Treatise on Poisons by Sir Robert Christison
2. If the copper be extremely minute in quantity, sulphuretted hydrogen
4374 words | Chapter 130
will not act upon it in a fluid much charged with organic matter. To
meet this possible case, which may occur when the subject of analysis is
an organ of the human body into which the poison has been conveyed by
absorption,—let the liquid be evaporated to dryness, and charred in the
following manner. Heat in a porcelain basin a quantity of nitric acid
equal in weight to the residuum, together with a fifteenth of chlorate
of potash. Add the dry residuum in successive portions of such magnitude
as not to occasion too great effervescence. When it has been all added,
heat the product till it become dark-red and thick. It will then, or
soon afterwards, begin suddenly to char, and at length a thick vapour
will arise in dense clouds; upon which, the charring being complete, the
heat must be withdrawn. Pulverise the carbonaceous mass; boil it with
nitric acid diluted with its own volume of water; and evaporate the
filtered fluid to dryness, so as to expel any excess of acid. Dissolve
the saline residuum, and test the solution with the usual reagents.
The first branch of this process is nearly the same with the one adopted
in the last edition of the present work. The second is derived from a
process lately proposed by Orfila.[1089]
The principles on which it is founded are these. 1. Of the numerous
organic compounds formed by vegetable and animal principles with the
salts of copper, all either dissolve in very weak acetic acid, or part
with their oxide of copper to it. This was pointed out by me in my last
edition. 2, Weak acetic acid, as already mentioned (p. 356), has been
shown by M. Devergie to be incapable of dissolving that copper which is
contained naturally in the tissues, at least so as to render it
discoverable by the subsequent steps of the process. 3, According to
Orfila, copper naturally present in organic substances, is never
indicated by the second branch of the process, provided the charred
product of the action of nitric acid and chlorate of potash be not
heated to incineration. It does not appear why the charring process,
when so conducted, should separate adventitious copper, and not that
which is present naturally. But the empirical fact may be accepted in
the mean time, as it rests on apparently careful experiments.
Orfila does not use acetic acid in the first branch of his process, but
merely infuses the suspected matter in cold water, and if copper be not
thus found, he has recourse to boiling water. But this method introduces
needless complexity; and besides neither maceration, nor boiling with
mere water, will dissolve out the whole oxide of copper. Acidulation
with acetic acid dissolves it all; and Devergie has shown that this
advantage is gained without any additional fallacy arising from the
possible presence of copper as a natural ingredient of the substance
under examination (p. 356).
SECTION II.—_Of the Action of Copper, and the Symptoms it excites in
Man._
The symptoms caused by copper have at least two varieties in their
character. One class arises from its local action on the alimentary
canal; the other from its operation on distant organs.
This double influence is proved by the experiments of Drouard on
animals, published in his inaugural dissertation at Paris in 1802; and
by those of Orfila in his Toxicology.
When Drouard gave twelve grains of verdigris to a strong dog fasting, he
observed that it caused aversion to food, efforts to vomit, diarrhœa,
listlessness, and death in twenty-two hours; and that the stomach was
but little inflamed. When two grains dissolved in water were injected
into the jugular vein of another dog, it caused vomiting and discharge
of fæces in seven minutes, then rattling in the throat, and death in
half an hour; and there was no particular morbid appearance in the
body.—Half a grain killed another in four days; and in addition to the
preceding symptoms, there was palsy of the hind legs for a day before
death. Six grains of the sulphate introduced into the stomach killed a
dog in half an hour, without producing any appearance of
inflammation.[1090]
These experiments prove that it is not by causing local irritation that
this poison proves fatal. But its mode of action is more distinctly
shown in the later and more accurate experiments of Orfila. He found
that twelve or fifteen grains of the neutral acetate generally killed
dogs within an hour; and that besides the usual symptoms of irritation
in the stomach, they often had insensibility, almost always convulsions,
and immediately before death rigidity, or even absolute tetanus. He
likewise remarked violent convulsions and insensibility when a grain of
this salt was injected into the veins; and death was then seldom delayed
beyond ten minutes. In no case was there any particular morbid
appearance, except loss of contractility in the voluntary muscles.[1091]
More recently results nearly the same have been obtained by
Mitscherlich; and when doses of two drachms of sulphate of copper were
given, he observed after death pale blueness of the villous coat of the
stomach, mingled with brownness,—the apparent effect of chemical
action.[1092]
Allied to these results are those obtained by my late colleague, Dr.
Duncan, and by Mitscherlich, when the sulphate was applied to a wound.
