Treatise on Poisons by Sir Robert Christison
CHAPTER II.
1158 words | Chapter 47
CLASS FIRST.
ON IRRITANT POISONS GENERALLY.
The class of irritant poisons comprehends all whose sole or predominant
action consists in exciting irritation or inflammation. That is, it
comprises both those which have a purely local, irritating action, and
likewise many which also act remotely, but whose most prominent feature
of action still is the inflammation they excite wherever they are
applied.
This subject will be introduced with an account of the general symptoms
and morbid appearances caused by the irritants, and a comparison of
these with the symptoms and morbid appearances of the natural diseases
which are chiefly liable to be confounded with irritant poisoning, or
mistaken for it.
SECTION I.—_Of the Symptoms of the Irritant Poisons, compared with those
of natural diseases._
The symptoms caused by the irritating poisons, taken internally, are
chiefly those of violent irritation and inflammation of one or more
divisions of the alimentary canal.
The mouth is frequently affected, especially when the poison is easily
soluble, and possesses a corrosive as well as irritating power. The
symptoms referrible to the mouth are pricking or burning of the tongue,
and redness, swelling and ulceration of the tongue, palate, and inside
of the cheeks.
The throat and gullet are still more frequently affected; and the
affection is commonly burning pain, sometimes accompanied with
constriction and difficulty in swallowing, and always with redness of
the visible part of the throat and gullet.
The affection of the throat and mouth precedes every other symptom when
the poison is an active corrosive, and more particularly when it is
either a fluid poison or is easily dissolved. Nay, sometimes burning
pain of the mouth, throat, and gullet occurs during the very act of
swallowing.—On the contrary if the poison is soluble with difficulty,
and is only an irritant, not a corrosive, and still more if it is only
one of the feebler irritants, the throat is frequently not affected
sooner than the stomach, occasionally not at all.
The stomach is the organ which suffers most invariably from the
operation of irritant poisons. The symptoms referrible to their
operation on it are acute and general burning pain, sometimes
lancinating or pricking pain,—sickness, vomiting, tenderness on
pressure, tension in the upper part of the belly, and occasionally
swelling. Of these symptoms the sickness is generally the first to
develope itself. In the instance of corrosive irritants pain commonly
commences along with it. The matter vomited is at first the contents of
the stomach, afterwards tough mucus, streaked often with blood and
mingled with bile, frequently clots of purer blood. The powerful
corrosives affect the stomach the moment they are swallowed; irritants
which are either liquid or very soluble also affect it very soon; but
the more insoluble irritants, such as arsenic, generally do not begin to
act till half an hour or even more than a whole hour has elapsed.—The
stomach may be affected without any other part of the alimentary canal
participating in the injury; but much more frequently other parts suffer
also, and in particular the intestines.
The action of irritant poisons on the intestines is marked by pain
extending over the whole belly, sometimes even to the anus. This pain,
like that of the stomach, is often a sense of burning; but it is also
frequently a pricking or tearing pain, and still more frequently a
twisting, intermitting pain like that of colic. It is seldom attended
with much swelling, but often with tension, and tenderness of the whole
belly; and at times the inflammatory state of the mucous coat of the
intestines is clearly indicated by excoriation of the anus and prolapsus
of the rectum, which is of a bright red colour. The pain of the bowels
is most generally attended by purging, rarely with constipation,
frequently with tenesmus. The matter discharged, after the alimentary
and feculent contents have passed, is chiefly a mucous fluid, often
abundant, often also streaked with blood or mixed with considerable
quantities of blood. In some cases the intestines are affected when no
other part of the alimentary canal suffers, not even the stomach. But
much more generally the stomach and intestines are affected together.
In a few very aggravated cases of poisoning with the irritants the whole
course of the alimentary canal, from the throat to the anus, is affected
at one and the same time.
The symptoms now briefly enumerated are accompanied in almost every
instance with great disturbance of the circulation—quick, feeble
pulse—excessive prostration of strength,—coldness, and clammy moisture
of the skin.
The other symptoms, which are often united with the preceding, do not
belong to the irritants as a class. Perhaps, however, among the symptoms
of the class may be mentioned those of irritation and inflammation of
the windpipe and lungs, and those of irritation in the urinary organs. A
great number of the irritant poisons cause hoarseness, wheezing
respiration, and other signs which indicate the spreading of the
inflammation of the throat to the windpipe: some likewise cause darting
pains throughout the chest: and not a few are very apt to cause
strangury and other signs of inflammation of the urinary passages.
Of the effects of the irritants when applied externally little need be
said at present. Their most striking external symptoms will be noticed
under the head of one of the orders of this class, the vegetable acrids.
In the chapter on the local action of poisons some account was given of
the several effects which are produced by the application of poisons to
the skin. It is there stated that some produce merely redness, that
others cause blistering, that others bring out a crop of deep-seated
pustules, that others corrode the tissues chemically, and so give origin
to a deep slough, and that others excite spreading inflammation of the
cellular tissue under the skin and between the muscles.
Such is a general view of the symptoms caused by the irritant poisons.
This topic will be afterwards taken up in detail under the head of the
several species. At present an important subject remains for
consideration, namely, the natural diseases whose effects are apt to be
mistaken for the effects of poison. The remarks now to be made might be
extended to many diseases. In fact, they might be extended to all which
prove fatal suddenly, for all such diseases are apt in peculiar
circumstances to give rise to a suspicion of poisoning. But those only
will be here noticed which occasion the greatest embarrassment to the
medical jurist, and which are most likely to come under his review in
courts of law. They are the following:—Distension and rupture of the
stomach; rupture of the duodenum, biliary ducts, uterus, or other organs
in the belly; the effects of drinking cold water; bilious vomiting and
common cholera; malignant cholera; inflammation of the stomach;
inflammation and perforation of the intestines; inflammation of the
peritonæum; spontaneous perforation of the stomach; melæna and
hæmatemesis: colic, iliac passion and obstructed intestine.
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