XIX. OF POISONING WITH BARYTA
Baryta and its salts, the last genus of the metallic irritants which requires particular notice, are commonly arranged among earthy substances, but on account of their chemical and physiological properties, may be correctly considered in the present place. These poisons are worthy of notice, because they are not only energetic, but likewise easily procured, so that they may be more extensively used, when more generally known.
SECTION I.—Of the Chemical Tests for the preparations of Baryta.
Three compounds of this substance may be mentioned, the pure earth or oxide, the muriate, or chloride of barium, and the carbonate. The pure earth, however, is so little seen, that it is unnecessary to describe its chemical or physiological properties.
The Carbonate of Baryta is met with in two states. Sometimes it is native, and then commonly occurs in radiated crystalline masses, of different degrees of coarseness of fibre, nearly colourless, very heavy, and effervescing with diluted muriatic acid. It is also sold in the shops in the form of a fine powder of a white colour, prepared artificially by precipitating a soluble salt of baryta with an alkaline carbonate. It is best known by its colour, insolubility in water, solubility with effervescence in muriatic acid, and the properties of the resulting muriate of baryta.
The Muriate of Baryta, or chloride of barium, is the most common of the compounds of this earth, having been for some time used in medicine for scrofulous and other constitutional disorders. It is procured either by evaporating the solution of the carbonate in hydrochloric acid, or by decomposing a more common mineral, the sulphate, by means of charcoal aided by heat, dissolving in boiling water the sulphuret so formed, and decomposing this sulphuret by hydrochloric acid.
It is commonly met with in the shops irregularly crystallized in tables. It has an acrid, irritating taste, is permanent in the air, and dissolves in two parts and a half of temperate water.
The solution is distinguished from other substances by the following chemical characters. From all other metallic poisons hitherto mentioned, it is easily distinguished by means of hydrosulphuric acid, which does not cause any change in barytic solutions. From the alkaline and magnesian salts it is distinguished by the effects of the alkaline sulphates, which have no visible action except on the barytic solution, and cause in it a heavy white precipitate, insoluble in nitric acid. From the chlorides of calcium and strontium, it is to be distinguished by evaporating the solution till it crystallizes. The crystals are known not to be chloride of calcium, because they are not deliquescent. The chloride of strontium (which resembles that of barium in many properties, but which must be carefully distinguished, as it is not poisonous), differs in the form of the crystals, which are delicate six-sided prisms, while those of the barytic salt are four-sided tables, often truncated on two opposite angles, sometimes on all four,—by its solubility in alcohol, which does not take up the chloride of barium,—and by its effect on the flame of alcohol, which it colours rose-red, while the barytic salts colour it yellow. The chloride of barium is known from other soluble barytic salts, by the action of nitrate of silver, which throws down a white precipitate.
Vegetable and animal fluids do not decompose the solution of chloride of barium, except by reason of the sulphates and carbonates which most of them contain in small quantities. But the action of its tests may be distinguished, although the salt has not undergone decomposition. In that case the most convenient method of analysis is to add a little nitric acid, which will dissolve any carbonate of baryta that may have been formed,—to filter and then throw down the whole baryta in the form of sulphate, by means of the sulphate of soda,—and to collect the precipitate, and calcine it with charcoal for half an hour in a platinum spoon or earthen crucible, according to the quantity. A sulphuret of baryta will thus be procured, which is to be dissolved out by boiling water, and decomposed after filtration by muriatic acid. A pure solution is thus easily obtained. Orfila has lately proposed a process more complex in its details, but the same in principle.[1380]
SECTION II.—Of the Action of the Salts of Baryta, and the Symptoms they excite in Man.
