CHAPTER XXI.

OF POISONING WITH CANTHARIDES. The second group of the present Order of poisons comprehends most of those derived from the animal kingdom. In action they resemble considerably the vegetable acrids, their most characteristic effect being local inflammation; but several of them also induce symptoms of an injury of the nervous system. This group includes cantharides, poisonous fishes, venomous serpents, and decayed or diseased animal matter. The first of these is familiarly known as a poison even to the common people. I am not aware that it has ever been used for the purpose of committing murder. But on account of its powerful effect on the organs of generation it has often been given by way of joke, and sometimes taken for the purpose of procuring abortion. Fatal accidents have been the consequence. The appearance of the fly is well known. When in powder, as generally seen, it has a grayish-green colour, mingled with brilliant green points. It has a nauseous odour and a very acrid burning taste. Alcohol dissolves its active principle. This principle appears from a careful analysis by M. Robiquet to be a white, crystalline, scaly substance, insoluble in water, but soluble in alcohol as well as in oils, and termed cantharidin.[1482] In compound mixtures cantharides may generally be detected by the green colour and metallic brilliancy even of its finest powder, if examined in the sunshine—and sometimes by making an etherial extract of the suspected matter, and producing with this extract the usual effects of a blister on a tender part of the arm. By these two tests Barruel discovered cantharides in chocolate cakes, part of which had been wickedly administered to various individuals. From the late important researches of M. Poumet[1483] it appears, that cantharides cannot be detected by its chemical properties in the contents, or on the inner surface, of the alimentary canal of animals poisoned with it; and that in such circumstances it is seldom to be discerned even by the shining green colour of its particles, unless the matter to be examined be dried. The method he recommends for a medico-legal investigation is to detach the stomach, small intestines, and great intestines, each separately from the body,—to wash out their contents with rectified spirit, and dry the pulpy fluid on sheets of glass,—to dry the stomach and intestines by distending them, removing their mesentery, and hanging them up vertically with a weight attached to stretch them,—and then to examine both the surface of the glass, and the inside of the stomach and intestines with the aid of sunshine or a bright artificial light. In this way cantharides may be detected, by the peculiar green hue of its powder, in most cases where this poison may have proved fatal; for M. Poumet constantly found it in dogs. The same author ascertained that the green particles generally abound most in the contents of the great intestine or on its inner membrane, next in the small intestines, and least of all in the stomach; and that they may be seen in the bodies of animals at least seven months after interment. Orfila had previously ascertained, that cantharides powder may be recognized by its brilliancy in various organic mixtures after interment for nine months.[1484] Poumet farther states that the green particles of cantharides may be confounded with the particles of other coleopterous insects, and also somewhat resemble particles of copper and tin. But he with reason asks, what possible accident could introduce the powder of any other coleopterous insect into the alimentary canal? And as to particles of copper or tin, he ascertained, that, unlike cantharides, these substances are visible in the contents, or on the tissues, of the stomach and intestines only before desiccation, and never after it. SECTION I.—_Of the Action of Cantharides and the Symptoms it excites in Man._ Cantharides, either in the form of powder, tincture, or oily solution, is an active poison both to man and animals. As to its action on animals, Orfila found that a drachm and a half of a strong oleaginous solution, injected into the jugular vein of a dog, killed it in four hours with symptoms of violent tetanus; that three drachms of the tincture with eight grains of powder suspended in it caused death in twenty-four hours, if retained in the stomach by a ligature on the gullet,—insensibility being then the chief symptom; and that forty grains of the powder killed another dog in four hours and a half, although he was allowed to vomit. In all the instances in which it was administered by the stomach, that organ was found much inflamed after death; and generally fragments of the poison were discernible if it was given in the form of powder. When applied to a wound the powder excites surrounding inflammation; and a drachm will in this way prove fatal in thirty-two hours without any particular constitutional symptom except languor.