CHAPTER XXXV.

OF THE NARCOTIC RANUNCULACEÆ. The greater part of the poisons belonging to the Natural Family _Ranunculaceæ_ are acrid only in their action, and have been already taken notice of among the irritants. Two only are yet known to possess narcotic properties, namely, _monkshood_, and _black hellebore_. The latter is a true narcotico-acrid. The former has till lately been always considered so; but its acrid properties seem doubtful or feeble, while its action on the nervous system is most intense. _Of Poisoning with Monkshood._ Monkshood, the _Aconitum napellus_ of botanists, is an active poison, and has commonly been considered a true narcotico-acrid. But its effects have been hitherto much misunderstood. It has been used for criminal purposes in Ireland; and in 1841, a woman, M’Conkey, who was executed there for poisoning her husband, was proved to have administered this substance [see p. 61]. The root of another species, the _A. ferox_, is well known to be in common use as a poison, under the name of Bikh, in Bengal, and Nabee, in the Madras Presidency. The toxicological history of the genus, and of this species in particular, has been rendered complex and obscure, by the extreme difficulty of distinguishing accurately the several species from one another. The whole genus, now a numerous one, is generally conceived to be eminently poisonous. But from some observations of my own, as well as an elaborate inquiry, not yet made public, by Dr. Alexander Fleming,[2247] a recent graduate of this university, I am inclined to think that this is a mistake, that the poisonous species are not numerous, and that many aconites are inert, at least in this climate. The _A. napellus_, a doubtful native of Britain, and the most common species in our gardens, shoots up annually a leafy stem from a black, tapering, spindle-shaped root. The stem, which is from two to five feet high, ends in a long dense spike of fine blue flowers; and when the seeds ripen in autumn, it dies down, and the root also shrivels and perishes. But in the spring, while the stem is rising, one or more tubers form near the crown of the root; each tuber quickly assumes the spindle-shaped form of its parent, but has a light brown, instead of a brownish-black tegument; and when the plant is in flower, the new tuber, destined for the root of next year’s plant, is as large as the parent one, firmer, more amylaceous, and not so apt to shrivel in drying. This mode of propagation has led some to describe the root erroneously as sometimes palmated. Dr. Fleming considers the young, full-grown tuber to be the most active part of the plant; but the root of the existing plant, the leaves, and also the seeds, are highly energetic; and every part is more or less so. Every part of the _A. napellus_, but especially the root, affects remarkably the organs of taste, producing a very singular sense of heat, numbness, and tingling of those parts of the mouth to which it is applied. Dr. Fleming has ascertained, that this peculiar taste, or rather sensation, is a property belonging to the narcotic principle of monkshood, and that in all probability it is a measure of the activity of the plant as a poison. It is most intense in the root, next in the seeds, and next in the leaves before the flowers blow. Geiger first ascertained, and I have since observed, that the sensation thus occasioned by the leaves diminishes in intensity as the flowers expand, and almost disappears when the seeds ripen. Contrary to what has been often stated, it is not diminished by drying the leaves, even with the heat of the vapour-bath. Nor is it materially lessened by time, if the dried leaves be preserved with care; for I have found it intense after six years. Geiger observed some years ago, that several species or varieties do not possess it. I have ascertained that _A. napellus_, _sinense_, _tauricum_, _uncinatum_, and _ferox_, possess it intensely, _A. schleicheri_ and _nasutum_ feebly, _A. neomontanum_ very feebly; all of which are therefore probably poisonous, in proportion to the intensity of their taste. _A. ferox_, well known as a deadly poison in the East, and undoubtedly the most virulent of all the species, produces by far the most intense and persistent effect on the mouth of all the species I have had an opportunity of examining. Those which do not produce it at all, at least in this climate, are _A. paniculatum_, _lasiostomum_, _vulparia_, _variegatum_, _nitidum_, _pyrenaïcum_, and _ochroleucum_. It would be premature to say that all these species are inert; but I suspect they are: and, at all events, I have ascertained that the leaves of _A. paniculatum_, although the officinal species recognised in the London Pharmacopœia, are quite inactive in this climate; and Dr. Fleming has found the root inert in medicinal doses of considerable magnitude. The properties of monkshood have been traced by Geiger and Hesse to a peculiar alkaloid, named aconitina: which is white, pulverulent, fusible, not volatile, soluble in ether and alcohol, sparingly so in water, and capable of forming crystallizable salts with acids. It produces most intensely the peculiar impression caused by the plant on the mouth, tongue, and lips; and it is a poison of tremendous activity, probably indeed the most subtle of all known poisons. Although not a volatile principle, it has been supposed peculiarly liable to decomposition by heat, at least in its natural state of combination in the plant or its pharmaceutic preparations. This opinion is founded on the uncertainty of the medicinal action of the common extract of the shops, and on the results of experiments on animals by Orfila.