The action of the barytic salts on the body is energetic. Like most metallic poisons, they seem to possess a twofold action,—one local and irritating, the other remote and indicated by narcotic symptoms. This narcotic action is more decided and invariable than in the instance of any of the metallic poisons hitherto noticed. Such at least is the result of the experiments of Sir B. Brodie,[1381] which have since been amply confirmed by Professor Orfila[1382] and Professor Gmelin.[1383] Orfila found that when the chloride was injected into the veins of a dog in the dose of five grains only, death ensued in six minutes, and was preceded by convulsions, at first partial, but afterwards affecting the whole body. Sir B. Brodie found the same effects follow in twenty minutes, when ten grains were applied to a wound in the back of a rabbit,—the convulsions being preceded by palsy, and ending in coma. Half an ounce when injected into the stomach excited the same symptoms in a cat, and proved fatal in sixty-five minutes, though the animal vomited. Schloepfer observed, that when a scruple, dissolved in two drachms of water, was injected into the windpipe of a rabbit, it fell down immediately, threw back its head, was convulsed in the fore-legs, and died in twelve minutes.[1384] Gmelin observed in his experiments that it caused slight inflammation of the stomach, and strong symptoms of an action on the brain, spine, and voluntary muscles. He found the voluntary muscles destitute of contractility immediately after death; yet the heart continued to contract vigorously for some time, even without the application of any stimulus. From some experiments made on horses by Huzard and Biron, by order of the Société de Santé of Paris, it appears that the hydrochlorate, when given to these animals in the dose of two drachms daily, produced sudden death about the fifteenth day, without previous symptoms of any consequence.[1385] In the experiments now related, very little appearance of inflammation was found in the parts to which the poison was directly applied. It is also worthy of remark that the heart does not seem to have been particularly affected; and yet according to the recent researches of Mr. Blake, the barytic salts are the most powerful of all inorganic poisons in their action on the heart, when they are injected into the veins. A quarter of a grain of the chloride appreciably depresses arterial action; two grains completely arrest the heart’s contractions in twelve seconds; and when it is injected back into the aorta from the axillary artery, it causes at first some obstruction to the capillary circulation, but soon arrests the action of the heart, as when it is introduced into the veins.[1386]
The pure earth appears to produce nearly the same effects in an inferior dose. When swallowed, the symptoms of local irritation are more violent; but death ensues in a very short space of time, and is preceded by convulsions and insensibility. The stomach after death is found of a reddish-black colour, and frequently with spots of extravasated blood in its villous coat.
The carbonate in a state of minute division is scarcely less active than the hydrochlorate, since it is dissolved by the acid juices of the stomach. A drachm killed a dog in six hours; vomiting, expressions of pain, and an approach to insensibility preceded death; and marks of inflammation were found in the stomach.[1387] Pelletier made many experiments on the poisonous properties of the carbonate. Fifteen grains of the native carbonate killed one dog in eight hours, and another in fifteen.[1388] Dr. Campbell found it to be a dangerous poison, even when applied externally. Twelve grains introduced into a wound in the neck of a cat, excited on the third day languor, slow respiration, and feeble pulse; towards evening the animal became affected with convulsions of the hind-legs and with dilated pupils; and death followed not long afterwards.[1389] This substance, before its real nature was known, used at one time to be employed in some parts of England as a variety of arsenic for poisoning rats.
The salts of baryta are absorbed in the course of their action. The chloride has been detected by Dr. Kramer both in the blood and urine by incineration with carbonate of potash, washing the ashes with weak solution of carbonate of potash, dissolving the residue in diluted nitric acid, and testing the solution for baryta.[1390] Orfila has also obtained baryta, by his process alluded to above, in the liver, kidneys, and spleen of animals killed by the chloride.[1391]
The symptoms produced by the salts of baryta in man have seldom been particularly described. An instance is shortly noticed in the Journal of Science, where an ounce of the hydrochlorate was taken by mistake for Glauber’s salt, and proved fatal. The patient immediately after swallowing it felt a sense of burning in the stomach; vomiting, convulsions, headache, and deafness ensued; and death took place within an hour.[1392] A similar case, fatal in two hours, has been related by Dr. Wach of Merseburg. A middle-aged woman who, though generally in good health, had suffered for a day or two from pains in the stomach, took one morning a solution of half an ounce of chloride of barium by mistake for sulphate of soda. She was soon seized with sickness, retching, convulsive twitches of the hands and feet, vomiting of clear mucus, great anxiety, restlessness, and loss of voice; and she died under constant efforts to vomit, and violent convulsive movements, but with her faculties entire.[1393]
Unpleasant effects have been observed from too large doses of the chloride administered medicinally. A case is mentioned in the Medical Commentaries of a gentleman who was directed to take a solution as a stomachic, but swallowed one evening by accident so much as seventy or eighty drops. He had soon after profuse purging without tormina, then vomiting, and half an hour after swallowing the salt excessive muscular debility, amounting to absolute paraplegia of the limbs. This state lasted about twenty-four hours, and then gradually went off.[1394] I have known violent vomiting, gripes, and diarrhœa produced in like manner by a quantity not much exceeding the usual medicinal doses.
