, etc., etc. 2. Give freely white of egg in water or milk. Give Tannic Acid or Gallic Acid (30 grains in 2 214 A MANUAL OF TOXICOLOGY. tablespoonfuls of water), or give copious draughts of strong tea, or a decoction of oak bark (% ounce to a small 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 (Powdered Opium, 1 to 2 grains every to 2 hours by mouth, or teaspoonful in gruel or starch water by rectum as frequently), or Morphine Sulphate (% grain by mouth or hypo- dermically every % to 2 hours), to relieve pain and nervous irritability. KEY TO TREATMENT. (A digest arranged from the preceding pages of Part II.) POISON TREA ANTIDOTAL T M E N T ANTAGONISTIC ACETANILID. ANILIN. ANTI PYRIN E. EXALGIN. PHEN ACETIN. Evacuate the stomach. Recumbent position. Stimulants. Artificial respiration. ACID- ACETIC. -Mineral Acids- HYDROCHLORIC. PHOSPHORIC. NITRIC. SULPHURIC. f Magnesia. Albumin. Lime-Water. Soap, Demulcents. Stimulants. Opium. ACID- CARBOLIC (and CREOSOTE). Alcohol. Evacuate stomach. Sodium or Magnesium Sulphate. Lime-Water or Syrup of Lime. Soap. Vegetable Demulcents. Atropine. Opium. Stimulants.. External heat. 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. Evacuate stom- ach if there is time. Demulcents if required. Cold douches. Ammonia or Chloride of Lime inhalations. Artificial respiration. Stimulants. ACID- OXALIC. Lime in any form. Magnesia. Demulcents. Stimulants. Opium. External heat. ACONITE. Tannic Acid or animal Charcoal. 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 various cardiac and respiratory stimulants, such as Ammonia, Digitalis, Caffeine, Strychnine, Nitroglycerine, Atropine, etc. 216 KEY TO TREATMENT. POISON TRE^ ANTIDOTAL T M E N T ANTAGONISTIC 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 Alcohol. ALKALIES- AMMONIA, CAUSTIC POTASH, CAUSTIC SODA, LIME, etc. Dilute Acids, especially Vegetable Acids. Milk. Oil. Stimulants. Artificial heat. Opium. For Ammonia: Aconite, Digitalis, cold air. ALKALOIDS. Tannic Acid. Charcoal. Iodine. Albumin. Evacuate stomach. s Maintain circulation and respiration. ANESTHETICS- CHLOROFORM, ETHER, NITROUS OXIDE. When Swallowed: Evacuate stomach if possible, and give demulcents if necessary. Rem.ove '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. 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. Stimulants. Opium if necessary. BARIUM and its COMPOUNDS. Evacuate stomach. Mag- nesium or Sodium Sul- phate. Demulcents. Stimulants. Opium if necessary. BELLADONNA. HYOSCYAMUS. STRAMONIUM. Tannic' Acid. Evacuate stomach. Opium. Pilocarpine Ni- trate. Muscarine. Arti- ficial respiration. Alter- nate hot and cold douches. External heat. Stimulants. CANNABIS- AMERICAN or INDIAN HEMP. Tannic Acid. Evacuate stomach. Stimulants. External heat. A MANUAL OF TOXICOLOGY. 217 POISON T R E A ANTIDOTAL T M E N T ANTAGONISTIC CHLORAL. Evacuate stomach. (Is well to syphon out stomach with tea or coffee.) Liquor Potass®. Artificial respiration. Cold to head. Ammonia and Oxygen inhalations.' External heat. Picro- toxin. Strychnine. Atropine,. Stimulants. COCAINE. If swallowed: Give Tannic Acid and evac- uate stomach if possible. Horizontal position. Fresh air. Artificial res- piration. Stimulants. Oxygen. Electricity. CONIUM. Tannic Acid. Evacuate stomach. Demulcents. Place head- low. Stim- ulants. Artificial heat. Artificial' respiration if necessary. COPPER and its COMPOUNDS. Potassium Ferrocyanide. Albumin or milk. Evacuate stomach. Demulcents. Artificial heat. Stimulants. Opium. CROTON OIL. Evacuate stomach. Demulcents. Artificial heat. Opium. Stimulants. DIGITALIS. Tannic Acid. Evacuate stomach. Magnesium Sulphate. Horizontal position. Aconite. Saponin. Alcoholic stimulants. Artificial respiration. 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. Starch or flour with water. Evacuate stom- ach. Demulcents. Stimulants. Artificial heat. Morphine. LEAD and its COMPOUNDS. Magnesium or Sodium Sulphate. Evacuate stomach. Demulcents. Stimulants. Opium if necessary. 218 KEY TO TREATMENT. POISON TREA ANTIDOTAL T M E N T ANTAGONISTIC LOBELIA. Tannic Acid. Evacuate stomach. Castor Oil. Stimulants. Artificial heat. Opium. Stimulants. Artificial heat. Opium. MERCURY and its COMPOUNDS. Albumin. Evacuate stomach if vomiting has not oc- curred. NITRO- GLYCERINE. Horizontal position. Cold to head. Atropine. Ergot. Strychnine. NUX VOMICA, STRYCHNINE, BRUCINE, etc. Charcoal, Tannic Acid, or Potassium Perman- ganate. Evacuate stom- ach quickly before con- vulsions. Horizontal position in dark, quiet room. Arti- ficial respiration. Chlor- oform for convulsions. Bromides. Chloral. Opium. OPIUM- LAUDANUM. PAREGORIC. MORPHINE. CODEINE. ' HEROINE, etc. Potassium Permangan- ate or Tannic Acid. Evacuate stomach. Keep patient awake by flagellation, electricity, etc. Atropine. Artificial respiration. External heat. Stimulants. Coffee, Tincture of Capsicum, vinegar, or lemon juice. PHOSPHORUS. Copper Sulphate. Old Oil of Turpentine. Po- tassium Permanganate early. Evacuate stom- ach. Magnesium Sul- phate. (No fats or oils.) Opium. Oxygen inhalations. SILVER COMPOUNDS. Sodium Chloride. Evacuate stomach. Demulcents of albumin, milk, etc. Opium. Stimulants if necessary. STROPHANTHUS. Tannic Acid. Evacuate stomach. Saline cathartic. Chloroform or Ether inhalations. Chloral or Bromide. Artificial res- piration. 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. Artificial heat. Opium. Electricity. ZINC COMPOUNDS. Tannic Acid. Evacuate stomach. Albumin. Lime-Water. Soap. Mucilage. Milk. Morphine. Hot fomentations. INDICATIONS OF VARIOUS SYMPTOMS. 219 PART III. THE INDICATIONS OF VARIOUS SYMPTOMS. Suspect: Wood Alcohol, Barium, Digitalis, Qui- nine, Nicotine, etc. BLINDNESS. 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. BREATH (Phosphorescence of Breath). Suspect: Phosphorus. COLLAPSE. Suspect: Concentrated corrosive acids or alka- lies, Antimonial preparations, Arsenic,' Colchicine, Nicotine. COLOR (Objects Appear Yellow or Green). Suspect: Santonin. COMA, PROFOUND. Suspect: Alcohol, Aniline Oil, Belladonna, Car- bon Monoxide, Chloral and its analogues, Chloro- form and its analogues, Coal Gas, Opium or Mor- phine, Oxybutyric Acid, Sulfonal, Trional. 220 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, 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. Suspect: Acid Hydrocyanic, Acid Carbolic, Car- bon Dioxide, Creosote, Potassium Cyanide or other cyanides. DEATH, QUICK AND SUDDEN. DELAYED SYMPTOMS. (First symptoms of poisoning 12 to 24 hours after eating). Suspect: Arsenic (not in solution), Mushrooms containing Phallin, Virus of rabid animals. Suspect: Alcoholism, Cocaine habit, Morphine habit, Maydism, Mercurialism Ergotism, Ether- ism, Saturnism, Carbon Disulphide, Iodoform. DEPRESSION, MENTAL. Suspect: Antimony and substances containing it, Arsenic and substances containing it, Colchicine, DIARRHCEA WITH VOMITING. INDICATIONS OF VARIOUS SYMPTOMS. 221 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, but not Blue). Suspect: Poisoning by Arsenic (Arsenical-mel- anosis), Copper; Lead, Mercury, Argyria. 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. Reddish-Yellow: Salts of Chromic Acid and Bi- chromates. Greenish-Blue: Paris Green, salts of Copper. DISCOLORATION (Icteric, or Pseudo-Icteric, Yellowish-Brown Discoloration of the Conjunc- tiva or of the Skin). ySuspect: Amyl Nitrite, Arsine, Helvellaic Acid, Phosphorus, Phallin, Potassium Chlorate, Pyro- gallol, Saponin substances, Sodium Nitrate, Sola- nin. ERUPTION (Acne Pustules). Suspect: Bromides, compounds of or substances which contain Antimony, arsenicals, Emetine. 222 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. GUMS (Dark Line or Border on Gums). Suspect: Bismuth, Copper (green), Lead (blue), Mercury (bluish), Silver. HEARING, IMPAIRED OR LOST. Suspect: Barium'; Bromism, Cinchonism, Sali- cism. ILLUSIONS, VISIONS, ETC. - Suspect: Absinthe, Opium and Morphine, Co- caine, etc. MANIA OR DELIRIUM (Raving Mania, Rag- ing Delirium, or Mental Excitation). Suspect: Alcoholism (chronic), Atropine, Cam- phor, Cannabinon, Cocaine, Physostigmine, Vera- trine. MISCARRIAGE OR ABORTION. May be due to: Cotton Root Bark, Cornutin, Pennyroyal, Phosphorus, Rue, Savine, Tansy, etc. INDICATIONS OF VARIOUS SYMPTOMS. 223 CEDEMA (of Glottis). Suspect: Ail the corrosive poisons. CEDEMA (Pulmonary). Suspect: Ammonia, Morphine, Muscarine, Pilo- carpine. PARALYSIS (As a rule, Ascending). Suspect: Colchicine, Coniine, Curare, Ergotinic Acid, Guachamaca-poison. PERSPIRATION, PROFUSE. Suspect: Aconite, Acetanilid, Antipyrine, Exal- gin, Phenacetine, Sulfonal, etc. 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- talin group. 224 A MANUAL OF TOXICOLOGY. PUPILS, CONTRACTED. Suspect: Codein, Morphine (Opium), Musca- rine, Nicotine, Physostigmine, Pilocarpine. PUPILS, DILATED. Suspect: Aconitine, Atropine, Cocaine (subse- quently contracted), Coniine, Eppedrin, Gelsemine, Homatropine, Hyoscyamine, Scopolamin (Hyos- cin). SALIVATION. Suspect: Ammonia, Antimony, Arsenic, Can- tharidin, Cytisin, Mercury, Muscarine, Nicotine, Physostigmine, Pilocarpine, Saponin substances, etc. SKIN, MOUTH AND PHARYNX, VERY DRY. Suspect: Atropine, certain parts of Belladonna, Hyoscyamus, Thorn, Apple, Allantotoxin (from de- caying fish), Hyoscin, Hyoscyamine, Scopolamin. SKIN, MOIST. Suspect: Aconitine, Antimony, Lobelin, Mor- phine, Muscarine, Nicotine, Opium, Physostigmine, Pilocarpine. SKIN, YELLOW. Suspect: Picric Acid and its salts. TASTE, FOUL. Suspect: Arsenic, Copper, Lead, Mercury, Po- tassium Iodide, Tartar Emetic. INDICATIONS OF VARIOUS SYMPTOMS. 225 TEMPERATURE, MARKED ELEVATION 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. URINE, CLARET-COLORED (from Haemato- porphyrin). Suspect: Sulfonal, Trional. URINE, REDDISH-YELLOW. Suspect: Picric Acid and its salts. URINE, ICTERIC. Suspect: Cephalanthin, Phallin, Phosphorus. Tolulene, Diamin. URINE, ACID (Containing Colorless Crystals). Suspect: Oxalic Acid and its Salts. URINE (Becoming Scarlet Upon Exposure to Air). Suspect: Santonin. 226 A MANUAL OF TOXICOLOGY. URINE (Becoming Dark-Green Upon Exposure to Air). Suspect: Carbolic Acid. 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- gallol, Uranium salts. URINE (Very Odorous). Suspect: Ammonia, Asparagus, Tellurium, Tur- pentine Oil (violets), and other ethereal oils. URINE (Unnatural Scantiness or Suppression). Suspect: Cantharidin, Corrosive Sublimate and other mercurial preparations, Oxalic Acid, Oxa- minic Acid, Oxamid, Potassium Oxalate. VISION, DOUBLE. Suspect: Belladonna, Conium, Gelsemium, Pto- maine-poisoning, etc. VOICE (Loss of Voice). In Barium, Lead paralysis, Trichinosis, etc. INDICATIONS OF VARIOUS SYMPTOMS. 227 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- cissus poison, etc. ACID CARBOLIC. 229 PART IV. TABLE OF IDENTIFICATION TESTS FOR POISONS. ACID CARBOLIC (PHENOL). Carbolic acid added either to albumin or collodion causes such to coagulate. An aqueous solution of carbolic acid treated with one drop of ferric chloride solution gives a permanent violet blue color (the reaction may be interfered with by the presence in excess of hydrochloric or acetic acid or alcohol) ; the color produced by creosote with ferric chloride solution is at first violet blue, but changes rap- idly to greenish and brown, with formation usually of a brown precipitate. With bromine water, carbolic acid forms a white flocculent precipitate of tribrom-phenol. Carbolic acid mixed with ammonia water and a little chlorinated soda solution, and warmed, develops a blue color. To a few drops of carbolic acid solution on a white porcelain surface add three or four drops of a solution of one part of molybdic acid in ten or fifteen parts of concentrated sulphuric acid; a yellowish- brown coloration results, which is soon followed by a beautiful purple color. When carbolic acid is in the urine, it is in combina- tion with the sulphates, so that neither the sulphuric nor the phenol radical will respond to the usual tests; but the natural quantities of sulphates again appear if the urine be boiled with hydrochloric acid. The pre- ceding tests may then be employed. In making post-mortem investigations, the odor of 230 A MANUAL OF TOXICOLOGY. carbolic acid is, as a rule, observable upon opening the body. The stomach contents are to be acidified and distilled, and the various tests applied to the dis- tillate. ACID HYDROCHLORIC. Hint.-All acids turn blue litmus red. If a glass rod be dipped in ammonia water and then held over hydrochloric acid, dense white fumes are pro- duced. Hydrochloric acid, even in diluted solutions, treated with silver nitrate, gives a curdy white precipitate which is dissolved upon adding ammonia water, and reprecip- itated by nitric acid. ACID HYDROCYANIC. A characteristic test is its odor: it has the odor of bitter almonds or peach kernels. A glass rod moistened with silver nitrate becomes milky in the vapor of hydrocyanic acid. By silver nitrate, the acid is precipitated as silver cyanide, a white, curdy precipitate, not soluble in cold or weak nitric acid, but entirely soluble in boiling con- centrated nitric acid. To the suspected liquid add a little solution of potash and then a mixture of ferrous and ferric sulphates; a dirty greenish-blue precipitate results, which, should hydrocyanic acid be present, becomes clear Prussian blue on acidifying with pure hydrochloric acid. Liebig's test (characteristic in the absence of me- conic acid) :- Treat a solution of hydrocyanic acid with ammonium sulphide, and gently heat; a white sulphocyanide of ammonium is produced; by touching this with a drop of persulphate or perchloride of iron, a blood-red sul- phocyanate of iron results. Make suspected fluid slightly alkaline with potash; add cupric sulphate solution and a greenish-white pre- ACID NITRIC. 231 cipitate will be obtained; add a few drops of hydro- chloric acid, and it turns white. If, in post-mortem investigations, the jar in which the liver, brain, stomach and contents, and other or- gans, is received, is gently warmed, and a glass rod or watch glass moistened with silver nitrate solution held over its mouth, the vapor which rises from the contents of the jar will, if hydrocyanic acid is present, form white, crystalline silver cyanid, on the rod or watch glass. This may be proved to be silver cyanid and not silver chlorid by its turning blue, upon adding hydrochloric acid and a mixture of ferrous and ferric sulphate. Extended chemical analysis is carried out as indicated in Part V of this book. As a rule, hydrocyanic acid may be found in the body for about three weeks after death. But in case of body decomposition the sulphuretted hydrogen gen- erated may convert the acid into the thiocyanate. In such case the thiocyanate should be dissolved out by alcohol, and this followed by filtration and evaporation. The residue should then be dissolved in water and tested by a ferric salt. Thiocyanate has been found in the body as long a time after death as four months. The fact that thiocyanates are found in the saliva and the latter may have been mixed with the material under investigation, should not be overlooked. ACID NITRIC. Concentrated nitric acid is known by its orange colored, irritating fumes. Poured on copper filings it effervesces, gives off red acrid vapor and, a blue liquid remains. Nitric acid mixed with hydrochloric acid dissolves gold. A trace of nitric acid with sulphuric acid gives a blood-red color with narcotine. The strong acid gives a deep red color with brucine. Nitric acid stains all albuminoid substances yellow; gives a yellow stain on skin or piece of quill; reddens morphine and its salts; blackens green iron sulphate in the presence of sulphuric acid. 232 A MANUAL OF TOXICOLOGY. ACID OXALIC. The crystals are oblique, flattened, octahedral prisms, colorless, odorless, permanent in the air, and very acid; thus distinguished from crystals of magnesium sul- phate, and zinc sulphate. When the crystals are heated they melt, dissipate without charring and leave no residue. Cupric sulphate added to solution of oxalic acid gives a light-blue precipitate of cupric oxalate not re- dissolved by a few drops of hydrochloric acid. Adding lime water forms calcium oxalate, which is insoluble in excess of lime water but soluble in nitric acid or hydrochloric acid, but not in any vegetable acid. To a solution of oxalic acid add silver nitrate and a white precipitate of oxalate of silver is produced, soluble in nitric acid; when dried and heated on plati- num foil it detonates and evolves a white vapor. In post-mortem analyses, acidify the material to be tested (kidneys, stomach and contents, etc.) with hy- drochloric acid and digest the whole for several hours with dilute alcohol, stirring frequently. After filtra- tion ammonium hydroxid should be added to the fil- trate until the latter is alkaline; acetic acid should then be added until a slight excess results; then add cal- cium chlorid; after thorough stirring stand the mix- ture aside. If a precipitate results, it is from the combination of oxalic acid with calcium. Under the microscope the characteristic octahedral crystals may be identified. The salt turns gray upon being heated. Dissolve some of the precipitate in water, acidify with dilute sulphuric acid; upon adding a few drops of potassium permanganate solution, decolorization of the permanganate occurs. The acid looks oily and is heavy. It feels soapy in the fingers. Concentrated sulphuric acid is usually white, or if impure, a brownish colored liquid, and chars wood or other organic matter. ACID SULPHURIC. ALKALIES. 233 Upon mixing it with water, heat is evolved. It forms sulphurous acid gas when boiled with mercury. Add a small portion of veratrine to some of the diluted acid, carefully evaporate to dryness, and a crim- son-purple color is obtained. Sulphuric acid gives a white precipitate with barium chloride. ALKALIES (SOLUTIONS OF AMMONIA, POTASSA, SODA). The alkalies turn red litmus blue. They feel soapy in the fingers. They are not precipitated by adding solution of potassium carbonate as the solution of alkaline earths are. They neutralize acids, and saponify fats. The presence of one of the caustic alkalies, in vom- ited matters or stomach contents, may be suspected, when in addition to alkaline reaction and soapy feeling in the fingers, the suspected materials become frothy when shaken, and produce but slight effervescence upon adding an acid. Potash, or soda, would be indi- cated if, when the suspected materials are warmed, ammoniacal odor is absent, and the holding over them of a glass rod, dipped in hydrochloric acid, produces no cloudy effect upon the surface of the rod. If some of the suspected material be filtered, the filtrate evap- orated to dryness, then heated to a dull red heat until all organic matter is destroyed, and then cooled, upon adding a small quantity of dilute hydrochloric acid a solution is obtained with which to determine whether the alkali is potash or soda. Upon testing this solution with a platinum wire held in the colorless flame of a Bunsen burner, a lavender color imparted to the flame indicates potassium, a yellow one sodium. ALKALOIDS. Wormley's test directs to treat the suspected sub- stance, in solution, with an alcoholic solution of picric acid, and if alkaloids are present a yellow precipitate will be obtained. 234 A MANUAL OF TOXICOLOGY. Mayer's reagent gives a white precipitate with alka- loids. Wagner's reagent gives with alkaloids a brown pre- cipitate soluble in alcohol. A powder of either brucine, delphine, morphine, im- pure strychnine, or physostigmine with nitric acid, gives a red color; if by adding stannic chloride it be- comes violet, it is brucine; if it becomes black, it is del- phine ; if it is soluble, giving off free iodine when iodic acid is added, it is morphine; if not soluble and will not decompose iodic acid, it is strychnine; if the powder became green when nitric acid was added, it is so- lanine; if the powder is insoluble in ether and does not redden nitric acid, it is emetine; if it is soluble in ether, does not redden nitric acid, and is volatilized, it is atropine; if it is soluble in ether, does not redden nitric acid, and is not volatilized, it is veratrine. ANTIMONY. Tartar emetic is the principal medicinal salt of anti- mony. Tartar emetic is soluble in water, but not in alcohol. If a portion of tartar emetic is heated to redness, it chars, emits an odor of burning sugar, and leaves a black residue, having an alkaline reaction. If this is mixed with charcoal and heated in a small glass tube, a dark mirror-like ring of metallic antimony will form in the cooler portion of the tube. A solution of tartar emetic treated with tincture of nutgall or solution of tannic acid gives a whitish-yel- low precipitate of tannate of antimony. Sulphuretted hydrogen gives an orange colored pre- cipitate with antimony solution. (See also Marsh's and Reinsch's Tests, described under arsenic.) ANTIPYRINE. Antipyrine gives a red color with ferric chloride; the color disappears upon adding a few drops of sul- phuric acid. ARSENIC. 235 Antipyrine gives a green color with nitric acid. To a solution add 12 drops of sulphuric acid, 2.5 grammes of sodium metaphosphate, filter and add a few drops of solution of sodium nitrate, and a green color is obtained. ARSENIC. Gives garlic-like color when sublimed on charcoal or red-hot iron. When heated in glass tube it sub- limes, forming small octahedral crystals on the sides of the tube. Sulphuretted hydrogen gives a yellow precipitate with arsenic. Ammoniated solution of cupric sulphate gives a green precipitate. Marsh's Test: Introduce some pieces of zinc, free from arsenic and antimony, into a bottle holding about 150 c.c.; then pour over them sulphuric acid, diluted with 4 parts of distilled water; close the flask with a cork containing a funnel tube, which reaches nearly to the bottom of the bottle and a delivery tube, drawn to a fine point, into which a bulb containing a pledget of cotton has been introduced. After allowing the gen- eration of hydrogen to go on for about half an hour, to expel the air from the upper part of the flask, light the gas at the open end of the delivery tube and hold a cold porcelain surface down upon the flame. If the zinc and sulphuric acid used contain no arsenic or antimony, no black stain will be produced on the por- celain. It thus being evident that the apparatus and materials are free from arsenic, put out the flame and pour the suspected fluid through the funnel tube so as to admit little or no air with it into the flask. Then ignite the gas and test the flame again with the cold porcelain surface. If a brilliant black or brown stain, soluble in a solution of chlorinated soda is obtained it is probably arsenic. If you moisten one of these spots with nitric acid it should disappear, then evap- orate the acid over a lamp, moisten the spot with water, and hold the dish over a vessel containing sulphuretted hydrogen, prepared by the action of sulphuric or hy- drochloric acid upon sodium or potassium sulphide. 236 A MANUAL OF TOXICOLOGY. If the stain was due to arsenic, the spot will turn lemon-yellow. The antimony mirror is insoluble in chlorinated soda (Labarraque's Solution), and after treatment as above, gives an orange stain. Now soften the glass, bend the delivery tube downward, and let it dip into a solution of silver nitrate; after an hour pour some very weak solution of ammonium hydroxide upon the surface of the silver nitrate solution. A yel- low precipitate at the line of separation of the two liquids shows the presence of arsenic. If the sub- stance to be tested is a solid, a small portion of it may be thrown upon glowing charcoal, when if arsenic be present, it will give a garlic-like odor. [Various modifications of Marsh's test have been proposed by different writers; one, in which, instead of the use of porcelain, the arsenic is deposited in a drawn-out narrow tube, as advised by Otto and others.] Reinsch's Test may also be employed as follows: Boil the liquid suspected of containing arsenic, with one-sixth of its bulk of pure hydrochloric acid. Then, or before boiling, introduce a bright slip of copper when, if arsenic be present, it will coat the copper with an iron-gray deposit. Remove the copper, wash it with distilled water and dry it between folds of blotting paper. Then cut it into slips, introduce it into a reduction tube and apply heat, when, if arsenic be present, arsenous' acid will be sublimed and de- posited on the sides of the tube in minute octahedral crystals. These may be dissolved in water and tested by the various reagents. Antimony deposits nearer the copper than arsenic does, and it produces a blue or violet tinted deposit on the copper foil. The interference encountered by the presence of organic matter in the suspected mixture may be overcome by separating the arsenic by dialysis. The copper and hydrochloric acid used in the above process should have been previously tested as to purity by boiling the copper with a mixture of the acid and distilled water. BARIUM SALTS. 237 When arsenic is supposed to be present in organic matters, a distillation process may advantageously be resorted to as follows: Dry the suspected matters on a w'ater bath, not using too great heat. Then introduce them into a flask fitted with a long bent tube; add a quantity of strong hydrochloric acid (previously proved free from arsenic), sufficient to drench the ma- terial. Digest the whole for several hours. Then apply heat to the flask by means of a sand-bath and a receiver, containing a little water, fitted to the bent tube. Both receiver and tube should be kept cool. By this distillation'process arsenic passes over in the form of arsenous chloride and is collected in the receiver. An additional portion of hydrochloric acid may be used to remove any traces of arsenic in the organic material. The arsenic may be obtained from the chloride by boiling with pure polished copper, as de- scribed above in Reinsch's process. A few drops of sulphuric acid dropped in the sus- pected fluid gives a white precipitate, insoluble in nitric acid. [If the barium is in a colored menstrum, it should be bleached with chlorine; then drive off the chlorine by heat before applying the test.] Burnt on platinum wire barium salts give a greenish flame. BARIUM SALTS. BELLADONNA AND ATROPINE. Treat the suspected substance with a few drops of concentrated sulphuric acid and warm. If atropine be present an odor resembling a mixture of roses and orange flowers develops; on now gradually adding a few minute fragments of potassium dichromate, the odor will change to that of bitter almonds; the color will be green. Atropine dilates the pupils when a drop of a very weak solution is introduced into the eye. In suspected poisoning by Belladonna, the vomit 238 A MANUAL OF TOXICOLOGY. stools and stomach contents should be thoroughly ex- amined for seeds, berries, or the remains of leaves or root. The stomach and its contents should be thoroughly comminuted, then acidified with warm alcohol and acetic acid. The mixture should then be filtered and the filtrate treated with sulphuretted hydrogen and lead subacetate, thus precipitating lead sulphide. The clear filtrate should then be evaporated to dryness, acidified, saturated with solution of potash in excess, and after the addition of alcohol suitable identification tests may be applied to the extract. Nitric acid dissolves it and colors it blood-red. By then adding solution of protochloride of tin, color changes to deep violet. BRUCINE. CANTHARIDES. If the cantharides be undissolved, there are shining green pieces of the drug. Water gives a white precipitate when added to the alcoholic solution, the precipitate being afterwards soluble in an excess of water. By exhausting the suspected material with ether, cantharidin may be separated out of it. The ethereal solution may then be evaporated until nearly dry, and spread on oiled silk. If upon applying it to the skin, it blisters, cantharidin is present. CARBONIC ACID GAS. When the gas is present in the proportion of 12 to 15 per cent, it extinguishes a candle. Agitating solution of lime or solution of subacetate of lead in this gas produces a white precipitate in the solution. Agitating a litmus-blued solution of chloride of lime in the gas drives off the color, which is evidence that it is not nitrogen. COPPER SALTS. 