Treatise on Poisons by Sir Robert Christison

CHAPTER I.

1501 words | Chapter 3

ON THE PHYSIOLOGICAL ACTION OF POISONS. I shall discuss this subject by considering first the mode in which poisons act, and secondly, the causes by which their action is liable to be modified. SECTION I.—_On the Mode of Action of Poisons._ On attending to the effects which follow the application of a poison to the body, we perceive that they are sometimes confined to the part where it is applied, and at other times extend to distant organs. Hence the action of poisons may be naturally considered as _local_ and _remote_. The local effects of poisons are of three kinds. Some decompose chemically or corrode the part to which they are applied. Others, without immediately injuring its organization, inflame or irritate it. Others neither corrode nor irritate, but make a peculiar impression on the sentient extremities of the nerves, unaccompanied by any visible change of structure. We have examples of local _corrosion_ or chemical decomposition in the effects of the concentrated mineral acids or alkalis on the skin, and in the effects of strong oxalic acid, lunar caustic, or corrosive sublimate on the stomach. In all of these instances the part to which the poison is applied undergoes chemical changes, and the poison itself sometimes undergoes chemical changes also. Thus oxalic acid dissolves the gelatin of the animal textures; and in the instance of corrosive sublimate, the elements of the poison unite with the albumen, fibrin, and other principles of the tissues. Of local _irritation_ and its various consequences we have many examples, from redness, its slightest, to ulceration and gangrene, its most severe effect. Thus externally, alcohol reddens the skin; cantharides irritates the surface of the true skin and causes vesication; tartar-emetic causes deep-seated inflammation of the true skin and a pustular eruption; the juice of manchineel[1] spreading inflammation of the subcutaneous cellular tissue; arsenic inflammation of all these textures, and also death of the part and subsequent sloughing. Internally, alcohol reddens the stomach, as it does the skin,—but more permanently; while other substances, such as the diluted mineral acids, arsenic, cantharides, euphorbium, and the like, may cause all the phenomena of inflammation in the stomach and intestines, namely, extravasation of blood, effusion of lymph, ulcers, gangrene. Many of these irritants, such as arsenic, are in common speech called corrosives; but they have not any power of causing chemical decomposition: if they produce a breach in the texture of an organ, it is merely through the medium of inflammation and its effects. Of _nervous impressions_, without any visible organic change, few well authenticated and unequivocal instances are known. A good example has been mentioned by Sir B. Brodie in the effect of monkshood on the lips when chewed,[2] an effect which I have also often experienced: it causes a sense of numbness and tingling in the lips and tongue, lasting for some hours, and quite unconnected with any affection of the general nervous system. Another instance, first mentioned to me by M. Robiquet, and which I have verified, occurs in the effects of the strong hydrocyanic acid: when this acid is confined in a glass tube with a finger on its open end, the point of the finger becomes benumbed, exactly as from the local action of great cold. These are undoubted instances of a purely nervous local impression on the external surface of the body. The most unequivocal instance I know of a similar impression on internal parts is a fact related by Dr. W. Philip with regard to opium.[3] When this poison was applied to the inner coat of the intestines of a rabbit during life, the muscular contractions of the gut were immediately paralyzed, without the general system being for some time affected. The same effect has been observed by Messrs. Morgan and Addison to follow the application of ticunas to the intestine:[4] an instant and complete suspension of the peristaltic movement took place as soon as it touched the gut. A parallel fact has also been described by Dr. Monro, _secundus_:[5] when an infusion of opium was injected between the skin and muscles of the leg of a frog, that leg soon became palsied, while the animal was able to leap briskly on the other three. Analogous results have farther been obtained with the prussic acid by M. Coullon.