Dr. Wilson of London has lately described a distinct case of poisoning with the carbonate. The quantity taken was half a tea-cupful; but emetics were given, and operated before any symptoms showed themselves. In two hours the patient complained of dimness of sight, double vision, headache, tinnitus, and a sense of distension in the stomach, and subsequently of pains in the knees and cramps of the legs, with occasional vomiting and purging next day; for some days afterwards the head symptoms continued, though more mildly, and she was much subject to severe palpitations; but she was in the way of recovery when the account of her case was published.[1395] Mr. Parkes mentions that, according to information communicated to him by the proprietor of an estate in Lancashire, where carbonate of baryta abounds, many domestic animals on his estate died in consequence of licking the dust of the carbonate, and that it once proved fatal to two persons, a woman and her child, who took each about a drachm.[1396] Dr. Johnstone says he once swallowed ten grains of this compound, without experiencing any bad effect.[1397]
SECTION III.—Of the Morbid Appearances caused by the Salts of Baryta.
In animals the mucous membrane of the stomach is usually found of a deep-red colour, unless death take place with great rapidity, in which case the alimentary canal is healthy. In all the animals, which in Dr. Campbell’s experiments were killed by the application of the muriate to wounds, the brain and its membranes were much injected with blood; and in one of them the appearances were precisely those of congestive apoplexy.
In Wach’s case the stomach was dark brownish-red externally, and the small intestines brighter red. Internally the stomach presented uniform deep redness, with clots of blood, and bloody mucus scattered over it; and near the cardiac end there was a perforation, above half an inch in diameter within, and half as wide at the outside, and surrounded with swollen edges and extensive thickening of the villous coat. The small intestines were internally very red and lined with red mucus interspersed with clots of blood. The great intestines were extremely contracted. The lungs were gorged, the heart full of dark liquid blood, and the cerebral vessels distended. Chloride of barium was detected in the stomach and intestines. The perforation in this case was evidently an accidental concurrence.
SECTION IV.—Of the Treatment.
The treatment of this variety of poisoning consists chiefly in the speedy administration of some alkaline or earthy sulphate, such as the sulphate of soda or sulphate of magnesia. The poison is thus immediately converted into the insoluble sulphate of baryta, which is quite inert. Two drachms of muriate of baryta were injected by Orfila into the stomach of a dog, and eight minutes afterwards two drachms of sulphate of soda. The gullet was then secured by a ligature. At first efforts were made to vomit, and in an hour sulphate of baryta was discharged with the alvine evacuations. There was neither insensibility nor convulsions; and the next morning the animal evidently suffered only from the ligature on the gullet. This fact not only proves the efficacy of the sulphate, but likewise shows that in the kinds of poisoning where diarrhœa occurs, the poison is very soon discharged, and ought therefore to be looked for in the evacuations from the bowels.[1398]
A few observations may be here added on the effects of the salts of strontia on the animal frame. These compounds bear a close resemblance to the salts of baryta, and the two earths were consequently long confounded together till Dr. Hope pointed out their distinctions. One of the most striking differences is, that the salts of the strontia are very feebly poisonous. Some experiments of this purport were made by M. Pelletier of Paris,[1399] and by Blumenbach; but the most accurate researches are those of Professor Gmelin. He found that ten grains of the chloride in solution had no effect when injected into the jugular vein of a dog,—that two drachms had no effect when introduced into the stomach of a rabbit,—that half an ounce was required to cause death in that way,—that two drachms of the carbonate had no effect,—and that two drachms of the nitrate, dissolved in six parts of water and given to a rabbit, merely caused increase of the frequency and hardness of the pulse and a brisk diarrhœa.[1400] Mr. Blake also found that small doses of the salts of strontia have little effect when injected into the veins; but that forty grains arrest the action of the heart in fifteen seconds.[1401]
Chapter XX
The fourth order of the irritant poisons contains a great number of genera derived from the vegetable kingdom, and at one time commonly arranged in a class by themselves under the title of Acrid Poisons. The order includes many plants of the natural families Ranunculaceæ, Cucurbitaceæ, and Euphorbiaceæ, and other plants scattered throughout the botanical system. It likewise comprehends a second group consisting of some acrid poisons from the animal kingdom, namely, cantharides, poisonous fishes, poisonous serpents, and animal matters become poisonous by disease or putrefaction.