239 COPPER SALTS. Whether in solution or not, all cupric salts are blue and green. The reaction of the solution is usually acid. To a suspected solution add solution of ammonia, a bluish-white precipitate is produced, soluble in excess of the ammonia, producing a violet-blue solution when copper is present. Potassium ferrocyanate gives a chocolate-brown pre- cipitate or reddish-brown color, if copper is present, although only in small quantities. Sulphuretted hydrogen gives a deep brownish-black precipitate when added to a solution of a copper salt. If polished steel is suspended in a copper solution, it speedily becomes coated with copper. Pour the suspected solution on a platinum plate, acidulate with nitric acid, then touch the platinum passing through the solution, with a slip of zinc, and if copper is present, it will deposit upon the platinum. In examining such organs as the kidneys, liver, etc., for the presence of copper, the organ or organs Under examination should be incinerated, the resulting ash treated with dilute hydrochloric or sulphuric acid and the various tests for copper applied. In examining vomited matter or stomach contents, they should be diluted, if necessary, stirred and allowed to stand in a conical vessel for several hours. To the clear fluid which separates the various tests for copper may be applied as above given. CREOSOTE. Creosote has a peculiar smoky odor, and instantly coagulates albumen. With Ferric Chloride creosote gives a violet colored solution, rapidly changing to green, then brown and forming a brown precipitate. Phenol gives a purple colored solution. Creosote is not soluble in glycerine; phenol is, Creosote does not coagulate collodion; phenol does. 240 A MANUAL OF TOXICOLOGY. FORMALDEHYDE. Dissolve a decigram of morphine in 1 c.c. of sul- phuric acid; gently add, without mixing, an equal vol- ume of the suspected liquid; if there be any formalde- hyde present the liquid will soon assume a red violet color. ILLUMINATING GAS. Blood charged with illuminating gas does not coagu- late. When shaken a distinct froth forms. The blood is of a bright cherry color, which is per- sistent. If to the blood which has taken up illuminating gas a 5 per cent, solution of caustic soda be added, the bright red color of the blood will be maintained or in- tensified ; whereas in normal blood the color will change from red to green and later a dark brown. Hemoglobin in combination with carbon monoxide is not changed by adding reducing agents. The oxy- hemoglobin of ordinary blood is changed. Both kinds of blood show two absorption bands when examined through the spectroscope, but they vary slightly in position. Upon adding a reducing agent to ordinary blood, the two bands disappear and a broad band of reduced hemoglobin appears in their place. This does not occur with the blood which is saturated with the gas if more than 27 per cent, of the hemoglobin be saturated with carbon monoxide. Rubner's test for carbon monoxide in blood, is: Shake the blood with 4 or 5 volumes of lead acetate in solution; if the blood contains carbon monoxide, it will retain its bright color; if not, it becomes a choco- late-brown. IODINE. Free iodine turns gelatinized starch blue. Acetate of lead gives a yellow precipitate of lead iodide. By sublimation a violet or purple vapor is produced. LEAD. 241 To a solution of an iodide add nitrate of silver so- lution, a pale yellow precipitate results, insoluble in nitric acid or ammonia water. Potassic iodide gives a scarlet precipitate with a solution of bichloride of mercury. Iodides mixed with starchy solutions and treated with chlorine gas or nitrous acid give a blue color. When iodine is combined as in the form of an iodide or iodoform, it must be set free in order to test it. The urine or stomach contents suspected to contain such should first be digested with distilled water, then filtered. If upon adding first some chlorine water and then a few drops of starch paste to a little of this fil- trate, a blue color is obtained, the presence of iodine in the above combined form, in the original solution, is indicated. Free iodine would be indicated by a blue color obtained in the same way, but omitting the chlor- ine water. LEAD. Solution of potassic sulphate will give a white pre- cipitate. Sulphuretted hydrogen gives a black precipi- tate. Potassic chromate produces a yellow precipi- tate. Dissolve in acetic acid, add potassic iodide, which gives a yellow plumbic iodide precipitate. MERCURY SALTS. Salts of mercury are either mercuric or mercurous. The most important salt of mercury, from a toxico- logical standpoint, is corrosive sublimate (mercuric chloride). .This and other mercuric salts are identi- fied by the following tests : With potassium iodide solution, a scarlet precipitate is formed, which dissolves upon adding excess of the potassium iodide solution. With solutions of soda or potash, a yellow pre- cipitate is formed. Heated with sodium carbonate in a tube, globules of metallic mercury are formed. 242 A MANUAL OF TOXICOLOGY. Upon a bright gold surface drop some of a solu- tion of the suspected poison, when, if corrosive sub- limate be present, it will form an amalgam when the gold surface is touched by the point of a knife through the fluid. Mercurous salts, such as mercurous nitrate, calo- mel, etc., are identified by giving a black precipitate with alkaline hydroxides, a greenish-yellow precipitate with potassium iodide. If a solution of stannous chloride be added to a suspected mercury salt solution, a white and gray pre- cipitate consisting of metallic mercury and calomel is produced. In the examination of suspected urine it should be evaporated to dryness by gentle heat on a water bath. The residue should then be dissolved in distilled water with a few drops of hydrochloric acid boiled and fil- tered, when the various tests for mercury salts may be employed. NITROBENZOL. When nitrobenzol is mixed with organic matter, it may be separated by distillation, after having added sulphuric acid. NUX VOMICA AND STRYCHNINE. Aciding nitric acid to an aqueous infusion of mix vomica gives a bright red color. Adding ferric chloride to aqueous infusion of nux vomica gives a green color. No change occurs upon dissolving strychnine in sul- phuric acid; however, if we add an oxidizing agent, such as potassium bichromate, manganese dioxide, lead peroxide, etc., a play of colors from deep blue to purple, violet, rapidly changing to red or crimson, and orange-yellow, results. Quebrachine is the only alka- loid substance which produces the same colors in the same order, but it differs from those of strychnine in the intensity and duration of the color play; and que- OPIUM AND MORPHINE. 243 brachine dissipates on heating on a water-bath, strych- nine does not. After being absorbed, strychnine is deposited in the various organs like mineral poisons. It is usually found in the liver and kidneys, but has been discovered in the blood, spleen, brain, heart, etc. To detect it, it is necessary to finely subdivide the suspected tissues and digest them in alcohol acidulated with sulphuric acid. The mixture is then cooled, filtered and con- centrated, the residue washed with acidulated alcohol, and evaporated. Chloroform is then employed the same way, and after evaporation the residue is purified and suitable identification tests applied. OPIUM AND MORPHINE. Ferric chloride gives a deep red color with an aque- ous solution of opium. Also apply tests for morphine. In making a toxicological examination for the detec- tion of opium in the stomach, vomit or tissues, the stomach contents should first be examined for particles of undissolved opium, and an effort made to discover the odor of opium or one of its preparations. In examining vomited matter, or the stomach con- tents, such should be finely divided, if in a solid state, distilled water added until a thin paste is secured, the mixture acidulated with tartaric or acetic acid, and then digested over a water-bath for about an hour. It should then be filtered and the filtrate evaporated. Two or three volumes of 95 per cent, alcohol should then be added to precipitate the organic matter and the mixture should be well stirred. The insoluble material should then be separated by filtration, and the filtrate evaporated, thus removing the alcohol. The residue should then be dissolved in water acidulated with tar- taric or acetic acid, to still further separate extraneous organic matter, after which it should again be filtered. A slight excess of lead acetate should now be added to the filtrate until there is no further precipitation. The 244 A MANUAL OF TOXICOLOGY. precipitate produced is insoluble lead meconate and contains the meconic acid, if such were present, in the materials under examination. After allowing the pre- cipitate to stand, it should be placed on a filter and washed with distilled water. The substance on the filter should now be analyzed for meconic acid; the filtrate should be analyzed for morphine, it being pres- ent in that solution as an acetate. Process A. Separation of the meconic acid: Slightly wash the material on the filter with dis- tilled water, to dissolve out any soluble portions. Then wash the precipitate from the filter into a beaker; after which pass sulphuretted hydrogen through the con- tents of the beaker, thus precipitating the black insolu- ble lead sulphide, leaving the meconic acid in solution. Then filter the mixture to remove the lead sulphide. The filtrate contains the meconic acid and should be concentrated by evaporation, after which it may be tested by adding a little ferric chloride to a portion of it to determine the presence of meconic acid. With ferric chloride, a red color would be produced, which would not be destroyed by strong mineral acids. If another portion of the filtrate be taken and concen- trated by evaporation, the meconic acid may crystallize out if present in sufficient quantity. Process B. Separation of the morphine: The filtered liquid which contains the morphine ace- tate together with the lead acetate in excess, should be taken and treated with sulphuretted hydrogen, by pass- ing the latter through it to saturation, thus removing the excess of lead acetate, the lead being converted into the insoluble sulphide. In order that the sulphide may settle, the mixture should be allowed to stand in a warm place for a number of hours. The sulphide may then be separated by filtration. It may then be evap- orated by a gentle heat, placed in a test tube, a slight excess of ammonia added, then a double volume of amyl alcohol, the mixture thoroughly shaken and allowed to stand. In a short time the amyl alcohol will rise to the top of the tube and may be removed by OPIUM AND MORPHINE. 245 using a pipette. Then another portion of amyl alco- hol is used to repeat the operation, the two portions mixed, and a gentle heat employed to evaporate this mixture. A microscope should then be used to exam- ine the residue for morphine. Before applying the characteristic tests for mor- phine, all impurities and foreign matter should be separated from the residue; this is done by dissolving the residue in a little dilute acetic acid and then filter- ing the mixture. The morphine may then be left un- affected and all impurities taken up, by making the remaining fluid alkaline with potassium carbonate, and shaking the mixture with hot amyl alcohol added in double volume. The various tests for morphine may then be applied. Regarding the detection of morphine in the organs and tissues, the organ to be examined should be finely subdivided and subjected to the same course of pro- cedure as detailed above for the examination of vom- ited matter or stomach contents. To powder supposed to be morphine, or to strong cold solution supposed to contain morphine, add strong nitric acid in excess and an orange-red color will be produced, which slowly fades to yellow and is not changed to purple upon adding stannous chloride, as occurs with brucine. Solution of ferric chloride neutralized by potash gives an inky-blue color when applied to a cold and not very acid solution. (As phenol, gallic acid, tannic and salicylic acids give a similar color, care should be taken to insure their absence.) Iodic acid mixed with starch produces a purplish or deep purple color when added to a cold and not very acid solution. (Husemann's Delicate Morphine Test) : Heat the suspected liquid to 1500 F. for a few minutes with concentrated sulphuric acid; let it cool and add a trace of potassium chlorate or chlorine water; a blue to violet-red color, changing to blood- red and finally disappearing, is produced. 246 A MANUAL OF TOXICOLOGY. SILVER NITRATE. An aqueous solution of silver nitrate gives with hydrochloric acid a white precipitate of silver chloride, soluble in ammonia. All the chlorides precipitate a solution of silver nitrate .in the form of a white powder, which blackens by light. Potassium chromate gives a dull red precipitate, soluble in acids. TYROTOXICON. Tyrotoxicon forms crystals with potassium hydrate. When treated with a mixture of carbolic and sul- phuric acids, a green color is produced. In whey, tyrotoxicon varies in color from yellow to orange-red. ZINC. Zinc Sulphate : Potassic chromate precipitates yellow zinc chromate. Ammonium sulphide in the presence of ammonium hydroxide gives a white precipitate. Potassium ferrocyanide gives a gelatinous white pre- cipitate. 247 This and the following- chart, by Thompson of England, are worthy of the analyst's consideration : "A CONDENSED CHART FOR THE DETECTION OF METALS IN SOLUTION." Group I. Group II. Group III. Group IV. Group V Add HCL 'Lead. Mercurous 1 Salt. f White I Silver. ppt. ] Bismuth or Antimony | asoxychlo- ( rates. Add excess HCL ppt. ( Bismuth dissolves-/ or Anti- if ( mony. If precipitate does not dissolve, boil; if dissolved, Lead is indicated. If un- changed add ammo- nia. Precipitate dissolves = Silver. Turns black = Mer- cury. Pass H2S into solution. f Mercuric Salt. Black I Copper, ppt. | Bismuth. ( Lead. Add Sol. Pot. lodid. to same. If it turns Red = Mercury. Green = Bismuth. Yellow = Lead. Brown = Copper. Yellow f . | Arsenic. P? f -{ Cadmium. g ^Stannic Salt. Add to same Ammon. Sulphyd. Arsenic=dissolves. Tin = dissolves. Cad miu m = insoluble. If ppt. is dissolved add HCL. Arsenic is precipitated, Tin is not. Brown ppt. with H2S=Stan- nous Salt. Orange ppt. with H2S=Anti- mony. Add AmCL AmHO (till it smells when shaken). AmHS (a little). Black J < Cobalt. ppt- { Nickel. To original solution add R 41-e2Cy j 2 • Blue ppt. = Iron. Plum color ppt.= Cobalt. Yellowish ppt. or none=Nickel. White J Alum, ppt. | Zinc. To original solution add K4FeCyB. White ppt. = Zinc. No ppt. = Alum. Green ppt. = Chro^ mium. The AmHS and Am HO must give a green ppt. for Cr. If white with Am HO, Al or Fe is indicated. Flesh color ppt. ;= Manganese. Add to last solution Am2CO3. sin.-. ( Barium. Wh"e; Strontium. PP ' ( Calcium. Dissolve the ppt. in Acetic Acid and add K2CrO4. Yellow ppt. = Ba- rium. If no ppt. add H2 SO4. Dilute= White ppt. on stand- ing or shaking = Strontium. No ppt. add Am2 C2O4. White ppt. - Cal- cium. Add to original solu- tion Na2HPO4. White ppt. = Mag- nesium. If no ppt. is obtained in either group, Potassium, Sodium or Ammonia are indicated. Potassium. Yellow ppt. with Pt Cl4. White ppt. with strong solution of Acid. Tart. Sodium. No ppt. with above and yellow flame. Ammonia. Heat with KHO, gas evolved. (Nessler's test.) 248 " 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. H0SO4. Decomposes. Group II. BaCl2. Precipitates. Group III. CaCl2 Precipitates. Group IV. AgNO3. Precipitates. Group V. Fe2Cl6. 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, White. Tartrates " Bromides, Yellowish White. Iodides, Yellow. Phosphates " Chromates, lied. Arseniates, Chocolates. Arsenites, Yellow. Ferrocyanides, Blue. Borates, Yellowish. Nitrates. Should the precipitates produced by this reagent be insoluble in HNO3, a sulphate is indicated. Should the precipitate be soluble, pass on to Group III. Should the precipitate produced by this reagent be insoluble in acetic acid, but soluble in HCI, the presence of an oxalate is indicated. Confirm. Tartrate of calcium is also insoluble in acetic acid, an acid tartrate of calcium being formed, which may be distinguished from the amorphous oxalate of calcium by its crystalline character. Confirm. Should the precipitate be soluble in acetic acid, test for citrates. The colour of the precipitates by this reagent is very characteristic. If the precipitate is white and insoluble in HNO3, but soluble in dilute solution of ammonia, the presence of a chloride is indicated. Confirm. Should the previous reagents give no precipitate, add a crystal of sulphate of iron and a few drops of strong sulphuric acid. The formation of a black colour indicates a nitrate. Confirm. Apply heat, and notice any odour which may be evolved. Sulphides give off H2S (sulphuretted hydrogen). Confirm. Sulphites give off SO2 (sulphurous acid gas). Confirm. Carbonates effervesce and give off CO2 (carbonic acid gas). Confirm. Cyanides give off the odour of HCy (hydrocyanic acid). Confirm. Acetates give off the odour of acetic acid. Confirm. A yellowish precipitate indicates a borate. Confirm. Group I. H2SO4 , Group II. BaCl2 Group III. CaCl2 Group IV. AgNO3 Group V. Fe2Cl« Group VI. H2SO4 + FeSO4 OUTLINE OF PROCEDURE. 249 PART V. 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 such 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 chemists' 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 impos- sible to obtain the whole of an organ, the proportion which the part obtained bears to the whole organ should be ascertained. Careful inspection should be made of all organs 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. 250 A MANUAL OF TOXICOLOGY. It is rarely necessary to analyze the whole body. As a rule the following are the organs to be examined, 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, 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 uniform mixture. The mixture should now be weighed and about one-twelfth or one-fifteenth (not over one- tenth) of it weighed out and employed for the prelim- inary tests. In testing vomited matters, a clear liquid, serviceable for preliminary tests, may usually be obtained by plac- ing them in a cone-shaped glass vessel, and setting them aside for 12 to 24 hours. In the 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 crystal- lizable salt) from the complex matters associated with it; either alcohol or water, according to their ability 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 sulphides of mercury, lead, arsenic, etc. The hemoglobin of the blood becomes converted into sulphuret-hemoglobin, and ultimately into ferrous sulphate. These two com- OUTLINE OF PROCEDURE. 251 pounds give the body a greenish color in the earlier periods of decomposition. The analyst, upon receiving the samples or materials 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 microscopical examination of the sus- pected organs and their contents is often advisable; the identification and subsequent exhibition of char- acteristic crystalline forms is thus provided for. Be- fore a suspected organ is destroyed in process of in- vestigation, 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, stomach contents, or intestinal 252 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 oilv mat- OUTLINE OF PROCEDURE. 253 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.)" 254 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 nour. 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. 255 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 256 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, however, 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. AUTENRIETH'S METHOD. 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. 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. 257 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 258 A MANUAL OF TOXICOLOGY. again with ether, which dissolves almost every al- kaloid save morphine and apomorphine ; the ethereal 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. 259 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 011 the filter, if present at all, will be: mercury, sulphide, lead sulphide, copper sulphide, cadmium sulphide. In the filtrate may be arsenic sulphide, antimony sulphide, tin sulphide; and there may also be a small portion of copper sulphide, because the latter is somewhat soluble in a considerable quantity of ammonium sulphide. The filtrate from the original hydric sulphide pre- cipitate will contain, if present, the sulphides of zinc and chromium in solution. INVESTIGATION OF THE SULPHIDES SOLUBLE IN AMMONIUM SULPHIDE, VIZ., ARSENIC, ANTIMONY, TIN. The ammonium sulphide solution is evaporated to dryness in a porcelain dish, strong nitric acid added and again dried. To this residue a little strong caustic soda solution is added, and then it is inti- 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. The 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. The 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. 260 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. A MANUAL OF TOXICOLOGY. 261 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 I part of sodium hydrate. This is added, little by little, into a red-hot porcelain crucible. The melted mass is cooled, dissolved in 262 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. 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 bella- donna, leaves fragments such as those from digitalis, bvoscyamus, lobelia, root fragments from aconite, the shining, green particles from cantharides, etc. THE SIGNS OF DEATH. 263 PART VI. 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. TESTS. i. 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 conjunctivae exhibit gray, cloudy discol- orations, rapidly changing to black, upon their sur- faces, due to formation of films of mucus or to ca- daveric imbition from decomposition changes. 6. After death, any external pressure on the eye- 264 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. 11. Inject ammonia solution subcutaneously; if living, a port-wine congestion will appear in the surrounding parts; if dead, 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 with % t° 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- red in from 1 to 4 days, THE MODES OF DEATH. 265 PART VIL THE MODES OF DEATH. (Adapted from Bichat and Herold). The actual or immediate cause of sudden death is obviously dependent upon one or other of the three great centres of life, the heart, the lungs, and 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. The modes of death have been classified into:- I-Death beginning at the brain, coma. 2-Death beginning at the heart, syncope. 3-Death beginning at the lungs, asphyxia or ap- noea. The immediate cause of death should be sought in the brain, heart or lungs, no matter what the remote cause of the death may be. COMA. Causes: 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- 266 A MANUAL OF TOXICOLOGY. 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 external 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 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. SYNCOPE. 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- THE MODES OF DEATH. 267 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. • 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 respiratory 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 cav- ities. Symptoms: A sense of suffocation, associated with a vigorous effort to breathe; face livid; uncon- sciousness; vertigo; sphincter muscles relaxed; general convulsions. 268 A MANUAL OF TOXICOLOGY. Post-Mortem Appearances: The lungs may be engorged with dark blood; the pulmonary 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 cav- ities of the right side of the heart are empty. PART VIII.-UNCONSCIOUSNESS OR COMA.-Its Interpretation and Treatment. KIND OF COMA. ETIOLOGY. DEVELOPMENT. CHARACTER. CONVULSIONS. PARALYSIS RESPIRATION. TEMPERATURE. FACE. j PUPILS. PULSE. SKIN. STOMACH AND BOWELS. ODOR OF BREATH, ETC. URINE. TREATMENT. Alcohol. Alcoholism. Delirium. Coma lasts for hours; gradually lessens. Aroused by ammonia or shaking, but is incoherent. No convulsions. No paralysis. "Steamboat." Stertorous. Heavy. Low. Falls progres- sively from 1° to 6° below normal. Flushed and swollen; may jecome pallid. Dilated as a rule; but may be' nor- mal; conjunctiva congested. ■ t ■» Full and strong; later eeble. Is strong in Can- nabis Indica. First moist and warm, ;hen cold. Vomiting, usually. Breath alcoholic. But alcohol may have caused ruptured cere- bral blood vessels in other coma. By analysis alco- hol. Urine re- tained. Apomorphine hypodermically. Empty stomach. Cold to head. Heat to extremities. Strych- nine to support heart. Belladonna. Belladonna, etc. Dryness of mouth and throat. Delirium precedes coma. Slow and deep. Frequently elevated. Flushed. Dilated. Much in- creased. Hot and dry. Urine retained. Emetics or wash out stom- ach; inject Pilocarpine and stimulants subcutaneously. Douches; Opium. Chloral. Chloral, etc. Profound coma. Can- not be aroused. Diminished, sigh- ing or stertorous; then shallow and feeble. As low as 94° F. or even 91 ° F. Livid and floated. Contracted. Di- lated when awake. Slow, or very weak and quick. Later lost. Very cold. Fi- nally urticaria. Emetic or pump; arouse; hot applications; coffee, strych- nine; artificial respiration. Hydrocyanic Acid. Hydrocyanic acid, etc. Profound coma. Convulsions common. Short inspiration. Prolonged expira- tion. Gasping, panting. Dilated. Not re- actino- tn light. • ** Imperceptible. Cold, covered with clammy perspiration. Odor of bitter al- monds. Stimulants; Ammonia in- ha'ations. 