[2248] In one experiment he found that half an ounce of the extract of the Parisian shops had no effect at all on a dog, while a quarter of an ounce killed another within two hours. Careless preparation may account for such differences; but at the same time an error in choosing the species of plant is an equally probable explanation. The properties of monkshood appear to me to resist a heat of 212°, either in drying the plant or in preparing an extract from it. The medico-legal chemistry of monkshood has not been studied. If any of the suspected matter be obtained in a pure state, its best character is its remarkable taste; to which I have found nothing exactly similar in the numerous trials I have made with other narcotic and acrid plants. A complex substance, such as the contents of the stomach, or vomited matter, should be evaporated over the vapour-bath to the consistence of thin syrup, and agitated with absolute alcohol. The filtered alcoholic solution being then evaporated, the extract may be subjected to the sense of taste. _Action._—The action of monkshood is a subject of great interest, but has hitherto been much misunderstood. Sir B. Brodie, who was the first to examine it in recent times, found that the leading phenomena in animals, were staggering, excessive weakness, slow laborious respiration, and slight convulsive twitches before death.[2249] Had these observations been followed up by his successors with a discriminating eye, toxicologists would not have been so much misled as they have been. Orfila, who was the next to examine the subject experimentally, failed to appreciate the phenomena with exactness.[2250] He thinks monkshood acts peculiarly upon the brain, causing delirium, and that it is a local irritant, capable of developing more or less intense inflammation. A single experiment made in 1836 convinced me that the former statement is incorrect, and led me to consider that the symptoms depend in a great measure on gradually-increasing paralysis of the muscles, which terminates in immobility of the chest and diaphragm, and consequent asphyxia. Dr. Pereira, in some experiments with an alcoholic extract, published in 1842, took notice of two remarkable phenomena,—an extraordinary diminution of common sensation, evidenced by the animal being insensible to pinching and pricking,—and the total absence of stupor, as shown by the animal following its owner, and recognizing him when called.[2251] Similar observations have been made in poisoning with monkshood in man. The ablest investigation yet undertaken into the actions of this substance is contained in the unpublished Inaugural Dissertation of Dr. Fleming. He found that the most remarkable symptoms are weakness and staggering, gradually increasing paralysis of the voluntary muscles, slowly increasing insensibility of the surface, more or less blindness, great languor of the pulse, and convulsive twitches before death. He farther observed that the pupil becomes much contracted; that the irritability of the voluntary muscles is impaired; that the veins are congested after death, the blood unaltered, and the heart capable of contracting for some time after respiration has ceased. Lastly, he maintains that this poison has not, as is generally thought, any irritant properties, that neither the plant, nor its extract, nor its alkaloid occasions vascularity in any membrane to which it is applied, even, for example, in the lips or tongue while burning and tingling from its topical action; that this peculiar effect is therefore merely a nervous phenomenon; and that he never could observe either the diffuse cellular inflammation described by Orfila to arise from the application of monkshood to a wound, or the inflammatory redness of the alimentary canal noticed by others as one of its effects when swallowed. Orfila ascertained that monkshood exerts its action through the medium of the blood; for its effects are greater when it is introduced into a wound, than when it is swallowed, and they are still greater when it is injected directly into a vein. It is a poison of very great activity. I have found that thirty grains of an alcoholic extract, the produce of three-quarters of an ounce of fresh leaves, will kill a rabbit in two hours and a quarter, if introduced between the skin and muscles of the back. Five drachms of the root in one of Orfila’s experiments with the dog, occasioned death in twenty-one minutes, when swallowed. The alkaloid, aconitina, seems to produce in animals precisely the same effects as the plant or its extract. Orfila and Dr. Pereira agree in this; and my own observation, limited to a single experiment, is to the same effect. It is probably the most subtile of all known poisons. Dr. Pereira mentions that the fiftieth part of a grain has endangered life when used medicinally.