OF POISONING WITH THE VEGETABLE ACRIDS.
The vegetable acrids are the most characteristic poisons of this order. They will not require many details, as they are seldom resorted to for criminal purposes, and their mode of action, their symptoms, and their morbid appearances are nearly the same in all.
We are chiefly indebted to Professor Orfila for our knowledge of their mode of action. He has subjected them to two sets of experiments. In the first place, he introduced the poison in various doses into the stomach, sometimes tying the gullet, sometimes not: and, secondly, he applied the poison to the subcutaneous cellular tissue by thrusting it into a recent wound.
In the former way he found that, unless the gullet was tied, the animal soon discharged the poison by vomiting, and generally recovered; but that, if the gullet was tied, death might be caused in no long time by moderate doses. The symptoms were seldom remarkable. Commonly efforts were made to vomit; frequently diarrhœa followed; then languor and listlessness; sometimes, though not always, expressions of pain; very rarely convulsions; and death generally took place during the first day, often within three, six, or eight hours. The appearances in the dead body were redness over the whole mucous coat of the stomach, at times remarkably vivid, often barely perceptible, and occasionally attended with ulcers; very often a similar state of the whole intestines, more especially of the rectum; and in some instances a slight increase of density, with diminished crepitation, in patches of the lungs.
When the poison, on the other hand, was applied to a recent wound of the leg, the animal commonly whined more or less; great languor soon followed; and death took place on the first or second day, without convulsions or any other symptom of note. It was seldom that any morbid appearance could then be discovered in the bowels. But in every instance active inflammation was found in the wound, extending to the limb above it and even upwards on the trunk. Every part affected was gorged with blood and serum; and an eschar was never formed. The appearances in short were precisely those of diffuse inflammation of the cellular tissue, when it proves fatal in its early stage.[1402]
Since these poisons do not appear to act more energetically through a wound than through the stomach, it has been generally inferred that they do not enter the blood, and consequently that the local impression they produce is conveyed to distant organs through the nerves. This inference is correct in regard to such species of the vegetable acrids as act in small doses. But the validity of the conclusion may be questioned when the poison acts only in large doses, as in the case with many of those now under consideration. For they cannot be applied to a wound over a surface equal to that of the stomach, and may therefore be more slowly absorbed in the former than in the latter situation. And, in point of fact, a few plants of the present order have been found to act through the medium of absorption, as soon as chemistry discovered their active principles, and thus enabled the physiologist to get rid of fallacy by using the poison in small quantity. This principle has been proved to be in some plants a peculiar resin, in others a peculiar extractive matter, in others an oil, in others an alkaloid, and in others a neutral crystalline matter. But in all there exists some principle or other in which are concentrated the poisonous properties of the plant. Some of these principles appear to act through the medium of the blood.
There is no doubt, however, but many plants of the present order, as well as their active principles, have a totally different and very peculiar action. They produce violent spreading inflammation of the subcutaneous cellular tissue, and acute inflammation of the stomach and intestines, without entering the blood; and death is the consequence of a sympathy of remote organs with the parts directly injured.
As to their forming a natural order of poisons, it is evident, that if a general view be taken of their properties, they are distinguished by obvious phenomena from the three orders hitherto noticed. But if their effects on man be alone taken into account, when of course their influence on the external surface of the body must be left out of view, nothing will be discovered to distinguish them from several of the metallic irritants.