1-50 grain Atropine hypodermically. Artificial respiration. Battery. Opium. Opium, etc. Developed gradually. Aroused by noise, not by shaking. When aroused is coherent. No paralysis. First 8 to 10 per min., but deep; then 4 to 5 and long pauses. Shal- low. Suffused and red, then cya- notic; finally pale and livid. Contracted. In- sensible to light. Strong. Slow and full till late in poison- ing. First dry, then later warm sweat. Opium in breath. Opium. Wash stomach; one pint strong coffee into rectum; Battery; keep moving; Atro- pine subcutaneously; artifi- cial respiration. Pot. Permang. Asphyxia. Exposure to gas or foul air. Cannot be aroused. May end in convulsions fol- lowing distress- ed breathing. Difficult owing to oedema of lungs. Low. Lips and tongue blue and discolored. Small. Rapid. Weak. Surface dry and hot. Much CO or CO2 in breath. Fresh air; inhalation of oxy- gen; artificial respiration. If by CO transfuse blood. Syncope (Cerebral Anaemia). Shock, etc. Coma develops sud- denly, but is tran- sient. Weak but unem- barrassed. Sighing. Pale. * Absent at wrist. Cold and per- spiring. Lower head; stimulants; smelling salts; cold water to face. Heat to body. Congestive.- Insolation. Thermic fever. Sunstroke. Exposure to heat or sun's rays. Develops gradually. Coma yields readily to treatment. No true paral. No coma. Col- lapse in heat exhaustion. Shallow. May be noisy. High. In heat ex- haustion no fever. Flushed. Pale. Contracted or di- lated. Rapid. In heat exhaust'n, soft, feeble. Congested. In beat exhaustion moist, cool, pale. Involuntary diarrhoeal discharges. Passed involun- tarily. In heat stroke, cold to entire body, as by bath; cold ene- meta; stimulants. In sunstroke, cold to head, heat to body. Apoplectic (Sine trauma.) Apoplexy (as a rule the left side). Suddenly developed. Profound stupor from beginning. No signs of injury. No oozing from nose or ears. One side toss- ed, other side motionless. Hemiplegia. Slow; stertorous. Elevated particularly on side paralyzed. Pale. May be drawn to one side. Unequal. Small. Slow. Weak. In head injury suspect cranial fracture. Body emaci- ated. Faeces retained. Breath sweet or may smell of alcohol, as acute alcoholism may have ruptured certain blood vessels. Urine abundant; passed involun- tarily; smells sweet. Keep head elevated; reduce pressure in arteries; venesec- tion if necessary; ice-bag to head; heat to extremities; purge; then alteratives. Epileptic. Diabetic. Epilepsy. Diabetes. Cannot be aroused. Attack is short. Develops slowly with sleepiness and great oppression. Patient can- not be aroused. Coma gradually deepens. Follows con- vulsions. No convulsions. No true pa- ralysis. Natural. Rapid. May be noisy. High. Usually normal. May go down to 90°. Pale, or blue froth ' about mouth. Tongue bitten. Pale. Regular. Nearly normal. Rapid. Weak. , Odorless. Breath smells sweet, like pear or apple, or chloroform. Protect body from cold or heat. Patiently wait for con- sciousness, protecting pa- tient from bruises. Chemical exam- ination shows sug- ar. Large amount passed involuntar- ily Give inhalations of oxygen; intravenous injection of sa- line solution; opium if con- vulsions appear. Uraemic. Uraemia. Begins with delirium or convulsions; coma complete. Repeated con- vulsions, per- haps from first. Deep; quick; stertorous. Without convulsion is low, 91°-95°. With convulsion, high; may reach 108°. Waxy. Equal, size nor- mal or dilated. Puffy eyelids. Full, hard and strong, but not fast. Often only 40 to 50. General oedema of body. Urine odor about patient. Albumen and casts; urine scanty and re- tained. Uraemic coma not neces- sarily fatal. Pilocarpine ''hy- podermically; Croton oil gtt. j. If plethoric venesec- tion; chloroform inhalation; support heart. Remarkable recoveries. Traumatic. (Cerebral. Meningeal- Hemorrhage). History of. an injury. Patient may recover and relapse. Signs of head injury. May be bloody or se- rous discharge. Is grad- ually increasing stupor. Both sides may show paralysis, or one tossed. Slow; stertorous. Lips inflated on one side on ex- piration. Usually high. Palsy. May be drawn to one side. Pup^ unequal. Apt to be strong and slow. Hot or dry. Early operation for removal of blood clot, and if neces- sary ligation of artery. Hysterical. Trance. (3) Hypnotic. (3) Hysteria. (Fe- males mostly.) Consciousness suddenly lost. Hypnotized. Developed suddenly. Coma alternates with hysterical delirium. No stertor; may be weak. Usually lowered. (3) Expres- sionless. (3) Deathlike. Natural. Sensitive to light. Feeble, and frequent. Flushed and hot. (2) Skin cold. (3) Limbs remain as placed. No vomiting. No diarrhoea. No odor. Incontinence. Cold applications. Give Arom. Spt. Ammon. (2) Watch; nourish. (3) Interrupt. GUIDE TO POST-MORTEM PROCEDURE. 273 PART IX. GUIDE TO POST-MORTEM PRO- CEDURE. (In Suspected Poisoning.) In cases of suspected poisoning, the following practical di- rections are given by Professor Reese, to be observed by those who have charge of post-mortem examinations:- i. Ascertain whether the individual has labored under any previous illness; and how long a time had elapsed between the first suspicious symptoms and his death ; also, the time that had elapsed after death before the inspection is made. 2. Note all the circumstances leading to a suspicion of mur- der or suicide-such as the position and general appearance of the body, and the presence of bottles or papers containing poi- son about his person, or in the room. 3. Collect any vomited matters, especially those first ejected, and preserve them in a clean glass jar, carefully stoppered and labelled. The vessel in which the vomited matters have been contained should be carefully inspected for any solid (min- eral) matters which may have sunk to the bottom, or adhered to the sides. If no vomited matters be procurable, and vom- iting has taken place on the dress, bed-clothes, furniture, etc., then portions of these must be carefully preserved for future examination. 4. Before removing the stomach, apply two ligatures beyond each extremity, dividing between each pair, so as to prevent the loss of any of the contents. 5. If the stomach be opened for inspection, this should be performed in a perfectly clean dish, and the contents collected carefully in a graduated vessel, so as to properly estimate their quantity. [Note here, also, the presence of blood, mucus, bile, or undigested food.] These contents should be preserved in a perfectly clean glass jar, securely stoppered, covered over with 274 A MANUAL OF TOXICOLOGY. bladder and sealed. The contents of the duodenum should be collected and preserved separately. 6. Carefully inspect the state of the throat, (esophagus, and wind-pipe for the presence of foreign substances, and for marks of inflammation or corrosion. 7. Observe the condition of the large intestine-especially the rectum; the presence of hardened faeces would indicate that purging had not very recently taken place. 8. Note any morbid changes in the lungs, as congestion, inflammation or effusion; in the heart, as contraction, flac- cidity, presence of a clot; and the condition of the contained blood. 9. Examine the state of the brain and spinal marrow, and, in the female, the condition of the uterus, ovaries, and genital organs. (Poisons have sometimes been introduced into the vagina.) 10. Along with the contents of the stomach and duodenum, the viscera that are to be reserved for chemical analysis are the stomach and duodenum (to be kept separate from the others), the liver and gall-bladder, spleen, kidney, rectum, and urinary bladder with its contents. Sometimes, also, a portion of the blood may be required for the examination. 11. As the legal authorities will rigorously insist upon the proof of the identity of the matters alleged to be poisonous, it is of the greatest importance to preserve such matters from all possible contamination by incautious contact with calico or paper for wrapping up the specimens. When once the sus- pected articles are deposited in the hands of a medical man, he must preserve them strictly under lock and key, and confide them only to a trusty agent for transportation. Many cases are on record where the chemical evidence failed simply from a want of power clearly to establish the identity of the mat- ters analyzed. Actual testing for poisons in cases of suspected criminality ought to be undertaken only by those whose chemical knowl- edge and skill are considerable. MINERAL ACIDS. 275 POST MORTEM APPEARANCES IN POISONING. THE MINERAL ACIDS (IN GENERAL). Appearance of body may be healthy. As a rule there are stains about the mouth, fingers and other places with which the acid has come in contact. Mouth cavity and esophagus are usually white and corroded at first but become dark brown and shriveled; mucous membrane detachable. Epi- glottis and glottis swollen. The stomach is some- times contracted, sometimes distended with gas; contains a thick, dark-brown fluid. Outer surface of stomach and intestines is very vascular and that of the stomach may be corroded or perforated. Inner surface of stomach may appear charred and the mucous membrane between the rugae present a scarlet hue. In poisoning by the acids the lining membrane of the esophagus is usually wrinkled or furrowed longitudinally and the mucous membrane of the stomach raised in discolored ridges. The py- lorus is usually contracted. The appearance of the inner surface of the small intestines is similar to that of the stomach, if the patient has lived long enough, but is less in degree. Perforation, if it oc- curs, usually takes place posteriorly if before or after death the person lay on the back, and the edges of the rent are found to be softened. The perito- neum may be greatlv inflamed from the escape of the stomach contents through the perforation into 276 A MANUAL OF TOXICOLOGY. the abdominal cavity. The bodies of persons dead from poisoning by mineral acids seem, for some time, to resist putrefaction. MINERAL ACIDS. (In Detail). ACID HYDROCHLORIC. No stains on lips or face. Usually the mucous membrane of the mouth, esophagus, etc., are white or whitish-brown, blackened or charred. Ridges on the inside of the stomach. Glottis and larynx may be injected and corroded. Hydrochloric Acid poisoning has not been found to result in perforation. ACID NITRIC. Discoloration of lips, tongue and inside of the mouth. Mouth and spots on skin where acid has been in contact appear yellow, which is intensified by a solution of caustic potash which would dis- charge Bromine or Iodine stains. Mucous mem- brane of digestive tract eroded and softened, but stomach rarely perforated although softened; it may be shreddy. The color appearance of the stomach varies-it may be yellow, due to the action of the acid upon the mucous membrane; black from the action of the acid on the blood; green or brown from the action of the acid on the bile. Bladder usually is empty. Blood dark and thick. The lining membrane of the esophagus may be divided into minute squares by longitudinal and transverse fur- rows. Seldom that action of acid is well marked beyond the duodenum. Post mortem appearances differ in stomach and internal organs according to whether death is rapid ACID SULPHURIC. VEGETABLE ACIDS. 277 or slow, whether the patient dies from acute poison- ing, or lives some time and dies from ulceration and contraction of some part of the alimentary canal. Usual appearances are: larynx, trachea and lungs softened and blackened ; esophagus grayish or black- ish, softened, and mucous membrane may be sepa- rated and peel off. Stomach is softened or perforat- ed ; contents may be blackish pulpy and tar-like from altered blood; contents of blood vessels black and hard; if there has been perforation, the edges of the opening appear dark and ragged, and the adjoining viscera is blackened and softened. If death was not immediate, may be evidences of inflammation of intestines, peritoneum, etc. In rapid cases exten- sive coagulation of epithelium in the convolated and straight urinary tubes; the kidney parenchyma is destroyed but there is absence of inflammation. If acid entered the air passages they will present evi- dences of corrosive action. Skin of face or sur- rounding parts touched by acid will generally be corroded and as if covered with white paint, browned or blackened. (But if the poison was taken from a spoon or the neck of a bottle, the mouth may show no signs). VEGETABLE ACIDS, CARBOLIC ACID, ETC. The mucous membrane of the stomach is not cor- roded nor softened but is blackish near the pylorus. Coagulated blood in submucous areolar tissue of stomach, interspersed with black elevations. Tongue and esophagus a dirty brown color. ACID ACETIC. ACID CARBOLIC. The odor of the acid can be perceived in the body after death. When Carbolic Acid is introduced by subcutaneous injection or by outward application 278 A MANUAL OF TOXICOLOGY. there are no characteristic post mortem appear- ances ; but when by mouth, brownish wrinkled spots may be found on the cheeks or lips; the mouth, throat, esophagus and stomach often are whitened and sodden and their mucous membrane may be readily detached. If the acid was concentrated, the surface may be eroded. There is reddening (in- flammation) between the folds of the stomach. Sometimes the stomach is thickened, contracted and blanched; often greatly congested, and mucous membrane detached or destroyed. The duodenum and further portions of the intestines may be af- fected. The respiratory passages often inflamed and the lungs usually filled with blood. The left ventricle of the heart is contracted; the right ven- tricle is distended. The blood is fluid and dark col- ored. The bladder usually is empty. The brain is sometimes congested, fluid being found in the ven- tricles. The blood vessels of the liver, kidneys and spleen are gorged with blood. Death resulting from sudden nervous shock, caused by taking a large quantity of the acid, would of course present differ- ent post mortem appearances from the foregoing. ACID HYDROCYANIC. There are no constant or characteristic lesions. The stomach may be normal or congested. A gen- eral venous congestion is the most common sign. It may be said in a general way that with the ex- ception of the changes which may be found in the stomach after doses of Potassium Cyanide the pathological changes produced by Hydrocyanic Acid and Potassium Cyanide are very similar to those produced by suffocation. The most notice- able fact about the body is the presence of bright- red spots or patches on the surface of it, due to the formation of cyanmethae-moglobin. The lungs and right heart are full of blood and the pulmonic block produces a backward engorgement. If death be ACID OXALIC. 279 rapid, the left side of the heart is usually empty and strongly contracted; but if death be slow, left side is full of either black and fluid or of coagulated blood. The arterial system is empty. The liver and kidneys, vessels of head and veins of the neck usually are congested. The lungs are gorged and frequently portions of them are oedematous and there is a bloody foam in the mucous membrane of the bronchial tubes. The pleura and other serous membranes are ecchymotic. As a rule an odor of Hydrocyanic Acid exists everywhere, unless con- cealed by putrefaction, by tobacco, onions, or a strong smelling ethereal oil. The odor of Hydro- cyanic Acid may be noticed in the stomach or other parts of the body in some cases, or it may be absent in the stomach and present in other parts of the body. Sometimes the bile is found to be of a deep blue color and the blood black, fluid, or coagulated, and the odor of Hydrocyanic Acid easily recog- nized. There may be turgescence of the vessels of the brain and an effusion into the ventricles. Casper and Blyth recommend that the head be first opened and examined to perceive the odor in the brain, where, if present, it may longer be detected than in the abdominal and chest cavities, owing to the earlier putrefactive changes in the latter. No inflammatory change in the stomach mucous mem- brane would be expected in poisoning by Bitter Al- monds, yet an eroded and inflamed patch was found in one case. Cherry Laurel Water. The stomach is very red. One case showed intense venous congestion every- where. ACID OXALIC. The mucous membrane of the mouth, pharynx and esophagus is usually soft or brittle, white, shriv- 280 A MANUAL OF TOXICOLOGY. eled and easily removed. The surface of the eso- phagus may appear brown and raised in longi- tudinal folds. The stomach is frequently con- tracted, containing a highly acid, brown, jelly-like liquid, mainly consisting of altered blood; if death be rapid, the mucous membrane may be soft and pale, but if delayed is usually black in some parts of it and in other parts greatly congested, in rugae, with some portions peeling off in patches and the underneath coats gangrenous. Actual corrosion and perforation is however rare, although the stom- ach may be too softened to remove entire. The in- testines are usually much congested and contracted more or less throughout their whole extent if death was not prompt. The blood is fluid in all parts of the body, except the esophagus and stomach. As a rule the lungs are congested. Occasionally the brain is found to be congested. The kidneys are usually dark and full of blood; may show a fine striping corresponding to the canaliculi; the whole boundary layer may be colored white, due to a depo- sition of Calcium Oxalate. The urine is albumin- ous and contains hyaline casts and deposits of oxa- lates. Sometimes there are no abnormal post mortem appearances. ACID OXALATE OF POTASH. The pathological changes by the Acid Oxalate of Potash are identical with those of Oxalic Acid in both the esophagus and stomach. These parts are almost always more or less inflamed or corroded, and the inflammation may have extended into the intestines. As a rule the stomach while not actu- ally eroded is unnaturally transparent. ACID TARTARIC. Intense inflammation of the stomach and intes- tines, ACONITE AND ACONITINE. 281 ACONITE AND ACONITINE. No characteristic lesions. May be more or less congestion of lungs and liver and general venous congestion. The brain and its membranes fre- quently are injected and the stomach and intestines reddened; there is more or less dark and fluid blood in the right side of the heart. The blood is as a rule fluid. There is a fullness of the large veins. Some- times the body is of a marble-like paleness.. ALCOHOL. Remarkably good preservation and persistent rigidity of the body, as a rule. The stomach is deeply congested and has the odor of alcohol. The lungs, brain, cerebral vessels and membranes,, right side of the heart, and the great veins of the neck more or less congested. The pia full of blood, en- gorgement of sinuses and plexus. Serum is often found in the ventricles. The blood usually is dark and fluid, The great veins of the abdomen are full of blood and in prolonged coma the bladder is dis- tended with urine. Sometimes there are burn-like blebs on the extremities. As a rule the pupils are dilated. The right side of the heart is empty. ANTIMONY - TARTAR EMETIC. Usually signs of inflammation of mucous mem- brane of stomach and intestines, sometimes extend- ing to esophagus and throat. Ulcers and pustules have been found upon the mucous membrane of the mouth. Stomach and intestines usually coated with mucus and signs of inflammation may be absent. The blood is thinner than usual. The brain is, as a rule, congested, and the viscera may be engorged with blood. Lungs generally exhibit signs of em- physema and there may be effusions into the pleura. 282 ( A MANUAL OF TOXICOLOGY. ARSENIC. As a rule the body is remarkably well preserved, putrefaction being most delayed in those organs which contain Arsenic. The antiseptic properties of Arsenic permit of the recognition of the inflam- matory changes several months after death. But putrefactive changes may produce quite similar red- ness in a healthy stomach. In acute Arsenic poi- soning with diarrhoea, the blood may be thickened and all the organs will present a very dry appear- ance. In the narcotic form of poisoning the vessels of the brain are usually very plain. The character- istic lesions usually found in Arsenical poisoning are inflammation of the stomach and intestines and a fatty degeneration of the heart, liver and kidneys, with infiltration of the epithelial cells. In acute cases the stomach is most affected. In chronic cases the whole alimentary canal presents an inflamed and ulcerated appearance, particularly the duodenum and rectum. Sometimes the tongue is greatly swollen. The Stomach: The stomach may be empty or it may contain blood mixed with mucus. It may be contracted and the inner lining corrugated, or the wholq interior may show streaks of severe conges- tion or be of a light-red or brownish color. Some- times the congested patches are thickened; they may be covered with a false membrane mixed with particles of Arsenic. It is common to find an ex- travasation of blood into the mucosa. Although the poison be absorbed by the skin or otherwise, there are usually evidences of acute gastritis. Frequently there are thick, pasty, whitish-gray, or green (from Paris Green) patches, usually surrounded by brightly injected membrane, where particles of solid Arsenic adhere to the walls of the stomach. The stomach may appear white externally but show a softened and ulcerated condition internally. The Intestines: Usually similar but less severe BELLADONNA AND ATROPINE. 283 inflammation in this part of the alimentary canal. Congestion and inflammation of the whole intestines may be present. Unless the patient has lived for some days after taking the poison, the large intes- tine is usually unaffected. Sometimes Peyer's patches, the solitary lymph nodules, and the mesen- teric nodes are found to be swollen. The Tongue, Pharynx and Esophagus: They may be more or less inflamed. The esophagus streaked in dull or bright red patches or even cor- roded. The Heart: If death is sudden the heart is usually unchanged; if otherwise, shows evidences of fatty degeneration. The walls of the heart are pale, yel- lowish, and unnaturally yielding. Ecchymosis of muscular tissue under the endocardium and usually on the left ventricle, the posterior walls or the intra- ventricular septum of the heart. The Liver: It may be enlarged, as is usual after sudden death. Sometimes marked symptoms of fatty degeneration. In subacute.cases fatal results are as much due to inflammation of liver and kid- neys as to the poisonous effects produced in the stomach. The Kidneys: Enlarged, soft, and pale. Upon section, microscope shows a general or streaked yel- lowish-gray color and a thickened cortex. BELLADONNA AND ATROPINE. Usually no very characteristic appearances. The eyes dilated and brilliant and the cerebral vessels and lungs congested, are the chief points. Tongue may be red and mucous membrane of stomach and small intestines injected. If Belladonna berries were eaten, the mucous membrane of the tongue may be purplish. Sometimes there are no post- mortem effects observable. 284 A MANUAL OF TOXICOLOGY. BROMINE. Interior of stomach coated with thick, black layer and mucous membrane greatly congested. Ex- terior of stomach may be injected. Stomach con- tents generally thick reddish and give forth odor of Bromine. The viscera in the vicinity of the stom- ach may be a deep yellow color. The peritoneal coat of the duodenum is usually injected. CANTHARIDES. Mucous membrane of the stomach and intestines is intensely inflamed. Inflammation of the mouth, esophagus, throat, ureters, kidneys, and bladder. The mouth is swollen. The tonsils may be ulcer- ated. May be purulent matter covering the mucous membrane of the intestines. Sometimes congestion of the brain. When the powder has been taken, can recognize the shiny green particles in the stom- ach and intestines. Blood and fatty epithelial casts and pus in the urine. CARBON MONOXIDE -COAL GAS. Often rose-red or bluish-red, irregularly shaped patches on face, neck, chest and abdomen, but not on the back. They are due to a paralysis of the small arteries of the skin, which arteries conse- quently become injected with the changed blood, it is said. The blood is generally fluid and peculiarly red with a bluish tinge. Face calm, pale, and as a rule no foam on the lips. Right heart usually filled with blood; left contains very little. Usually some of the internal organs are congested. Putrefaction usually greatly delayed. Membranes of brain usu- ally much injected. Sometimes lungs congested or even cedematous with effusion. Sometimes the most congestion is in the abdominal cavity. CHLORAL. 285 CHLORAL. Odor of drug may be observed. Hyperaemia of brain in some cases. No characteristic lesions. CHLOROFORM. Frequently odor of anesthetic perceptible. Rigor mortis persistent. Retarded putrefaction. No characteristic lesions in death from inhalation. Bronchial tubes, lungs and vessels of brain may be congested. Heart often found flabby and collapsed. The blood is dark and fluid. The post-mortem ap- pearances when Chloroform has been swallowed are chiefly a redness of the mucous membrane of the stomach. Epithelium of pharynx, epiglottis and esophagus partly detached, whitened and softened. CHROMIUM - POTASSIUM BICHROMATE. The blood thin and black. The stomach inflamed and destroyed or marked with dark-red patches. COLCHICUM. Usually inflammation of stomach, intestines, and lungs. May be congestion of pia mater. Some- times there are no abnormal appearances. COPPER. The surface of the body may appear yellowish. The stomach and intestines show signs of inflamma- tion ; may be ulcerated. There may be a distinct dirty, bluish-green discoloration of the intestinal mucous membrane, produced by the contact of the Copper. This is a valuable sign when present. Touching with Ammonia intensifies the tint. Par- ticles of Copper may be found adhering to the intes- tinal coats. The lungs may be congested, the rec- 286 A MANUAL OF TOXICOLOGY. turn ulcerated. Sometimes the mucous membrane of the stomach and small intestines is thickened and inflamed; may be softened, ulcerated, or even gan- grenous. The substance of the liver may be friable and fatty; the kidneys swollen and the cortical sub- stance colored yellow; the pyramids a pale brown and compressed. DIGITALIS AND DIGITALIN. No very characteristic lesions. May be inflam- mation of the mucous membrane of the stomach, and congestion of the brain and its membranes. The blood dark and fluid. Right ventricle and auricle filled with blood ; left empty. ETHER. If the autopsy is performed soon after death, the odor of the anesthetic is perceptible. The cavities of the heart are filled with dark fluid blood. Usu- ally there is congestion of the brain and lungs. ERYTHROXYLON AND COCAINE. There are no very characteristic lesions. There may be congestion of the lungs and other organs and the blood fluid and dark. In acute Cocaine poi- soning, hyperaemia of liver, spleen, kidneys, brain and spinal cord have usually been found. HEMLOCK (CONIUM). There are no characteristic post-mortem appear- ances. The blood usually is dark and fluid. There may be congestion of the brain or lungs. Stomach, lungs and brain usually found congested. Intestines invariably healthy. WATER HEMLOCK. 