[2252] In my experiment the tenth of a grain, introduced in the form of hydrochlorate into the cellular tissue of a rabbit, killed it in twelve minutes. _Symptoms in Man._—A perplexing discrepance exists in the accounts that have been published of the effects of monkshood on man; which seems to have arisen, less from any actual contrariety in the phenomena, than from loose observation, or a misunderstanding of the facts; for most of the recent statements of competent observers are consistent with one another. Dr. Fleming says that in medicinal doses it occasions warmth in the stomach, nausea, numbness and tingling in the lips and cheeks, extending more or less over the rest of the body, diminution in the force and frequency of the pulse, which sometimes sinks to 40 in the minute, great muscular weakness, confusion of sight or absolute blindness; and if the dose be unduly large, there is a sense of impending death, sometimes slight delirium, and a want of power to execute what the will directs, but without any loss of consciousness. The warmth which is excited is unattended with any elevation of temperature, vascularity of the skin, or acceleration of the pulse. No true hypnotic effect is produced; but by inducing serenity, or deadening pain, it may predispose to sleep. The highest degree of these effects is not unattended with danger. When it is administered in doses adequate to occasion death, it seems in general to operate by inducing extreme depression of the circulation. Dr. Fleming recognizes two other modes of death in animals,—first, by an overwhelming depression of the nervous system, proving fatal in a few seconds, without arresting the action of the heart,—and secondly, by asphyxia, or arrestment of the respiration, the result of paralysis gradually pervading the whole muscular system, respiratory, as well as voluntary. But these effects, he thinks, cannot be recognized in the cases which have been published of poisoning in man, because the dose required to produce either of them is very large. The least variable symptoms in the human subject are, first, numbness, burning, and tingling in the mouth, throat, and stomach,—then sickness, vomiting, and pain in the epigastrium,—next, general numbness, prickling, and impaired sensibility of the skin, impaired or annihilated vision, deafness, and vertigo,—also frothing at the mouth, constriction at the throat, false sensations of weight or enlargement in various parts of the body,—great muscular feebleness and tremor, loss of voice, and laborious breathing,—distressing sense of sinking and impending death,—a small, feeble, irregular, gradually-vanishing pulse,—cold, clammy sweat and pale bloodless features,—together with perfect possession of the mental faculties, and no tendency to stupor or drowsiness,—finally, sudden death at last, as from hemorrhage, and generally in a period varying from an hour and a half to eight hours. The symptoms may begin in a few minutes, as in a case observed by Dr. Fleming, which was occasioned by the tincture of the root; or they may be postponed for three-quarters of an hour, as in an instance recorded by Dr. Pereira,[2253] which arose from the root being used by mistake for horse-radish. Two or three drachms of the root are sufficient to kill a man; and Dr. Fleming mentions one instance where two grains of the alcoholic extract occasioned alarming effects, and another where four grains proved fatal. I may observe, however, that I have given six grains of a carefully prepared alcoholic extract (the same of which thirty grains killed a rabbit in little more than two hours), to a female suffering from rheumatism, without being able to observe any effect whatsoever. If all the reports of cases now on record are to be trusted, the following anomalies have occurred. Some persons are said to have presented convulsions. Slight spasmodic twitches of the muscles are not uncommon, and probably depend, as Dr. Fleming suggests, on venous congestion, the result of incomplete asphyxia. Stupor and even apoplectic insensibility are also sometimes represented to have been observed. If really ever present, they must depend on the same cause; but there is reason to apprehend, that extreme nervous depression and faintness have been mistaken for stupor and coma. Delirium of the frantic kind, mentioned by some of the older authors, is justly considered by Dr. Fleming to be of doubtful occurrence, as it has never been observed in recent times. Irritation in the alimentary canal is distinctly mentioned as indicated by prominent symptoms, even in some cases observed but a few years ago, and apparently with care. Dr. Fleming properly objects to nausea, vomiting, or pain in the epigastrium as evidence of irritation in the stomach; for these symptoms may all depend on the same local nervous impression which is produced on the organs of taste. And he denies that purging is ever produced in any genuine case of poisoning with monkshood. The following, however, seem unequivocal examples of irritation in the alimentary canal. M. Pallas[2254] mentions, that three out of five persons, who took a spirituous infusion of the root by mistake for lovage [_Ligusticum levisticum_], died in two hours with burning in the throat, vomiting, colic, swelling of the belly and purging. A similar set of cases is described by M. Degland.