[6] He remarked, that when one hind-leg of a frog was plunged in the acid, it became palsied in thirty-five minutes, while the other hind-leg continued perfectly sensible and irritable. Acetate of lead probably possesses the same property. These facts are important, because some physiologists have doubted whether any local impressions of a purely nervous nature, unconnected with appreciable organic change, may arise from the action of poisons. Yet the existence of impressions of the kind is essential to the stability of the doctrine of the sympathetic operation of poisons,—that is, of the transmission of their influence from organ to organ along the nerves. Nay, in the instance of many poisons supposed to act in that manner, we must still farther believe in the existence of primary nervous impressions, which are not only unconnected with organic change, but likewise undistinguishable by any local sign whatsoever. Of the three varieties in the local effects of poisons—corrosion, irritation, and nervous impressions,—the first two may take place in any tissue or organ; for example, they have been observed on the skin, on the mucous membrane of the stomach, intestines, windpipe, air tubes, bladder, and vagina, in the cellular tissue, in the serous membranes of the chest and abdomen, in the muscular fibre. We are not so well acquainted with the nature of local nervous impressions on different tissues; but it is probable that in some textures of the body they are very indistinct. So much for the local effects of poisons. On tracing the phenomena which follow more remotely, we observe that the affected part sometimes recovers without any visible change, sometimes undergoes the usual processes consequent on inflammation, sometimes perishes at once and is thrown off; and if the organ is one whose function is necessary to life, death may gradually ensue, in consequence of that function being irrecoverably injured. The purest example of the last train of phenomena is to be seen in the occasional effects of the mineral acids or alkalis: death may take place simply from starvation, because the inner surface of the stomach and intestines is so much injured that a sufficient quantity of nutriment cannot be assimilated. But death and its antecedents can seldom be accounted for in this way. For symptoms are often witnessed, which bear no direct relation to the local injury: death is generally too rapid to have arisen from the function of the part having been annihilated: and the rapidity of the poisoning is not proportional in different cases to the local injury produced. Even the mineral acids and alkalis seldom kill by impeding or annihilating digestion, because they often prove fatal in a few hours; and among other poisons there are few which ever cause death simply by disturbing the function of the part primarily acted on. Death and the symptoms preceding it arise from an injury of some other organ, to which they are not and cannot be directly applied. We are thus led to consider their remote action. The term _remote_ is here used in preference to the common phrase _general_ action, because the latter implies an action on the general system or whole body; whereas it appears that an action of such a kind is rare, and that most poisons which have an indirect action exert it on one or more of the important organs only, and not on the general system. There is not a better instance of the remote action of poisons than oxalic acid. It has been already mentioned that concentrated oxalic acid is a corrosive: yet it never kills by destroying the function of the stomach. Man, as well as the lower animals, will live several days or weeks without nutriment. Now this poison has been known to kill a man in ten minutes, and a dog in three minutes only. Neither does it always induce, when swallowed, symptoms of an injury of the stomach; for death is often preceded by tetanus, or apoplexy, or mortal faintness. Nor is the violence of the poisoning proportional to the extent of the local injury: in fact, death is most rapid under circumstances in which the stomach is least injured, namely, when the acid is considerably diluted.[7] Let us now proceed to enquire, then, in what way the influence of a poison is conveyed from one organ to another. Here it will at once be perceived that the conveyance can be accomplished in one of two ways only. Either the local impression passes along the nerves to the organ secondarily affected; or the poison enters the bibulous vessels, mingles with the blood, and passes through the medium of the circulation. In the former way poisons are said to act through _sympathy_, in the latter, through _absorption_.

