3. If antimony be not indicated in either of these ways in the fluid

part of the subject of analysis, the solid portion may next be subjected to the second process; but success will very seldom attend the search when the previous steps have failed. The first branch of this process,—a slight modification of Dr. Turner’s,—is a very delicate and satisfactory method of detecting antimony in organic mixtures. Some practice is required to transmit the hydrogen gas with the proper rapidity. The gas ought to be allowed to pass for some time before the spirit-lamp flame is applied, otherwise the oxygen remaining in the apparatus may cause an explosion, or will oxidate the metallic antimony, formed by the reduction of the sulphuret. As soon as the reduction of the sulphuret begins, the tube is blackened on account of the action of the sulphuretted-hydrogen on the lead contained in the glass. This obscures the operations within the tube; but on subsequently breaking it, a metallic button or a sublimate will be easily seen. When the sulphuret is considerable in quantity and the gaseous current slow, the metal remains where the sulphuret was; but if the mass of sulphuret is small and the current rapid, then the metal is sublimed and condensed in minute scaly brilliant crystals. The second branch of the process is a modification of the method lately employed by Professor Orfila for detecting antimony in the textures and secretions of animals poisoned with tartar-emetic. It is probably more delicate than the other, but not more satisfactory. The method of analysis here recommended, as well as every other yet proposed for organic mixtures, merely detects the presence of antimony. It does not indicate the state in which the metal was combined. It is a process in short for antimony in every state of combination. It is almost unnecessary to observe that when the contents of the stomach or vomited matters are the subject of analysis, care must be taken to ascertain that tartar-emetic was not administered as a remedy. SECTION II.—_Of the Action of Tartar-Emetic, and the Symptoms it excites in Man._ There is little peculiarity in what is hitherto known of the symptoms of poisoning with tartar-emetic in man. Cases in which it has been taken to the requisite extent are rarely met with; and it has seldom remained long enough in the stomach to act deleteriously. But its action on animals would appear from the experiments of Magendie to be in some respects peculiar. He found that dogs, like man, may take a large dose with impunity, for example half an ounce, if they are allowed to vomit; but that if the gullet is tied, from four to eight grains will kill them in a few hours. His subsequent experiments go to prove that death is owing to the poison exciting inflammation in the lungs. When six or eight grains dissolved in water were injected into a vein, the animal was attacked with vomiting and purging, and death ensued commonly within an hour. In the dead body he found not only redness of the whole villous coat of the stomach and intestines, but also that the lungs were of an orange-red or violet colour throughout, destitute of crepitation, gorged with blood, dense like the spleen, and here and there even hepatized. A larger quantity caused death more rapidly without affecting the alimentary canal; a smaller quantity caused intense inflammation there and death in twenty-four hours; but the lungs were always more or less affected.[1134] It is a fact, too, worthy of notice, that in whatever way this poison enters the body its effects are nearly the same. This is shown not only by the researches of Magendie already mentioned, but likewise by the experiments of Schloepfer, who found that a scruple dissolved in twelve parts of water and injected into the windpipe, caused violent vomiting, difficult breathing, and death in three days; and in the dead body the lungs and stomach were much inflamed, particularly the former.[1135] It farther appears from an experiment related by Dr. Campbell, that, when applied to a wound, it acts with almost equal energy as when injected into a vein. Five grains killed a cat in this way in three hours, causing inflammation of the wound, and vivid redness of the stomach.[1136] He did not find the lungs inflamed. Magendie infers from his own researches that tartar-emetic occasions death when swallowed, not by inflaming the stomach, but through means of a general inflammatory state of the whole system subsequent to its absorption,—of which disorder the affection of the stomach and intestines and even that of the lungs are merely parts or symptoms. The later experiments of Rayer tend in some measure to confirm these views, by showing that death may occur without inflammation being excited any where. In animals killed in twenty-five minutes by tartar-emetic applied to a wound, he, like Dr. Campbell, could see no trace of inflammation in any organ of the great cavities.