The symptoms occasioned in man by the irritant poisons of the vegetable kingdom, are chiefly those indicating inflammation of the villous coat of the stomach and intestines. When taken in large doses, they excite vomiting soon after they are swallowed; by which means the patient’s life is often saved. But sometimes, like the mineral poisons that possess emetic properties, the vegetable acrids present a singular uncertainty in this respect: they may be retained without much inconvenience for some length of time. If this should happen, or if the dose be less, in which case vomiting may not be produced at all, or if only part of a large dose be discharged at an early period by vomiting,—the other phenomena they give rise to are sometimes fully developed. The most conspicuous symptom then is diarrhœa, more or less profuse. The diarrhœa and vomiting are commonly attended by twisting pain of the belly, at first remittent, but gradually more constant, as the inflammation becomes more and more strongly marked. Tension, fulness and tenderness of the belly, are then not unfrequent. The stools may assume all the characters of the discharges in natural inflammation of the intestinal mucous membrane, but an additional character worthy of notice is the appearance of fragments of leaves or flowers belonging to the plant which has been swallowed. At the same time there is generally excessive weakness. Sometimes, too, giddiness and a tendency to delirium have been observed. But the latter symptoms are rare: if they occurred frequently, it would be necessary to transfer any poison which produced them to the class of narcotico-acrids.
The properties now mentioned have long ago attracted the attention of physicians, and led them to introduce many vegetable irritants into the materia medica. In fact they comprehended a great number of the most active, or, as they are technically called, drastic purgatives. Among others, elaterium, euphorbium, gamboge, colocynth, scammony, croton, jalap, savin, stavesacre, are of this description. The effect of most of them, however, is so violent and uncertain, that few are now much used except when combined with other milder laxatives.
The morbid appearances they leave in the dead body are the same with those noticed under the head of their mode of action,—more or less redness of the stomach, ulceration of its villous coat, redness of the intestines, and especially of the rectum and colon, which are often inflamed when the small intestines are not visibly affected.
In the following account of the particular poisons of this order, a very cursory view will be taken of their physical and chemical properties. A knowledge of these properties will be best acquired from any author on the materia medica; and an account of them would be misplaced in a work which professes to describe only the leading objects of the medical jurist’s attention.
A great number of genera might be arranged under the present head. But the following list comprehends all which require mention. Euphorbia, or spurge, the ricinus, or castor-oil tree, the jatropha, or cassava-plant, croton-oil, elaterium, or squirting cucumber, colocynth, or bitter-apple, bryony, or wild cucumber, ranunculus, or buttercup, anemone, stavesacre, celandine, marsh marigold, mezereon, spurge-laurel, savine, daffodil, jalap, manchineel, cuckow-pint.
The first plants to be noticed belong to the natural order Euphorbiaceæ, namely, the euphorbia, ricinus, jatropha, and croton.
Of Poisoning with Euphorbium.
Euphorbium is the inspissated juice of various plants of the genus euphorbia or spurge, but is principally procured from the E. officinarum, a species that abounds in Northern Africa. It contains a variety of principles; but its chief ingredient is a resin, in which its active properties reside. It has been analysed by Braconnot, Pelletier, Brandes,[1403] and Drs. Buchner and Herberger. According to Brandes the resin forms above 44 per cent. of the crude drug, and is so very acrid, that the eyelid is inflamed by rubbing it with the finger which has touched the resin, even although it be subsequently washed with an alkali.[1404] According to the most recent analysis, that of Drs. Buchner and Herberger, this resin is a compound substance, which consists of two resinous principles, one possessing in some degree the properties of an acid, and the other the properties of a base. The latter, which they have called euphorbin, is considered by them the true active principle of euphorbium.[1405] It will be mentioned under the head of Jalap, that they have taken the same view of the nature of other resinous poisons.
Orfila found that a large dog was killed in twenty-six hours and a half by half an ounce of powder of euphorbium introduced into the stomach, and retained there by a ligature on the gullet.
