Memoranda on Poisons Part 3

_Symptoms._-The effects of poisoning by oxalic acid are peculiar. When the dose is large (half an ounce or more) and the solution concentrated, it proves very rapidly fatal. It produces a hot burning sensation in the fauces and sophagus in the act of swallowing, severe burning pain in the stomach, and in most instances immediate vomiting. The vomited matters are strongly acid, of a dirty green or black color, and consist of the contents of the stomach with altered mucus and blood. The remaining symptoms are a sense of constriction or suffocation, lividity of the countenance, great prostration of strength, feeble pulse, cold clammy perspirations, and convulsions, which speedily terminate in death. When a smaller quant.i.ty has been taken, much diluted, its corrosive properties are weakened or destroyed, but the nervous symptoms, as cramps and numbness, may be well marked.

In cases of recovery the mouth may remain sore for some time, the tongue swollen, the abdomen tender, the stomach very irritable, and there may be troublesome diarrha. In two instances there has been loss of voice for several days, owing to the action of the poison on the nervous system. Twitching of the muscles of the face and extremities has also been observed.

_Post-mortem Appearances._-The mucous membrane of the fauces, sophagus, and stomach is generally white and brittle, but often colored with the brown mucous matter discharged. The stomach often contains a black fluid, like coffee-grounds, consisting princ.i.p.ally of altered blood; and its sub-mucous coats are vascular and dark colored.

The stomach though seldom perforated, may yet be so softened as to be with difficulty removed entire, and sometimes this is not possible. This softening may be due to the post-mortem action of the poison; but its effects during life in softening and bleaching the mucous membrane are sufficiently marked. Occasionally the stomach is black and gangrenous looking. If death has occurred quickly, the small intestines are seldom much affected; but where the symptoms have been protracted there are usually signs of congestion and inflammation.

_Treatment._-Chalk, whiting, or magnesia, suspended in water, or in some demulcent fluid, must be administered immediately; and if necessary, vomiting should be excited by tickling the fauces, or administering emetics of sulphate of zinc and ipecacuan, followed by large quant.i.ties of emollient drinks. The antidote, to be effective, must be given as soon as possible, the plaster of the apartment, or any form of mortar being used in the absence of the remedies just mentioned.

Alkalies (soda, potash, or their carbonates) are not only useless, but they form salts with oxalic acid, which are as injurious as the acid itself. When there are symptoms of collapse, stimulants are to be freely employed.

From the tendency to softening, the stomach-pump should not be used.

_Tests._-Crystals of oxalic acid are met with as four-sided prisms, colorless, without odor permanent in the air, and very acid; this last character distinguis.h.i.+ng them from crystals of sulphate of magnesia and sulphate of zinc. The crystals, when heated, melt, and are dissipated without combustion, and leaving no residue. This character is important as a means of distinguis.h.i.+ng oxalic acid from other similar crystals.

They are soluble in from eight to twelve parts of cold water. This acid may be thus recognised in solution:

1. _Nitrate of silver_ throws down, with oxalic acid, an abundant white precipitate (oxalate of silver), which is soluble in nitric acid. The oxalate of silver, when dried and heated on platinum foil, detonates, and is dissipated in a white vapor.

2. _Sulphate of calcium_ causes a white precipitate with oxalic acid (oxalate of calcium) which is soluble in nitric or hydrochloric, but not in any vegetable acid.

The solution containing the acid should be concentrated before testing, if it be not present in considerable quant.i.ty.

Lime water and all soluble lime salts throw down precipitates with oxalic acid; but as these are liable to be mistaken for a precipitate with sulphuric acid, it is better to use sulphate of calcium which is slightly soluble, as the test agent. A good deal of the test solution must be used, and the precipitate takes time to settle.

3. _Sulphate of copper_ gives a faint bluish precipitate with oxalic acid (oxalate of copper), which is not redissolved by a few drops of hydrochloric acid.

These tests will not act if the solution contain nitric acid in excess, in which case the liquid must be evaporated to crystallization, and the crystals washed and redissolved in water.

These tests for oxalic acid should never be applied without previously separating it from all organic matter. This is best done by first of all acidulating the suspected fluid with acetic acid, and then adding acetate of lead, which combines with the oxalic acid to form a white insoluble salt, which may ordinarily be removed by filtration or subsidence. This filtrate, after being well washed, is to be diffused in water, and into this a current of sulphuretted hydrogen gas is to be pa.s.sed for some considerable time. This will throw down the lead as sulphide, leaving the oxalic acid in the fluid; any organic matter will also be carried down. Filtration will separate the solids from the liquid containing the acid, which may now be evaporated until crystals are formed, which may be tested in the usual way.