[1137] Orfila has proved by analysis the important fact that tartar-emetic is absorbed in the course of its action, and may be detected in the animal tissues and secretions. He found that, when it is applied to the cellular tissue of small dogs, two grains disappear before death: That antimony may be detected by his process given above throughout the soft textures generally, but especially in the liver and kidneys: but that it is quickly discharged from these quarters through the medium of the urine. Hence in an animal that died in four hours he found it abundantly in the liver and still more in the urine; in one that survived seventeen hours, the liver presented mere traces of the poison, but the urine contained it in abundance; and in one that lived thirty-six hours, there was a large quantity in the urine, but none at all in the liver. He also ascertained that antimony is generally to be found in the urine of persons who are taking tartar-emetic continuously in large doses for pneumonia according to Rasori’s mode of administering it.[1138] These results have been confirmed by the conjoined researches of Panizza and Kramer, who found antimony in the urine and blood of a man during a course of tartar-emetic.[1139] And Flandin and Danger also satisfied themselves that in animals it may be generally detected in the liver.[1140] _Effects on Man._—When tartar-emetic is swallowed by man, it generally causes vomiting very soon and is all discharged; and then no other effect follows. But if it remains long in the stomach before it excites vomiting, or if the dose be large, more permanent symptoms are sometimes induced. The vomiting recurs frequently, and is attended with burning pain in the pit of the stomach, and followed by purging and colic pains. There is sometimes a sense of tightness in the throat, which may be so great as to prevent swallowing. The patient is likewise tormented with violent cramps. Among the cases hitherto recorded no notice is taken of pulmonary symptoms; which might be expected to occur if Magendie’s experiments are free of fallacy. The late introduction of large doses of tartar-emetic into medical practice having excited some doubt as to its poisonous properties, it becomes a matter of some moment to possess positive facts on the subject. The following cases may therefore be quoted, which will satisfy every one that this substance is sometimes an active irritant. The first is particularly interesting from its close resemblance to cholera. It occurred in consequence of an apothecary having sold tartar-emetic by mistake for cream of tartar. The quantity taken was about a scruple. A few moments afterwards the patient complained of pain in the stomach, then of a tendency to faint, and at last he was seized with violent bilious vomiting. Soon after that he felt colic pains extending throughout the whole bowels, and accompanied ere long with profuse and unceasing diarrhœa. The pulse at the same time was small and contracted, and his strength failed completely; but the symptom which distressed him most was frequent rending cramp in the legs. He remained in this state for about six hours, and then recovered gradually under the use of cinchona and opium; but for some time afterwards he was liable to weakness of digestion.[1141] The next case to be mentioned, where the dose was forty grains, proved fatal, although the person vomited soon after taking it. The symptoms illustrate well the compound narcotico-acrid action often observed in animals. The poison was taken voluntarily. Before the person was seen by M. Récamier, who relates the case, he had been nearly two days ill with vomiting, excessive purging, and convulsions. On the third day he had great pain and tension in the region of the stomach, and appeared like a man in a state of intoxication. In the course of the day the whole belly became swelled, and at night delirium supervened. Next day all the symptoms were aggravated; towards evening the delirium became furious; convulsions followed; and he died during the night, not quite five days after taking the poison.[1142] Severe effects have also been caused by so small a dose as six grains. A woman, who swallowed this quantity, wrapped in paper, was seized in half an hour with violent vomiting, which soon became bloody. In two hours the decoction of cinchona was administered with much relief. But she had severe colic, diarrhœa, pain in the stomach, and some fever; of which symptoms she was not completely cured for five days.[1143] A case has been published, where a dose of only four grains caused pain in the belly, vomiting, and purging, followed by convulsions, failure of the pulse, and loss of speech; and recovery took place very slowly.