Chapters

1. Chapter 1 2. PART II.—OF INDIVIDUAL POISONS. 3. CHAPTER I. 4. 1. _On the Action of Poisons through Sympathy._ In the infancy of 5. 2. _Of the Action of Poisons through Absorption._—If doubts may be 6. 1. _Quantity_ affects their action materially. Not only do they produce 7. 2. _As to state of aggregation_,—poisons act the more energetically the 8. 3. The next modifying cause is _chemical combination_. This is sometimes 9. 4. The effect of _mixture_ depends partly on the poisons being diluted. 10. 5. _Difference of tissue_ is an interesting modifying power in a 11. 6. With respect to differences arising from _difference of organ_, these 12. 7. _Habit and Idiosyncrasy._—The remarks to be made under the present 13. 8. The last modifying cause to be mentioned comprehends certain 14. CHAPTER II. 15. 1. The first characteristic is the _suddenness of their appearance and 16. 2. The next general characteristic of the symptoms of poisoning is 17. 3. Another characteristic is _uniformity in the nature of the symptoms_ 18. 4. The fourth characteristic is, that _the symptoms begin soon after a 19. 5. Lastly, _the symptoms appear during a state of perfect health_. This 20. 1. As to the _suddenness of their invasion and rapidity of their 21. 2. As to the uniformity or _uninterrupted increase of the symptoms_, it 22. 3. It was stated above, that the third character, _uniformity in kind_ 23. 4. In the next place, it was observed that some reliance may be placed 24. 5. Little need be said with regard to _the symptoms beginning, while the 25. 1. It may have been discharged by vomiting and purging. Thus on the 26. 2. The poison may have disappeared, because it has been all absorbed. It 27. 3. Poisons may not be found, because the excess has been decomposed. 28. 4. Lastly, the poison which has been absorbed into the system, and may 29. 1. The evidence derived from _the effects of suspected food, drink, or 30. 2. In the case of _the vomited matter_ or _contents of the stomach_ 31. 3. The effects of _the flesh of poisoned animals_, eaten by other 32. 3. The next article, which relates to the proof of the administration of 33. 4. The next article in the moral evidence relates to the intent of the 34. 5. The next article among the moral circumstances,—the simultaneous 35. 6. The next article of the moral evidence relates to suspicious conduct 36. CHAPTER III. 37. CHAPTER I. 38. 1. _Arsenical_ White arsenic 185 39. 2. _Acids_ Sulphuric acid 32 40. 3. _Mercurials_ Corrosive sublimate 12 41. 4. _Other mineral irritants_ Tartar-emetic 2 42. 5. _Veget. irritants_ Colchicum 3 43. 7. _Opium_ Opium or Laudan. 180 44. 8. _Hydrocyanic acid_ Med. Hydroc. acid 27 45. 9. _Other veget. Narcotics_ Nux-vomica 3 46. 11. Unascertained 22 47. CHAPTER II. 48. 1. _Distension of the Stomach._—Mere distension of the stomach from 49. 2. _Rupture of the Stomach_ is not a common occurrence; but it sometimes 50. 3. _Rupture of the Duodenum_ is a very rare accident from internal 51. 4. Under the next head may be classed rupture of the other organs of the 52. 5. The next accident which may be noticed on account of its being liable 53. 6. _Of Bilious Vomiting and Simple Cholera._—Of all the diseases which 54. 7. _Of Malignant Cholera._—The history of this disease affords a fair 55. 8. _Of Inflammation of the Stomach._—Chronic inflammation of the stomach 56. 9. _Inflammation of the Intestines_ in its acute form is more common 57. 10. _Inflammation of the Peritonæum_, or lining membrane of the belly, 58. 11. The subject of _Spontaneous Perforation of the Stomach_ is an 59. 12. The _gullet_ may be perforated in a similar manner either with or 60. 13. _Perforation of the alimentary canal by worms_ may here also be 61. 14. The next diseases to be mentioned are melæna and hæmatemesis, or 62. 15. The last are _colic_, _iliac passion_, and _obstructed intestine_. 63. CHAPTER III. 64. 1. _When concentrated_ it is oily-looking, colourless, or brownish from 65. 2. _When diluted_, it may be distinguished from all ordinary acids by 66. 3. It is seldom that the medical jurist is called on to search for 67. 1. The most ordinary symptoms are those of the first variety,—namely, 68. 