Dr. Duncan observed that death took place in twenty-two hours, and the
body was every where in a healthy state. Mitscherlich found that a
drachm of either sulphate or acetate proved fatal in four hours, with
symptoms of extreme prostration. The experiments of M. Smith, repeated
by Orfila, are at variance with these; for one or two drachms of the
acetate applied to a wound in the thigh of a dog caused only local
inflammation, and no constitutional symptoms.[1093]
It follows from the researches now detailed, that the salts of copper
act in whatever way they are introduced into the system, and the more
energetically, the more directly they enter the blood. The inquiries
of Mr. Blake farther show, that when injected into the blood-vessels,
they act with peculiar force in exhausting muscular irritability, and
occasion death by paralysing the heart if they are injected into a
vein. Six grains of the sulphate injected into the jugular vein of a
dog reduced the force of the heart’s contractions, and fifteen grains
arrested them in twelve seconds, leaving in the dead body distension
of the heart, loss of contractility, and florid blood in the left
cavities. Ten grains injected into the aorta through the axillary
artery caused no sign of obstruction in the capillary system; and
small doses of three or four grains occasioned vomiting, dyspnœa, and
stiffness of the limbs; and immediately after death the muscles had
lost their irritability.[1094]
Copper has been sought for, with variable success, in the blood of
animals poisoned with its salts. Drouard was unable to detect it in the
blood. But this need not excite surprise, because the same physiologist
could not detect it, even when he had injected it into a
vein.—Lebküchner, who published a thesis at Tübingen in 1819, on the
permeability of the living membranes, succeeded in discovering it. He
introduced four grains of the ammoniacal sulphate into the bronchial
tubes of a cat, and five minutes afterwards, when the animal was under
the action of the poison, he drew some blood from the carotid artery and
jugular vein; and he detected copper in the serum of the former, but not
in the latter, by sulphuretted-hydrogen and hydrosulphate of
ammonia.[1095]—Afterwards Dr. Wibmer of Munich also succeeded in
discovering it. In a dog which had taken from four to twenty grains of
the neutral acetate daily for several weeks, he found the metal in the
substance of the liver, but not anywhere else. In the charcoally matter
left by incinerating the liver, nitric acid formed a solution, which
when neutralized gave the characteristic action of the salts of copper
with sulphuretted-hydrogen, ferro-cyanate of potash, and ammonia.[1096]
Fischer also found copper in the blood of a dog which in forty-three
days had got gradually-increasing doses of acetate of copper, till at
length twelve grains were taken daily.[1097] Orfila has recently often
detected copper in the liver, spleen, heart, kidneys, and lungs of
animals poisoned with its salts.[1098] These facts are not all
invalidated by the late discovery of the presence of copper in the
animal tissues of men and animals not poisoned with its preparations.
For in the experiments of Wibmer and of Orfila the quantity found in
cases of poisoning was much larger than in the ordinary state of things;
and the poison was accumulated in particular organs, especially the
liver. The absorption of copper may therefore be considered as fully
substantiated; and it is equally important whether it be regarded as a
physiological or medico-legal fact.
Dr. Duncan’s experiment on its effect when applied to a wound shows that
it may prove fatal when applied externally. Yet in small quantities, the
sulphate is daily used with safety for dressing ulcers.
As to the preparations of copper which are poisonous, it is pretty
certain that, like all other metals, it is not deleterious unless
oxidated, and that its soluble salts are by far the most energetic.
Portal, indeed, has related the case of a woman who, while taking from a
half a grain to four grains of copper filings daily, was seized with
symptoms of poisoning.[1099] But it is probable the filings were
oxidated; for Drouard gave an ounce to dogs without injuring them at
all,[1100] and Lefortier more lately observed that two drachms had no
effect.[1101] The same explanation must be given of the injury sustained
by those artisans who prepare and use what is called “bronze dust” in
printing and paper-staining. If the substance employed be nothing else
than an alloy of copper and zinc, as is alleged, the injurious effects
to be mentioned presently can only be explained on the supposition that
the copper becomes oxidated either before or after coming in contact
with the body. It deserves to be added, that many persons have swallowed
copper coins and retained them for weeks without having any symptoms of
poisoning.