[1144] Under the head of the treatment another case will be noticed where half a drachm excited severe symptoms, and was probably prevented from proving fatal only by the timely use of antidotes. While these examples prove that tartar-emetic is occasionally an active irritant in the dose of a scruple or less, it must at the same time be admitted to be uncertain in its action as a poison. This appears from the late employment of it in large doses as a remedy for inflammation of the lungs. The administration of tartar-emetic in large doses was a common enough practice so early as the seventeenth century, and was also occasionally resorted to by physicians between that and the present time. But it is only in late years that, by the recommendations of Professor Rasori of Milan,[1145] and M. Laennec of Paris, it has again become a general method of treatment. According to this method, tartar-emetic is given to the extent of twelve, twenty, or even thirty grains a day in divided doses; and not only without producing any dangerous irritation of the alimentary canal, but even also not unfrequently without any physiological effect whatever. Doubts were at one time entertained of the accuracy of the statements to this effect published by foreign physicians; but these doubts are now dissipated, as the same practice has been tried, with the same results, by many in Britain. Rasori ascribes the power the body possesses of enduring large doses of tartar-emetic without injury, to a peculiar diathesis which accompanies the disease and ceases along with it. And it is said, that the same patients, who, while the disorder continues, may take large doses with impunity, are affected in the usual manner, if the doses are not rapidly lessened after the disease has begun to give way. The testimony of Laennec on the subject is impartial and decisive. He observes he has given as much as two grains and a half every two hours till twenty grains were taken daily, and once gave forty grains in twenty-four hours by mistake; that he never saw any harm result; and that vomiting or diarrhœa was seldom produced, and never after the first day. The power of endurance he found to diminish, but not, as Rasori alleges, to cease altogether, when the fever ceases; for some of his patients took six, twelve, or eighteen grains daily when in full convalescence.[1146] My own observations correspond with Laennec’s, except as to the effects of large doses during convalescence, of which effects I have had no experience. I have seen from six to twenty grains, given daily in several doses of one or two grains, check bad cases of pneumonia and bronchitis, without causing vomiting or diarrhœa after the first day, and also without increasing the perspiration. At the same time I have twice seen the first two or three doses excite so violent a purging and pain in the stomach and whole bowels, that I was deterred from persevering with the remedy. In continued fever too I have repeatedly found that the doses mentioned above did not cause any symptoms of irritation in the stomach or intestines. The large quantities now mentioned have even been sometimes given in a single dose with nearly the same results. Dr. Christie mentions in his Treatise on Cholera that he sometimes gave a scruple in one dose with the effect of exciting merely some vomiting and several watery stools. But he admits that in one instance symptoms were induced like those of a case of violent cholera.[1147] The same large doses have been given by some in delirium tremens without any poisonous effect being produced. A correspondent of the Lancet has even mentioned that on one occasion, after gradually increasing the dose, he at last wound up the treatment, successfully as regarded the disease, and without any injury to the patient, by giving four doses of twenty grains each, in the course of twenty minutes.[1148] These facts are sufficiently perplexing, when viewed along with what were previously quoted in support of the poisonous effects of tartar-emetic. On a full consideration of the whole circumstances, however, I conceive the conclusion which will be drawn is, that this substance is not so active a poison as was till lately supposed;—that in the dose of four, six, or ten grains, it may cause severe symptoms, but is uncertain in its action,—and that although there appears to be some uncertainty in the effects of even much larger doses, such as a scruple, yet in general violent irritation will then be induced, and sometimes death itself. An instance is related in the Journal Universel of a man who, while in a state of health, swallowed seventeen grains, and then tried to suffocate himself with the fumes of burning charcoal. He recovered, though not without suffering severely from the charcoal fumes; but he could hardly be said to have been affected at all by the tartar-emetic.