[2255] Four persons took the tincture of the root by mistake for tincture of lovage; and three of them were seized with burning pain from the throat to the stomach, a sense of enlargement of the tongue and face, colic, tenderness of the belly, vomiting, and purging. One of these, who ultimately recovered, had frantic delirium for some time after the other symptoms went off. The two others died, one in two hours, the other half an hour later. Dr. Pereira[2256] and Dr. Fleming doubt the authenticity of these cases; and it may be, that such unusual symptoms may have arisen either from some other root mistaken by the narrators for monkshood, or from irritant substances given along with or after it. At the same time I may mention, that in the first trials I made with monkshood as a medicine, using a carefully prepared extract of the root, I was deterred from proceeding by two patients being attacked with severe vomiting, griping, and diarrhœa. It may be well to conclude these general statements by the particulars of a few well authenticated cases. Dr. Pereira describes two that were occasioned by the root having been dug up in February by mistake for horse-radish.[2257] The parties, a gentleman and his wife, ate, the former about a root and a half, the latter not much more than half a root. Both of them in three-quarters of an hour had burning, and numbness in the lips, mouth, and throat, extending to the stomach and followed by vomiting. The husband had subsequently violent and frequent vomiting, partly owing to an emetic. His extremities became cold, the lips blue, the eyes glaring, and the head covered with cold sweat. There was no spasm or convulsion, but some tremor. He had no delirium, or stupor, or loss of consciousness, but complained of violent headache. The respiration was not affected; and although he felt very weak, he was able to walk with a little assistance only a few minutes before death; which took place, as if from fainting, about four hours after the poison was swallowed.—His wife, in addition to the early symptoms already mentioned, had such weakness and stiffness of the limbs that she was unable to stand; and she could utter only unintelligible sounds; but she had no spasms or convulsions. She experienced a strange sensation of numbness in the hands, arms, and legs, diminution of sensibility over the whole integuments, especially of the face and throat, where the sense of touch was almost extinguished. She had also some dimness of vision, giddiness, and at times an approach to loss of consciousness, but no delirium, sleepiness, or deafness. She recovered, under the use of emetics, laxatives, and stimulants. In neither of these cases was there any diarrhœa.—A patient of Mr. Sherwen,[2258] five minutes after taking a tincture of the root, suffered from the same incipient symptoms as above, but without actual vomiting. The face seemed to her to swell, and the throat to contract; she became nearly blind, and excessively feeble, but did not lose her consciousness. The eyes were fixed and protruded, and the pupils contracted, the jaws stiff, the face livid, the whole body cold, the pulse imperceptible, the heart’s action feeble and fluttering, and the breathing short and laborious. An emetic was followed first by violent convulsions, and then by vomiting; after which she slowly recovered. At all times she was so sensible as to be able to tell how the accident happened.—Dr. Ballardini of Brescia met with twelve simultaneous cases of poisoning with the juice of the leaves, used by mistake for scurvy-grass [_Cochlearia officinalis_]. Each person had three ounces of juice. Three of them died in two hours; but the rest were saved. The chief symptoms were extreme weakness and anxiety, paleness and distortion of the features, dilatation of the pupils, dulness of the eyes, giddiness, headache, chiefly occipital, some distension and pain of the belly, vomiting of a green matter, and in some diarrhœa. The whole body was cold, the nails livid, the limbs cramped, the pulse small and scarcely perceptible. In the fatal cases there were convulsions.[2259]—MM. Pereyra and Perrin mention, that, while using the alcoholic extract in the Hospital of St. André at Bordeaux, the sample of the drug happened to be changed when the dose had been raised so high as ten grains; and that the patients who were taking it were then all seized with burning in the mouth and throat, vomiting, pungent pains in the extremities, cold sweating, anxiety, extreme general prostration, great slowness and irregularity of the pulse, convulsions, and congestion in the venous system. One patient died; the others recovered under no other treatment than stimulant friction along the spine.[2260] An infant at Suippe, in the French Department of the Marne, ate a few leaves and flowers of monkshood, while walking in a garden. Soon afterwards he began to stagger as if tipsy, and to complain of pain in the belly. In two hours an emetic was given; but a few minutes afterwards, the eyes became convulsed, the jaws locked, the trunk bent rigidly backward, and the limbs convulsed; and death ensued in five minutes more.