The whole coats of the stomach, but especially the villous membrane, were of a deep-red or almost black colour; the colon, and still more the rectum, were of a lively red internally, and their inner membrane was checkered with little ulcers. Two drachms of the powder thrust into a wound in the thigh, and secured by covering it with the flaps of the incision, killed a dog in twenty-seven hours; and death was preceded by no remarkable symptom except great languor. The wounded limb was found after death highly inflamed, and the redness and sanguinolent infiltration, which were alluded to in the general observations on the vegetable acrids, extended from the knee as high up the trunk as the fifth rib,—a striking proof of the rapidity with which this variety of inflammation diffuses itself.[1406] Mr. Blake concludes from his experiments, that euphorbium, when injected in a state of solution in the jugular vein, acts by obstructing both the pulmonary and systemic capillaries, and so preventing the passage of the blood into the left side of the heart; but that the heart is not primarily acted on.[1407]
The most common symptoms occasioned in man by euphorbium are violent griping and purging, and excessive exhaustion; but it appears probable that narcotic symptoms are also at times induced. A case of irritant poisoning with it has been related in the Philosophical Transactions; but it is not a pure one, as a large quantity of camphor was taken at the same time. Much irritation was produced in the alimentary canal; but by the prompt excitement of vomiting and the subsequent use of opium the patient soon recovered.[1408] Mr. Furnival has related a fatal case which arose from a farrier having given a man a tea-spoonful by mistake for rhubarb. Burning heat in the throat and then in the stomach, vomiting, irregular hurried pulse, and cold perspiration were the leading symptoms; and the person died in three days. Several gangrenous spots were found in the stomach, and its coats tore with the slightest touch.[1409] The operation of this substance is so violent and uncertain, that it has long ceased to be employed inwardly in the regular practice of medicine, and has been even excluded from some modern Pharmacopœias. It is still used by farriers as an external application; and in the Infirmary of this city I met with a fatal case of poisoning in the human subject, which was supposed to have been produced by a mixture containing it, and intended to cure horses of the grease. Pyl has related the proceedings in a prosecution against a man for putting powder of euphorbium into his maid-servant’s bed; and from this narrative it appears, that, when applied to the sound skin, it causes violent heat, itching and smarting, succeeded by inflammation and blisters.[1410] Dr. Veitch denies that the powder has any such power;[1411] but the effects described by Pyl correspond with popular belief.
Probably all the species of euphorbium possess the same properties as E. officinarum. Orfila found that the juice of the leaves of E. cyparissias and lathyris produces precisely the effects described above. Sproegel applied the juice of the latter to his face, and was attacked in consequence with an eruption like nettle-rash; and he found that it caused warts and hair to drop out.[1412] Vicat mentions analogous facts, and Lamotte notices the case of a patient who died in consequence of a clyster having been prepared with this species instead of the mercurialis.[1413] The seeds and root of the E. lathyris or caper-spurge are used by the inhabitants of the northern Alps in the dose of fifteen grains as an emetic; and very lately the oil of the seeds has been employed in Italy as an active purgative, which in the dose of two or eight grains is said to possess all the efficacy of croton oil.[1414] MM. Chevallier and Aubergier have also found the seeds of the E. hybeua and their expressed oil to be very energetic. The seeds yield 44 per cent. of oil, which in the dose of ten drops produces copious watery evacuations without pain, and resembles closely croton-oil in its effects.[1415] The E. esula appears to be a very active species. Scopoli says that a woman who took thirty grains of the root died in half an hour, and that he once knew it cause fatal gangrene when imprudently applied to the skin of the belly.[1416] Withering observes that all the indigenous species blister and ulcerate the skin, and that many of them are used by country people for these purposes.[1417]
I have no where seen any notice taken by authors of narcotic symptoms as the effect of poisoning with euphorbium; and indeed this substance has always been considered a pure irritant. I am informed, however, by the Messrs. Herring, wholesale druggists in London, that their workmen are subject to headache, giddiness and stupor, if they do not carefully avoid the dust thrown up while it is ground in the mill; and that the men themselves are familiarly acquainted with this risk. An analogous fact has likewise been communicated to me by Dr. Hood of this city, relative to the effects of the seeds of the E. lathyris. A child two years of age ate some of the seeds, and soon after vomited severely, which is the usual effect. Drowsiness, however, succeeded; and after a few returns of vomiting, which were promoted by an emetic, deep sleep gradually came on, broken by convulsions, stertorous breathing and sighs. Sensibility was somewhat restored by blood-letting and the warm bath; after which the tendency to sleep was interrupted by frequent agitation and exercise in the open air. The vomiting then recurred for a time; but the child eventually got well.