[1149] Here the inactivity of the poison was probably owing to the narcotic effects of the fumes. The effects of tartar-emetic on the skin are worthy of notice; but they have not yet been carefully studied. Some facts tend to show that even its constitutional action may be developed through the sound skin. Mr. Sherwen attempted to prove by experiments on himself and two pupils, that five or seven grains in solution will, when rubbed on the palms, produce in a few hours nausea and copious perspiration.[1150] His observations have been confirmed by Mr. Hutchinson.[1151] But Savary, a French physician, on repeating these experiments, could remark nothing more than a faint flat taste and slight salivation;[1152] and Mr. Gaitskell could not remark any constitutional effect at all.[1153] Sometimes it has appeared to cause severe symptoms of irritant poisoning when used in the form of ointment to excite a pustular eruption. An instance of this has been described in a late French Journal.[1154] Nay, in the Medical Repository there is a case, in which the external use of tartar-emetic ointment is supposed to have been the cause of death. The subject was an infant, two years old, who, soon after having the spine rubbed with this ointment, was seized with great sickness and frequent fainting, which in forty-eight hours proved fatal.[1155] Considering the numerous opportunities which medical men have had of witnessing the effects of tartar-emetic applied in the same manner, and that these are solitary cases, doubts may be entertained whether the irritant symptoms in the one case, or the child’s death in the other, were occasioned in the way supposed. Although the constitutional action of tartar-emetic is not easily developed through the sound skin, its local effects are severe and unequivocal. When applied to the skin it does not corrode, but excites inflammation, on which account it is much used instead of cantharides. It does not blister; but after being a few days applied, it brings out a number of painful pustules; if it be persevered in, the skin ulcerates; and if it be applied to an ulcerated surface it causes profuse suppuration, or sometimes even sloughing. Tartar-emetic is one of the substances which appear to possess the property of acting on the infant through the medium of its nurse’s milk. I do not know, indeed, what may be the general experience on this point; but a French physician, M. Minaret, has published a clear case of the kind, in the instance of a young woman who was taking tartar-emetic for pleurisy, and whose infant was attacked with a fit of vomiting immediately after every attempt to suck the breast.[1156] There is some reason to suppose, that the vapours of antimony may prove injurious when inhaled. Four persons, constantly exposed in preparing antimonial compounds to the vapour of antimonious acid and chloride of antimony, were attacked with headache, difficult breathing, stitches in the back and sides, difficult expectoration of viscid mucus, want of sleep and appetite, mucous discharge from the urethra, loss of sexual propensity, atrophy of the testicles, and a pustular eruption on various parts, but especially on the scrotum. They all recovered.[1157] SECTION III.—_Of the Morbid Appearances produced by Tartar-emetic._ The morbid appearances caused by tartar-emetic have not been often witnessed in man. In M. Récamier’s case there were some equivocal signs of reaction in the brain. The organs in the chest were healthy. The villous coat of the stomach, except near the gullet, where it was healthy, was everywhere red, thickened, and covered with tough mucus. The whole intestines were completely empty. The duodenum was in the same state as the stomach; but the other intestines were in their natural condition. M. Jules Cloquet observed in the body of a man who died of apoplexy, and who in the course of five days had taken forty grains of tartar-emetic, without vomiting or purging,—that the villous coat of the stomach had a deep reddish-violet colour, with cherry-red spots interspersed; and that the whole small intestines were of a rose-red tint spotted with cherry-red.[1158] The only other dissection I have seen noticed is one by Hoffmann. He says that in a woman poisoned by tartar-emetic he found the stomach gangrenous, and the lungs, diaphragm, and spleen as it were in a state of putrefaction.[1159] Little credit can be given to this description. In animals Schloepfer found the blood always fluid.[1160] SECTION IV.