ACETIC ACID.-Although this acid, in its concentrated state, is highly corrosive, yet it is very seldom brought under the notice of the toxicologist.

In the case of a young woman reported by Orfila, death quickly occurred after several attacks of convulsions. At the subsequent post-mortem examination, the integuments of the dependent parts of the body were found very livid; the tongue and sophagus were of a dirty brown color, the latter being intersected by a fine net-work of capillary vessels; and the interior of the stomach was interspersed with black elevations caused by the presence of coagulated blood in the sub-mucous areolar tissue. The mucous membrane was entire.

As regards the _treatment_, it is only necessary to administer draughts containing magnesia or its carbonate, followed by mucilaginous or demulcent drinks.

TARTARIC ACID, though not a corrosive, may be here placed along with the other vegetable acids. Strange as it may seem, tartaric acid has destroyed life in at least one instance in this country; an ounce having been given in mistake for an aperient salt. The deceased swallowed the whole at once, and immediately called out that he had been poisoned. He complained of intense pain in the throat and stomach, as if he had swallowed oil of vitriol, or was on fire. Soda and magnesia were administered without avail; and after death, at the end of nine days'

suffering, the stomach and intestines were found much inflamed.

CHAPTER VIII.

THE CAUSTIC ALKALIES AND THEIR CARBONATES; POTASH, SODA, AMMONIA.

The second division of the cla.s.s of Corrosives has now to be considered.

It contains the Caustic Alkalies, and some of their Salts. Poisoning by any of these agents is rare.

POTASH.-This substance, in its caustic state, as found in commerce, is in the form of grey-colored cakes. It has an acrid taste, is soapy to the touch, and very deliquescent. Moulded in cylinders, it is often employed as a caustic (Pota.s.sa fusa). In solution (Liquor pota.s.sae) it is strongly alkaline, and imparts a brown stain to black cloth.

_Pota.s.sium carbonate_ or _Carbonate of Potash_ (Pearlash) is extensively used by laundresses and in the dressing of woollen cloth. It is generally sold in a granular condition, white, inodorous, and strongly alkaline; it is soluble in water, but not in alcohol.

CAUSTIC SODA.-This agent resembles potash in its general properties.

The _Sodium Carbonate_ or _Carbonate of Soda_ (Soap-lees) bears a similar resemblance to the carbonate of potash, except that it crystallizes easily, and effloresces on exposure to the air.

AMMONIA.-When pure, ammonia is a colorless, pungent gas; but it is commonly met with dissolved in water, as the liquor ammoniae. Its vapor is poisonous, and may prove fatal by producing inflammation of the larynx and trachea, and even of the lungs. A case is recorded of a French boy, aet. six, who killed his younger sister by making her swallow several teaspoonfuls of a solution of ammonia. Other instances have also occurred where the liquor ammoniae has either been taken in mistake for the aromatic spirit of ammoniae, or purposely, to destroy life. An instance is recorded by Dr. Taylor, as occurring in the practice of Mr.

Hilton, where liquor ammoniae, given by mistake, caused corrosion of the throat and gullet and obstruction of the bronchial tubes by false membrane. The sophagus was completely dissolved at its junction with the stomach, and there was an aperture in the anterior wall of that organ such as might have been caused by oil of vitriol.

The _Ammonium Carbonate_ or _Carbonate of Ammonia_ (Hartshorn, Smelling Salts) has been used as a poison. It may be distinguished from other salts by its being alkaline, by its entire volatility, and by its pungent odor. A young woman in a state of unconsciousness, was made to swallow a quant.i.ty of hartshorn. In an hour there was great pain, sickness, and vomiting of blood. The haematemesis continued for some days, and then feebleness and emaciation set in, death occurring in three months. On examination the pylorus was found contracted to the size of a crow-quill, while there was a large cicatrix on the posterior wall of the stomach.

_Symptoms._-The chief symptoms occasioned by the foregoing poisons are, an acrid, burning taste, with a sensation of excoriation and burning extending along the mouth and throat, to the stomach. There soon ensue exquisite pain in the epigastrium, and tenderness on pressure.

Frequently there is cough, hoa.r.s.eness, dyspna, as well as vomiting of altered mucus mixed with blood and detached portions of the mucous membrane. The tongue, mouth, and fauces become swollen, soft, and flabby, and deglut.i.tion is difficult. The surface of the body gets cold and moist, the pulse small and feeble, and there is great pain over the abdomen, with diarrha. Death took place, in the case of a boy, in three hours from the time of swallowing a strong solution of carbonate of potash. Ammonia, by its effect on the air pa.s.sages, has proved fatal in four minutes. When recovery from the immediate effects of the poison has taken place, death has subsequently ensued from stricture of the sophagus, producing starvation. By the proper use of bougies, &c., life may occasionally be prolonged for many months, or even for years.