287 WATER HEMLOCK (COWBANE). Stomach red, blood fluid. May be corrosion and perforation of the stomach. HYOSCYAMUS. There are no characteristic lesions after death. The brain and its mebranes usually are congested. IODINE. Appearances of a corrosive irritant poison. The liver enlarged and congested. The brain may also be congested. Ulcers are sometimes found in the stomach. Lungs natural. The other lesions are such as are usually produced by an iritant poison. LEAD. The post-mortem signs are not very distinct. There may be inflammation and contraction of the alimentary canal; the stomach may be whitened. In chronic lead poisoning there is a granular condi- tion of the kidneys; the large intestines may show signs of contraction, and the muscles specially af- fected present a whitish, flabby appearance. May be a grey-black appearance of the intestinal mucous membrane, due to a deposit of Lead Sulphide. As a rule the stomach contains no unabsorbed poison. MERCURY - CORROSIVE SUBLIMATE. Corrosive Sublimate is said to take 2 hours to reaeh the urine, 4 hours to reach the saliva, and is eliminated from the system in 24 hours. Post- mortem signs are mainly found in the alimentary canal. The mucous membrane of the mouth, fauces and esophagus is softened and presents a whitish or bluish-grey color. Frequently the stomach is 288 A MANUAL OF TOXICOLOGY. softened, particularly at the cardiac end of it, and portions of it may be destroyed. Stomach coats are sometimes very much blackened, probably re- sulting from Sulphide of Mercury. The intestines particularly the caecum, may present the same ap- pearances. There may be inflammation of the kid- neys and bladder, the bladder empty and contracted. There is marked congestion of the kidneys about the Malpighian bodies; the epithelial cells deformed, granular, and more or less destroyed. More or less intestinal inflammation have been caused by Mer- curic Cyanide, Mercuric Iodide, White Precipitate, and Turpeth Mineral. MERCURIC CYANIDE. The stomach and intestines present a greatly in- flamed appearance. POISONOUS MUSHROOMS. Stomach and intestines usually inflamed and may be gangrenous. The vessels of the brain are as a rule much congested. The liver is enlarged. Search the stomach for the gills and spores of the mush- room. The spores of the common mushroom are oval and dark slate-colored. The discovery of pink irregular spores, or of rusty brown irregular spores, or of round white prickly spores, would be good evi- dence that a poisonous mushroom had been eaten. Plain round spores might indicate either edible or poisonous. Identify the fungus. NUX VOMICA AND STRYCHNINE. No characteristic appearances. Brain and spinal cord may be congested and considerable blood ef- fused. Blood usually fluid and often very dark. Stomach and lungs sometimes found intensely con- gested. Heart usually has right side gorged with OPIUM AND MORPHINE. 289 blood, sometimes is empty and contracted. Lungs congested. Usually relaxation of body at time of death, but rapid, extreme, persistent rigidity ensues soon after it. Rigidity usually remains for a long time; may disappear within 24 hours or last two months. All these leading symptoms rarely pro- duced except by this poison. Bladder usually con- tains urine, which should of course be preserved for chemical analysis. OPIUM AND MORPHINE. No very certain nor characteristic signs. The blood is as a rule fluid. Stomach and intestines usu- ally appear normal. The peculiar Opium odor may be noticed as soon as the stomach is opened. The vessels of the brain usually found in a turgid state, a serous effusion into ventricles and at the base of the brain. Lungs and other vascular organs may be congested. May be heart clots in both sides of heart and a thrombosis of the pulmonary artery. External surface of body is either livid or pale. Bladder is full of urine. These are, however,-not characteristic of death from this poison. Pupils are sometimes contracted, sometimes dilated. Some- times there is nothing abnormal in the post-mortem appearances, and a pathologist could not in any single case positively determine the cause of death from only the organic appearances. PHOSPHORUS. Post-mortem appearances vary according to the form of poison taken, but usually those of a corro- sive irritant poison. When the poison is taken in a pure state or dissolved in oil, the esophagus and other portions of the alimentary canal usually show the injurious effects. Rapidly fatal cases exhibit signs of irritant poisoning. If death is delayed there may be a softening of the stomach, a peculiarly 290 A MANUAL OF TOXICOLOGY. jaundiced skin and ecchymosis beneath pleura, peri- toneum, pericardium, and in lungs, kidneys, bladder, uterus, muscles and subcutaneous tissue (probably all due to a rapid disintegration of the blood corpuscles). The lesions in many respects resemble the most aggravated forms of sea scurvy. The vis- ceral cavities may contain bloody fluid. May be luminosity of the stomach or other parts. The liver is usually enlarged, doughy with well marked acini and cells filled with large fat drops. A remarkable, acute, fatty degeneration of the liver, kidneys, heart and other muscles and usually of the walls of the arterioles and capillaries constitute the most marked lesions. The blood is usually dark and fluid, but of a syrupy consistence. The most constant stomach lesion is a granular degeneration of the cells, filling the gastric follicles, thus altering the appearance of the mucous membrane, which becomes white, grey or yellow and thick and opaque. There may be perforation, but usually small circumscribed spots of inflammation, erosion or gangrene. The small intestine may be normal or congested. The heart is usually discolored, empty and contracted, but may contain a small quantity of fluid blood. Phos- phorus has caused death without leaving recognized lesions. POTASSA - SODA - AMMONIA. The mucous membrane of mouth, throat, eso- phagus and stomach softened, detached, and choco- late-colored or black in recent cases. Signs of ul- ceration in esophagus and stomach or intestines, associated with more or less constriction, when death has resulted from the secondary effects of the poison. In some cases of poisoning by stronger Ammonia there may be perforation of the stomach, with congestion and blackening of its mucous mem- brane. POTASSIUM CHLORATE. 291 POTASSIUM CHLORATE. Blood usually brownish and thickened. Kidneys injected. POTASSIUM CYANIDE. The appearances in poisoning by Potassium Cy- anide are mainly such as are described under Hydro- cyanic Acid, with the addition perhaps of caustic local action. When the poison is taken directly after a hearty meal, there may be no signs of corro- sion or even redness, owing to the protection of the stomach by its contents, or the neutralization of the Potassium Cyanide by the acid of the stomach. Erosions of the lips may be caused by a very strong solution of the poison and the caustic effect may be traced in the mouth and esophagus to the stomach and duodenum ; but this is not common, the stomach and duodenum only showing the local effects. The mucous membrane is swollen, may be ulcerated, and is colored blood-red ; its reaction is strongly al- kaline. The coloring matter of the blood, dissolved out by the Potassium Cyanide, frequently dyes the upper layers of the epithelium, as a post-mortem effect; this can can be imitated by digesting the mucous membrane of a healthy stomach in a Po- tassium Cyanide solution. The dose of the poison and the condition of the stomach as regards empti- ness, of course, entirely govern the intensity of these changes. Although the stomach may be empty when the poison is taken, a dose just large enough to destroy life may produce but little redness or swelling of it. Inflammatory changes in the larynx may be produced by vomit drawn into the air pas- sages in vomiting. The blood often exhales the odor of the poison, and as the acid may often be dis- tilled from it, some of it should be preserved for analysis. 292 A MANUAL OF TOXICOLOGY. Essence of Almonds may produce the slight in- flammation of the other essential oils, but no ero- sion, no strong alkaline reaction, nor effects, such as the caustic Potassium Cyanide produces. POTASSIUM NITRATE. The contents of the stomach may be mixed or tinged with blood. Interior of stomach and in- testinal canal exhibit signs of severe inflammation. Mucous membrane may be detached in places, and there may be perforation. PTOMATROPINES. Swelling of pharynx, esophagus and mucous mem- brane of the stomach. May be venous hyperaemia of brain, lungs and kidneys. There may be injec- tion of intestines and swelling of the solitary and Peyer's patches and degeneration of the heart muscle. SAVINE. The capillary and venous systems usually con- gested. Heart full of blood, particularly on right side. The blood is of a black color. A general plethora of intestinal vessels. Usually more or less inflammation of bowels, stomach and intestinal tract, with congestion of kidneys. SILVER CYANIDE IN POTASSIUM CYANIDE. (Counterfeiter's Silver Coating). Distinct smell of Hydrocyanic Acid. Eyes glist- ening; pupils dilated; jaws clenched; strong rigor SILVER NITRATE. 293 mortis ; cerebral membranes congested ; lungs highly congested; bronchial tubes and lung cells filled with frothy mucus; right side of heart full of black fluid blood, left side empty; bladder empty; stomach red. (Death in 40 minutes; autopsy after 32 hours). SILVER NITRATE. In rapid poisoning, a blue line around gums; in slow poisoning, a bluish tint of the body. Stomach and intestines show either a white color from the action of the caustic salt, a black from decomposi- tion of animal matters, or an intensely red color, due to inflammation. TOBACCO AND NICOTINE. No characteristic signs from Nicotine. Is con- gestion of liver, brain and lungs. A diffused red- ness over the mucous surfaces of the stomach and bowels. The heart is empty. Blood dark and fluid. May detect Nicotine in the body a long time after death. Has been found in animals after the lapse of years. Nicotine should be sought in the stomach, lungs and liver. ZINC. Zinc Sulphate is apt to produce inflammation. Intestinal tract inflamed and usually congestion of brain and lungs. Mucous membrane of stomach may be much wrinkled. Stomach and intestines contracted. Zinc Chloride corrodes. A peculiar whiteness and opacity of mucous membrane of mouth and eso- phagus. Stomach usually corrugated, contracted, opaque, leaden color, leathery and hard. All parts of very acid reaction. Lungs and kidneys congested as a rule. The fluid in the stomach has the appear- ance of curds and whey. There may be fatty de- generation of various internal organs. 294 POST MORTEM KEY TO POISON. A MANUAL OF TOXICOLOGY. Appearance (Post Mortem). Probable Cause of Death. Arsenic, silver. Coal gas, cyanides, hydrocyanic acid. Carbolic acid,coal gas, nitro-benzol,silver- nitrate. Arsenic. Phosphorus, poisonous mushrooms. Phallin, phosphorus, solanine. Alkalies, bromine, carbolic acid, chro- mates, corrosive acids, ergot, iodine. Bromine. Icterus of . . Papular, pustular or ulcerative Tan-like and partly necrosed Chloroform, nux vomica, strychnine. Alcohol, arsenic, carbolic acid, chloro- form. Poisonous mushrooms. Putrefaction fastened (no rigor ( Yellowish or Lips and around Mouth K brownish... ( Whitish . Carbolic acid, nitric acid, sulphuric acid. Carbolic acid, oxalic acid, sulphuric acid. Copper (chronic poisoning). Arsenic. HaIR 1 Sudden loss of Opium, physostigmine. Belladonna, gelsemium, hyoscyamus, scopolamine, stramonium. Arsenic, ergot, lead. Muscles, Atrophy of Mouth, Inflammation of Iodine. Tongue and mouth inflamed, teeth loose 1 Blue line on Bismuth, mercury. Gums ] Dark lire on Bismuth, mercury, silver. Phosphorus. Nitric acid, oxalic acid (occasionally). Sulphuric acid. Carbolic acid, chloroform (by mouth), corrosive sublimate, hydrochloric acid, oxalic acid (occasionally). Hydrochloric acid, nitric acid, ammonia, potassa, soda. Quick-lime. Carbon monoxide, cowbane, illuminating gas.. Arsenic (occasionally), potassium chlorate Savine. tobacco. Yellow, green or Mouth f Grayish, brownish mouth Corroded or blackish fHROAT^ and JWhitish 1 softened Stomach I Chocolate-colored f Intensely red | Bluish-red or cherry-red, and j fluid Blood j | Brownish and thickened j Black [Extended coagulation of Bromine. POST MORTEM KEY TO POISON. 295 Post Mortem Key to Poison (Continued). Appearance (Post Mortem). Probable Cause of Death. Odor (characteristic) ; especially notice- able upon opening body Alcohol, amyl nitrite, anilin, acetic acid, arsenic, ammonia, bromine, camphor, carbolic acid, cbloroform, chlorine, cyanides, ether, ethyl bromine, hydro- chloric acid, hydrocyanic acid, iodine, nicotine, nitrobenzol, opium, phospho- rus, rue, savine, tobacco. Copper salts, Paris green. Lead chromate, orpi.nent, picric acid, potassium bichromate. Bismuth, copper, lead, mercury. Arsenic, potassium nitrate. Phosphorus. Cantharides. Poisonous mushrooms. Arsenic, carbolic acid. Zinc. Corrosive sublimate, acetic acid (near pylorus), oxalic acid (occasionally). Arsenic. Arsenic. Iodine. Zinc. Carbolic acid, oxalic acid, zinc. Arsenic. Matches (phosphorus). Aconite, belladonna, hyoscyamus, savine, stramonium, tobacco. Nux vomica. Castor oil, hyoscyamus, laburnum, stra- monium. Antimony, antimonious sulphide, arsen- ous oxide or sulphide, metallic arsenic, calomel, chromium preparations, iodine, mercuric oxide. Arsenic, baryta, phosphorus. Acids, acid salts. Alkaline earths, caustic alkaiies, potas- sium cyanide. 'Green or bluish green Yellow or reddish yellow [also walls] Turn . black when ex- Contents-^ posed to ammo. nium sulphide.. Hematic Luminous in dark. Contain shining green particles.. Stomach] [Gills and spores... White spots Purple-red (mu- cous membrane). Red (deep or dark) Walls Yellow stains Yellow-brown Leathery Wrinkled, con- tracted Corrugated and thickened [Small pieces of wood Leaves Fragments of hair-coated seeds Fragm ents of 'Contains -, non-coated seeds Mineral particles Gastro Intestinal-, Canal Hemorrhagic ( material Wa>ls (Acid an 1 Alkaline [Contents 1 296 Post Mortem Key to Poison (Continued). A MANUAL OF TOXICOLOGY. Appearance (Post Mortem). Probable Cause of Death. f Villi turn black Silver. Walls and (Yellowish Contents! Greenish of Duo- । denum, t Brownish etc. Intestines t ( Black and ulcer- , La'g.e J ated Nitric acid, picric acid, plumbicchromate. Cupric sulphate, Paris green, Scheele's green, verdigris. Bromine, iodine, phosphorus, potassium chromate. Bismuth. Castor beans. Lead. Intestine ( Dysenter!c General contraction of or gray-black mucous mem- brane Bluish-green mucous mem- brane Copper. f Yellow patches Arsenic. Abdominal I Red * " Antimony. Mercury. Ammonia, antimony, arsenic, iodine, phallin, phosphorus. Ammonia, antimony, arsenic, iodine, phallin, phosphorus. Baryta, lead, mercury, oxalic acid. Morphine, muscarine, nicotine, pilocarp- ine, etc. Hydrocyanic acid in some form. Alcohol', digitalis, etc. Viscera "j Grayish or blackish [ patches, and corroded... Liver, fatty Heart, fatty degeneration of, also of muscles and kidneys Kidney, rough, grating, sound in cutting Lungs, CEdema of (Odor of peach pits or hydro- Braink cyanic acid ( Congestion of CHRONIC POISONING AND DRUG HABITS. CHRONIC POISONING. 299 PART X. CHRONIC POISONING AND DRUG HABITS. By more or less continued and prolonged use of the various preparations of Alcohol, Opium, Mor- phine, Chloral, Chloroform, Cocaine, Ether, Paralde- hyde, Wormwood, etc., some persons acquire a habit for such poison, and a state of chronic poi- soning. The brain structure is deranged, mental function is more or less <seriously disturbed, the vital organs are weakened or actually diseased, and a degenera- tion of the whole physical economy is induced. Furthermore, the effects, most unfortunately, are not limited to the individual, but may be trans- mitted to succeeding generations, producing var- ious brain abnormalities, perversion of morals, and defects of mind. Of all the various kinds of chronic poisonings, the most important are those by Alcohol, Opium (including Morphine), and Cocaine. Dr. Kellogg, formerly superintendent of the New York State Asylum, says: "There are chronic intoxications from poisons inten- tionally taken, as in the widespread drug habits. * * * In their physiological effects there is a specific difference in poisons as to the prevailing emotional mood excited, but in their pathogenetic relations to insanity they result in maniacal or melancholic states more in accordance with in- dividual and constitutional peculiarity. Toxic insanity is acute or chronic vesania caused by the 300 A MANUAL OF TOXICOLOGY. medium of toxic substances acting on the cerebro-spinal or sympathetic nervous system and clinically manifested by motor, sensory, trophic, vasomotor and psychic disorder, varying according to the individual idiosyncrasy of reaction to the toxic agencies which have invaded or been generated in the organism. In some toxic cases, motor anomalies, in others sensory perversions, and in others intellectual disorder may predomi- nate, according to the vascular areas and nervous tracts in- volved in the pathological changes initiated by the poison. The cerebro-s.pinal lesion may give rise to a symptom com- plex like that of general paresis. Some of the more common toxic agents which cause in- sanity are here named and classified: I. Mineral Poisons and Drugs.-1, Lead; 2, Mercury; 3, Arsenic; 4, Chloral; 5, Bromide of Potassium; 6, Iodoform; 7, Paraldehyde. II. Vegetable Poisons.-1, Opium; 2, Belladonna; 3, Can- nabis Indica; 4, Hyoscyamus; 5, Stramonium; 6, Tobacco; 7, Cocaine; 8, Conium; 9, Erythroxylon Coca; TO, Astragalus Hornii; 11, Secale Cornutum. III. Intoxicants and Noxious Gases.-I, Alcohol; 2, Ether; 3, Chloroform; 4, Carbonic Oxide; 5, Sulphurous Acid Gas. IV. Acute Infections and Diseases.-1, Typhoid Fever; 2, Smallpox; 3, Scarlet Fever; 4, Typhus Fever; 5, Diph- theria; 6, Cholera; 7, Puerperal Sepsis; 8, Epidemic Influenza; 9, Purpura; 10, Erysipelas; 11, Bubonic Plague; 12, Lepra Vera; 13, Lessa Humana. V. Auto-Intoxications.-1, Leucomains; 2, Ptomains. Some of these toxic agents only act upon special tissues, but most of them deleteriously affect the entire organism, and their evil effects continue long after their elimination from the system." ALCOHOL - ALCOHOLOMANIA - CHRONIC ALCOHOLISM (CHRONIC ALCOHOLIC POISONING). By alcoholomania is meant the possession of an overpowering impulse, crave, craze.or mania for in- toxication by alcohol. ALCOHOL, ETC. 301 By chronic alcoholism is meant the morbid effect of chronic excess in the use of alcoholic beverages. The spirit obtained from potatoes is the most in- jurious of all the alcoholic beverages, owing to the large amount of amyl alcohol (fusel oil) which it contains. Many of the cheap spirits have this as their basis. SYMPTOMS: The system gradually undergoes an alcoholiza- tion. Nutrition is impaired, the various organs of the body gradually undermined, the natural physio- logical processes being by degrees converted into pathological ones. The alcohol irritates the stom- ach and digestive apparatus, and precipitates the pepsin of the gastric juice, inducing heart burn, neuralgia of the stomach, belching, melancholia and various distressing symptoms associated with chronic dyspepsia. The structure of the liver is gradually altered and it becomes enlarged and fatty or contracted and cirrhosed. The kidney is seriously impaired. The heart becomes more or less fatty, hypertrophied, weak, flabby and incapable, so that the patient suffers from palpitations, dyspnoea, "stitches," etc. Frequently the tongue is parched and furred, and the breath foul. There is often per- sistent and urgent thirst, nausea, flatulence, severe pain in the vicinity of the stomach, loss of appetite, dislike for food, sense of severe coldness or heat, stabbings, twitchings and uneasiness throughout the body. The limbs become enfeebled and trem- ulous. There is more or less mental degredation, low-spiritedness, indeterminate fears of impending disaster, irritability, cowardliness, cunning, inde- cision of character, inability to concentrate the thought, violence of temper, untruthfulness and weakness of purpose. The chronic alcholic is a va- cant, silly and foolish dement. The morbid tissue changes produced by the alco- hol deprave the brain, intellect and moral sense, 302 A MANUAL OF TOXICOLOGY. and the anesthetic influence of the alcohol so dulls the perceptive faculties as to make the alcoholic unconscious of the damage being done to his body and mind. Destructive changes, which normally are painful, elicit no complaint from the benumbed senses. Violent acts, even manslaughter, may un- intentionally be committed through the inability to estimate or determine the amount of force em- ployed in various physical efiforts. An intended friendly tap may thus be delivered with crushing force. Unusually immoral and indecent acts may be committed through an enfeebled, deteriorated and degraded moral sense, dependent upon cerebral and other tissue changes. There is a more or less complete paralysis of will power, mind and morals. Delirium tremens, dementia, mania, epilepsy, or even general paralysis may characterize the prog- ress of the disease. In beer and other malt liquor drunkards, there is more or less tendency to obesity. There is puffing and blowing upon the least exertion, and the move- ments are more or less sluggish and clumsy. The features become dull and expressionless, the face red or purplish, and the blood vessels in the regions of the eyes and nose enlarged and congested. The skin is blotched, greasy and glistening, the eyes red and moist and the conjunctiva yellowish. Death, frequently, finally occurs from embolism, syncope, or dropsy. Spirit drinkers incline to emaciation, but ulti- mately, from ascites or anasarca resulting from cirrhosis of the liver and kidneys and fatty degen- eration of the heart, may become quite rotund or large limbed. Their restlessness, imaginings, and disturbed, mirefreshing sleep often induce a highly dangerous resort to opiates or other narcotics. They suffer from delusions of persecution, and some of them experience a sense of double consciousness. ARSENIC, ETC. 303 TREATMENT: Various mysterious chemicals, medicinal prepara- tions and processes, including hypnotism, have from time to time been exploited and claimed to be a specific remedy for chronic alcoholism. The so- called "gold cure" has seemed to prove efficacious in some cases, and a most dismal failure in others. As a rule the best plan to pursue is to commit the alcoholic to some institution where he will be in- spired with hope, his will fortified, poisoning dis- continued, and his system built up with such tonics as iron, arsenic, cod-liver oil, etc. ARSENIC - CHRONIC ARSENICAL POISON- ING. HISTORY: Chronic poisoning by arsenic may be caused by arsenical wall papers, candles, artificial flowers, toys, India rubber balls, carpets, advertising and playing cards, floor-cloths, the colored wrappers of some cigarettes, japanned goods, etc. SYMPTOMS: Thirst and dryness of mouth; nausea; vomiting; perhaps slimy, bloody diarrhoea; voice rough and harsh; eyes red and smarting; eyelids puffed; appe- tite lost and a sense of weight or soreness at the pit of the stomach; skin dry, covered with sore spots or scales; disturbed sleep; aching in joints or limbs; there may be spitting of blood, great loss of flesh, and general debility. TREATMENT: Remove the cause. Provide plenty of fresh air and various tonics, such as iron, quinine, cod-liver oil, strychnia, etc. A complete change of air and scene often proves of the greatest benefit. 