[1485] M. Poumet has since obtained results not materially different. These experiments do not furnish any satisfactory proof of the absorption of the poison, but rather tend to show that it does not enter the blood. Such a conclusion, however, must not be too hastily drawn; since its well-known effects on man when used in the form of a blister lead to the conclusion that it is absorbed, and that it produces its peculiar effect on the urinary system through the medium of the circulation. On account of the magnitude of the dose required to produce severe effects on animals, Orfila’s experiments on the stomach and external surface of the body cannot, for reasons formerly assigned (452) be properly compared together. The effect of cantharides, when admitted directly into the blood, seems much less than might be expected. Mr. Blake found that an infusion of two drachms injected into the jugular vein of a dog, caused some difficulty of breathing, irregularity of the pulse, and diminished arterial pressure, but apparently no great inconvenience to the animal.[1486] The greater effect observed in Orfila’s experiment was probably owing to obstruction of the pulmonary capillaries by the oil. Orfila has examined with care not only the preparations of cantharides already mentioned, but likewise the various principles procured by M. Robiquet during his analysis; and it appears to result, that the active properties of the fly reside partly in the crystalline principle, and partly in a volatile oil, which is the source of its nauseous odour. The symptoms produced by cantharides in man are more remarkable than those observed in animals. A great number of cases are on record; but few have been minutely related. Sometimes it has been swallowed for the purpose of self-destruction, sometimes for procuring miscarriage. But most frequently, on account of a prevalent notion that it possesses aphrodisiac properties, it has been both voluntarily swallowed and secretly administered, to excite the venereal appetite. That it has this effect in many instances cannot be doubted. But the old stories, which have been the cause of its being so frequently used for the purpose, are many of them fabulous, and all exaggerated. Often no venereal appetite is excited, sometimes even no affection of the urinary or genital organs at all; and the kidneys and bladder may be powerfully affected without the genital organs participating. It is established, too, by frequent observation, that the excitement of the genital organs can never be induced, without other violent constitutional symptoms being also brought on, to the great hazard of life. The following abstract of a case by M. Biett of Paris gives a rational and unexaggerated account of the symptoms as they commonly appear. A young man, in consequence of a trick of his companions, took a drachm of the powder. Soon afterwards he was seized with a sense of burning in the throat and stomach; and in about an hour with violent pain in the lower belly. When M. Biett saw him, his voice was feeble, breathing laborious, and pulse contracted; and he had excessive thirst, but could not swallow any liquid without unutterable anguish. He was likewise affected with priapism. The pain then became more extensive and severe, tenesmus and strangury were added to the symptoms, and after violent efforts he succeeded in passing by the anus and urethra only a few drops of blood. By the use of oily injections into the anus and bladder, together with a variety of other remedies intended to allay the general irritation of the mucous membranes, he was considerably relieved before the second day; but even then he continued to complain of great heat along the whole course of the alimentary canal, occasionally priapism, and difficult micturition. For some months he laboured under difficulty of swallowing.[1487]—Another case very similar in its circumstances has been related by M. Rouquayrol. In addition to the symptoms observed in Biett’s patient there was much salivation, and towards the close of the second day a large cylindrical mass, apparently the inner membrane of the gullet, was discharged by vomiting.[1488]—A case of the same kind, but less severe, is related in the Medical Gazette. A woman, who had taken an ounce of the tincture, was observed throughout the day to be apparently intoxicated. Next morning, when she for the first time told what she had done, she had excruciating pain, great tenderness and distension of the belly, a flushed anxious countenance, a dry, pale tongue, a natural pulse, and urine loaded with sediment and fibrinous matter. In the evening there was extreme weakness, cold extremities, a scarcely perceptible pulse, and retention of urine; and at night she was delirious. After this she recovered progressively, the chief symptoms then being pain in the kidneys and inability to pass urine.[1489] Among the symptoms the affection of the throat, causing difficult deglutition and even an aversion to liquids, appears to be pretty constant. The sense of irritation along the gullet and in the stomach is also generally considerable. Sometimes it is attended with bloody vomiting, as in four cases related by Dr. Graaf of Langenburg;[1490] and at other times, as in the instance of poisoning with the acids, there is vomiting of membranous flakes. These have been mistaken for the lining membrane of the alimentary canal, but are really in general a morbid secretion.[1491] At the same time there is reason to believe that a portion of the membrane of the gullet was discharged in Rouquayrol’s case; for there were ramified vessels in it, and one so large that blood issued on pricking it. A prominent symptom in general is distressing strangury, and it commonly concurs with suppression of urine and the discharge of blood.