The sulphuret is equally innocuous with the metal if pure; but it
appears probable that it becomes oxidated by long exposure to the air,
and passes into the state of sulphate. Orfila found that an ounce of
recently prepared sulphuret had no effect on a dog; but half an ounce of
a parcel which had been long kept caused vomiting, and yielded a little
sulphate to water.[1102] The power of the oxides has not been
ascertained. They are certainly poisonous; and Lefortier found that both
the red dioxide and black protoxide undergo solution in no long time in
the stomachs of dogs.[1103] The hydrated protoxide is probably more
active. From some experiments made at the hospital of St. Louis in
Paris, it appears that twelve grains will cause nausea, pain in the
stomach and bowels, vomiting and diarrhœa.[1104] There is no doubt that
the carbonate or natural verdigris, the phosphate, and even the
subphosphate, though quite insoluble in water, are capable of acting as
poisons, because Lefortier found that they are soon dissolved in the
stomachs of dogs, and in small doses cause severe vomiting in the course
of fifteen minutes.[1105] But it is chiefly in the soluble salts that we
are to look for the full development of the action of this poison. A
very small quantity of the sulphate will prove fatal; for, as already
noticed, Drouard found that six grains killed a dog in half an hour.
The symptoms caused by the soluble salts of copper in man are, in a
general point of view, the same with those caused by arsenic and
corrosive sublimate. But there are likewise some peculiarities.
According to the cases related by Orfila in his Toxicology, the first
symptom is violent headache, then vomiting and cutting pains in the
bowels, and afterwards cramps in the legs and pains in the thighs.
Sometimes throughout the whole course of the symptoms there is a
peculiar coppery taste in the mouth, and a singular aversion to the
smell of copper. Drouard notices this in his thesis; and says, that,
having himself been once poisoned with verdigris, the smell of copper
used to excite nausea for a long time after.[1106] Another symptom,
which occasionally occurs in this kind of poisoning, and never, so far
as I know, in poisoning with arsenic or corrosive sublimate, is
jaundice. It likewise appears that, when the case ends fatally,
convulsions and insensibility generally precede death.
A set of cases illustrating the slighter forms of poisoning with copper
has been published by M. Bonjean of Chambéry. The cause was the
preparation of an acid confection in a copper vessel. Two women suffered
from severe headache, constriction of the throat, nausea, colic, and
extreme weakness. Two young men, who had eaten the confection more
freely, had for some hours excruciating colic, severe pain in the mouth
and throat, impeded breathing, and hurried irregular pulse; and for
twenty-four hours they suffered severely from headache and prostration
of strength.[1107]
The following case communicated to Professor Orfila by one of his
friends will convey a good idea of the symptoms in severe cases, which
do not prove fatal. A jeweller’s workman swallowed intentionally half an
ounce of verdigris, suspended in water. In fifteen minutes he was
attacked with colic pains and profuse vomiting and purging. When seen by
the physician eight hours afterwards there was not much vomiting, but
frequent eructation of a matter containing verdigris, some salivation, a
small pulse, and blueness about the eyes. In sixteen hours jaundice
began to appear. In the course of the night he was a good deal relieved
from the colic pains by three alvine discharges; and next morning he had
ceased to vomit, and the pain had disappeared. But he complained of a
taste of copper in his mouth, and the jaundice had increased. From this
time he recovered rapidly, and on the fourth day convalescence was
confirmed.[1108]
When the poisoning ends fatally, convulsions, palsy, and insensibility,
the signs in short of some injury done to the brain, are very generally
present. This is illustrated by a good example in Pyl’s Essays and
Observations. It was the case of a confectioner’s daughter, who took two
ounces of verdigris, and died on the third day under incessant vomiting
and diarrhœa, attended towards the close with convulsions, and then with
palsy of the limbs. This case, however, is chiefly valuable for the
dissection, which will be noticed presently.[1109] But two cases of the
same description are related in greater detail by Wildberg in his
Practical Manual, which clearly show the action of this poison on the
brain. They are the cases formerly alluded to of a lady and her daughter
who were poisoned by sour-krout kept in a copper pan. Soon after dinner
they were attacked first with pain in the stomach, then with nausea and
anxiety, and next with eructation and vomiting of a green, bitter, sour,
astringent matter. The pain afterwards shot downwards throughout the
belly, and was then followed by diarrhœa; afterwards by convulsions, at
first transient, then continued; and finally by insensibility. The
daughter died in twelve hours, the mother an hour later.[1110] In these
three cases, although there was not any jaundice noticed during life,
the skin was very yellow after death.—In some instances it would appear
that narcotic symptoms form the commencement and irritant symptoms the