—_Of the Treatment of Poisoning with Antimony._ The treatment of poisoning with tartar-emetic is simple. If the poison be not already discharged, large draughts of warm water should be given and the throat tickled, to bring on vomiting. At the same time some vegetable decoction should be prepared, which possesses the power of decomposing the poison; and none is better or more likely to be at hand than a decoction of cinchona-bark, particularly yellow-bark. The tincture is also a good form for giving this antidote. The administration of bark has been found useful even after vomiting had continued for some length of time, probably because a part of the poison nevertheless remained undischarged. Before the decoction is ready, it is useful to administer the bark in powder. It is alleged, however, by M. Toulmouche that decoction of cinchona is not nearly so serviceable as infusion of galls, and that powder of galls is better still.[1161] When there is reason to believe that the patient has vomited enough, and that a sufficient quantity of the antidote has been taken, opium is evidently indicated and has been found useful; but venesection may be previously necessary if the signs of inflammation in the stomach are obstinate. The following case related by M. Serres was probably cured by cinchona. At all events, the effect of the antidote was striking. A man purchased half a drachm in divided doses at different shops, and swallowed the whole in a cup of coffee. Very soon afterwards he was attacked with burning pain in the stomach, convulsive tremors, and impaired sensibility,—afterwards with cold clamminess of the skin, hiccup, and some swelling of the epigastrium, but not with vomiting. Decoction of cinchona was given freely. From the first moment almost of its administration he felt relief, and began to sweat and purge. Next morning, however, he vomited, and for some days there were evident signs of slight inflammation in the stomach; nay, for a month afterwards he had occasional pricking pains in that region; but he eventually recovered.[1162] Another and more pointed case has been related by Dr. Sauveton of Lyons. A lady swallowed by mistake for whey a solution of sixty grains of tartar emetic. In ten minutes she was seen by her physician, and at this time vomiting had not commenced. Tincture of bark was immediately given in large doses. No unpleasant symptom occurred except nausea and slight colic.[1163] Orfila considers that the diuretic plan of treatment recommended by him for arsenic [p. 288] is equally applicable in the case of antimony. Having ascertained that a grain and a half of tartar-emetic applied to a wound constantly killed dogs in a period varying from seventeen to thirty-six hours, if no treatment was employed,—he administered to them in this way a dose varying from a grain and a half to three grains, and by then giving diuretics effected a cure in four out of five instances.[1164] _Chloride of Antimony._ The chloride of antimony [sesquichloride, muriate, or butter of antimony] being now put to little use and seldom seen except as an intermediate product obtained in the preparation of other compounds of antimony, it is rarely met with as the cause of poisoning, and therefore scarcely deserves notice here, were it not that its effects differ widely from those of tartar-emetic and other antimonials. It is easily known by the characters mentioned above. It has not yet been made the subject of investigation by experiments on the lower animals. Mr. Taylor has collected three cases of poisoning with it, which show that it is a powerful corrosive and irritant, and that its effects, as hitherto witnessed, seem to depend entirely on this action. In one instance, that of a boy, twelve years old, who swallowed four or five drachms of the solution by mistake for ginger-beer, the symptoms were vomiting in half an hour, then faintness and extreme feebleness, and next day heat in the mouth and throat, difficulty in swallowing, slight abrasions of the lining membrane of the mouth, and general fever; but he got quite well in eight days. In the case of another boy, ten years old, who got about the same quantity by mistake for antimonial wine, there was an immediate sense of choking and inability to speak, then vomiting and pain in the throat, next a general state of collapse, with dilated pupils and a tendency to stupor, and on the subsequent day bright scarlet patches on the throat, with difficulty of swallowing. This patient also recovered completely in a few days. The third was the case of a surgeon who took intentionally between two and three fluid ounces, and was found in an hour by his medical attendant in a state of great prostration, and affected with severe efforts to vomit, violent griping, and urgent tenesmus. Reaction soon ensued, the pain abated, and the pulse rose to 120; a strong tendency to doze succeeded; and in ten hours and a half he expired. The whole inside of the alimentary canal, from the mouth to the jejunum, was black as if charred; the mucous membrane seemed to have been removed along the whole of this extent of the canal; and the submucous and peritoneal coats were so soft as to be easily torn with the finger.[1165]