[1492] It would appear that, when the genital organs are much affected, the inflammation may run on to gangrene of the external parts. Ambrose Paré notices a fatal instance of the kind, which was caused by a young woman seasoning comfits for her lover with cantharides.[1493] The preceding symptoms are occasionally united with signs of an injury of the nervous system. Headache is common, and delirium is sometimes associated with it.[1494] In a case communicated to Orfila the leading symptoms at first were strangury and bloody urine; but these were soon followed by violent convulsions and occasional loss of recollection.[1495] The quantity in that instance was only eight grains; and it was taken for the purpose of self-destruction. In one of Graaf’s four cases the patient was attacked during convalescence with violent phrensy of three days’ continuance.[1496] An instance is also related in the Transactions of the Turin Academy, of tetanic convulsions and hydrophobia appearing three days after a small over-dose of the tincture of cantharides was taken, and continuing for several days with extreme violence.[1497] The cause of the symptoms, however, is here doubtful. A rare occurrence is relapse after apparent convalescence. In a case communicated to me by Dr. Osborne of Dundee, which there was every reason to believe had arisen from cantharides administered to a girl by an unprincipled scoundrel, the usual symptoms of violent irritation in the bladder and rectum prevailed for 36 hours; and an interval of quiet and apparent convalescence ensued for three days. But on the fifth day the urinary symptoms returned, and were attended with great prostration, a rapid feeble pulse, and severe diarrhœa for two days longer. She eventually recovered. Another girl, poisoned at the same time, had most distressing irritation in the bladder, and for some time passed nothing but drops of blood; but she got well in two days, and had no relapse. The following fatal cases deserve particular mention. Orfila quotes one from the _Gazette de Santé_ for May, 1819, which was caused by two doses of twenty-four grains taken with the interval of a day between them, for the purpose of suicide. The ordinary symptoms of irritation in the bowels and urinary organs ensued, miscarriage then took place, and the patient died on the fourth day, with dilated pupils and convulsive motions, but with unimpaired sensibility.[1498] Another instance related by Dr. Ives of the United States, presented two stages, like that related by Orfila, but with the remarkable difference that an interval of several days intervened between the irritant and narcotic effects. A man swallowed an ounce of the tincture and was seized in a short time with hurried breathing, flushed face, redness of the eyes and lacrymation, convulsive twitches, pain in the stomach and bladder, suppression of urine and priapism; in the evening delirium set in, and next morning there was loss of consciousness; but from this time under the use of blood-letting, emetics, blisters, sinapisms, and castor-oil, he got well and continued so for fourteen days. But after that interval he was suddenly attacked with headache and shivering, then with convulsions, and subsequently with coma; which, however, was removed for a time by outward counter-irritants. Next day the coma returned at intervals, and on the subsequent day the convulsions also, which gradually increased in severity for three days more, and then proved fatal.[1499] In this case it admits of question whether the affection which proved the immediate cause of death really arose from the cantharides, or was an independent disease.—A third case, fatal on the fourth day, occurred in April, 1830, near Uxbridge in the south of England. I have not been able to learn the particulars exactly; but it appears to have been produced by cantharides powder, which was mixed with beer by two scoundrels at a dancing party for the purpose of exciting the venereal appetite of the females. A large party of young men and women were in consequence taken severely ill; and one girl died, who had been prevailed on to take the powder at the bottom of the vessel, on being assured that it was ginger. The quantity of the powder or tincture requisite to prove fatal or dangerous has not been accurately settled. Indeed practitioners differ much even as to the proper medicinal doses. The smallest dose of the powder yet known was twenty-four grains (Orfila); and the smallest fatal dose of the tincture was one ounce, which is equivalent to six grains of powder.[1500] It is probable that this is one of the poisons whose operation is liable to be materially affected by idiosyncrasy. The medicinal dose is from half a grain to two grains of the powder, and from ten drops to two drachms of the tincture. But Dr. Beck has quoted an instance where six ounces of the tincture were taken without injury.[1501] On the other hand Werlhoff has mentioned the case of a lad who used to be attacked with erection and involuntary emission on merely smelling the powder.