304 A MANUAL OF TOXICOLOGY. CHLORAL-CHLORALISM. HISTORY: Chloralism may be the result of the long contin- ued use of the drug as a sleep producer, to relieve neuralgia or other pain, etc. SYMPTOMS: The chief symptoms are a disturbance of diges- tion, chiefly from the direct effect of the drug upon the mucous membrane of the stomach; an eruption of the skin, dyspnoea, depression, vertigo, insomnia, excitement, volubility, reduction in nerve power, lessened mentality, etc. TREATMENT: Prevent the obtaining of the drug, and build up the system. This can ofttimes be best accomplished by placing the patient in a good sanitarium for a time. COCAINE - THE COCAINE HABIT - CO- CAINOMANIA-COCAINE INEBRIETY- COCAINISM. HISTORY: The dangers and disasters resulting from a pro- tracted or habitual use of cocaine can scarcely be enumerated or estimated. This is probably the most seductive, dangerous and mentally, physically and morally destructive of all the drug habits. Erlenmeyer has denominated cocaine the third scourge of humanity, following in order after al- cohol and opium, in this respect. Cocaine fascinates by the promptness with which it relieves all sense of exhaustion, dispels gloom and exhilarates, produc- ing a sense of happiness and well-being which trans- ports at once to a longed-for elysium. Primarily, the after-effects are scarcely percept- ible, but through continual indulgence an intense craving for the drug or its effects is produced. Cocaine, etc. 305 SYMPTOMS: The habitue is afflicted with sleeplessness, ner- vousness, tremulousness, nervous and muscular ir- ritability, illusions of sight and hearing, insensibility to pain, indecision, dyspepsia, palpitation, disincli- nation to work, avoidance of friends and society, in- sane jealousy, mistrust, moral perversion, bodily emaciation, decay of mind, etc. When the 'toxica- tion is frequently repeated there is a tendency to raving insanity. Regarding cocainism, Superintendent Kellogg, of the State Asylum, says: "Cocainism develops a reasoning form of mental aliena- tion with change of hallucinations 2nd corresponding de- lusions, anxious and excitable moods, attaining melancholic states of agitation on withdrawal of the drug, or even at- tacks cf stuporous collapse." Regarding a comparison of the cocainist with the morphinist and the deleterious effects of cocaine, Professor Berkley, of Johns Hopkins University, in his "Treatise on Mental Diseases," in speaking of drug habits, says: "Even less than the Morphinist are the Cocaine de- bauchees to be trusted, inasmuch as their moral rectitude and will power have always suffered severely. * * * Under the deleterious influence of the continued use of Cocaine, especially when it is superadded to the Morphine habit, the gravest somatic indications may arise. The bodily weight sinks rapidly, even 1-5 to 1-3 of the whole being lost within a few weeks. The skin hangs in folds and has a dirty yellow tint, the countenance assumes a distressed look, muscular weakness and tremor become profound. As happens in other states of inanition, the reflexes be- come exalted, cramps make their appearance, there is mus- cular unrest with tremor, particularly noticeable in the tongue. The symptoms of collapse increase. There is a growing tendency to fainting attacks, with irregularity in the cardiac action, accompanied by profuse sweating and dilatation of the pupils. Sleep is much disturbed. The patients usually retain their appetite and powers of as- similation, but the waste being greater than the supply, rapid 306 A MANUAL OF TOXICOLOGY. emaciation results. Sometimes from the direct poisonous influence of the alkaloid, sometimes from the continued de- nutrition of the entire body the person habituated to Co- caine acquires an indubitable insanity, which assumes the customary type of a hallucinatory psychosis. Usually after a short prodromal period of motor unrest, anxiety, mis- trust of family or companions, and increasing irritability are noted. Hallucinations which may involve all the special senses, quickly follow. Those of hearing are the most frequent. Obscene language and scolding voices are overheard; vile words are shouted at the sufferers; they hear noises made by thieves in the midnight watches; they are threatened with in- jury; their most secret thoughts are blazoned forth to the edi- fication of the populace; they are made exhibitions of to the delight of their enemies; the roar of machinery, the clanging of bells, wailings, loud screams, and shrieks of murder are somewhat less frequent. Hallucinations of sight customarily accompany those of hearing. * * * Soon the cocaine suf- ferer becomes dangerous to himself, his family or the com- munity." Regarding the prognosis in these cases, Prof. Berkley says: "This is most gloomy. Even though the patient recover from one attack, he very frequently relapses into his evil habits. In the most favorable cases there ever remains an ex- traordinary weakness of the will power, with accentuated ten- dency to relieve the physical and psychical languor, by substi- tuting for the cocaine alcohol, morphine, antipyrine and other nervines in large quantities." Although the cocaine habit has in some instances been the result of experimentation or of unwise medication, it usually results from the careless and persistent taking of cocaine as an analgesic, or of taking remedies to cure various ailments, or taking so-called cures for the alcohol or opium habit, which remedies or cures contained cocaine. The attempt to substitute cocaine for alcohol or opium is as hazardous as it is unsuccessful, the evil only being added to, instead of lessened. TREATMENT: The treatment is practically the same as that for morphinism (q. v.). Berkley says: THE CYANIDES. 307 "Persons addicted to the combined morphine-cocaine habit should be allowed their morphine, at least until the immediate effects of the cocaine have passed away. In chronic cocaine insanity home treatment is rarely admissible, especially as there are nearly always dangerous tendencies." THE CYANIDES. HISTORY: Photographers, electroplaters and gilders fre- quently suffer from chronic poisoning by the cy- anides. SYMPTOMS: Headache, dizziness, ringing in the ears, pains in the cardiac region, dyspnoea, nausea, pallid skin, of- fensive breath, etc. TREATMENT: Promptly resort to ammonia inhalations, cold douches, chloride of lime held to the nostrils, etc., etc. Employ electricity, friction and artificial respira- tion if necessary. A mixture of ferrous and ferric sulphates with sodium or potassium hydroxide or carbonate is the best antidote to employ. ETHER - ETHERISM - CHRONIC ETHER POISONING. HISTORY: Ether drinking as a habit was at one time quite extensively practiced in Ireland. It was indulged in by people of all classes and even children. It was sold in shebeens and groceries, often bartered for poultry and farm produce, being delivered at the doors of the people by hawkers. From a tea- spoonful to two or more fluid ounces were drunk at a time by the users. The average daily quantity by the moderate ether-drinker was two drachms three or four times a day. The habit, in time, extended to England, Scot- 308 A MANUAL OF TOXICOLOGY. land, France and the United States. Some ether- tipplers inhale it instead of drinking it, thus using about a pint per day. SYMPTOMS: Ether-drinking produces mainly symptoms of a purely functional disturbance. There is burning pain in the stomach, digestive disturbances, loss of appetite, and symptoms of acute or chronic gastritis. Insomnia, tremors, pallor, gloom, fear, despair, sus- picions, chills, lemon-colored or blue skin, irregular heart action, tottering gait, loss of strength, prema- ture decay, etc., are among the chief symptoms. TREATMENT: Isolation, predigested food, soothing gastric treat- ment, and the general treatment employed in chronic alcholism. LEAD: -, PLUMBISM - LEAD COLIC - LEAD PALSY - WRIST DROP. HISTORY. Compositors, house painters, potters, card play- ers, paper hangers, file cutters, electric light work- ers, japanners, enamellers and others are very apt to be afflicted with lead poisoning. Some hair dyes and cosmetics, hat linings, or goods whitened with a lead preparation, tea packed in lead, water or beer which has stood for some time in lead pipes, or soda water from lead-topped syphons, spirits which have been in leaden recep- tacles, wine sweetened with lead acetate, foods from lead-soldered tins, or lead wrappers, or loaf sugar from lead moulds, snuff adulterated with red lead, etc., are sometimes the source of lead poisoning. SYMPTOMS: A general sense of ailing; anaemia, dull-colored skin. A blue line at the edge of the gums where they meet the teeth is one of the first and most last- MERCURY, ETC. 309 ing symptoms. It is not found when there are no teeth and shows plainly in those who neglect to clean their teeth. Not found usually on those who attend to them. It is the result of the formation of lead sulphide. In Lead Colic - "Painters' Colic" - the chief symptoms are a tearing pain in the umbilical region, which, as a rule, is relieved by pressure; the walls of the abdomen are rigid and retracted; there are usually also constipation and other digestive dis- turbances; there may be lead paralysis or wrist dfop in lead poisoning; also cramps in the calves of the legs, in the scrotum and penis in men, in the uterus in women; pain may occur in the joints, par- ticularly those of the extremities. Other symptoms of lead poisoning are headache, vertigo, insomnia, irritability of mind', anaemia, emaciation, disturbed digestion, anesthesia of por- tions of body, sexual degeneracy, tearing, burning pain in arms and shoulders, convulsions, etc. In women profuse menstruation or even abortion may occur. TREATMENT: Give a blue pill at night, followed by a saline in the morning. Iron, Magnesia, Chloroform, and Potassium Iodide, 3 or 4 times a day, are beneficial. Tincture of Belladonna may be given to relieve the colic. Nourish well, and give Cod-liver Oil, Malt Extract, Hypophosphites, Wine, etc. Faradization and massage are helpful. Strychnine in large doses is beneficial. Employ warm baths frequently. MERCURY - MERCURIALISM - PTYAL- ISM (SALIVATION) - MERCURIAL TREMORS (SHAKING PALSY). SYMPTOMS: In chronic mercurial poisoning- there is usually debility, nausea, vomiting, colicky pains, a metallic taste in the mouth; the gums are dark red, swollen 310 A MANUAL OF TOXICOLOGY. and tender; the teeth adhere; the tongue is furred and swollen and the breath foul; may be hacking cough and spitting of blood. In ptyalism the saliva is greatly increased in quantity (sometimes as much as pints secreted in 24 hours). There may be ulceration of the mucous mem- brane of the mouth, a skin eruption, and even peri- ostitis ; later there may be mercurial tremor, paraly- sis, or convulsions. The mercurial tremors of those engaged in handling mercurial compounds or exposed to the fumes of mercury, affect first th*e upper extremities and gradually the whole body. Co-ordination power is lost and the movements are erratic; ultimately result in mania and imbecility. [Salivation is sometimes produced by Antimony, Bromine, Lead, Hydrocyanic Acid, Nux Vomica, Gold, Cantharides, Digitalis, Conium, Belladonna, Opium, and especially by Potassium Iodide. Great fetor of breath and painful sponginess of gums is peculiar to mercurial salivation, and in case of doubt the saliva should be examined for mercury], TREATMENT: Tonics, fresh air, albumin, port wine, chlorate of potash, gargles, plenty of good food, and perhaps small doses of Potassium Iodide, comprise the best treatment. OPIUM AND MORPHINE - THE OPIUM HABIT - THE MORPHINE HABIT - OPIOMANIA - MORPHINOMANIA - CHLORODYNOMANIA - ETC. HISTORY. Opiomaniacs and morphinomaniacs by long-con- tinued habitual misuse of these drugs are enabled to take enormous doses of them without the effects proving immediately fatal. Various devotees have OPIUM AND MORPHINE. 311 been known to average such large quantities, daily, of one or the other, as the following: Opium, 30 grains; an ounce or more of Tincture of Opium; of Morphine salts, 8 grains or more. Three ounces of Laudanum daily have been taken for a week or two at a time by a young woman habitue ; another wo- man drank 1^4 ounces daily for 7 months; still an- other woman drank of a mixture of Laudanum, Spirit of Chloroform and Spirit of Lavender (equal parts), 7 ounces daily; every day for years, an adult, 50 years of age, drank 2*4 ounces of Laudanum and ounces of Paregoric; De Quincey finally took 8,000 to 10,000 drops of Laudanum daily; doses of 20, 40, or 60 grains of Sulphate of Morphine are not rare. Such surprising quantities as the following have been recorded: The drinking by an adult female of a pint of Laudanum daily; the taking by a man of 150 grains of solid Opium in one day in 30 grain doses; the daily hypodermic injection, in a man, of 60 grains of the Hydrochlorate of Morphine; the taking of a fluid ounce of Chlorodyne (Oil of Pep- permint ; Prussic Acid and Muriate of Morphine; the Morphine 2*4 gr. to the ounce), etc. It would appear that some children are kept more or less under the effects of Morphine by the use of various soothing nostrums. Mrs. Winslow's Sooth- ing Syrup is said to contain about one grain of Mor- phine to the ounce; Godfrey's Cordial about one grain of Opium in two ounces, and Dalby's Car- minative one grain in six. SYMPTOMS. By the narcotizing, anesthetic influence, of both Alcohol and Opium, sensation is deadened, nervous ability benumbed, the vital powers and intellectual faculties undermined by starvation, resulting in an atrophic physical wasting and a depraved moral sense. Opium produces so depressant an effect on the 312 A MANUAL OF TOXICOLOGY. special nerve centres and general nervous system as to cause frequently sterility in women and impo- tence in men. The hereditary influence of these drugs is more apparent in alcoholists than in opiumists or mor- phinists. Cardialgia is a common symptom where either of these two poisons are heavily indulged in. Opium users, as a rule, take the drug regularly. Alcohol- ists are apt to be periodical in their excessive use of alcohol. Opium lessens the peristaltic action of the intestines, resulting in constipation, acidity of the stomach, anorexia, deficient digestion, a foul tongue, incontinence of the urine^ etc. Cardiac innervation is disturbed, resulting in attacks of false angina pectoris, and pericardial anxiety, producing alarm- ing symptoms of distress. The opiumist's or morphinist's skin becomes yel- low, nails brittle, teeth loosened, a most profound anaemia usually results; furthermore an exceed- ingly obstinate sleeplessness is encountered in the final stages of chronic morphinism." The morphine habit greatly depraves both brain and body nutrition. The body gradually emaciates. The higher brain functions undergo serious alter- ation manifested by loss of self-respect, a tendency to coarseness, baseness, and untruthfulness, to seek questionable associations, and, in fact, a loss of all moral restraint. Persons addicted to the morphine or opium habit seem incapable of a correct statement of facts or occurrences. Their untruthfulness and deceitful- ness are amazing. As McBride declares: "They misconstrue statements, they habitually misrepre- sent and misunderstand. If a statement can be given two meanings they will apply the wrong one." Their ability to inspire confidence in their state- ments, by earnestness, apparent frankness, and im- pressive solemnity of manner, although, in fact, they are cunningly and deliberately lying, is as mar- OPIUM AND MORPHINE. 313 velous as it may prove serious. In this respect some of them are possessed with a most distinct and depraved viciousness, indifferently or even with heartless satisfaction grievously misrepresenting and irreparably wronging innocent persons. And for this they may afterwards show no contrition, either lacking the moral courage to acknowledge their fault or their cerebral degeneration prohibiting their subsequent faithful interpretation of the true facts. They are thus a serious menace to the well-being of not only their own households but to the com- munity in which they live. As a rule the person addicted to Opium does not exhibit the tendency to violence manifested by so many alcoholists. But owing to the narcotic hold the drug has upon the nervous system, opium users are more difficult to cure than alcoholists. Dr. Kellogg, formerly Superintendent of the State Asylum, says in his "Text Book of Mental Dis- eases," regarding the effects of morphinism: "Morphinism results in amnesic states, affective perver- sion, irritable, suspicious and fearful delusions, complete moral degeneracy, suicidal impulses lacking force of execu- tion and distressing hallucinations on cessation of the drug, with cramps and vasoparetic states." Chronic Opium Intoxication is a condition of abandonment to self-gratification and utter indiffer- ence to duty and the rights and interests of others, as is confirmed by various authors, as follows: Regarding the Morphine habit, Berkley says: "In the mentally robust the most common cause of morphin- ism is the continued use of the drug for the relief of pain, neuralgias, sciatica, repeated migraines, tabetic pains, rheuma- tism, hepatic or renal colic, dysmenorrhoea, and a host of other somatic troubles; then, when the pain has ceased, the habit is continued for the pleasurable excitement and feeling of tem- porary happiness induced by it. * * * Tn another class of cases the patients are of a neuropathic disposition and have the same craving for morphine as a stimulant that others have for alcohol., ether, or essence of ginger. The neurasthenic, the 314 A MANUAL OF TOXICOLOGY. hysterical, the hypochondriac, the periodical melancholic or drunkard, all turn to opium for that sense of well-being only attainable while they are under the influence of some perni- cious anodyne. Still another class of morphinists is met with. * * * Persons who have become a prey to grief or despondency * * * as well as those who are sleepless or overworked are too apt to seek the haven of rest and rare sense of mental relief only to be found in the extract of the poppy. The sleep of the opium habitue is never profound but is broken by the recurring visions which in the dream state are constantly changing. The majority of these are agree- able. * * * [but] may be of a disagreeable nature; in- numerable faces float before the eye of the imagination. * * Time is annihilated or increased to an eternity. * * * The permanent effect * * * is shown in pronounced moral obliquities, and in the resort to any means, no matter how unscrupulous, even actual forgery and theft, to obtain the drug. The idea of any personal responsibility falls to the lowest ebb; thought action, and even the most impera- tive duties, are shunned. While the largest number of these unfortunates are not insane in the stricter sense of the word, there is always present a certain degree of ethical obliquity, irritability, peevishness and moroseness. It is never safe to believe the word of an opium eater; he will prevaricate with or without reason, his disposition is uncertain and treacherous, his conscience is obtunded, he ig dissolute, and has tendencies to morbid impulses." And the distinguished author and president of the British Society for the Study of Inebriety, Dr. Norman Kerr, of London, in speaking of the chronic morphinist, says: "He is harassed by frequent palpitation of the heart, op- pressed breathing, cramps in the abdomen and leg muscles, nocturnal pains, fitful sleep with terrifying dreams, trembling and fear at imaginary or real voices. There is an exaggerated sensibility, slight pains seem to be acute agony, resolution is transformed into irresolution, with uncertainty of purpose, confusion of thought, morbid melancholy and despair, ano- rexia alternating with fitful voracious appetite, general consti- pation with, it may be, frequent prostrating diarrhoeal or dysenteric attacks, salivation, listlessness, and indifference to cleanliness, personal appearance, and the claims of duty. The OPIUM AND MORPHINE. 315 moral sense is by and by perverted, so that the person's word cannot be relied on, and the no longer pleasant though neces- sary opiate oblivion is procured, if it cannot be honestly, by theft, the sale of one's living body, or murder. * * * * Sexual function is in general disturbed. In the female amenorrhoea prevails, in the male impotence, but in both sexes functional normality is gradually recovered on aban- donment of the drug. The effects of the cachectic marasmus, which is apt to have a fatal ending, often remains long after abandonment, though in most cases they are in time over- come. Death may supervene in various ways: from some intercurrent malady, opiumists being peculiarly prone to be attacked by some diseases, while apparently almost proof against others; from an overdose taken either intentionally or accidentally; or, at rare times, from the effects of the shock incident on some surgical operation." McBride, of California, in his most excellent ar- ticle on "The Morphine Habit," says: "In respect of the moral qualities the morphinist is a cripple and he will remain so until he regains health, if he ever does, by a slow process of character growth which can only be begun after the drug is stopped and then con- tinued for some time subsequently. The quitting of the morphine habit is, therefore, but part of the cure. Though the patient may have quit the drug, and though he is com- fortable without it, the cure is far from complete." Nearly all morphine or opium habitues will offer some plausible, self-exonerating excuse or expla- nation for having become addicted to the use of the drug. They very commonly place the blame for having acquired the habit, upon the family physi- cian, if they have such, or upon some remedy given or recommended by a friend. In the vast majority of cases their own deliberate and wanton self-indul- gence and dream-state seeking, are the true cause of the habit. McBride sums up the results of his own extended experience and observations, in these cases, as follows: "It is certainly true of a very large proportion of mor- phinists that they are people who are originally weak in self-control, and usually, too, they are impulsive and selfish. I have exceptionally been able to verify the common state- 316 A MANUAL OF TOXICOLOGY. ment of patients that they became addicted to the habit from the drug having first been given by a physician, so that I think many of the statements to this effect are misrepresen- tations. It seems to me that very many of them are volun- tary victims in the sense that they began taking the drugs from precisely the same motive that most alcoholic in- ebriates begin to drink liquor, that is because they find pleasure in it. As a rule we have in the morphinist as in the alcoholic inebriate, a man who was originally weak in self-control, and strong only in the qualities that thrive on human frailty. The number of these people who have origin- ally some twist in the mental make-up is surprisingly large, for, however talented they may be, and I have found some unfinished geniuses among them, the majority are certainly ill-balanced, unadjustable people, with a genuine talent for selfishness, and who in their constant attempts to make themselves comfortable fall upon the habit that becomes their ruin. The chapter is yet to be written which will fitting- ly describe the mental peculiarities and moral deficiencies of these people from whom this straggling, ruined army of humanity is recruited. It is not, therefore, probable, indeed it is hardly possible, that such people who in health begin the habit, will, when self-control, always weak, has been further weakened by disease or morbid habit be able to resist the temptation to indulgence. To consider the morphinist cured and ready to go back into the world soon after the use of the drug has been discontinued, is like expecting the typhoid patient to go about his business as soon as the tem- perature has dropped to normal, ignoring the tedious con- valescence and the perils that beset it. The cure of the morphine habit, like the cure of chronic insanity, to be permanent must be carried, to a restoration of lost character elements." TREATMENT: Of the various methods of cure of the opium or morphine habit, that of more or less rapid reduc- tion of the size of the dose is undoubtedly the most successful and inflicts the least suffering upon the patient. Sudden and complete withholding of the drug is rarely if at all practiced now as a means of cure. The latter course entails severe suffering without any material benefit. OPIUM AND MORPHINE. 317 McBride's views are expressed as follows: "Of the possible methods of cure that of sudden, entire withdrawal is not practiced now as far as I know. Either rapid or slow reduction enables the habit to be broken off with comparatively a small amount of suffering." Kerr says: "In the drastic abrupt withdrawal, however, the agonies of the sufferer are so practically unbearable, as a rule, that only in rare cases has the writer carried out this plan suc- cessfully." The opiumist or morphinist can, except very rarely, only be treated successfully when under per- fect control. This is almost impossible in private practice, hence an institution is the proper place for such habitue. There he can be carefully watched, constantly prevented from obtaining the drug, and medicine and nourishment administered according to the indications. Depressed vitality, weak and inefficient circulation, gastric hyperacidity and catarrh, anorexia, nausea, vomiting, various pecu- liar pains, prostration, sleeplessness, and over- whelming craving for the drug can all be promptly dealt with. The patient will require tonics, perhaps trional chloral, hyoscyamus, or some other hypnotic to pro- cure sleep ; the hyperacidity of the stomach which not only distresses but also either precipitates or aggravates the insatiable craving for the accus- tomed drug, calls for the administration of an alka- line carbonate or bicarbonate, such as sodium bi- carbonate. The opium or morphine may be rapidly or very gradually reduced, according to the indications noted by frequent observations, such as are best provided for in an institution. The dosage may fluctuate, in the reduction process, according to the tolerance of the patient's nervous system to the shock of reduction. The final reductions are the least well borne, the system clinging tenaciously t^ every fraction of usual effect. 