Of Poisoning with the Seeds of the Castor-Oil Tree.
Castor-oil at present so extensively used as a mild and effectual laxative, is nevertheless derived from a plant hardly inferior in activity as a poison to that just considered. It is the expressed oil of the seeds of the Ricinus communis or Palma Christi. Much discussion has taken place as to the source of the acrid properties of this seed, some supposing that they reside in the embryo, others in the perisperm, others in the cotyledon, others in a principle formed from the oil by heat; and the question is scarcely yet settled. It is certain, however, that, although castor oil owes its occasional acridity to changes effected by the heat to which it is sometimes exposed in the process of separation, nevertheless the cotyledons are in themselves acrid.[1418]
Two or three of the seeds will operate as a violent cathartic. Bergius, as quoted by Orfila, says he knew a stout man who was attacked with profuse vomiting and purging after having masticated a single seed. Lanzoni met with an instance where three grains of the fresh seeds, taken by a young woman, caused so violent vomiting, hiccup, pain in the stomach, and faintness, that for some time her life was considered in great danger.[1419] Mr. Alfred Taylor met with three cases of poisoning with castor-oil seeds. Two sisters, who took each from two to four seeds, suffered severely; and a third, who took twenty, died in five days, with symptoms like those of malignant cholera.[1420] Climate probably affects their activity; for I have known a person eat without any effect several seeds ripened in the open air in this neighbourhood. Dogs vomit so easily that they may take thirty seeds without material inconvenience, if the gullet is not tied. But if the gullet is secured, a much less quantity will occasion death in six hours. They produce violent inflammation when applied to a wound.[1421]
Of Poisoning with the Physic-nut.
The plants of the genus Jatropha, belonging to the same natural family, have all of them the same acrid properties as the castor-oil tree. The seeds of the J. curcas, the physic-nut of the West Indies, when applied in the form of powder to a wound, produce violent spreading inflammation of the subcutaneous cellular tissue; and when introduced into the stomach they inflame that organ and the intestines.[1422] Four seeds will act on man as a powerful cathartic.[1423] I have known violent vomiting and purging occasioned by a few grains of the cake, left after expression of the fixed oil from the bruised seeds; and in some experiments performed a few years ago, I found that twelve or fifteen drops of the oil produced exactly the same effects as an ounce of castor-oil, though not with such certainty. In the last edition of this work some observations were made, on the authority of MM. Pelletier and Caventou, respecting the properties of a pure oil and a volatile acid, supposed by them to exist in the physic-nut; but they analyzed the croton seed by mistake for it.
Two other species have been also examined, but not with care, namely, the Jatropha multifida, and the Jatropha or Janipha manihot. It is probable that the seeds of both are acrid, and also the oil which may be extracted from them by pressure. But a much more interesting part of the latter species in a toxicological point of view is the root; the juice of which is a most energetic poison. The Janipha manihot, or cassava-plant, has two varieties, one of which produces a small, spindle-shaped, bland root, called, in the West Indies, sweet cassava, while the other has a much larger, bitter, poisonous root, called bitter cassava, and in universal use for obtaining the well-known amylaceous substance, tapioca. The juice of the bitter variety is watery, and so poisonous that, according to Dr. Clark of Dominica, negroes have been killed in an hour by drinking half a pint of it.[1424] It has been commonly, but erroneously, arranged among acrid poisons. It really belongs to the narcotic class, for it occasions coma and convulsions. And we now know the cause of this extraordinary anomaly in the natural family to which the species belongs; because MM. Henry and Boutron ascertained that the juice imported into France, as well as what they expressed from fresh roots sent from the West Indies, contains hydrocyanic acid, produces in animals all the usual effects of that poison, and is rendered inert by such means as will remove the acid,—for example, by the addition of nitrate of silver.[1425] I confirmed this singular discovery in 1838 by examination of some well-preserved juice from Demerara. It is easy to see how tapioca, which is obtained from the poisonous root by careful elutriation, becomes quite bland during the process.