2. The second variety of symptoms belong to a peculiar modification of 69. 3. The third variety includes cases of imperfect recovery. These are 70. 4. The last variety comprehends cases of perfect recovery, which are 71. 1. _When concentrated_, nitric acid is easily known by the odour of its 72. 2. _In a diluted state_ this acid is not so easily recognised as the 73. 3. _When in a state of compound mixture_, nitric acid, like sulphuric 74. 1. Hydrochloric acid, _in its concentrated state_, is colourless, if 75. 2. _When diluted_, it is recognised with facility, first by 76. 3. In the last edition of this work I proposed for the detection of 77. CHAPTER IV. 78. CHAPTER V. 79. CHAPTER VI. 80. 1. In the form of a pure solution, its nature may be satisfactorily 81. 2. The only important modifications in the analysis rendered necessary 82. CHAPTER VII. 83. CHAPTER VIII. 84. CHAPTER IX. 85. CHAPTER X. 86. CHAPTER XI. 87. CHAPTER XII. 88. CHAPTER XIII. 89. 3. The arsenite of copper, or _mineral green_. 4. The arsenite of potass 90. 2. _Of the Tests for Arsenious Acid._ 91. 7. After the precipitate has thoroughly subsided, the supernatant liquid 92. introduction as a poison into the body. This topic, one of paramount 93. 1. _Arsenic may exist as an adulteration in some reagents._—It must be 94. 2. _Arsenic may be present in some articles of chemical 95. 3. _Arsenic may have existed in antidotes administered during life._—It 96. 4. _Arsenic sometimes exists naturally in the human body._—This 97. 5. _Arsenic may exist in the soil of churchyards._—This proposition too 98. 3. _Arsenite of Copper_. 99. 4. _Arsenite of Potass_. 100. 5. _Arseniate of Potass._ 101. 6. _The Sulphurets of Arsenic._ 102. 7. _Arseniuretted-Hydrogen._ 103. 1. In one order of cases, then, arsenic produces symptoms of irritation 104. 2. The second variety of poisoning with arsenic includes a few cases in 105. 3. The third variety of poisoning with arsenic places in a clear point 106. CHAPTER XIV. 107. 1. _Of Red Precipitate._ 108. 2. _Of Cinnabar._ 109. 3. _Of Turbith Mineral._ 110. 4. _Of Calomel._ 111. 5. _Of Corrosive Sublimate._ 112. 1. _Hydrosulphuric acid gas_ transmitted in a stream through a solution 113. 1. _Lime-Water_ throws down the binoxide of mercury in the form of a 114. 6. _Of Bicyanide of Mercury._ 115. 7. _Of the Nitrates of Mercury._ 116. 1. The symptoms in the first variety are very like what occur in the 117. 2. The second variety of poisoning with mercury comprehends the cases, 118. 3. The third variety of poisoning with mercury comprehends all the forms 119. introduction of corrosive sublimate into the stomach. The poison then 120. CHAPTER XV. 121. 1. _Mineral Green._ 122. 2. _Natural Verdigris._ 123. 3. _Blue Vitriol._ 124. 1. _Ammonia_ causes a pale azure precipitate, which is redissolved by an 125. 2. _Sulphuretted hydrogen gas_ causes a dark brownish-black precipitate, 126. 3. _Ferro-cyanate of potass_ causes a fine hair-brown precipitate, the 127. 4. A polished rod or plate of _metallic iron_, held in a solution of 128. 4. _Artificial Verdigris._ 129. 1. Should the subject of analysis not be a liquid, render it such by 130. 2. If the copper be extremely minute in quantity, sulphuretted hydrogen 131. CHAPTER XVI. 132. 1. _Caustic potass_ precipitates a white sesquioxide, but only if the 133. 2. _Nitric acid_ throws down a white precipitate, and takes it up again 134. 3. The _Infusion of Galls_ causes a dirty, yellowish-white precipitate; 135. 4. The best liquid reagent is _Hydrosulphuric acid_. In a solution 136. 5. When the solution is put into Marsh’s apparatus for detecting arsenic 137. 1. Subject a small portion of the liquid to a stream of hydrosulphuric 138. 2. If hydrosulphuric acid do not distinctly affect the liquid, or if no 139. 3. If antimony be not indicated in either of these ways in the fluid 140. CHAPTER XVII. 141. CHAPTER XVIII. 142. 1. _Of Litharge and Red Lead._ 143. 2. _Of White Lead._ 144. 3. _Of Sugar of Lead._ 145. 1. _Hydrosulphuric acid_ causes a black precipitate, the sulphuret of 146. 2. _Chromate of potass_, both in the state of proto-chromate and 147. 3. _Hydriodate of potass_ causes also a lively gamboge-yellow 148. 