[1502] This statement, though extraordinary, is not without support from the parallel effects of other substances. The familiar effects of cantharides on the external surface of the body are not unattended with danger, if extensive, or induced in particular states of the constitution. An ordinary blistered surface often ulcerates in febrile diseases; and in the typhoid state which characterizes certain fevers, this ulceration has been known to pass on to fatal sloughing, especially when the blister has been applied to parts on which the body rests. I have met with two such cases. On the other hand if the blistered surface be very extensive, death may take place in the primary stage of the local affection, in consequence of the great constitutional disturbance excited. Thus in 1841 a girl, affected with scabies, received cantharides ointment by mistake instead of sulphur ointment from an hospital-serjeant at Windsor Barracks; and having anointed nearly her whole body with it, was seized with violent burning pain of the integuments, followed by vesication, general fever, and the usual symptoms of the action of this poison on the urinary organs. These effects were so severe that she died in five days.[1503] SECTION II.—_Of the Morbid Appearances caused by Cantharides._ The only precise account I have hitherto seen of the morbid appearances caused by cantharides is contained in the history of the case from the _Gazette de Santé_. The brain was gorged with blood. The omentum, peritonæum, gullet, stomach, intestines, kidneys, ureters, and internal parts of generation were inflamed; and the mouth and tongue were stripped of their lining membrane.—In dogs Schubarth observed, besides the usual signs of inflammation in the alimentary canal, great redness of the tubular part of the kidneys, redness and extravasated patches on the inside of the bladder, and redness of the ureters as well as of the urethra.[1504] M. Poumet denies that any morbid appearance is ever found in any part of the genito-urinary organs of animals; but he sometimes found blood effused into the stomach and intestines.[1505] In Dr. Ives’s case the blood-vessels of the brain and cerebellum were gorged, the cerebellum spread over with lymph, the villous coat of the stomach softened and brittle, and the kidneys inflamed and presenting blood in their pelvis. When the case has been rapid, the remains of the powder may be found in the stomach or intestines by Poumet’s process. From the researches of Orfila and Lesueur, confirmed by those of Poumet, it appears not to undergo decomposition for a long time when mixed with decaying animal matters. After nine months’ interment the resplendent green points continue brilliant.[1506] SECTION III.—_Of the Treatment of Poisoning with Cantharides._ The treatment of poisoning with cantharides is not well established. No antidote has yet been discovered. At one time fixed oil was believed to be an excellent remedy. But the experiments of Robiquet on the active principle of the poison, and those of Orfila on the effects of its oleaginous solution, rather prove that oil is the reverse of an antidote. The case mentioned in the Genoa Memoirs was evidently exacerbated by the use of oil. When the accident is discovered early enough, and vomiting has not already begun, emetics may be given; and if vomiting has begun, it is to be encouraged. Oleaginous and demulcent injections into the bladder generally relieve the strangury. The warm bath is a useful auxiliary. Leeches and blood-letting are required, according as the degree and stage of the inflammation may seem to indicate. Many other insects besides the _Cantharis vesicatoria_ possess similar acrid properties. Two of them, however, may be briefly alluded to, because they have caused fatal poisoning. The one is the _Meloë proscarabæus_, the _Maiwurm_ of the Germans, a native of most European countries. In Rust’s Magazin there is an account of four persons who took the powder of this insect from a quack for spasms in the stomach. The principal symptoms were stifling and vomiting; and two of the people died within twenty-four hours.[1507] The other is the _Bombyx_, of which at least two species are believed to possess powerful irritant properties, the _B. pityocarpa_ and _B. processionea_. The following is an instance of their effects. A child ten years old had a common blister applied to the neck and spine as a remedy for deafness; and four days afterwards her mother dressed the abraded skin with the leaves of beet-root, from which she had previously shaken a great number of caterpillars. The child soon complained of insupportable itching and burning in the part, and endeavoured to tear off the dressings. The mother persevered, however; and her child died in two days of gangrene of the whole integuments of the back. The surgeon who saw the child on the last day of her life, ascribed the gangrene to the insects mentioned above, and states that they possess the power of exciting erysipelas when applied even to the sound skin.[1508] It is probable that many other insects in Europe have similar properties. The _Mylabris cichorii_, which is partially used in Italy,[1509] and is in common use in India and China for blistering, possesses active irritant properties. The _Cantharis ruficollis_, another species used in the Nizam’s Territories in India, is also energetic. Other species known to possess activity are _Mylabris fusselini_, _Meloe majalis_, _M. trianthemum_, _Coccinella bipunctata_, _C. septem-punctata_, and _Cantharis vittata_.