[2261] _Morbid Appearances._—In Ballardini’s fatal cases the pia mater and arachnoid were much injected; there was much serosity under the arachnoid and in the base of the cranium; the lungs were considerably gorged with blood; the heart and great vessels contained but a little black fluid blood: the villous coat of the stomach was spotted with red points; and the small intestines presented inwardly red patches and much mucus. In the Bordeaux case there was venous congestion in the head and chest, the lungs particularly being much gorged with blood. The right side of the heart was full of blood, of gelatinous consistence. In Pallas’s cases the gullet, stomach, small intestines and rectum were very red, the lungs dense, dark, and gorged, and the cerebral vessels turgid. Few trustworthy observations have been made on the effects of the other species of aconite. Dr. Pereira found the A. ferox of the East Indies to be a much more deadly poison to animals than common monkshood; but its effects were otherwise identical.[2262] Three grains of the root put into the throat of a rabbit, killed it in nineteen minutes; one grain of the alcoholic extract, introduced into the peritonæum, proved equally deadly. Nine grains will kill a cat in four hours.[2263]——Of the other aconites the A. cammarum, and A. lycoctonum are said to have proved fatal frequently in Germany; but no accurate facts on the subject are on record.—It was stated above that the A. paniculatum, supposed by De Candolle to have been the true aconite of Baron Störck, is inert in this country. I introduced the alcoholic extract of three ounces of the fresh leaves collected near the end of June, into the cellular tissue between the skin and muscles of a young rabbit, having previously converted the extract into an emulsion with mucilage and water. This was four times the dose of A. napellus, which I had found sufficient to kill a strong adult rabbit in two hours and a quarter; but no effect whatever was produced.—Mr. Ramsay of Broughty Ferry has described a case of fatal poisoning with a handful of aconite leaves which were mistaken for parsley, and which he supposes to have been those of A. neomontanum. The subject, a boy of fourteen, was attacked with a sense of burning in the mouth, throat, and stomach, afterwards with vomiting and convulsions, and died considerably within five hours.[2264] The very feeble taste of this species—which besides is little cultivated in Scotland,—inclines me to doubt whether it was the species that produced such violent effects. _Of Poisoning with Black Hellebore._ Black hellebore, or Christmas-rose, the _Helleborus niger_ of botanists, is a true narcotico-acrid poison. It is a doubtful native of this country. It produces a large white ranunculus-like flower about midwinter. The root, the only part used in medicine, or to be found in the shops, consists of a short root-stock and numerous, long, black undivided rootlets. The fresh root in January is not acrid to the taste. Its active principle appears from the researches of MM. Feneulle and Capron, to be an oily matter containing an acid.[2265] Its action has not yet been examined with particular care. Two or three drachms of the root killed a dog in eighteen hours, when swallowed; two drachms killed another in two hours, when applied to a wound; and six grains in a wound caused death in twenty-three hours. In all cases the leading symptoms are efforts to vomit, giddiness, palsy of the hind-legs, and insensibility.[2266] Ten grains of the extract introduced into the windpipe killed a rabbit in six minutes.[2267] Orfila found redness of the rectum, when the animals survived a few hours. But none of these experiments show the powerful irritant action exerted by the root upon man. The Bulletins of the Medical Society of Emulation mention two cases of poisoning with hellebore, which arose from the ignorance of a quack doctor. Both persons, after taking a decoction of the root, were seized in forty-five minutes with vomiting, then with delirium, and afterwards with violent convulsions. One died in two hours and a half, the other in less than two hours.[2268] Morgagni has related a case which proved fatal in about sixteen hours, the leading symptoms of which were pain in the stomach, and vomiting. The dose in this instance was only half a drachm of the extract.[2269] In a case not fatal, related by Dr. Fahrenhorst, the symptoms were those of irritant poisoning generally, that is, burning pain in the stomach and throat, violent vomiting, to the extent of sixty times in the first two hours, cramps of the limbs, and cold sweating. The most material symptoms were at this time quickly subdued by sinapisms to the belly and anodyne demulcents given internally; and in four days the patient was well. The dose here was a table-spoonful of the root in fine powder.[2270] In small doses of ten or twenty grains, it is well known to be a powerful purgative to man. I have known severe griping produced by merely tasting the fresh root in January. The morbid appearances in Morgagni’s case were the signs of inflammation in the digestive canal, particularly in the great intestines. In the case described in the French Bulletins, there was gorging of the lungs, and the stomach had a brownish-black colour as if gangrenous. The other species of hellebore have not been carefully examined; but it is probable that they all possess similar properties. The _H. hyemalis_ and _viridis_ are said by Buchner to be weaker than the _H. niger_; and the _H. fœtidus_ is the most poisonous of all.[2271]