318 A MANUAL OF TOXICOLOGY. The patient should not know how much of the drug he is taking when the reduction is made or the drug altogether discontinued. A hot bath, massage, rubbing the legs with alco- hol and ether, the use of bromides, gentian, nux vomica, strychnine, digitalis, quinine, extract of coca, and coffee are among the beneficial measures to be employed; chloralamid and even codeine may be required. Fresh air and a fair amount of exer- cise in the convalescent part of the treatment, and a healthful occupation of the mind throughout, are important points. Every case is to a certain ex- tent a law unto itself and will call for the physi- cian's highest skill and persistent patience. Re- lapses, which may prove permanent, are apt to occur, even after long abstinence perhaps extend- ing over years. Berkley says: "Comparatively few Morphine habitues are ever broken of their slavery to the alkaloid, and many that recover under treatment relapse in the course of a few months. Especially difficult to treat are those patients who have superadded Cocaine or Alcohol to the original habit, the combinations inducing new trains of symptoms even more difficult to combat than those from Morphine alone." * * * "Not more than ten per cent, of all cases permanently re- cover; the remainder relapse within a few months." PARALDEHYDE - CHRONIC PARALDE- HYDE POISONING. SYMPTOMS: Constipation, flatulence, muscular weakness, tre- mors, restlessness, feeble, unsteady gait, insomnia, anxiety, discontent, unreasonableness, deficient memory, difficult speech, delusions, hallucinations of sight and hearing, irregular heart action, anaemia and emaciation are the chief symptoms. PHOSPHORUS, ETC. 319 TREATMENT: Discontinuance of the drug, with quieting and tonic treatment are, as a rule, promptly effective in establishing a cure. PHOSPHORUS - CHRONIC PHOSPHORUS POISONING. Phosphorus may produce necrosis of the jaw from a periostitis resulting from the slow and con- tinuous action of phosphorus. The periostitis, as a rule, spreads from decayed teeth. The lower jaw is, generally, the one affected. The remedy for such necrosis is surgical. SULPHONAL - TRIONAL - CHRONIC SUL- PHONAL POISONING - CHRONIC TRI- ONAL POISONING. HISTORY: Chronic poisoning by sulphonal or trional are in- variably the result of the daily taking of one or the other drug to produce sleep. SYMPTOMS: The symptoms are, in many respects, similar. Chief among these are noted frequently, disturbance of digestion, nausea, vomiting, constipation or diarrhoea, noises in the ears, headache, vertigo, men- tal and physical incapacity, difficulty of speech, un- steadiness of gait, sometimes more or less paralysis, great emaciation, etc. TREATMENT: The treatment consists of a discontinuance of the drug, rest, a carefully regulated diet, tonics, mas- sage, etc. 320 A MANUAL OF TOXICOLOGY. WORMWOOD - ABSINTHE - ABSINTH- ISM. HISTORY: Wormwood combined with alcohol and some- times adulterated with other noxious substances, and in either case known as absinthe, is an intense poison, rather than a tonic and aid to digestion as many suppose. Absinthe, so freely used in France, particularly in Paris, and gradually in other parts of Europe, is undoubtedly one of the greatest curses of the French nation. A reckless absinthe mania is said to pervade both rich and poor classes. The craving for the draught is most intense, the poison becoming almost an ab- solute necessity of existence. Its effects on the human brain are very serious. An alcoholic infusion of wormwood with other plants may be distilled to produce absinthe or as is now more commonly done, alcohol is added to vari- ous herb essences with essence of wormwood. (The liquer is also said to be an alcoholic solution of oil of wormwood with a little angelica, anise, and mar- joram) . SYMPTOMS: Absinthe reduces the gastric juice, inter- feres with digestion and produces a most distressing dyspepsia. The drug is said to produce its effect mainly on the cervical portion of the spinal cord. There is nocturnal restlessness and morning nausea and vomiting; the tongue and hands tremble, there is blindness, stupor, headache, apathetic listlessness, epileptiform convulsions, unconsciousness, falling, foaming at the mouth and throwing the limbs about, etc. The alcohol of the absinthe relaxes, the worm- wood tightens, so that the action of the former is succeeded by that of the latter. Alcohol produces coldness which absinthe increases, so that nervous WORMWOOD, ETC. 321 chills, unnatural coldness, trembling, nausea and staggering may result from drinking absinthe. The alcohol has paralyzed the inhibitory power so that the voluntary muscles, urged by the absinthe and unrestrained and uncontrolled, are forced into convulsions of an epileptic character associated with complete unconsciousness. A repetition of the ab- sinthe effect during the alcoholic relaxation is apt to result in confirmed epilepsy. It is said that "the characteristic phenomena of absinthecum-alcohol inebriety, are the epileptic explosion, vertigo, and early delirium." It is also said that "the more con- centrated the poison the more pronounced is its local gastric causticity, alcohol being an irritant as well as a narcotic poison." If the poison be freely di- luted with water it is more rapidly and completely absorbed, consequently increasing the other toxic properties. The fascination which absinthe has for the ab- sinthe drinker is intense. Perhaps the mental ef- fect of his indulgence is a sufficient explanation of this. Under its influence he may believe himself to be a participant in the most momentous affairs. A panorama of battling hosts, raging elements, scenes of unrestrained revelry, of the transit of worlds of indescribable beauty and brightness, etc., passes swiftly before his distorted vision. Pie is lost in admiration and ecstacy, or overwhelmed with the intensity of stormy passions. He lives in another realm, and revels in it. He may be afflicted with terrifying hallucina- tions. TREATMENT: Although some claim that absinthism may be cured by discontinuing the poison and building up the nervous system, there can be no question but that the habit has an exceedingly strong hold upon its victim, greatly injures him, and that it is very difficult to permanently discontinue it. DOSE TABLE. 323 APPENDIX. DOSE TABLE, Showing the Minimum and Maximum Doses of the Principal and Many New Remedies. (This table is the result of the author's comparing arid averaging the doses stated by the leading American and European authorities). Note 1.-Approximate reduction to Metric doses may be ob- tained by multiplying Grains or Minims by 6%, giving Centi- grams ; by multiplying Drachms by 4, giving Grams; by mul- tiplying Ounces by 31, giving Grams. It is customary to count 8 teaspoonfuls to the ounce, especially when a gradu- ated medicine glass is used.) Note 2.-The following signs are used to confirm large doses intended to be prescribed in a prescription (2 grains are taken as an example) : By underscoring thus: gr. ij or thus: gr. ii. By emphasis after, thus: gr. ij ! or 1!! By spelling out the quantity: gr. ij two grains. By writing after the quantity : gr. ij correct dose. By writing after the quantity: gr. ij large dose intended. Note 3.-Dr. Young's Rule for finding the fractional adult dose for a child:- Divide the age by the age plus 12. Thus a child 3 years of 3 1 age would get Q -.-yn = of the adult dose. O"j" o For children the doses of narcotics should be still smaller and of purgatives larger. At the age of 20 or 21 years the full dose of a medicine is given. The hypodermatic dose is about % that by the mouth. The rectal or vaginal dose about twice that by the mouth. For some of the NEWEST remedies the author, after careful review, lias adopted the doses recommended by Merck & Co. for the excellent products they manufacture. 324 A MANUAL OF TOXICOLOGY. APPORTIONATE DOSE TABLE. From 20 to 60 years of age give full dose; From 60 to 80 " " % to % full dose; From 80 to 100 " " % to 14 From 14 to 20 " " % " At 14 years of age give % full dose; At 12 " " % At 8 " " 2-5 At 6 " " % At 4 " " 14 At 3 " " 1-5 At 2 " " 1-7 At 1 " " 1-12 At 6 months of " 1-16 " At 3 " " 1-20 At birth give 1-60 to 1-30 " DOSE TABLE. Remedy. Absinthin Dose. Minimum. Maximum. 15 to 30 gr. Acetal 1% to 3 dr. Acetanilidum 2 to 10 gr. Acetonum 5 to 15 min. Acetum Opii [Black Drop (E)].. 5 to 15 min. Acidum Agaricicum 1-12 to % gr- Arsenosum 1-60 to 1-20 gr. Benzoicum 5 to 30 gr. Boricum 5 to 30 gr. Camphoricum 10 to 30 gr. Carbolicum % to 3 gr. Catharticum 4 to 5 gr. Chrysophanicum % to 10 gr. Citricum 5 to 30 gr. Fluoricum Dilutum 15 to 20 min. Gallicum 5 to 30 gr. Gynocardicum % to 3 gr. Hydrobromicum Dilutum % to 2 dr. Hydrochloricum Dilutum .. .. 5 to 30 min. Hydrocyanicum Dilutum 1 to 5 min. Hypophosphorosum Dilutum (10 per cent.) 10 to 30 min. Lacticum 15 to 30 gr. Nitricum Dilutum 5 to 30 min. DOSE TABLE. 325 Remedy. Dose. Minimum. Maximum. Acidum Nitrohydrochloricum 1 to 10 min. Dilutum 5 to 20 min. Oxalicum . % to 1 Phosphoricum Dilutum 5 to 30 min. Picricum to 5 gr. Salicylicum 5 to 30 gr. Sulphuricum Aromaticum 5 to 15 min. Dilutum 5 to 20 min. Tannicum 1 to 20 gr- Tartaricum . 10 to 30 gr- Valerianicum 2 to 10 min. Aconitina (Potent., Cryst.) . 1-650 to 1-200 gr. (Mild Amorph.) . 1-60 to 1-20 gr. Duquesnel . 1-400 to 1-100 gr. Aconitinae Nitras . 1-500 to 1-250 gr. Adonidin . 1-16 to % gr- Aether to 60 min. Hydrobromicus . 10 to 60 min. Agaricin . % to 1 gr. Agathinum 5 to 10 gr. Alantol (Inulol) . 1-6 to % gr. Allyl Tribromidum 3 to 8 min. Aloe Purificata •... 1 to 5 gr. Aloinum 1 to 3 gr. Alumini Hydras 3 to 15 gr. Aminiformum (Urotropin. Formin) 5 to 20 gr- Ammonii Arsenas . 1-20 to 1-12 gr. Benzoas 5 to 15 gr. Bromidum 5 to 30 gr. Carbonas 3 to 15 gr. Chloridum 1 to 20 gr. lodidum 2 to 10 gr. Phosphas 5 to 20 gr. Pieras to % gr. Salicylas 2 to 20 gr. Valerianas 1 to 5 gr. Ammonol (Ammonium Phenyl Acetamid) . 3 to 20 gr. Salicylas 4 to 8 gr. Amyl Nitris to 1 min. Amyleni Hydras .. 15 to 90 min. Amylum lodatum 3 to 30 gr. Analgen 2 to 15 gr. Anarcotina (Narcotin) 1 to 3 gr. 326 A MANUAL OF TOXICOLOGY Remedy. Anemonin Dose. Minimum. % to Maximum. % gr. Antifebrin 2 to 10 gr. Antikamnia 4 to 10 gr. Antikol 3 to 10 gr. Antimonii et Potassii Tartras 1-20 to % gr. Oxidum 1 to 2 gr. Sulphidum Purum % to 1 gr- Antimonium Sulphuratum 1 to 2 gr. Antipyrinum (Phenazonum, B. P.).... 2 to 20 gr. Antisepsin (Asepsin) 3 to 10 gr. Antispasmin % to 2 gr. Antithermin 3 to 8 gr. Antitoxin (Diphtheria) 5 to 10 cc. Apiolinum 1 % to 3 gr. Apiolum 2 to 10 min. Apiolum (Cryst.) 4 to 15 gr. Apocodeinae Hydras 3 to 4 gr. Hydrochloras 1 to P4 gr. Apocynin % to % gr. Apolysin 1 to 30 gr. Apomorphinae Hydrochloras 1-10 to 1-6 gr. (Hypodermically) .... 1-30 to 1-10 gr. Aqua Ammonia 5 to 30 min. Creosoti '. % to 2 dr. Laurocerasi 5 to 30 min. Arbutin 2 to 15 gr. Afecolin 1-20 to 1-16 gr. Argenti Cyanidum .... 1-60 to 1-20 gr. lodidum % to 1 gr. Nitras % to % gr. Oxidum . % to 2 gr. Arsenauro 5 to 15 min. Arseni Bromidum ,.... 1-60 to 1-20 gr. lodidum .... 1-20 to M2 gr. Asaprol 3 to 10 gr. Asparagin 3 to 10 gr. Aspidosperminae Hydrochloras .... 1-50 to 1-30 gr. Sulphas 1-30 to 1-10 gr. Aspirin 3 to 15 gr. Atropina 1-120 to 1-60 gr. Atropinae Sulphas 1-120 to 1-60 gr. Auri Bromidum 1-10 to 1-50 gr. Auri et Sodii Chloridum 1-30 to 1-10 gr. DOSE TABLE. 327 Remedy. Balsamum Gurjunae Dose. Minimum. . 10 to Maximum. 50 min. Baptisin 14 to 5 gr. 1 gr. Barii Chloridum . .1-10 to Sulphidum 14 to 1 gr. Benzanilidum . 10 to 15 gr. Benzolinum 3 to 10 gr. Benzonaphtol 4 to 8 gr. Benzosol (Benzol-guaiacol, Guaiacol-ben zoas) 3 to 15 gr. Berberina 1 to 10 gr. Berberinae Hydrochloras 1 to 10 gr. Beta-Naphtol 3 to 6 gr. Betol 5 to 8 gr. Bismuthi Benzoas 5 to 15 gr. Benzonaphtolas 15 to 30 gr. Beta-Naphtolas (Orphol) .• 5 to 15 gr. Carbolas (Phenol Bismuth) 5 to 15 gr. Lactas 5 to 15 gr. Oxyiodidum (Subiodidum) 5 to 15 gr. Salicylas 5 to 15 gr. Subcarbonas 5 to 60 gr. Subgallas 5 to 15 gr. Subnitras 5 to 60 gr. Tannas (Bismuthan) 5 to 30 gr. Blennostasin 1 to 4 gr. 30 to 60 gr. 20 min. Bromoformum 2 to Bromol 1 to 2 gr. Brucina * 1-12 to 14 gr. Bryonin 1-6 to 2 gr. Butyl-Chloral Hydras (Croton Chloral)... 5 to 10 gr. 1 to 5 gr. 10 gr. Citrata 1 to Effervescens 1 to 2 dr. Caffeinae Hydrobromas 14 to 2 gr. Hydrochloras 1 to 5 min. Salicylas 1 to 3 gr. Sodio-Benzoas 2 to 10 gr. Sodio-Salicylas 2 to 10 gr. Tri-iodidum 1 to 4 gr. Valerianas 1 to 3 gr. Calcii Bromidum 5 to 30 gr. Chloridum , 5 to 20 gr. 328 A MANUAL OF TOXICOLOGY. Remedy. Dose. Minimum. Maximum. Calcii Glycerophosphas 2 to 5 gr. lodidum 1 to 3 gr. Lactas 3 to 6 gr. Lactophosphas 3 to 10 gr. Phosphas Praecipitatus .... 8 to 20 gr. Calx Chlorata 3 to 6 gr. Sulphurata 1-10 to 1 gr. Cambogia 1 to 4 gr. Camphora 10 gr Monobromata 1 to 10 gr. Salicylata ¥3 to 3 gr. Cannabina (alkaloid) 1 to 4 gr. Cannabinse Tannas 2 to 10 gr. Cannabinon % to 1 gr. Capsicin Vs to % gr. Capsicum 1 to 5 gr Carbo Animalis Purificatus.. .•. 10 to 60 gr. Ligni 10 to 60 gr. Cascarine 2 to 3 gr. Castoreum : 10 to 50 gr. Caulophyllin (resinoid) to 2 gr. Cerii Oxalas 1 to 5 gr. Chinoidinum 1 to 30 gr. Chinol 3 to 5 gr. Chinolinae Tartras 5 to 20 gr. Chloral 5 to 20 gr. Chloralose 3 to 10 gr. Chloralamidum 10 to 40 gr. Chloral-Antipyrin (Hypnal) .. 15 to 30 gr. Chloral-Caffeina 3 to 7 gr. Chloretone 5 to 20 gr. Chlorodyne ....' 5 to 30 min. Chloroformum 2 to 10 min. Chrysarobinum 1-60 to 1-12 gr. Cimicifugin 1 to 3 gr. Cinchonina 1 to 30 gr. Cinchoninae Salicylas 1 to 30 gr. Sulphas 1 to 30 gr. Cinchonidinae Sulphas 1 to 30 gr. Citrophen 15 gr Cocainae Hydrochloras 2 er Salicylas Vs to 2 gr. Codeina ..... % to 1 gr. DOSE TABLE. 329 Remedy. Dose. Minimum. Maximum. Codeinae Phosphas % to % gr. Sulphas 44 to 1 gr. Valerianas 44 to 1 gr. Colchicin ..1-120 to 1-30 gr. Colocynthin . . 1-20 to 1 gr. Coniina .. 1-60 to 1-30 gr. Convallamarin % to 1 gr. Convallarin 2 to 4 gr. Convolvulin 1 to 2 gr. Cornutin (Ecboline) .. 1-20 to 1-10 gr. Cotoin % to 5 gr. Creatinum 1 to 144 gr. Creolin % to 5 gr. Creosotal (Creosote Carbonate) 3 to 15 min. Creosotum 1 to 3 min. Cupri Acetas % to 1 gr. Arsenas .. 1-130 to 1-100 gr. Sulphas 44 to 10 gr. Daturina .. 1-150 to 1-50 gr. Daturinae Sulphas ..1-150 to 1-50 gr. Digitalin, French (Merck) .. 1-250 to 1- 0 gr. German (Merck) . . 1-16 to (4 gr. Digitoxin . 1-250 to 1-120 gr. Dionin 44 to 1 gr. Diuretin (Theobromin Sodio-Salicylate) . 5 to 20 gr. Duboisinae Sulphas .. 1-100 to 1-60 gr. Duotal (Guaiacol Carbonate) 5 to 15 gr. Elaterinum . . 1-60 to 1-12 gr. Elaterium .. 1-10 to 44 gr. Emetina, Expectorant ..1-120 to 1-60 gr. Emetic 44 to 44 gr. Eosote .. 3 to 5 gr. Ergotinum, Bonjean 2 to 8 gr. Ergotole, by mouth 5 to 30 min. Hypodermic 5 to 20 min. Eserina (Physostigmin) ..1-200 to 1-60 gr. Eucalyptol 1 to 15 gr. Eudoxin 5 to 8 gr. Euonymin .. 44 to 3 gr. 44 to 3 gr Euquinin (Euchinin) 1 to 30 gr. Exalgine 1 to 3 gr. Extractum Aconiti % to 44 gr. 330 A MANUAL OF TOXICOLOGY. Remedy. Dose. Minimum. Maximum. Extractum Aconiti Fluidum .. . Vz to 2 min. Ailanthi Fluidum ... 10 to 60 min. Aloes Aquosum .. % to 3 gr. Apocyni Fluidum 5 to 20 min. Baptisiae Fluidum 2 to 10 min. Belladonnae Foliorum Alcoholicum.. .. 1-10 to % gr. Fluidum 3 to 6 min. Radicis to y4 gr- Fluidum 1 to 3 min. Berberis Vulgaris Fluidum 5 to 30 min. Boldi Fluidum 1 to 5 min. Buchu Fluidum ... 10 to 60 min. Cacti Grandiflora Fluidum 3 to 5 min. Cannabis Indicae to 1 gr. Fluidum 1 to 5 min. Cins Fluidum ... 15 to 60 min. Colchici Radicis to 3 gr- Fluidum 2 to 5 min, Seminis Fluidum 1 to 5 min. Colocynthidis to 2 gr. Conii 1 to 5 gr. Fluidum 2 to 5 min. Convallariae Fluidum 1 to 15 min. Digitalis to % gr. Fluidum 1 to 3 min. Ergotae to 8 gr. Fluidum to 60 min. Euonymi 1 to 5 gr- Gelsemii Alcoholicum .. *4 to % gr. Fluidum •. 1 to 5 min. Glandulae Suprarenales 3 to 8 gr- Guaranae Fluidum ... 10 to 30 min. Hyoscyami Alcoholicum 1 to 3 gr. Fluidum 3 to 10 min. Ignatiae .. % to % gr. Jambolanum Fluidum ... 10 to 20 min. Nucis Vomicae to % gr- Fluidum i to 5 min. Opii % to 1 gr. Passiflorae Fluidum 5 to 10 min. Physostigmatis .. 1-16 to % gr- Fluidum 1 to 3 min. Rhamni Purshianae Fluidum 1 to 5 min. DOSE TABLE. 331 Remedy. Dose. Minimum. Maximum. Extractum Rhois Toxicodendri Fluidum. . .. 1 to 5 min. Scillae Fluidum 1 to 5 min. Stramonii ... 1-6 to % gr. Veratri Viridis Fluidum 1 to 5 min. Viburni Prunifolii Fluidum % to 2 dr. Febralgene 5 to 15 gr. Fei Bovis Inspissatum 5 to 15 gr. Purificatum 5 to 10 gr. Ferratin 4 to 10 gr. Ferri Albuminas 10 to 20 gr. Arsenas ... 1-16 to % gr. Benzoas 1 to 5 gr. Bromidum 1 to 5 gr. Citras 2 to 10 gr. et Strychninae Citras 1 to 3 gr. Glycerophosphas 1 to 5 gr. lodidum 1 to 5 gr. Lactas 1 to 3 gr. Oxalas 1 to 2 gr. Phosphas 5 to 10 gr. Pyrophosphas 1 to 5 gr. ... 3 to 10 gr. Subcarbonas 5 to 30 gr. Sulphas 1 to 5 gr. Exsiccatus % to 3 gr. Valerianas % to 2 gr. Ferropyrin 5 to 15 gr. Ferrosomatose 15 to 60 gr. 10 to 30 min. Reductum 1 to 5 gr. Formin (Urotropin) 5 to 30 gr. Fuchsin (Rosein) ... 1-10 to 3 gr. Gelsemin (resinoid) % to % gr. Gelsemina (alkaloid) . . . 1-120 to 1-30 gr. Gelseminae Hydrochloras .. .1-120 to 1-30 gr. Geosote (Guaiacol Valerianas) 2 to 10 min. Glandulae Prostatae. Sicc. Pulv 14 to 2 gr. Suprarenales Sicc. Pulv 1 to 3 gr. Thymi (Thymus Gland) 4 to 10 gr. Thymi Sicc. Pulv 3 to 10 gr. Glonoinum (Nitroglycerin) ...1-200 to 1-50 min. Guaiacol % to 2 min. Benzoas (Benzosol) 3 to 15 gr. 332 A MANUAL OF TOXICOLOGY. Remedy. Guaiacol Carbonas (Duotal) Salicylas (Guaiacol Salol) Valerianas (Geosote) Guaiamar Dose. Minimum. 5 to 5 to 2 to 5 to Maximum. 15 gr. 15 gr. 10 min. 20 gr. Guaiaperol 4 to 20 gr. Guaiaquin (Guaiacol Quinin Bisulphonas) . 1 to 5 gr. Guaranin 1 to 5 gr. Helonin % to 3 gr. Hemalbumen 10 to 20 gr. Hemogallol 5 to 20 gr. Hemoglobin % to 2 gr. Hemol 5 to 10 gr. Heroina . 1-12 to 1-6 gr. Heroinae Hydrochloras . 1-12 to 1-6 gr. Homatropinae Hydrobromas .1-120 to 1-20 gr. Hydrochloras .1-120 to 1-20 gr. Salicylas .1-120 to 1-20 gr. Hydrargyri Chloridum Corrosivum . 1-80 to 1-10 gr. Mite 1-10 to 20 gr. Cyanidum .1-100 to 1-10 gr. lodidum Flavum 1-6 to 1 gr. Rubrum . 1-50 to 1-10 gr. Oxidum Rubrum . 1-10 to 1-5 gr. Salicylas . 1-10 to % gr. Subsulphas Flavum (Turpeth Mineral) to V2 gr. as emetic for child 2 to 3 gr. Taimas to 2 gr. Thymol-Acetas . 1-12 to 1-6 gr. Hydrargyrum cum Creta . % to 10 gr. Hydrastin (resinoid, eclectic) 5 to 10 gr. Hydrastina (alkaloid) . 1-16 to V2 gr. Hydrastinae Sulphas . 1-16 to % gr. Hydrastinina . 1-16 to 1-6 gr. Hydrastininse Hydrochloras . 1-16 to M2 gr. Hydrochinonum (Hydroquinone) .. 5 to 30 gr. Hyoscina .1-120 to 1-60 gr. Hyoscinae Hydriodidum .1-120 to 1-60 gr. Hydrobromas .1-120 to 1-60 gr. Hydrochloras .1-120 to 1-60 gr. Hyoscyamin (resinoid, amorphous) . % to H gr. Hyoscyamina (alkaloid, cryst.) .1-120 to 1-60 gr. Hyoscyaminae Hydrobromas .1-120 to 1-60 gr. Sulphas .1-120 to 1-60 gr. DOSE TABLE. 333 Remedy. Hypnacetin Hypnal Hypnone Ichthalbin Dose. Minimum. 3 to 15 to 1 to Maximum. 4 gr. 30 gr. 7 gr. 10 gr. 5 to Ichthyol 3 to 10 gr. Infusum Digitalis t 1 to 4 dr. lodipin . 15 to 60 min. lodocaffein 2 to 5 gr. lodoformum 1 to 3 gr. Iodol % to 3 gr. lodothyrin (Thyrein) 5 to 10 gr. Ipecacuanhse . 1-6 to 30 gr. Iridin 1 to 3 gr. Jalapa . 10 to 20 gr. Juglandin 1 to 5 gr. Kairin 3 to 15 gr. Kalagua . % to 5 gr. Kryofine 4 to 12 gr. Lactophenine Largin 8 5 to to 15 gr. 8 gr. 5 min. Liquor Acidi Arsenosi Arseni et Hydrargyri lodidi (Donovan' 3 s to Solution) 2 to 10 min. Ferri Chloridi 2 to 10 min. lodi Compositus (Lugol's Solution)... 1 to 10 min. Morphinae Bimeconatis 5 to 40 min. Opii Compositus (Squibb) 3 to 20 min. Potassae 5 to 30 min. Potassii Arsenitis (Fowler's Solution) 1 to 8 min. Sodii Arsenas 1 to 8 min. Lithii Benzoas 5 to 15 gr. Bromidum 5 to 20 gr. Carbonas 2 to 10 gr. Citras 2 to 5 gr. lodidum 1 to 8 gr. Salicylas 5 to 30 gr. Lobelin % to 1 gr. Lupulinum 5 to 10 gr. Lycetol Lysidin . 15 1 to to 30 gr. 5 gr. 5 gr. Massa Ferri Carbonatis 3 to Hydrargyri 1 to 10 gr. Magnesii Glycerophosphas 2 to 5 gr. 334 A MANUAL OF TOXICOLOGY. Remedy. Dose. Minimum. Maximum. Malakin 5 to 10 gr. Malarin 5 to 15 gr. Mangani Dioxidum (Binoxide, Peroxide) . 2 to 5 gr. Hypophosphis . 10 to 20 gr- gr. Sulphas 2 to 5 Menthol 3 to 5 gr. Methyl Salicylas 5 to 10 Methylal 2 to 5 min. Methylene Blue 1 to 8 gr. Migrainin 2 to 15 gr- Morphina . 1-20 to % gr. Morphinae Acetas . 1-20 to 14 gr. Hydrochloras . 1-20 to 14 gr. Sulphas . 1-20 to 14 gr. Muscarina . . 1-30 to 2 gr. Napellin . y2 to % gr. gr- Naphtalinum 2 to 15 Narceina ; . 1-6 to 1 gr. Narceinae Hydrochloras . 1-6 to 1 gr. Narcotina 2 to 15 gr. Nepenthe 5 to 30 min. Neurodin 5 to 10 gr. Niccoli Bromidum 2 to 8 gr. Nicotina ..1-20 to 1-10 gr. Nitroglycerinum .1-200 to 1-50 min. Nosophen (lodophen) 5 to 8 gr. Nuclein . 20 to 60 gr. Oleoresina Aspidii to 1 dr. Capsici . 14 to 1 min. Piperis . 14 to 1 min. Oleum Amygdalae Amarae .. 14 to 1 min. Anisi 1 to 5 min. Anthemidis 2 to 10 min Cajuputi 1 to 5 min Cari 1 to 5 min Caryophylli 1 to 5 min Chenopodii 5 to 10 min. Cinnamomi 1 to 5 min. Copaibae 1 to 15 min. Erigerontis 1 to 10 min. Gaultheriae 3 to 15 gr. Hedeomae 2 to 10 min. Juniperi 5 to 20 min. DOSE TABLE. 335 Remedy. Dose. Minimum. Maximum. Oleum Lavandulae Florum 1 to 5 min. Menthae Piperitae ...... 1 to 5 min. Phosphoratum 1 to 3 min. Rutae 1 to 5 min. Sabinae 1 to 5 min. Santoli 5 to 30 min. Sinapis Volatile . .. % to % min. Tanaceti 1 to 3 min. Terebinthinae 5 to 60 min. Tiglii % to 3 min. Opii Pulvis 14 to 3 gr. Opocerebrinum 3 to 6 gr. Opohepatoidinum 5 to 10 gr. Opohypophysinum % to % gr. Opolieninum % to 1% dr. Opomamminum 15 to 25 gr. Opomedullinum 3 to 15 gr.1 Opoorchidinum 8 to 12 gr. Opoossiinum 3 to 15 gr. Opoovariinum 3 to 12 gr. Opopancreatinum 3 to 12 gr. Opoprostatinum 1 to 3 gr. Oporeniinum 8 to 12 gr. Oposupranelinum 3 to 6 gr. Opothymiinum 3 to 8 gr. Opothyroidinum % to 1% gr. Orexin 2 to 6 gr. Orexinae Tannas 2 to 8 gr. Orthoform 5 to 15 gr. Orphol 5 to 15 gr. Oxycamphor 10 to 15 gr. Papain (Papoid) 2 to 5 gr. Papaverina % to % gr. Papayotin 14 to 1 gr. Paraldehydum , 30 to 60 min. Pelletierinae Hydrobromas 4 to 8 gr. Hydrochloras 4 to 8 gr. Sulphas 5 to 10 gr. Tannas 5 to 10 gr. Pellotina % to 1 gr. Pellotinae Hydrochloras % to 1% gr. Peptenzyme 10 to 20 gr. Peronin % to 1 gr. 336 A MANUAL OF TOXICOLOGY. Remedy. Phenacetinum Dose. Minimum. Maximum. 5 to 20 gr. Phenalgin 15 Kt Pheno-Bromate 5 to 20 gr. Phenocoll Hydrochloras 10 gr Salicylas (Salocoll) 3 to 30 gr. Phenol-Bismuth (Bismuthi Carbolas) 5 to 15 gr. Phenolid 5 to 10 gr. Phenosal 5 to 8 gr. Phesin 8 to 15 gr. Phloridzin (Phlorizin) 15 to 30 gr. Phospho-Albumen 5 to 15 gr. Phosphorus .1-120 to 1-50 gr. Physostigmina (Eserin) .1-200 to 1-60 gr. Physostigminse Salicylas .1-120 to 1-60 gr. Sulphas .1-120 to 1-60 gr. Phytolaccin 1 to 3 gr. Phytoline Picrotoxinum . 1-60 to 1-20 gr. Pilocarpinse Hydrochloras . 1-60 to % gr. Piperazinum . 5 to 10 gr Piperidin Guaiacolas 5 to 10 gr. Piperinum 1 to 8 gr. Plumbi Acetas % to 3 gr. lodidum . 14 to 14 gr. Potassi Acetas 5 to 60 gr. Arsenas . .1-120 to 1-10 gr. Bichromas . 1-12 to % gr. Bromidum 10 to 60 gr. Carbonas 2 to 20 gr. Chloras 2 to 20 gr. Ferrocyanidum .. 5 to 10 gr. lodidum 2 to 30 gr. Permanganas . % to 3 gr. Salicylas 5 to 15 gr. Protopin 40 to 100 gr. Pulvis Antimonialis (James' Powder).... . 3 to 10 gr. Elaterini Compositus 14 to 5 gr. Ipecacuanhse et Opii (Dover's Powder) 2 to 15 gr. Jalapae Compositus 10 to 60 gr. Morphinse Compositus (Tully's Powder) 5 to 15 gr. Rhei Compositus (Gregory's Powder). 20 to 60 gr. Quinidime Sulphas 1 to 30 gr. Quinime Arsenias . % to 1 gr. DOSE TABLE. 337 Remedy. Dose. Minimum. Maximum. Quininae Bisulphas 1 to 20 gr. Ferrocyanidum 5 to 10 gr. Hydrobromas 1 to 20 gr. Hydrochloras 1 to 20 gr. lodidum 1 to 5 gr. Sulphas 1 to 20 gr. Sulphocarbolas 1 to 6 gr. Tannas 1 to 6 gr. Valerianas 1 to 3 gr. Salicylas 1 to 5 gr. Resina Podophyllii % to 1 gr. Resorcinum 2 to 10 gr. Rubidii Bromidum 2 to 10 gr. et Ammonii Bromidum 1 to 15 gr. lodidum 1 to 5 gr. Saccharin (Glusidum, B. P.) 2 to 5 gr. Salacetol (Salantol) 20 to 30 gr. Salfene 5 to 10 gr. Salicinum 5 to 30 gr. Saligenin 5 to 30 gr. Salipyrin (Antipyrin Salicylas) 5 to 30 gr. Salocoll (Phenocoll Salicylas) 3 to 30 gr. Salol 3 to 30 gr. Salophen 5 to 20 gr. Sanguinarina . 1-12 to % gr. Sanguinarinae Nitras . 1-12 to % gr. Sulphas . 1-12 to % gr. Santoninum 1 to 5 gr. Saponinum % to 2 gr. Scoparin % to 1 gr. Scopolaminae Hydrobromas (Hypoderm.). . 1-250 to 1-60 gr. Sodii Acetas 15 to 60 gr. Arsenas . 1-60 to 1-10 gr. Benzoas 5 to 60 gr. Bromidum 5 to 60 gr. Glycerophosphas 3 to 10 gr. Salicylas 5 to 30 gr. Santonas 1 to 10 gr. Sozoidolas 5 to 30 gr. Sulphocarbolas 5 to 30 gr. Sulphoichthyolas 3 to 10 gr. Valerianas 1 to 5 gr. Solanina 14 to 1 gr. 338 A MANUAL OF TOXICOLOGY. Remedy. Dose. Minimum. Maximum. Somnal 15 to 30 min. Sparteinae Sulphas 1-10 to % gr. Spiritus Aetheris Compositus 5 to 60 min. Nitrosi % to 2 dr. Ammoniae Aromaticus ;. 15 to 60 min. Camphorae 5 to 40 min. Chloroform! 10 to 60 min. Glonoini 1 to 3 min. Strontii Bromidum 5 to 20 gr. lodidum 5 to 60 gr. Salicylas 5 to 15 gr. Lactas 1 to 10 gr. Strophanthin 1-120 to 1-60 gr. Strychnina 1-60 to 1-12 gr. Strychninae Arsenas . 1-60 to 1-12 gr. Nitras 1-60 to 1-12 gr. Sulphas 1-60 to 1-12 gr. Syrupus Acidi Hydriodici % to 3 dr. Allii 1 to 4 dr. Ferri lodidi 5 to 30 min. Ipecacuanhae 14 to 6 dr. Mangani lodidi 10 to 30 min. Scillae 30 to 60 min. Compositus 10 to 30 min. Sulphonal 10 to 40 gr. Svapnia % to 3 gr. Tannalbin 5 to 20 gr. Tannigen 2 to 10 gr. Tannopin (Tannone) 3 to 15 gr. Terebenum 2 to 20 min. Terpini Hydras 2 to 10 gr. Terpinol 3 to 5 gr. Tetronal 10 to 30 gr. Thallin % to 8 gr. Thallinae Sulphas % to 8 gr. Tartras % to 8 gr. Thebain 14 to 1 gr. Theina (Hypoderm.) 1-6 to 1 gr. Theobromin 5 to 15 gr. Theobrominae Lithium Salicylas (Uro- pherin) 5 to 15 gr. Sodio-Salicylas (Diuretin) .... 5 to 20 gr. Thermol 3 to 6 gr. DOSE TABLE. 339 Remedy. Thiocol ; Dose. Minimum. Maximum. . 5 to 20 gr. Thiol . 2 to 10 gr. Thymol % to 2 gr. Thymus Gland 4 to 10 gr. Dried, Powdered 3 to 10 gr. Thyreoids 2 to 5 gr. Thyroglandin 3 to 5 gr. Tinctura Aconiti to 5 min. Fleming / to 2 min. Ailanthi 10 to 120 min. Baptisiae 5 to 30 min. Belladonnas Foliorum 1 to 20 min. Berberis Vulgaris 10 to 60 min. Boldi 1 to 5 min. Bryon ire 5 to 30 min. Cannabis Indica 5 to 30 min. Cantharidis 1 to 20 min. Capsici . 10 to 30 min. Catechu Composita 10 to 60 min. Chloroformi Composita 20 to 60 min. Cimicifugae 5 to 60 min. Colchici Seminis 10 to 60 min. Conii 5 to 30 min. Digitalis 5 to 30 min. Gelsemii 5 to 15 min. Hyoscyami 15 to 60 min. lodi 1 to 5 min. Ipecacuanhae 2 to 15 min. Ipecacuanhae et Opii (Liq. Dover's Pow.) 2 to 15 min- Lobelia 5 to 30 min. Nucis Vomicae 5 to 20 min. Opii (Laudanum) 3 to 20 min. Camphorate (child. 3 to 30 drops) 1 to 4 dr. Compositus (Squibb) % to 1 dr. Deodorata 3 to 20 min. Physostigmatis 5 to 30 min. Simuli % to 2 dr. Stramonii 5 to 20 min. Strophanthi 2 to 10 min. Sumbul 5 to 30 min. Veratri Viridis . 3 to 10 min. Tolysal (Tolypyrin Salicylas) . 5 to 30 gr. Tribromphenol Bismuth (Xeroform) . 8 to 15 gr. 340 A MANUAL OF TOXICOLOGY. Remedy. Dose. Minimum. Maximum. Trimethylaminae Hydrochloras ... 1 to 3 gr. Tri-nitrinum. See Nitroglycerin. Trional ... 10 to 30 gr. Triphenin ... 4 to 15 gr. Tuberculin (Koch) ... 1-250 to 1-60 gr. Tussol (Antipyrin Mandelate) ... 1-20 to 8 gr. Uranii Nitras 14 to 14 gr. Urea 15 to 30 gr. Urethanum ... 10 to 30 gr. Uropherin 5 to 15 gr. Urotropin (Aminoform) .... 5 to 30 gr. Veratrin (resinoid) % to 14 gr. Veratrina ... 1-60 to 1-10 gr. Vinum Antimonii 1 to 10 min. Colchici Radicis 5 to 20 min. Seminis 10 to 60 min. Ergotae 1 to 4 dr. Ipecacuanhas 1 to 60 min. Opii (Sydenham's Laudanum) 3 to 20 min. Xeroform (Tribromphenol Bismuth)... 8 to 15 gr. Xylol 5 to 20 min. Zinci Acetas 14 to 2 gr. Bromidum 14 to 2 gr. Cyanidum ... 1-10 to 1 gr. lodidum 14 to 2 gr. Phosphidum ... 1-20 to 1-10 gr. Sulphas 10 to 30 gr. Sulphoichthyolas 14 to 1 gr. Sulphocarbolas 1 to 4 gr. Valerianas ... 14 to 3 gr. 341 TABLE OF MAXIMUM DAILY DOSES. (Total of safety in 24 hours.) (Arranged from P. G., Merck, etc.) Medicine. In a Day. Grains. Acetanilid . 60 Acid. Arsenous Carbolic. 9 u Hydrobromic, Dil 10 Drachms u Iodic 18 u Valerianic Adonidin 1 Agaricin 2 Aloin 10 Amylene Hydrate 120 m. + Antifebrin ...... ...... 60 Apiol, crystallized (solid Parsley-camphor) 60 Apocodeine 1]^ Apomorphine Hydrochlorate % Asparagin 414 Atropine Sulphate Baptisin 20 Benzene (Benzol) Berberine Hydrochlorate 45 Butyl-chloral Hydrate 60 4- Cannabine Tannate 40 Cannabinon 4^ Cerium Oxalate 15 Chrysarobin >4 Cocaine Hydrochlorate 6 Colocynthin 2 Coniine Hydrobromate % Convallamarin 5 Copper Arsenite 1 Cotoin 10 Creosote Daturine Digitalin (French) (Merck) Digitalis, Infusion " Extract 12 " Tincture I igitoxin Duboisine 50 Euonymin (the pure Resinoid!) 2o 15 Fluid Extract: Boldo Golden Seal (Hydrastis) 150 m. 342 A MANUAL OF TOXICOLOGY. TABLE OF MAXIMUM DAILY DOSES. (Continued). Medicine. Ina Day. Grains. Fluid Extract of Grindelia Robusta " " Kava-Kava (Piper Methysticum) 30 m. " " Lily of the Valley (Convallaria Majalis) 30 m. u " Piscidia (Jamaica Dogwood) «... Fuchsine 12 Gelseminine Hydrochlorate. >4 Guaiacol 8 m. + Guaiacol Carbonate 30+90 Homatropine Hydrobromate ; or Sulphate . Hydroquinone (Hydrochinone) 30 + Hyoscine Hydrochlorate 4- Hyoscyamine Sulphate 5'0 + Hypnone (Aceto-phenone) 23 Ichthvol 60 Iodine Trichloride 1)4 lodothyrine 40 Menthol 30+90 Mercury Bichloride % " Cyanide Methylene Blue (Medicinal) 15 Naphtalene 90 Naphtol, Beta-. 