termination of the poisoning. This unusual relation occurs in a case of
recovery related by M. Julia-Fontenelle, and also, though less
remarkably, in a fatal case mentioned by Wibmer. The subject of the
former was a man who intentionally took a solution of copper in vinegar,
prepared by keeping several sous-pieces seven days in that fluid. In
three hours he was found in a state of insensibility, with the jaws
locked, the muscles rigid and frequently convulsed, the breathing
interrupted, and the pulse small and slow. In half an hour he was so far
roused that he could tell what he had done; and soon after taking white
of eggs the convulsions ceased: but next day the belly was hard and
tender, and the repeated application of leeches was required to subdue
the abdominal irritation that ensued.[1111] In the fatal case by Wibmer,
that of a girl of 18, who was poisoned by a dish of beans having been
cooked in a copper vessel, sickness, pain of the belly and vomiting
speedily arose, but were soon followed by convulsions and loss of
consciousness. Next day there was little pain, but extraordinary
paralytic weakness of the arms and legs: the abdomen afterwards became
distended and painful; and death took place in seventy-eight
hours.[1112]—A case where convulsions were produced by two drachms of
blue vitriol is mentioned by Dr. Percival.[1113]—In other instances it
would appear that no nervous affection occurs at all, as in the case of
a young lady related by Percival, who, when poisoned with pickled
samphire containing copper, suffered chiefly from pains in the stomach,
an eruption over the breast, general shooting pains, thirst, a frequent
small pulse, vomiting, hiccup, and purging. Death occurred on the ninth
day, without stupor or convulsions.[1114]
Besides these effects when introduced in considerable doses and in the
form of soluble salts, copper is said to produce other disorders when
applied to the body for a long time in minute quantities and in its
metallic or oxidized state. Among those artisans who work much with
copper various affections are thought to be gradually engendered by
merely handling the metal. Patissier in his treatise on the diseases of
artisans says, that copper-workers have a peculiar appearance which
distinguishes them from other tradesmen,—that they have a greenish
complexion,—that the same colour tinges their eyes, tongue, and hair,
their excretions, and even their clothes through the medium of the
perspiration,—that they are spare, short in stature, bent, their
offspring ricketty, and they themselves old and even decrepit at their
fortieth or fiftieth year.[1115] Mérat also asserts that they are liable
to the painters’ colic, that peculiar disease soon to be noticed as a
common effect of the long-continued application of lead.[1116]
But these notions must be received with some limitation. At least the
alleged effects on copper-workers are by no means invariable. For
copper-workers now-a days in this country and elsewhere are by no means
the unhealthy persons Patissier represents them to be. As to colica
pictonum, it is very rare among them; and possibly the cases noticed by
Mérat might have been produced by the secret introduction of lead into
the body, if indeed they were not cases of common colic.
A very singular set of cases was lately brought under notice by Mr.
Gurney Turner, where poisoning seemed to have been occasioned by the
external application or inhalation of the fine dust used for imitating
gilding by painters, paper-stainers, and porcelain-painters, and which
is said to be essentially brass in a state of fine division. The workmen
who use it, are very apt to be attacked with irritation about the
private parts, and a vesicular eruption about the hairs on the
pubes,—with loss of appetite, tendency to vomiting, and other symptoms
of irritation in the stomach,—with obstinate constipation,—with soreness
and dryness of the throat and irritation in the nose,—and with want of
sleep, and a remarkable greenness of the hair over the whole body.[1117]
SECTION III.—_Of the Morbid Appearances caused by Copper._
The appearances found in the body after death by poisoning with copper
are chiefly the signs of inflammation.
Where death takes place very rapidly, however, it is probable, that no
diseased appearance whatever will be perceptible. At least this was the
case in the animals experimented on by Drouard and Orfila; and little
doubt can therefore be entertained that the result would be the same
with man also in similar circumstances.
When death ensues more slowly, as in the only fatal cases yet on record
of its action on man, the marks of inflammation coincide with the signs
of irritation during life. The best account I have seen of the morbid
appearances under such circumstances is in the cases related by Pyl, by
Wildberg, by Wibmer, and by Dégrange.
In Pyl’s case the whole skin was yellow. The intestines, particularly
the lesser intestines, were of an unusual green colour, inflamed, and
here and there gangrenous. The stomach was also green; its inner coat
was excessively inflamed; and near the pylorus there was a spot as big
as a crown, where the villous coat was thick, hard, and covered with
firmly adhering verdigris. The lungs are likewise said to have been
inflamed. The blood was firmly coagulated.