In some instances, however, it is almost impossible to effect dilatation, owing to the whole of the gullet becoming thickened and contracted, so that the opening into the stomach will hardly admit a crow-quill. The pylorus may also be contracted in like manner.

_Post-mortem Appearances._-The mucous membrane of the mouth and gullet is softened and inflamed, and portions of it detached. The coats of the stomach and intestines are inflamed, stained of a dark color, and sometimes ulcerated. When death has resulted from ammonia, signs of inflammation are usually found in the larynx and bronchial tubes. The other caustic alkalies may also destroy life by producing inflammation of the glottis, which consequently may be found thus occluded after death.

_Treatment._-The object must be to neutralize the poison, which may be effected by a weak acid. Vinegar and water is perhaps the best antidote, and that most readily procurable; its administration may be followed up by freely allowing acidulated demulcent drinks, orange juice, &c. The use of oil has been recommended, on the principle that it converts the alkali into a soap. But that its efficacy is doubtful has been in some measure shown by the death of two young children from swallowing a mixture of ammonia and oil. In one of these cases nearly two ounces of linimentum ammoniae (made of one part of liquor ammonia to two of olive oil) were poured down an infant's throat by a child five years old. Were, however, the oil given in much greater abundance, the result would probably be different. At all events, its administration should not be neglected.

_Tests._-The specific character of these substances is their strongly marked alkalinity, ammonia possessing, over and above, that of volatility. Potash is known from soda by being precipitated of a creamy yellow by platinum perchloride, soda remaining unaffected by that reagent.

II.-SIMPLE IRRITANTS.

CHAPTER IX.

SALTS OF THE ALKALIES AND ALKALINE EARTHS.

POTa.s.sIUM NITRATE or NITRATE OF POTASH (_Nitre_, _Saltpetre_, _Salprunelle_) is a more dangerous poison than is commonly supposed, provided the dose be large. It has ordinarily been given in mistake for other salts as a purgative, and in one instance, caused death in about two hours, in another such instance, referred to by Orfila, an ounce proved fatal in three hours. It produces symptoms of irritation in the alimentary ca.n.a.l, vomiting, and diarrha. There is generally also severe pain at the pit of the stomach, trembling of the limbs, scanty urine, and collapse. Marks of violent inflammation are found after death in the stomach and along the intestinal ca.n.a.l.

POTa.s.sIUM SULPHATE or SULPHATE OF POTASH (_Sal Polychrest_, _Sal de Duobus_, &c.) has proved fatal when taken in a large dose. It has caused death in two or three cases when purposely administered to procure abortion. Taylor quotes an instance of a lady, a week after delivery, being directed by her medical attendant to take ten drachms of this salt, in divided doses as a laxative. After the first dose she was seized with severe pain in the stomach, with vomiting, &c., the symptoms increasing after each dose, and proving fatal in two hours. At the post-mortem examination the mucous membrane of the stomach and intestines was seen to be soft and pale, and the stomach contained a quant.i.ty of reddish-colored liquid. This, on being a.n.a.lyzed, was found to contain no other irritant but this salt.

BITARTRATE OF POTa.s.s or HYDROGEN POTa.s.sIUM TARTRATE (_Cream of Tartar_, _Argol_.)-This salt has caused death in one case at least, in which about an ounce and a half was taken. The symptoms were those of an irritant poison, with paralysis of the lower extremities. Death occurred within forty-eight hours.

SULPHURET OF POTa.s.sIUM (_Liver of Sulphur_) has also caused death as an irritant poison.

_Treatment._-As no antidotes are known to these salts the treatment must consist in producing vomiting as speedily as possible by means of emetics; or the stomach-pump may be used. Demulcent drinks should be freely given subsequently, with soothing applications to the bowels. Ice may be given in any quant.i.ty.

LIME acts as an irritant poison, though a feeble one, when taken into the stomach or applied to a vital part. One fatal instance is reported, where a boy swallowed some lime in an apple-pie. He died in nine days, after suffering from a burning pain in the abdomen, great thirst, and obstinate constipation. Unslaked or imperfectly slaked lime may also prove fatal by being inhaled, and so giving rise to inflammation of the glottis.

BARIUM SALTS.-Two preparations of barium have caused death, viz., the chloride and the carbonate. These may also give rise to specific nervous symptoms, as cramps and convulsions.

_Chloride of Barium_ is found crystallized in irregular plates or tables, which are permanent in the air, soluble in water, and of a disagreeable bitter taste. Half an ounce has proved fatal in two hours, after causing symptoms of irritation, with vertigo, paralysis and convulsions.