30 Nickel Bromide 23 Nitroglycerine Nux Vomica, Extract 3 Opium, Extract (aq.) 5 Paraldehyde Pelletierine Sulphate ; or Tannate; Phenacetin 75 Picrotoxin Piperin 18 Resorcin ... 150 Salol .......... .... 150 Silver Cyanide .. % ** Iodide 2 + Solanine 7^ . Sparteine Sulphate 2 Strophanthin Sulphonal 120 Terpin Hydrate 45 Terpinol 45 Thalline Sulphate 24 Tincture of Strophanthus Means dose may be developed higher. POST-MORTEM EXAMINATIONS. 343 DIRECTIONS FOR MAKING POST-MOR- TEM EXAMINATIONS. (Witherstine). In conducting post-mortem examinations, with a view either to pathological study or medico-legal investigation, order and method are of great importance. The three great cavities-the head, the chest, and the abdomen-should always be examined, whether suspicion of disease in them exists or not. First, however (the autopsy being made from twelve to thirty-six hours after death), we should note the external appearance of the body-its size, weight, conformation, color of the skin, etc. (In cases of suspected violence, even abrasion should be minutely de- scribed.) To examine the head, an incision should be made through the scalp, across the top of the head, from ear to ear; the two flaps thus formed should be reflected, the one over the fore- head, the other over the occiput. The nature of the attach- ment of the occipito-frontalis muscle to the bone beneath is such as to allow, very easily, the loosening of the scalp. The cranium (calvaria) is now to be removed by means of a small saw. For the purpose of holding the head firmly during the use of the saw, Dr. T. A. Demme has furnished, as a substitute for the craniotome of Mr. Lund, of London, a cranium-holder, which enables the operator to make a section of the skull in any direction. It consists simply of a bar of iron, curved like the letter U, at each extremity of which two drill-screws are placed, which, when forced down upon the bone, holds the bar firmly in situ, and enables the examiner to control the head. The legs of the instrument, for use, are placed upon the lateral portions of the skull over the squamous portions of the tem- poral bones. The section of the cranium with the saw should be made through its outer table completely around the head-from before backward, from below the frontal protuberances to the squamous portion of the temporal bone, and from behind for- ward, from the occipital protuberance to the squamous portion of the temporal bone, meeting the line just described. The shape of the piece thus cut out enables it to be maintained in its proper position when the parts are readjusted. It is re- moved by the aid of an elevator, or chisel and hammer, frac- turing the inner table of the skull by strokes so applied as not to pierce the brain. 344 A MANUAL OF TOXICOLOGY. The dura-mater is next to be cut through, on each side of the superior longitudinal sinus; after which dividing the falx cerebri, the brain may be raised carefully with the hand placed under its anterior portion. The internal carotid artery and cranial nerves, etc., are now to be severed by the knife, and finally the vertebral arteries and spinal chord. The brain itself may then be taken out and inspected, by slicing it from the upper part downward, in successive horizontal layers. To examine the spinal column, an incision should be made from the occipital protuberance to the extremity of the os occygis. The deep muscles of the back should then be loosened from their attachments so as to expose the laminae and spinous processes of all the vertebrae. With the chisel and mallet, or saw, we must cut through the arches of the verte- brae on each side, close to their articular processes. After thus opening the spinal canal, the cord is to be exposed by dividing the dura-mater through its whole length. To examine the neck, an incision should be made through the skin, extending from above the hyoid bone to the upper part of the sternum. Avoiding penetration of the large veins of the neck, the parts to be examined may be carefully dis- sected, and, if desirable, removed from the body. The thyroid gland, larynx, and its appendages, tongue, pharynx, oesopha- gus, blood-vessels, and nerves of the neck, may be thus viewed. To examine the chest, two incisions are desirable; the one from the root of the neck, in front, to the extremity of the ensiform cartilage; the other at right angles to this, across the middle of the thorax. The cartilages of the ribs are to be cut through at the lines of junction with the ribs. The ensiform cartilage, being drawn outward, is to be detached from the soft parts, the knife being held close to the sternum. The sterno-clavicular articulation may now be opened, and the sternum with the costal cartilages raised from its position, a cautious use of the knife being made to remove the adherent soft parts. The thoracic viscera are now exposed, and may be drawn out with care and inspected in detail. To examine the abdomen, make a crucial incision; the one branch extending from the sternum to the pubes, passing to the left of the umbilicus; the other transversely across the middle of the abdomen. Care must be taken, in making these incisions, not to injure the subjacent viscera. Before removing the stomach or any portion of the intes- KEY TO URINALYSIS. 345 tines, ligatures should be placed above and below the part that is to be separated. When-as is always desirable, if possible-both of the large cavities of the trunk are to be opened, a single incision, ex- tending from the top of the sternum to the symphysis pubis, may be made. In every case incisions through the skin should be made, as far as practicable, only in those parts which are usually cov- ered by the clothes of the deceased. It is generally advisable, when the abdomen or thorax has been opened, to fill the cav- ities with bran or sawdust. After the examination has been completed, the edges of the divided integument should be brought together, and retained in apposition by the common continued suture. KEY TO URINALYSIS. (For exclusion purposes in toxicological investigations.) Fresh Normal Urine: Amber colored, transparent, aromatic odor, bitter saline taste, acid reaction, specific gravity, 1018 to 1022. Consists "chiefly of a solution of urea and certain organic and inorganic salts, holding in suspension epithelial cells and mucus." Composition not constant, but influenced by amount of water and other fluids taken, by temperature of skin, by emotions, local or general blood pressure, by amount of work done, time of day, age, sex, medicine, etc. (Condensed from Bartley.) CLEAR LIQUID PORTION OF URINE. If urine dark colored and specific gravity high, it indicates urea, uric acid or blood ; if urine light colored, indicates sugar. When specific gravity is more than 1025 - If gives crystals with nitric acid, indicates urea If gives reaction by Trommer's test or fermentation, indicates sugar. If is neutral or feebly acid, precipitates on boiling and precipitate is soluble in nitric acid, indicates earthy phosphates. If this last precipitate is not soluble in nitric acid, indicates albumin. If hydrochloric acid gives needle-shaped crystals, indicates hippuric acid. If is high colored and boiling produces coagula, indicates blood. If gives red color with hydrochloric acid, indicates excess of coloring matter. (Urorrhodin.) If color changes upon adding nitric acid (iridescent), indicates bile. URINARY DEPOSITS. (Bartley). Chemical Examination. Draw off a portion of the sediment with a. pipette or glass tube, and transfer to a watch-glass or small test-tube. White Deposit. Dissolves on heating urine Ammonium urate. Sol. in NH4OH, Cystin. Soluble in acetic acid, Earthy Phosphates. Insoluble in acetic acid, Calcium oxalate or oxalurate. Insoluble on heating. Insol. in NH4OH, Gelatinizes in NH40H, Pus (see above). 346 A MANUAL OF TOXICOLOGY. KEY TO URINALYSIS. (Continued.) Visibly crystalline (red), Uric acid. Colored Deposit. Amorphous, ' Pale, easily soluble by heat, Urates Deep-colored, slowly soluble by heat, Acid urates with uroerythrin. Red, insoluble by heat, alkalies, or acids, . . . Blood. Microscopical Examination. With a clean pipette draw off a small portion of the sediment, transfer to a clean glass slide, and examine with a ^-in. or X-'n. objective. A cover-glass may be dispensed with. Deposit is A mor- phous. Small granules with spicules on larger granules; vanishes on adding KOH orNaOH Permanent on adding KOH or NaOH, Calcium carbonate (rare). Globules, strongly refracting light, Fat. WCpt -Sodium urate. dark =A mmonium urate. Urine, Acid. Yellow, cross or whetstone shaped, or in groups, Uric acid. Regular octahedra, envelope-shaped, . . Calcium oxlate Hexagonal plates, soluble in NH4OH (white), . Cystin. Bundles of needles crossing each other, .... Tyrosin. Deposit is Crys- talline. Large prisms, soluble in acetic acid (coffin-lid shaped), A mmonium magnesium phosphate. Brown, double spheres, spiculatedV/zviAo/A/wwowAzAv. Club-shaped crystals, single or in groups, Calcium phosphate. Double spheres, radiated structure soluble in acetic acid with effervescence, Calcium carbonate (rare). Double spheres, insoluble in acetic acid, Calcium oxal- urate (rare). Double spheres, yellow or red, striated, . . Uric acid. Alkaline Urine. 'Red or yellow discs, biconcave; sometimes irregular in outline, Blood-cells. Granulated corpuscles. With 1 Albumin present, .... Pus. diluted acetic acid, show 3 > Albumin absent, Mucous corpus- to 5 nuclei, ) cles. Round, conical, or flat cells with one nucleus, Epithelium from urinary tract. Tadpole-shape, with long tail (small), .... Spermatozoa. Cylinders, parallel margins, clear, granular, or containing, epi- thelial cells or blood-cells, . . . Casts of uriniferous tubules. wFungi, yeast, hairs, threads, etc., etc. . Extraneous matters. Cellular Elements. APPROXIMATE MEASURES. 347 TABLES. 1 minim varies frdm 1 to 2 drops; 1 fluid drachm equals about 1 teaspoonful; 2 " " " 1 dessertspoonful; 4 " or % fluid ounce " " 1 tablespoonful; 2 " " " 1 wineglassful; 4 " " " 1 small teacupful or gill; 6 " " " 1 ordinary teacupful; 8 " " " 1 coffee cupful (% pt.), 1 tum- blerful ; 1 pint " " 1 pound (of water) ; 2 pints " " 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 O ils: Essential oils of vegetables .. 40 Tinctures: of all vegetables 40 Vinegars 26 Water: Distilled 15 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. APPROXIMATE MEASURES. 348 A MANUAL OF TOXICOLOGY. APOTHECARIES WEIGHT. 20 grains make one scruple ; 3 scruples " drachm (60 grains) ; 8 drachms " ounce (480 grains) ; 12 ounces " pound (5760 grains). 1 lb. = 12 ounces = 96 drachms = 288 scruples = 5,760 grains 1 ounce - 8 drachms = 24 scruples = 480 grains 1 drachm = 3 scruples = 60 grains 1 scruple = 20 grains TROY WEIGHT. 24 grains make one pennyweight; 20 pennyweights " ounce (480 grains); 12 ounce " pound (5760 grains). 1 lb. = 16 ounces = 256 drachms = 7,000 grains; 1 ounce = 16 drachms = 437)6 grains; 1 drachm = 27 3-10 grains. 1 grain Troy = 97-100 grain Avoirdupois. AVOIRDUPOIS WEIGHT. Pint. Fluid ounce. Fluid drachm. Minim. Gallon = 8 = fluid oz. 128 = fluid drm. 1024 = minim 61440; 1 = fluid oz. 16 = fluid drm. 128 = minim 7680 ; fluid oz. 1 = fluid drm. 8 = minim 480; fluid drm. 1 = minim 60. U. S. OR APOTHECARIES MEASURE. WEIGHT OF WATER. At 60° F. the U. S. fluid ounce of distilled water weighs 455.7 grains. The British fluid ounce 437.5 grains. The following are said to be the average weights and measurements of the viscera in health. Some allowance must, of course, be made for extremes (either way) of height and weight. The measure- ments are in inches: Heart-Adult, Male 11 oz. Usually about the size Heart-Adult, Female 9 oz. of the closed fist(i. e., 5 x BVs x 216 in.). WEIGHTS AND MEASURES OF VISCERA. METRIC MEASURES 349 Brain-Adult Male 49% oz. j Cuvier, 64 oz. z ( Byron, 58 oz. Brain-Adult Female 44 oz. Spinal Cord. . . 1 oz. to 1% oz. (18 in. long.) Liver 50 oz. to 60 oz. (12 x 7 x 3 in.) Pancreas 2% oz. to 3% oz. Spleen 5 oz. to 7 oz. Lungs-Ad., Male (together) 45 oz. Lungs-Ad., Female " 32 oz. Stomach 4% to 7 oz. (Moderately full, 12 in. horiz. x 4 in. vert. Holds 3 pints.) Thyroid body 1 oz. to 2 oz. Thymus at birth % oz. Kidneys, together 9 to 10 oz. (Size, 4 x 2 x 1 in. each.) Suprarenal capsules. ... 2 drachms. Prostate gland 6 drachms. Testicles, together....% oz. to 1 oz. Unimpregnated uterus.7 to 12 drachms. (Size, 3 x 2 x 1 in. o.r a little more.) 1 line (written ") is 1-12 of an inch (written ')• METRIC MEASURES. LENGTH. 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 WEIGHT. 1 gramme equals 15.434 grains. 1 decigramme equals 1.5434 grains. 1 centigram equals 15434 of a grain. 1 decagramme equals 154.340 grains. 1 hectogramme equals 1,543,402 grains. MEASURE. 1 litre equals 2.113 pints or 15,434 grains. 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. 350 A MANUAL OF TOXICOLOGY. TEMPERATURE EQUIVALENTS. 1° Fahrenheit = 5-9° Centigrade = 4-9° Reaumer. To re- duce F. to C., subtract 32 from F. degrees given and divide remainder by 1.8. To reduce C. to F. multiply C. degrees given by 1.8, and then add 32° to this. Giving Average Frequency at Different Ages (in health). In the foetus in utero. . 'between 150 and 140 beats per minute In new-born infants.... " 140 " 130 During 1st year from 130 down to 115 " 2d " " 115 " 100 " 3d " "105 " 95 From 7th to 14th year... " 90 " 80 " " 14th to 21st " ... " 85 " 75 " 21st to 60th " ...between 75 and 79 " In old age " 75 " 80 or more. The pulse is, as a rule, more frequent in females, by 10-15 beats per minute; during and after exertion, unless long con- tinued ; during digestion or mental excitement; generally, more frequent in the morning than later in the day. It is tempora- rily accelerated after sudden change of posture from the re- cumbent to the sitting, and from either to the standing posi- tion especially during convalescence and in other states where the action of the heart is feeble. PULSE TABLE. No. Resps. per Min. First year 35 Second year 25 RESPIRATION AT VARIOUS AGES. No. Resps. per Min. At puberty 20 x\dult 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. POISONING FATALITIES. 351 "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." Blyth says: Although so large a number of sub- stances destroy life by accident or design, yet there are in the list only about 21 which kill about 2 per- sons or above each year. The 21 substances ar- ranged in the order of their fatality are as follows: IN ENGLAND the following seems to be the order, 1851-1871: Caustic potash ..... 19 Poisonous fungi 23 Aconite 59 Mercury 60 Belladonna 76 Sulphuric acid 93 Ammonia 98 Chlorodyne 102 Alcohol 108 Arsenic 110 Chloroform 113 Vermin killer 127 Chloral 127 Phosphorus 155 Cyanide of potassium 166 Strychnine . 201 Nitric acid 204 Prussic acid 260 Carbolic acid 762 Lead 1,043 Opiates- 1,324 Suicidal Poisoning.-Poisons which kill more than one person suicidally each year are only 19 in number, as follows: POISONING FATALITIES. 352 A MANUAL OF TOXICOLOGY. IN GERMANY. Deaths from suicide during the ten years ending 1892- Potassic bichromate 10 Chloroform 14 Chloral 15 Chlorodyne 16 Aconite 19 Belladonna 20 Mercury 24 Nitric acid 27 Ammonia 34 Sulphuric acid 53 Arsenic 77 Phosphorus 84 Vermin killer 118 Prussic acid 122 Hydrochloric acid 138 Strychnine 150 Oxalic acid 200 Prussic acid 221 Opiates 281 Phenol 290 IN FRANCE. The following seems to be the order there, 1851-71- Arsenic 331 Phosphorus 301 Preparations of copper 183 The mineral acids 54 Cantharide.s 35 Strychnine 14 Opiates 12 Mercurial preparations 9 Antimonial preparations 6 Preparations of iron 5 Cyanides (that is, Prussic and Potassic Cyanide) . 5 IMPORTANT FACTS. Be cautious in giving atropia to flaxen-haired, light-com- plexioned, nervous women. Be cautious in the use of morphia subcutaneously after opiates or morphia have been given by the mouth or rectum. The healthy mucous membrane of the bladder never absorbs medicine; an ulcerated vesical mucous membrane does. ORDER OF ERUPTION OF THE TEETH. 353 Children are especially susceptible to the narcotic action of opium and its alkaloids. A catheter should never be forced into the bladder. All catheters should be kept perfectly clean. After each using they should be dipped in carbolized oil, washed in warm water, and, if gum elastic, be put away in zinc powder, powdered soapstone, or starch. All soft-rubber articles are rendered hard and brittle by contact with oil or grease. Catheters used in puerperal cases should be rendered thoroughly aseptic. THE ORDER OF THE ERUPTION OF THE TEETH. (An aid in determination of age.) FIRST DENTITION. 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. SECOND 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 13th year. Third molars 17th to 21st year. (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. So long as desquamation continues, or a purulent discharge from the ear or an abscess keeps up; THE ERUPTIVE FEVERS. 354 A MANUAL OF TOXICOLOGY. indefinitely in clothing, toys, books, etc., which have not been disinfected. Disease-Measles (Morbilli, Rubeola). Period of Incubation. Eight to ten days. Mode of Onset. Rather sudden; catarrhal symptoms; mod- erate 'fever. Eruption Appears. Fourth day; less commonly on the third or fifth. Eruption Fades. In about four days. Danger of Contagion. So long as the fine, branny desqua- mation lasts. Disease-Rotheln (Rubella, German or French Measles). Period of Incubation. Two or three weeks. Mode of Onset. Gradual, fever slight and transient, some- times absent. Eruption Appears. The eruption usually the first symptom. Eruption Fades. Irregularly; in about four to six days, without desquamation. Danger of Contagion. The duration of the liability to com- municate the disease is not known. Disease-Smallpox (Variola). Period of Incubation. Ten to fourteen days. Mode of Onset. Sudden; chill; high fever; headache; pain in loins, etc. Eruption Appears. On the third or fourth day; typical evolution, about the sixth day or the ninth of the disease char- acteristic pustules fully formed. Eruption Fades. Desiccation at the end of second week; crusts slowly separate, leaving marked and enduring cicatrices. Danger of Contagion. So long as crusts reform; indefi- nitely in fomites, etc. Disease-Varioloid (Modified Smallpox). Period of Incubation. Ten to fourteen days. Mode of Onset. Sudden; chill; high fever; headache; pain in loins, etc. Eruption Appears. On the third or fourth day; typical evolution, about the sixth day or the ninth of the disease char- acteristic pustules fully formed. Eruption Fades. Pocks do not go on to suppuration, but begin to dry up from the vesicular stage, i. e., the sixth or eighth day of the disease. THE ERUPTIVE FEVERS. 355 Danger of Contagion. So long as crusts reform; indefi- nitely in fomites, etc. 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. TO MAKE FOUR FLUID OUNCES OF THE SOLUTION. 3 % % % 9-1 % oi- ►d 0> o 0 o oi ol o 1 2 y2 3 4 5 6 7 8 10 12 15 20 25 Q wwwwww^w - s WWW 4-.W[OCO^m^m Qi Oi -1 X LO O CD -1 W Q! 4^ W GO LQ 07 -1 O IQ -- Qi Q X -O Oi 4^ q; IO X © © © 0- © '© k>- to © bo © © to >-< o b b k> bo © © © © © © © © © O © © O o © Ci Or za oo to TO ^5' o S □ oS p p CLi 3 d CO F ts -i a u w to t o - t-4 £-O OS TO 5 £ y n> o > It ID o CO COCO to H Or 4^. CO I-* • 3 Cr i- 05 CO lO Ot O O to C;t © 00 © © J4- CO tO t-* t^- *y N CH Distilled water q. s. to make 4 fl., oz. DIRECTIONS. « 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. 356 A MANUAL OF TOXICOLOGY. AN EPITOME OF IMPORTANT INCOM- PATIBLES. Acacia (gum) with alcohol, iron, lead-water, and mineral acids. Acids (mineral), with alkalies and relatively weak salts of other acids, such as bromides, chlorides, and iodides. Alkalies, with acids and with relatively weak salts. Antipyrin and antifebrin should be given with alcohol or water only. Arsenic, with tannic acid, salts of iron, and lime and mag- nesia. Bitter infusions and tinctures, with salts of iron and lead. Bromides, with acids, acid salts, or alkalies. Calomel, with antipyrin, alkalies, lime-water, salts of iron and lead, and iodide of potassium. Camphor (spirit of) with water. Carbonates, with acids and acid salts. Chloral, with cyanides. Chlorides, with silver salts, lead salts, and alkalies. Chloroform (except in minute quantity), with water. Corrosive sublimate, with alkalies, lime-water, salts of iron and lead, iodide of potassium, albumin, gelatine, and vegetable astringents. (It may, however, be advantageously combined with tincture of the chloride of iron and liq. acidi arsenosi, or with iodide of potassium.) Digitalis, with iron and preparations containing tannic acid. Iron (salts), with anything containing tannic acid. Tinc- ture of the chloride of iron, with alkalies, carbonates, muci- lages, and preparations containing tannic acid. Mucilages, with acids, iron salts, and alcohol.' Potassium chlorate (and potassium permanganate) should not be rubbed up with tannic acid or other organic oxidizable substance. Potassium (iodide of), with all strong acids and acid salts. (See Corrosive Sublimate.) Spirit of nitrous ether, with antipyrin, sulphate of iron, tinc- ture of guaiacum, and most carbonates. Vegetable preparations holding tannic acid, with salts of iron and lead. Alkaloids are precipitated or destroyed by tannic acid, alka- lies, iodin or iodides, and chlorinous compounds. Tinctures of gums or resins, with water. FREEZING MIXTURES. 357 FREEZING MIXTURES. (THOMPSON.) Ingredients. Parts by Weight. Temperature reduced from 10° C. or 50° F. to Hydrochloric Acid Sulphate of Sodium Snow or Fine shaved Ice . Chloride of Sodium Dilute Nitric Acid Sulphate of Sodium Dilute Nitric Acid Nitrate of Ammonium Sulphate of Sodium Dilute Nitric Acid Phosphate of Sodium . 8I 5 s 2 ) i y 2 ) 8 S' 4 5 P 6 ) 4 ) 9 S - 17° C. = + 1° F. - 18° C. - 0° F. - 19° C. = - 2° F. - 26° C. = - 15° F. - 29° C. = - 20° F. 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 macle to others than dealers, to sales by licensed pharmacists, druggists, or chem- ists. They require that the bottle or package con- taining the poison be carefully labeled with the name of the poison, the name and address of the seller, and the word poison (usually in red ink). Laws of nearly all the States, likewise the English Phar- macy Acts, not only anticipate that the seller will use discretion in making sales, but also require him to register, in a book kept for the purpose, sales of all very active poisons. The registration includes the name and quantity of article sold, use to which it is to be put, date of sale, name and address of purchaser, with his signature and that of the seller. In the State of New York the laws virtually require the registration of all poisons. 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 358 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 ? Plow 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. 359 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? i. By what avenues, other than the mouth, may poisons enter the system? By which one of these is the most prompt effect obtained? 2. What kinds of evidence, besides that called the symptoms, may serve to indicate the poison taken in a case of poisoning? Which of these is considered the most reliable? 3. Do all poisons produce their poisonous effects in the same time? Illustrate in answer. 4. What is meant by the local effect of a poison? Name one which has both a local and a gen- 360 A MANUAL OF TOXICOLOGY. eral or systemic poisonous effect, and state the emergency treatment for poisoning by it. 5. Name two substances which poison by being inhaled; also name two narcotic poisons, stat- ing the emergency treatment for poisoning by them. 6. Which would be the more dangerous poisonous dose of Arsenic, a small or a large one? Ex- plain. 7. What emergency treatment should be employed for poisoning by Laudanum? By Lead salts? 8. Name a poison, in poisoning by which, fats and oils should not be administered, and one in poisoning by which Sodium Bicarbonate should not be given. Explain. 9. Name a poison, in poisoning by which an emetic should not be given, and another in poisoning by which water should not be administered. Explain. 10. What does the Pharmacy Law direct regarding the sale of poisons belonging to "Schedule A''? 11. State the dose of Ammonium Chloride, Atro- pine Sulphate, Corrosive Mercuric Chloride, Guaiacol Carbonate. 12. State the dose of Ferrous Sulphate, Lead Ace- tate, Salol, Trional. 13. What is the dose of Antipyrine, Ingluvin, Naph- talin, Strychnine? 14. State the dose of Diluted Hydrocyanic Acid, Extract of Belladonna. Extract of Hyoscya- mus, Oleoresin of Aspidium. 15. What is the dose of Deodorized Tincture of Opium, Tincture of Strophanthus, Donovan's Solution, Fluid Extract of Viburnum Opulus? I. Name the best chemical antidote for: Corrosive Sublimate; Lead Water; Oxalic Acid; Paris Green; Tincture of Iodine. 2. Name the best physiological antidotes, with their antidotal doses and your method of ad- QUESTIONS FOR SELF-EXAMINATION. 361 ministration, in poisoning by Aconitine; by Morphine; by Strychnine. 3. What substance is considered a good antidote to the alkaloids? Why? In what dose is it given ? 4. Mention two substances which poison by being inhaled. Name two narcotic poisons. 5. Which is the more rapidly fatal poison, Potas- sium Cyanide or Potassium Hydrate? What emergency treatment should be employed for poisoning by each? 6. What emergency treatment should be employed for poisoning by Formaldehyde? By swal- lowing Chloroform? 7. Name two stimulants of different character. When is artificial respiration applicable and how is it performed ? 8. State the condition of pupils and skin in Bella- donna and in Morphine poisoning. 9. Name three good, vegetable emetics with emetic dose of each. What fluid aids emetic action? 10. What does the law require the pharmacist to ascertain and do when selling Carbolic Acid, Laudanum or Strychnine? ii. What proportion of the adult dose of a medi- cine should ordinarily be given children at the following ages: 2, 4, 8, 10, 14 years? 12. What is the hypodermic dose of Morphine Sul- phate, Strychnine Sulphate? What is the rectal dose of Cocaine, Chloral, Extract of Belladonna? 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? 362 A MANUAL OF TOXICOLOGY. I. What should be given for poisoning by Mer- curic Chloride? By any of the Zinc salts? 2. In Morphine poisoning, what oxidizing agent is employed and what alkaloid should be used for its physiological effects? 3. Name two different substances which may pro- duce eschars or stains on the lips or mouth ? 4. How would you determine whether a suspected powder was Calomel, Corrosive Sublimate, or Morphine Sulphate? 5. What is meant by circumstantial evidence? symptomatic evidence? chemical evidence? Which is the most reliable? 