In the cases related by Wildberg, which are very like each other, the
skin on various parts, and particularly on the face, was yellow, but on
the depending parts livid. The outer coat of the stomach and intestines
was here and there inflamed; and the inner coat of the former was very
much inflamed, and even gangrenous[1118] near the pylorus and cardia.
The duodenum and jejunum, and likewise the gullet, were in a similar
state. The blood in the heart and great vessels was black and fluid.
In the case of the girl referred to by Wibmer, the skin was
ochre-yellow, the stomach green, much inflamed, especially near the
pylorus, the gullet and intestines also inflamed, the diaphragm red, the
brain healthy, the lungs and heart “gorged with thick blood.”
In the case of poisoning with carbonate of copper described by Dégrange
[p. 348], in which, however, it is probable that death was accelerated
by a fall, there was found congestion of the surface of the brain,
arborescent redness of the gullet and a green sand over its surface,
general greenness of the villous coat of the stomach, with vascularity
of the fundus and points of superficial ulceration, greenness of the
whole intestines, with black vascular ecchymosed spots and softening,
except in the ileum, and redness of the inner surface of the heart.
Copper was detected in the contents of the stomach and intestines.
The intestines have been found perforated by ulceration, and their
contents thrown out into the sac of the peritonæum. Portal has related
one case where the small intestines were perforated, and several where
the perforation was in the rectum, which portion of the intestines, as
well as the duodenum, jejunum, and ileum, was also extensively
ulcerated.[1119]
The existence of verdigris in the form of powder lining the inside of
the stomach after incessant vomiting for three days, is of course an
important circumstance in the inspection of the body. But too much
reliance ought not to be placed on mere bluish or greenish colouring of
the membranes. For Orfila[1120] and Guersent[1121] have both observed,
that the inside of the stomach as well as its contents may acquire these
tints in a remarkable degree in consequence of natural disease.
SECTION IV.—_Of the Treatment of Poisoning with Copper._
The treatment of poisoning with the salts of copper has been examined in
relation to the antidotes by M. Drouard, M. Marcelin-Duval, Professor
Orfila, and M. Postel.
The alkaline sulphurets were at one time thought to be antidotes for the
poisons of copper, but without any reason. Drouard found that fifteen
grains of verdigris killed a dog in thirty hours, notwithstanding the
free use of the liver of sulphur.[1122]
Afterwards M. Marcelin-Duval was led from his experiments to infer that
sugar was an antidote,[1123] and in the first editions of his Toxicology
Professor Orfila agreed with him, and related some experiments of his
own, which, along with those of Duval, seemed to place the fact beyond
all doubt. Later and more careful experiments, however, satisfied
Orfila, that it only acts as an emollient after the poison has been
removed from the stomach, and that it has no effect at all if the poison
is retained by a ligature in the gullet.[1124] Sugar being thus rejected
as well as the sulphurets, he was led to try the effects of albumen; and
his experiments induced him to recommend that substance as an antidote
in preference to every thing else. He found that the white of six eggs
completely neutralized the activity of between 25 and 36 grains of
verdigris; so that even when the mixture was retained in the stomach by
a ligature on the gullet no effect ensued which could be ascribed to the
poison. He infers that white of egg is the best antidote for poisoning
with copper.[1125] He likewise found the ferro-cyanate of potass not
inferior.[1126]
Since the publication of these inquires the subject has been again
examined by M. Postel, who reverts to the original proposition of Duval,
that sugar is really a good antidote; and he rests this conclusion
partly on direct comparative experiments, showing that it is at least
equally effective with white of egg, and partly on the singular fact
ascertained by him, that sugar, which was believed to decompose the
salts of copper only at the temperature of 212°, does actually
accomplish this decomposition at the temperature of the human body, and
throws down the copper in the form of oxide.[1127]
According to the experiments of MM. Milne-Edwards and Dumas, metallic
iron is likewise a good antidote: they found that when fifteen, twenty,
and even fifty grains of sulphate of copper, acetate of copper, or
verdigris, were given to animals, and an ounce of iron filings
administered either immediately before, or immediately afterwards,—the
gullet being tied to prevent the discharge of the poison,—death did not
ensue for five, six, or even eight days, and consequently proceeded from
the operation on the gullet; and that in one experiment, on the ligature
being removed from the gullet, the opening healed up, and complete
recovery took place.[1128]
Before quitting the subject of the treatment, it is necessary to caution
the practitioner particularly against the employment of vinegar,—a
substance often ignorantly used for this, in common with many other,
species of poisoning. On account of its solvent power over the insoluble
compounds formed by the salts of copper with animal and vegetable
matters, it must be injurious rather than useful.
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