4. _A rod of zinc_ held for some time in the solution displaces the 149. 4. _Goulard’s Extract._ 150. introduction of lead into the body; and in the last the whole course of 151. introduction of lead into the body may be presumed to be the real cause. 152. introduction of lead into the system. Dr. Burton thinks it will when the 153. CHAPTER XIX. 154. CHAPTER XX. 155. CHAPTER XXI. 156. CHAPTER XXII. 157. CHAPTER XXIII. 158. CHAPTER XXIV. 159. CHAPTER XXV. 160. CHAPTER XXIV. 161. 1. Apoplexy is sometimes preceded at considerable intervals by warning 162. 2. Apoplexy attacks chiefly the old. It is not, however, confined to the 163. 3. The next criterion is, that apoplexy occurs chiefly among fat people. 164. 4. A fourth criterion is drawn from the relation which the appearance of 165. 5. Another criterion relates to the progress of the symptoms. The 166. 6. Although there is a great resemblance between the symptoms of 167. 7. In the last place, a useful criterion may be derived from the 168. 1. The epileptic fit _is sometimes preceded by certain warnings_, such 169. 2. The symptoms of the epileptic fit _almost always begin violently and 170. 3. As in apoplexy, so in epilepsy the patient _in general cannot be 171. 4. When a person dies in a fit of epilepsy, _the paroxysm generally 172. 5. M. Esquirol, a writer of high authority, says that epilepsy _very 173. CHAPTER XXVII. 174. 1. If there be any solid matter, it is to be cut into small fragments, 175. 2. Add now the solution of acetate of lead as long as it causes 176. 3. The fluid part is to be treated with hydrosulphuric acid gas, to 177. 4. It is useful, however, to separate the meconic acid also; because, as 178. 5. If there be a sufficiency of the original material, Merck’s process 179. 546. There is little doubt that poisoning with opium may cause 180. CHAPTER XXVIII. 181. CHAPTER XXIX. 182. CHAPTER XXX. 183. CHAPTER XXXI. 184. 1. M. Chomel of Paris has related a case of poisoning with the gas 185. 2. The fumes of burning charcoal have been long known to be deleterious. 186. 3. It is probable that in some circumstances a very small quantity of 187. 4. The vapours from burning coal are the most noxious of all kinds of 188. 5. Somewhat analogous to the symptoms now described are the effects of 189. CHAPTER XXXII. 190. CHAPTER XXXIII. 191. CHAPTER XXXIV. 192. CHAPTER XXXV. 193. CHAPTER XXXVI. 194. CHAPTER XXXVII. 195. CHAPTER XXXVIII. 196. CHAPTER XXXIX. 197. CHAPTER XL. 198. CHAPTER XLI. 199. 1. When the dose is small, much excitement and little subsequent 200. 2. When the effect is sufficiently great to receive the designation of 201. 160. In twenty-four hours more the breathing became laborious and 202. 3. The third degree of poisoning is not so often witnessed, because, in 203. CHAPTER XLII. 204. 1. _Poisoning with Arsenic and Alcohol._—A man, after taking twelve 205. 3. _Poisoning with Tartar-Emetic and Charcoal Fumes._—Under the head of 206. 4. _Poisoning with Alcohol and with Laudanum._—Under the head of 207. 5. _Poisoning with Laudanum and Corrosive Sublimate._—Of all the cases 208. 6. _Poisoning with Opium and Belladonna._—A lady, who used a compound 209. 7. In the following cases, the active poisons to which the individuals 210. 2. Apparatus for the distillation of fluids suspected to contain 211. 3. Tube for reducing very small portions of arsenic or mercury. The 212. 4. A small glass funnel for introducing the material into the tube 213. 5. The ordinary apparatus for disengaging sulphuretted-hydrogen. The 214. 6. Instrument for washing down scanty precipitates on filters. It is a 215. 7. Tubes of natural size for collecting small portions of mercury by 216. 8. Pipette, one-fourth the natural size, for removing by suction 217. 9. Apparatus for reducing the sulphurets of some metals by a stream of 218. 36. Quoted by Marx, die Lehre von den Giften, I. ii. 163. 219. 92. Vicarius, Ibidem, Obs. 100. Riselius, Ibidem, Dec. i. An. v. Obs. 220. 1762. See Marx, i. ii. 29. 221. 1. P. 476, changed “exasperated by the use of oil” to “exacerbated by 222. 2. P. 513, changed “I may here add a very opposite instance of 223. 6. Enclosed italics font in _underscores_.

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