6. Describe the characteristic symptoms of and give the emergency treatment for poisoning by Belladonna. For poisoning by Opium. 7. What emergency treatment should be employed for poisoning by Paris Green? By Salt of Sorrel? What is Paris Green? What is Salt of Sorrel? 8. What antidote, and how much, should be given for poisoning by Iodine? By Lunar Caustic? 9. What is the dose, and antidote for overdose, of Mercuric Cyanide? Of Tincture of Bella- donna? 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. 363 15. What is the dose of Mixture of Rhubarb and Soda, Syrup of Garlic, Wine of Antimony, Wine of Ferric "Citrate ? i. Define Toxicology, Antagonist, Corrosive, Nar- cotic, Ptomain. 2. Upon what does the rapidity of absorption of a poison depend ? 3. Describe the condition of the stomach after a large quantity of undiluted Carbolic Acid has been swallowed. (a) Is the corrosion superficial or deep? 4. What are the symptoms of and what emergency treatment should be employed for poisoning by Oxalic Acid? (a) Should the stomach tube be employed and should alkaline carbonates or bicarbonates be administered? Explain. 5. What signs and symptoms would indicate pois- oning by Sulphuric Acid? (a) State what emergency treatment should be employed and explain regarding use of emetic, Sodium Bicarbonate and much water. 6. What emergency treatment should be em- ployed for poisoning by Arsenic? (a) By Tyrotoxicon ? 7. What emergency treatment should be employed for poisoning by Cocaine? (a) By Trional. (b) State the proper dose of each. 8. Name three unrelated, mineral emetics, with dose of each. (a) Name three unrelated poisonous alkaloids (not mentioned in this paper), with dose of each. (b)_ Name five poisonous tinctures, with dose of each. (c) Name five demulcents and state for what poisoning such are employed. 364 A MANUAL OF TOXICOLOGY. 9. State the effect upon the heart and stomach, of the habitual, excessive use of Alcohol. (a) Of Tobacco. 10. What are the principal effects of the habitual use of Cocaine? ^a) Of Morphine? I. Define Toxicology, poison, cumulative poison, demulcent. 2. Into what general classes are poisons physi- ologically divided? (a) Name the first subdivisions of these gen- eral classes and mention a poison belonging to each subdivision. 3. What should be done in poisoning when the nature of the poison is unknown ? (a) By what may the effects of a poison be modified ? 4. State and illustrate the difference between an antidote and an antagonist. (a) State and illustrate the difference between antidotal measures and antagonistic measures. 5. In what kinds of poisoning should the follow- ing be avoided: emetics, the stomach pump, the stomach tube, glycerine, milk ? 6. Name a drug acting directly upon the heart and give the treatment for poisoning by that drug, (a) Name a poison directly affecting the stomach, and give the treatment for poisoning by it. 7. Name a common household article of which Phosphorus is an ingredient. . (a) Should oil be used in poisoning by Phos- phorus? Explain. 8. When should the following be employed as chemical or mechanical antidotes: Potassium Permanganate, Sodium Chloride, starch, Tan- nic Acid, Alcohol? Explain. (a) What is the treatment for poisoning by Wood Alcohol? By Opium? QUESTIONS FOR SELF-EXAMINATION. 365 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 ? 10. What are the symptoms of and what is the proper treatment for poisoning by coal gas? (a) Name a poison which uniformly produces blindness, more or less permanent. MISCELLANEOUS COLLEGE AND BOARD QUESTIONS. I. What effect does the dilution of a corrosive poison have upon its local effect? (a) If an ounce of Carbolic Acid, well diluted, were swallowed, would life be endangered? Ex- plain. (b) What is the'official antidote for poisoning by Arsenic, and how is it prepared? 2. What is the best chemical antidote for poisoning by Silver Nitrate, and what does it do? (a) 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? 366 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. 5 Heroin, gr. 2J 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 ? ii. 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, 222. Abrine, 28. Absinthe, 222, 320. Absinthism, 320. Absorption, Rapidity of, 6, 7, 8, 11. Absorption, Delay in, 11. Acetanilid, 7, 22, 51, 215, 220, 223. Acid, Acetic, 19, 22, 53, 70, 215, 277. Arsenous, 22, 87, 216. Carbolic, 9, 19. 22, 31, 33, 55, 215, 220, 221, 222, 225, 229, 277. Carbonic, 21, 57, 215. Chromic, 7, 19, 22,58, 221. Ergotinic, 223. Filic, 220. Formic, 226. Gallic, 213. Helvellaic, .221, 225. Hydrobromic, 22. Hydrochloric, 22, 30, 63, 215, 230, 276. Hydrocyanic, 19, 22, 33, 60, 215, 219, 220, 230, 278. Lactic, 19. Meconic, 22. Muriatic, 63. Nitric, 22, 30, 63, 215, 221, 231, 276. Nitrous, 136. Nitrous, Fumes, 139. Nitrohydrochloric, 63. Oxalic, 12, 19, 22, 29, 46, 65, 70, 215, 225, 226, 232, 279. Oxaminic. 226. Oxybutyric, 219. Phenic, 53. Phosphoric, 22, 63, 215. Picric, 22, 28, 221, 224,^25. Potassium-oxalates, 65. Prussic, 60, 309, 317. Salicylic, 19, 22, 68. Scheele's 60, 69. Of Sugar, 65. Sulphuric, 22, 30, 63, 69, 215, 232, 276. Tannic, 48, 213. Tartaric, 22, 70, 280. Acids; 28, 30. Amido-fatty, 29. Corrosive, 70, 219, 221. Fatty, 29. Inorganic, 40. Mineral, 22, 215, 275. 276. (Concentrated), 19, 63. Organic, 22, 40. Vegetable, 79, 277. Aconite, 13, 19, 39, 70, 215, 220, 221, 223 225 281 Aconitine, 22, 28, 33, 70, 220, 224, 281. Acne Pustule, 221. t Action, Antagonistic, 12. Aenanthe, 29. Age, 11. Albumin, 39. Poisonous, 29. Albuminoid Combination, 9. Alcohol, 6. 19, 22, 28, 31, 41, 73, 216, 219, 281, 300. Amyl, 73. Ethyl, 74 Methyl, 216. Wood, 219. Alcoholism, Chronic, 220, 222, 300. Alcoholomania, 300. Alkalies, 30, 77, 216, 233. Caustic, 14, 28. Corrosive (cone.), 219, 221. Mineral, 22. Alkaloids, 22, 79, 216, 233. Animal, 183. Liquid, Volatile, 31. Mydriatic Group, 31. Opium Group. 31. Oxidation of, 16. Strychnos Class, 29, 31. Vegetable, 31. Veratrines, 31. Allantotoxin, 220, 224. Almonds, Bitter and their Oil, 60, 163, 226. Aloes, 79. Alum, 36, 80. Amines, 29. Ammonia, 28, 30, 40, 77, 216, 219, 220, 223, 224, 226, 232, 290. Salts, 30. Water of, 19. Ammonium, 7, 22. Carbonate, 36, 40. Amyl, Nitrite, 6, 31, 81, 219, 222, 226. Amylene Hydrate, 219. Anaemia, 266, 267. Analysis, Autenrieth's Method of, 256. Chart, 247, 248. Chemical, 15. Of Various Substances, 229, 262. Analytical Plan, 254. Anesthetics, 19, 25, 82, 216. Anhydrides, Poisonous, 32. Anilin, 22, 28, 51, 222. Dyes, 84. Ink, 84. Oil, 219, 220. 368 A MANUAL OF TOXICOLOGY. Antagonist, 4, 215. Antidote, 4, 35, 36. Bouchardats, 43. Chemical or True, 4, 35, 39. Definition of, 4. General, 50. Mechanical, 4, 35, 37, 38. Antifebrin, 51. Antimony, 9, 22, 29, 84, 219, 220, 221, 224, 227, 234, 281. Compounds of, 22, 216. Wine of, 37. 84. Antipyrine, 7, 19, 22, 86, 215, 222, 223, 234. Aphonia, 220. Apocynum, 19. Apomorphine, 22, 227. Hydrochlorate, 37. Apoplexy, 14, 15. Appearances in Poisoning, Post-Mor- tem, 275. Post-Mortem, 17. Apportionate Dose Table, 324. Arabic, Gum, 42. Argentum, Nitrate, 233. Argyria, 221. Arnica, 19, 153. Arsenic, 13, 15, 19, 22, 29, 45, 87, 214, 216, 220, 224, 227, 235, 282, 303. Chronic Poisoning by, 303. Arsenical Fly Paper, 87. Melanosis, 221. Arsenicals, 221. Arseniuretted Hydrogen,139. Asphyxia, 1 i, 267. ■ Asthenia, 266, 267. Asthenics, 21. Cerebro-Spinal, 19. Atropine, 13, 22, 28, 90, 92, 220, 222, 223. 224, 237, 283. Auto-infection, 90. Auto-intoxication, 90. Autumn Crocus, 117. B Balsam Copaiba, 222. Barium, 22, 91, 219, 222, 226, 237. Acetate, 91. Chloride, 91, 236. Compounds, 216. Nitrate, 91. Oxide, 91. Soluble Salts of, 19. Baryta, 29, 77, 91, 223. Beer, 74. Belladonna, 19, 29, 92, 216, 219, 220- 222, 224, 226, 237. Benzene, 19, 22, 95. Benzine, 96, 175. Benzol, 95. Benzocoll, 220. Benzaldehyde, Oil, 226. Berry, Indian, 117. Bicarbonates, Alkaline, 46. Bichromate, 58, 113, 221. Bismuth, 222. Bhang, 103. Blindness, 219, 220. Blood, Coagulation of, 263. Change in, 6. Gravitation of, 17. Quantity of, in Blood Vessels, 8. Transudation of, 17. Bloodroot, 96, 189. Bluestone, 122. Body, Pallor of, 263. Lividity of, 263. Brandy. 74. Breath, Phosphorescence of, 219. Specific Odor of, 219. Bromides. 96, 221. Bromine, 7, 19, 22, 28, 97, 139, 219. 221, 284. Bromism, 222. Bromoform, 219. Brucine, 19 , 22, 98, 166, 218, 238. Bryony, 79, 98. Burial, Haste in, 14. c Cadovine, 186. Caffeine', 98. Calabar Bean, 29, 98, 100. Calcium, 101. Hydrate, 40. Carbonate, 41. Camphor, 19, 29, 31, 101, 222. Camphorated Oil, 101. Cannabis American, 103, 216. Indies, 19, 103, 216. Cannabinon, 222. Cantharides, 19, 28, 29, 104, 222, 238, 284 Cantharidin, 104, 223, 224, 226. Carbon Dioxide, 19, 220, 238. Disulphide, 28, 31, 220. Monoxide, 22, 28, 30, 106, 139, 219, 226, 284. Carbonates, Alkaline, 46. Carbonic Oxide, 19. Cardiac Pulsation, Absence of, 263. Cardol, 222. Castor Beans, 19, 108. Castor Oil, 38. Cathartics, 38. Caustic, Lunar, 158, 195. Centers, Respiratory, 11. Cephalmthin, 225. Cesspool Emanations, 139, 194. Charcoal, 41, 50. Fumes, 106. Chart, Analytical, 247. 248. Detection Acid Radicals,, 248 Detection Metals, 247. Cheese, Poisonous, 16. Cherry-Laurel, 69, 109, 279. Cholera Morbus, 15. Chloral, 7. 19, 22. 28, 29, 109, 217, 219, 222, 226, 285, 304. Chloralism, 304. INDEX. 369 Chlorate, Potassic, 28, 111, 182. Chlorinated Lime, 111. Chlorine, 19, 21, 22, 28, 30, 41, 139. Chlorodync, 113. Chlorodynomania 310. Chloroform, 19, 22, 28, 29, 31, 82, 113, 216, 219, 226, 285. Choke Damp, 57, 113. Chromate, 58, 113. of Lead, 58. of Potash, 58. Chrome, 29, 58. Chromium, 19, 285. Chromium and Zinc, Search for, 260. Chrysarobin, 226. Churrus, 103. Cicutoxin, 220. Cider, 74. Cinchona, 222. Cinchonism, 222. Classification, Chemical, 18, 22. Physiological, 18, 24. Tanners, 18, 23. Blyth, 18, 29. Robert, 18, 28. Coagulation, Venous, 263. Coal Gas, 22, 113, 145, 219, 284. Coal Oil, 175. Cobalt Salts, 87. Cocaine, 13, 19, 27, 28, 114, 217, 220, 222, 224, 228, 286, 304. Habit, 220, 224, 304. Cocainism, 304. Cocainomania, 304. Cocculus Indicus, 117 Codeine, 22, 117, 169, 218, 224. Colchicin, 22, 31, 117, 219, 223, 227. Colchicum, 19, 29, 117, 285. Colic, 14. Collapse, 219. Colocynth, 79, 119, 221, 227. Coma, 265, 270. Profound, 219. Condurangin, 220. Coniine, 22, 28, 119, 223, 224. Conium, 13, 19, 119, 217, 220, 226, 272. Constitutional Peculiarity, 13. Convallaria, 121, 129. Convallamarin, 129. Convulsions, 15, 220. Tetanus, 220. Convulsives, 29. Copper, 19, 22, 29, 122, 217, 221, 224, 239, 285, Arsenite, 222. Salts of, 221, 239. Subacetate, 122. Sulphate, 36, 42, 122. Cornutin, 220, 222. Corpus Delicti, 262. Corpuscles, Neutralizing by, 16. Corydalin, 220. Corrosion, 17. Corrosive Metallic Salts, 221. Corrosive Poisons, 221. Corrosive Sublimate, 19, 45, 124, 158, 226, 287. Corrosives, 9, 11, 17, 19. Local Action of, 9. Cotton Root Bark, 222. Cough, Barking, 220. Counterfeiter's Silver Coating, 292. Creosote, 19, 22, 53, 55, 124, 215, 219, 220, 239. (^fApotn Croton Oil,'19, 28, 32, 38, 124, 217, 221, 222, 227. Crowfoot, 222. Cubebs, 222. Curare, 19, 29, 126, 223. Curarine, 22,28,31,126. Cyanides, 28, 29, 215, 307. Cyanogen, 22. Cyanosis, 220, 224, 227. Cyclamin, 225. Cytisin, 220, 224, 227. D Daily Doses, Table of Maximum. Daturin, 92. Deadly Nightshade, 92. Deafness, 220. Death, Quick or Sudden, 230. Modes of, 265. Signs of, 263. Tests for, 263. Deliriants, 21, 29. Cerebro Spinal, 19. Delirium, 222. Demulcents, 39. Depressants, 21. Cerebro-Spinal, 19. Depression, Mental, 220. Devil's Apple, 200. Diamin, 225. Diamines, 29. Diarrhoea with Vomiting, 220. Digitalin, 22, 33, 129, 286. Digitalis, 13, 17, 19, 28, 29, 32, 129, 217, 219, 286. Digitaliresin, 220. Diphtheria, Toxin of, 33. Discoloration, 221. Disease, 13, 14, 15, 17. Symptoms, 15. Distillation, Separation by, 256. Diuretics, 11. Dog Bite, 131. Donovan's Solution, 87. Dose, 4. Gradual Increase in, 13. Large, 12. Lethal or Fatal, 5. Maximum. 5. Minimum, 5. Safe, 5. Size of, 11. Table, 323, 324. Table, Apportionate 324. Toxic or Poisoncus, 5. Doses, Large, 11. Repeated, 15. Table of. Daily, 341. Table of, Single, 324. 370 A MANUAL OF TOXICOLOGY. Drug Habits, 299. Dulcamara, 92, 131. Dyes, Anilin, 28, 84. E Effect, Local, 5. Remote, 5. Elaterin, 79. Elaterium, 79, 131. Emetic, Action of, 38. Emetics, 12. 35, 36. General, 36, 37. Local, 36. Emetine, 22, 37, 221, 227. Enzymes, 225. Eppedrin, 224. Ergot, 29, 32, 131. Ergotism, 220. Gangrenous, 221. Errata, 375. Eruptive Fevers, 353. Eruption, 221, 222. Erythroxylon, 286. Eserine, 46, 100. Ether, 7, 19, 22, 28, 41, 133, 216, 219, 286. 307. Brominated, 219. Ether Poisoning, Chronic, 307. Etherism, 220, 307. Eucaine, 114. Euphorbium, 79, 133. Evidence, Chemical, 15. Circumstantial or Moral, 14. Determinative, 14. Experimental, 16 Post-Mortem. 16, 17. Presumptive, 14, 17. Symptomatic, 14, 15. Exalgin, 51, 133, 215, 220, 223. Examination, Post-Mortem, 17, 273, 343. Examinations, Post-Mortem Directions for, 343. Exhaustion, 14. Eyes, Changes in, 263. F Facts, Important, 352. Fainting, 14. Fats, Melted, 37. Ferri Oxidum Hydratum, 43. Ferri Oxidum Hydratum cum. Mag- nesia, 44. Fevers, Eruptive, 353. Fish Berries, 19,117, 133. Fluorine, 22. Fly Paper, Poisonous, 113. Fly Stone, 87. Food, Poisonous, 14, 16, 19, 22, 29, 134, 217. Foods, 13. Formaldehyde, 133, 139, 240. Formalin, 133. Fowler's Solution, 87. Foxglove, 129. Freezing Mixtures, 357. Fuel Gas, 139. 145. Fungi, 19, 29, 135. Furnace Gas, 139. Fusel Oil, 73, 139. G Gamboge, 38, 79, 139. Gangrene, 17. Gangrenous Ergotism, 221. Gas, 137, 189. Illuminating, 7, 21, 139, 145, 239. Laughing, 82,155. Gases, 8, 21. Poisonous, 30. Gaseous Poisons, 11, 139, 217. Gasoline, 136, 140, 175. Gelatine, 42. Gelsemine, 140, 220, 224. Gelsemium, 19, 140, 217, 226. Gin, 74. Glucosides, 22, 32. Gluten, 42. Glycosuria, 29. Gold, 142. Grain, 72. Guacbamaca, Poison, 223. Guaiacol, 7. Guanidin, 220. Guide to Post-Mortem Procedure, 273. Gums, 222. Gunjah, 103. H Habit, 11, 13. The Cocaine, 304. The Morphine, 310. The Opium, 310. Haschisch, 103. Hearing, 222. Heart, Drugs Acting Directly Upon, 26. Paralysis of, 11. Poisons, 28. Heat, Loss of, 263. Hellebore, 19, 143. Green, 210. Helleborin, 28. Hemlock, 19, 29, 286. Common or Spotted, 117, 119. Water, 287. Hemp, American, 216. Indian, 29, 216. Heroine, 218. Hiera Piera, 79. Homatropine, 92, 224. Hydrocarbons, 31. Hydrogen Antimonide, 139. Arsenide, 139. Arsenuretted, 22. Cyanid, 7. Sulphide, 139, 143. Phosphoretted, 22, 139. Sulphuretted, 22. INDEX. 371 Hydrargyrum, 238. Hydrazine, 28. Hydric Cyanide, 28. Hydric Sulphide, 28, 30. Hyoscine, 92, 224. Hyoscyamine, 22, 92, 220, 223, 224. Hyoscyamus, 19, 29, 92, 216, 222, 224, 287. I Identification Tests, Table of, 229. Idiosyncrasy, 11, 13. Ignatia, 19. Illuminating Gas, 145, 240. Illusion, 14, 222. Immobility, 263. Incompatibles, Epitome of, 356. Inflammation, 17. Indian Berry, 117- Ink, Anilin, 84. Insect Powder, 84, 146. Insects, Poisonous, 146. Insensibility, 263. Intoxication, 15. Investigation, Chemical, 15. Investigation of Residue, 261. Iodides, 13. Iodine, 7,19,22, 28, 42,147,217, 219, 221, 222, 240, 287. Iodoform, 149, 219, 220. Ipecac, Fluid Extract of, 37. Syrup of, 37. Wine of, 37. Ipecacuanha, 149. Pulverized, 37. Iron, 19, 29, 43. Dialyzed, 44. Hydrated Oxide of, 50. Sesquioxide of, 44. Irritants, 17, 19, 25. Simulation of, 15. True, 19. J Jaborandi, 150. Jalap, 79, 152. Jamestown Weed, 200. Javelle Water, 41, 111. K Kerosene, 153, 175. Key to Poison, Post-Mortem, 294. Key to Treatment, 215. Key to Urinalysis, 345. Kombe Arrow Poison, 129, 200. L Labarraque's Solution, 111. Laburnum, 29, 153. Lactucarium, 155. Laudanum, 155, 169, 218. Laughing Gas, 82, 155. Laws Relating to Sale of Poisons, 357. Lead, 7, 19, 22, 28, 29, 155, 217, 221, 222, 223, 224, 241, 287, 308. Chromate, 58. Neutral, 58. Colic, 308. Palsy, 308. Paralysis, 226. Life, Income and Expenditures of, 350. Lime, 77, 156, 216. Chlorinated, 111. Quick, 19. Lily of the Valley, 121. Lips, Tingling, 225. Numbness, 225. Lithium Salts, 10. Lobelia, 19, 157, 218. Inflata, 29, 157. Lobelin, 224, 227. Lolium Teniulentum, 29. Lungs Poisonous Gases Affecting, 21. Lye, Concentrated, 19. M Magnesia, 44, 50. Magnesium, Sulphate, 38, 41, 45. Mania, 14, 222. Matches, 158, 177. Maydism, 220. Measure, Antagonistic, 4. Antidotal, 4. U. S. or Apothecaries, 348. Measures, Approximate, 347. Metric, 327. Medicine, Definition of, 4. Mercurialism, 13, 220, 309. Mercurial Tremors, 309. Mercuric Cyanide, 127. Mercury, 22, 29, 45, 158, 218, 221, 224, 241, 287, 309. Ammoniated, 158. Bichloride, 158. Cyanide of, 288. Metals, 258. Methyl, 74, 210. Methylguanidin, 175. Mezereon, 79. Milk, 16, 40. Poisonous, 16. Mirbane. Essence, 163. Miscarriage, 222. Mixtures, Freezing, 357. Monkshood, 70. Morphine, 13, 22, 28. 46, 161, 218, 219, 222, 223, 224, 243, 289. Habit, 310. Morphinomania, 310. Mummification, 263. Muscarine, 28, 31, 221, 223, 224, 227. Mushrooms, 7, 19, ^88. Containing Phallin, 220. Musk, 13. Mustard, 36. 372 A MANUAL OF TOXICOLOGY. N Narcotic Irritants, 17. Naphtha, 161. 175. Napthalin, 161. Narceine, 22, 169. Narcissus Poisoning, 227. Narcotics, 14, 17, 29. Cerebral, 19. Narcotine, 22. Nettle Rash, 14. Neurotics, 19, 20. Cerebral, 20. Cerebro-Spinal, 20. Spinal, 20. Nicotine, 19, 22. 28, 161, 204, 219, 221, 223, 224, 227, 292, 293. Nitrite of Ethyl, 81. Potassium, 81. Sodium, 81. Nitrobenzene, 7, 22, 28, 31, 161,219, 220. Nitrobenzol, 19, 161, 242. Nitrogen Monoxide, 139. Nitroglycerine, 7, 218. Nitrous Acid Fumes, 139. Oxide, 28, 82,139, 166, 216. Numbness of Lips or Tongue, 225. Nux Vomica, 19, 166, 218, 242, 288. 0 Oedema, 223. Oil, Curcas, 222. Fusel, 73, 139. Mineral, 175. Olive, 37. Turpentine, 206. Oils and Fats, 39. Ethereal, 219. Opiomania, 310. Opium, 13, 14, 19, 29, 46, 168, 214, 218, 219, 222, 223, 224, 240, 289. Opium and Morphine, 243, 310. Opium, The Habit, 310. Organs, Anatomical Changes of, 28. Oxalates, 29, 47. Oxaluria, 29. Oxamid, 226. Oxide Nitrous, 28, 82, 139, 166, 216. Oxy Acids, 29. P Pain, 14. Palsy. Shaking, 309. Paraffin. 175 Paraldehyde, 174, 219, 318. Poisoning. Chronic, 318. Paralysis, 223. Paralyzants, 19. Paregoric, 218. Paris Green, 87, 1J5, 216, 221. Peach Kernels, 60, 175. Pennyroyal, 222. Pental, 219. Perforations, 17. Peroxide of Hydrogen, 38. Perspiration, Profuse, 223. Petroleum, 175. Petrolatum, 209. Phallin, 134, 221, 225. Phenacetin, 7, 19, 27, 51, 177, 215, 220, 223 Phenol,' 19, 53, 177, 229. Phenomena, Nervous, Complex, 29. Phosphine, 139. Phosphorus, 7, 19, 22, 28, 29, 31, 44, 46, 177, 218, 219, 221, 222, 225, 289, 319. Phrynine, 28. Physic Nut, 79. Physostigma, 19, 100, 180, 222, 222, 224. Physostigmine, 22, 31, 46, 100. Phloridcin, 226. Phytolacca, 180. Picric Acid, 22, 28. Picrotoxin, 19, 32, 117, 181, 220. Pilocarpin, 22, 31, 150, 181, 221, 223, 224, 227. Pilocarpus, 150. Pinkroot, 19, 181, 199. Plan of Analysis. 254, 256. Plant Susceptibility, 13. Plumbism, 308. Plumbum, 241. Poison, 1. Absorbed, 6, 9, 11. Ante-Mortem Introduction of, 16, 17. Corrosive, 20, 21, 221, 227. Decomposition of, 16. Define Cumulative, 2. Deposited, 9. Deposition of, 9. Elimination of, 16. Fatal Dose of, 33. Indian Arrow, 126. Intense Action of, 11. In Urine, 9. Irritant, 12. Ivy, 187. Key to, 294. Key to, Post Mortem, 294. Legal Definition of, 2, 3. Non-Selective, 9. Oak, 181, 187. Outline of Procedure in Search for, 229. Oxidation of, 16. Physical Properties of, 15. Post-Mortem Introduction of, 16. Re-absorbed, 9. Removal of, 8, 9. Solubility of, 7. Sumach, 187. True, 2. Unabsorbed, 9. yine, 181, 187. Poisoning, Acute, 4. Alcoholic, Chronic, 300. Arsenic, 221. Auto, 29. Chronic, 299. Death by, 10. Evidence of, 20. Fatalities, 351. INDEX. 373 Laudanum, 46. Motives for, 14. Paraldehyde, Chronic, 318. Phosphorus, Chronic, 319. Post-Mortem, 15. Post-mortem Appearances in, 17, 261. Prompt Treatment for, 34. Ptomain, 226. Sausage, 33. Poisonous Cheese, 133. Gases, 8. Vapors, 8. Fish, 134. Food, 14, 16, 19, 22, 29, 134, 217. Insect Powder, 87. Principles, Destruction of, 15. Principles, Neutralized, 16. Poisons Affecting Nervous System, 29. Animal Insect, 19, 22, 33. Antagonistic Action of, 12. Blood, 28. Causing Immediate Death, 29. Change in, 6. Circulation of, 10. Classification of, 18, 19, 22, 28, 29, 30, 31, 32, 33. (Blyth), 30, 31. (Kobert), 28, 29. Tanner, 18, 23. Combining, 12, 13. Corrosive, 221. Effect of, 5, 10, 11. Effects Modified by, 11. Food, 14, 16, 19, 22, 29. Formed in Dead Animal Matters, 33. Gaseous, 217. Heart, 28. Identification of, 229. Injected, 8. Inorganic, 22, 33. Irritant, 29. Irritant and Narcotic, 29. Laws Relating to Sale of, 357. Metallic, 22. Mineral, 9, 10. Non-Corrosive, 22. Organic, 22, 256. Outline of Procedure in Search for, 249. Sale of, 357. Secreted by the Living, 32. Septic, 22. Specific Effects of, 10. Vegetable, 9. Volatile, 22. Poke Berry, 180. Root, 19, 180, 181. Poppy, 169, 181. Posology, 4. Post-Mortem, Appearances in Poison- ing, 275. Examinations, 17, 343. Key to Poison, 294. Poisoning, 15. Procedure, Guide to, 273. Potash, 30, 216. Acid Oxalate, 280. Chlorate of, 111, 182. Chromate of, 58. Cyanide of, 127. Potassa, 77, 232, 290. Potassium, 77, 181. Bicarbonate, 46. Bichromate, 58, 285. Carbonate, 19, 22, 46. Chlorate, 7, 19, 182, 221, 226, 291. Chromate, 58. Cyanide, 19, 220, 291. Ferrocyanide, 45. Hydroxide, 19, 22. Iodide, 9, 47, 224. Nitrate, 19, 292. Nitrite, 81. Oxalate, 226. Permanganate, 45, 46. Powder, Insect, 84, 146. Precipitate Red or White, 158, 183. Priapism, 223. Principals, Vegetable, Poisonous, 32. •Privy Emanations, 194. Ptomains, 16, 19, 22, 29, 33, 183, 220. Ptomain Poisoning, 226. Ptomatropines, 292. Ptyalism, 309. Pulsatilla, 185. Ptdse, 223. Pupils, 224. Purgatives, 11. Purging, 227. Putrefaction, 263. Pyrogallol, 226. Q Quabain, 200. Quaker Buttons, 166. Quassia, 37. Quinine, 219, 222. Questions for Self-Examination, 358. R Rabies, 188. Rat Paste, 87, 186. Poison, 177. Rats-bane, 166, 177. Redness, 17. Red Oxide of Mercury, 158. Red Precipitate, 158. Resorcin, 186. Respirations at Various Ages, 350. Respiratory Murmur, 263. Rhigolene, 175, 186. Rhus, 175, 187. Radicans, 187. Toxicodendron, 187. Venenata, 187. Ricine, 28. Rigor Mortis, 251. Rock Oil, 175. Rough on Rats, 87, 186, 216. Rue, 222. Rum, 74. 374 A MANUAL OF TOXICOLOGY. s Saffron, 117. Salicin, 22. Salicism, 222. Saliva of Rabid Animals, 188. Salivation, 224, 309. Salol, 68. Salt of Lemon, 65, 189. Sorrel, 65, 189. Salts, Ammonium, 30. Caustic, 28. Corrosive, Metallic, 221. Lithium, 10. Neutral Sodium, 30. Potassium, 12, 30. Strychnine, 46. Sanguinaria, 189. Santonin, 22, 32, 191, 219, 225. Saponification, 263. Saponins, 28, 32. Saturnism, 220. Savine, 19, 28, 29, 192, 222, 292. Scammony, 79. Scheele's Green, 87, 194. Scilla, 129, 200. Scillitin, 129. Scillitoxin, 129. Scoparin, 129. Scoparius, 129, 194. Scopolamine, 220, 223, 224. Secrecy in Poisoning, 14. Sedatives, 14. Self Examination, Questions for, 358. Self Poisoning, 90. Senna, 38. Sewer Gas, 14, 139, 194. Sex, 11. Shock, 10, 11. Siddhi, 103. Silver, 22, 29, 195, 222. Compounds, 218. Cyanide, 128. In Potassium Cyanide, 292. Nitrate, 195, 246, 293. Skin, Dry, Moist, Yellow, 224. Sleep, 14. Snake Bite, 197. Venom, 12, 22. Soap, Castile, 39. Suds, 37. Soda, 19, 30, 199, 216, 232, 290. Sodium Bicarbonate, 46. Carbonate, 19, 22, 46. Chloride, 37, 47. Hydroxide, 10, 22. Hyposulphite, 47. Nitrate, 221, 226. Nitrite, 7. Sulphate, 41, 45. Softening, 17. Solanine, 19, 22, 92, 221, 225. Solution, Fowler's, 216. Solutions, 11. Spanish Flies, 104. Spartein, 22, 129. Spigelia, 199, Spirit of Camphor, 101. Of Turpentine, 206. Spotted Hemlock, 117, 119. Squill, 129, 200. Syrup of, 37. Compound, 38. Squirting Cucumber, 79. Starch, 47. Iodide of, 47. State, Liquid, 11. Solid, 11. Stibin, 139. Stings, Bee, etc., 22. Stomach, Condition of, 11. Contents of,'ll. Pump, 35. Tube, 35. Ulceration of, 17. Stramonium, 19, 29, 92, 200, 216. Strophanthin, 22, 129, 200. Strophanthus, 129, 200, 218. Strychnine, 13, 14, 19, 22, 28,29, 33, 166, 218, 220, 242, .288. Strychnos, Ignatia, 166. Nux Vomica, 166. Substances, Animal, Putrid, 29. Locally Irritating, Organic, 28. Sulphides, Investigation of, 259. Sulphonal, 200, 218, 219, 222, 223, 225, 319 Poisoning, Chronic, 319. Sulphur Dioxide, 28, 139. Sulphurous Oxide, 139. Sulphuretted Hydrogen, 143, 203. Surface, Character of to Which Ap- plied, 8. Susceptibility, 13, 14. Swamp Sumach, 187. Symptoms, Ante-Mortem, 17. Characteristic, 14. Delayed, 220. Indications of, 219. Objective, 14. Severe, 14. Subjective, 14. Syncope, 266. T Table, Apportionate Dose, 324. Dose, 323, 324. Pulse, 228. For Making Per Cent. Sol., 355. Of Tests, Identification, 229. Tanacetum, Vulgare, 203. Tansy, 19, 203. Tar, 222. Tartar Emetic, 38, 84, 203, 224, 281. Taste, Foul, 224. Taxine, 31. Teeth, Order of Eruption of, 353. Tellurium, Salts of, 219, 226. Test, Distinctive, 16. Tests for Poisons, Table of, 229. Tetanies, 25. Tetanus, 15. Spinal, 19, INDEX. 375 Tetanus Bacillus, 220. Temperature, 225. Equivalents, 350. Thebaine, 19, 220. Thorn Apple, 200. 224. • Tin, 19, 22. Compounds, 203. Tobacco, 19, 29, 204, 218, 293. Indian, 157. Tolerance, 13, 14. Toludin, 220. Tolulene, 225. Tongue, Numbness, 225. Tingling, 225. Toxalbumins, 12. Toxicology, 1. Toxin, 16. Toxins, 22. Treatment, Key to, 215. Tremors, Mercurial, 309. Trichina, 19. Trichinosis, 226. Trional, 206, 218, 219, 225, 319. Poisoning, Chronic, 319. Truffles, 135, 206. Turpentine, 9, 13, 206. Oil of, 48, 206, 226. Turpeth, Mineral, 37. Tyrotoxicon, 16, 246. u Unconsciousness, 270. Uraemia, 14, 29. Uranium Salts, 226. Urethane, 207. Urinalysis, Key to, 345. Urine, 225, 226. Ulceration, 17. V Vanilla, 222. Vapors, 8, 28. Vaselin, 37, 209. Venous Coagulation, 263. Veratrine, 13, 22, 210, 222. Veratrum, 210, 218. Veratrum, Album, 210. Viride, 19, 210. Verdigris, 122, 212. Vermin Killer, 212. Vinegar, 53. Virus of Rabid Animals, 220. Visions, 222. Double, 226. Vitriol, Blue, 122. White, 212. Voice, Loss of, 226. Vomiting, 15, 227. Without Diarrhoea, 227. w Water, 49. Gas, 145. Javelle, 41, 111. Tepid, 37. Weed, Jamestown, 200. Weight, Apothecaries', 348. Avoirdupois, 348. of Water, 348. and Measures of Viscera, 348. Wheaten Flour, 47. White Precipitate, 158, 212. Vitriol, 212. Whisky, 74. Wines, 72. Wolfsbane, 70. Wood Alcohol, 76, 219. Spirit, 76. Woorara, 126, 212. Wormwood, 320.. Wounds, Poisonous, 212. Wrist Drop, 308. Y Yellow Jasmine, 140. Yew, 29. z Zinc, 19, 22, 29, 246, 279. Chloride, 212, 293. Compounds, 212, 213, 218. and Chromium, Search for, 260. Sulphate, 37, 212, 293. ERRATA. Page 17, line 17, read-transudation. Page 21, line 11, read-hyoscyamus. Page 41, under Alcohol, read after invaluable-but should be avoided in case of injury to the brain, or excessive cardiac action. Page 75, chart referred to is on page 270. Page 198, line 37, Antivene should be Antivenene. Page 264, line 36, with, should be within. Page 277, line 15, word should be convoluted.