Of Poisoning with Manchineel.
The manchineel [Hippomane mancinella], another plant of the same natural family, contains a milky juice, which is possessed of very acrid properties. Orfila and Ollivier have made some careful experiments with it on animals,[1426] and M. Ricord has since added some observations on its effects on man.[1427] From the former it appears that two drachms of the juice applied to a wound in a dog will cause death in twenty-eight hours, by exciting diffuse cellular inflammation; and that half that quantity will prove fatal in nine hours when introduced into the stomach. From the observations of M. Ricord it follows that inflammation is excited wherever the juice is applied, even in the sound skin; but he denies the generally received notion, that similar effects ensue from sleeping under the branches of the tree, or receiving drops of moisture from the leaves. This notion, however, it is right to add, has been adopted by other recent authors. Descourtils, for example, states that it is dangerous to sleep under the tree; that drops of rain from the leaves will blister any part of the skin on which they fall; and that on these accounts the police of St. Domingo were in the practice of destroying the trees wherever they grew.[1428] Other species of Hippomane are equally poisonous. The H. biglandulosa and H. spinosa are peculiarly so, especially the latter, which is known to the negroes of St. Domingo by the name of Zombi apple, and is familiarly used by them as a potent poison.[1429]
Of Poisoning with Croton.
The oil of the Croton Tiglium has been familiarly known for some years as a very powerful hydragogue cathartic in the dose of a few drops; and therefore little doubt could exist that both the oil and the seed which yields it must be active irritant poisons in moderate doses. Accordingly it has been lately found by experiments in Germany that forty seeds will kill a horse in the course of seven hours;[1430] and Rumphius mentions that it was a common poison in his time at Amboyna among the natives. I have known most violent watery purging and great prostration caused by four drops of the expressed oil. A fatal case of poisoning with it occurred not long ago in France. A young man who swallowed two drachms and a half of the oil by mistake, instead of using it as an embrocation, was soon seized with tenderness of the belly, violent efforts to vomit, cold sweating, laborious respiration, blueness of the lips and fingers, and an almost imperceptible pulse,—then with profuse, involuntary discharges by stool, burning along the throat and gullet, and insensibility of the skin;—and in four hours he expired. The villous coat of the stomach was soft, but not otherwise injured.[1431]
The activity of the seed and oil seems to depend on a peculiar volatile acid, which was discovered by MM. Pelletier and Caventou when they analysed the croton seed by mistake as the seed of the Jatropha curcas, or physic-nut. When the oil was saponified by potash and then freed of the acid by distillation, it became inert. On the other hand, the acid was found by them to excite inflammation of the stomach, and spreading inflammation of the cellular tissue, according as it was administered internally or applied to a wound.[1432]
The next natural family in which plants are to be found that possess the properties of the acrid poisons, is the Cucurbitaceæ, or gourds. This family, it should be remarked, does not in general possess poisonous properties. On the contrary, they are, with a few exceptions, remarkably mild; and many of them supply articles of luxury for the table. The melon, gourd, and cucumber belong to the order. The only poisons of the order which have been examined with any care are elaterium, bryony, and colocynth.
Of Poisoning with Bryony.
The roots of the Bryonia alba and Dioica possesses properties essentially the same with those of euphorbium. The B. dioica is a native of Britain, where it grows among hedges, and is usually known by the name of wild vine, or bryony. The flowers are greenish, and are succeeded by small, red berries. The root, which is the most active part of the plant, is spindle-shaped, and varies in size from that of a man’s thigh to that of a radish.
Orfila found that half an ounce of the root introduced into the stomach of a dog, killed it in twenty-four hours, when the gullet was tied; and that two drachms and a half applied to a wound brought on violent inflammation and suppuration of the part, ending fatally in sixty hours.[1433]
Bryony root owes its power to an extractive matter discovered in it by Brandes and Firnhaber, to which the name of Bryonine has been given. According to the experiments of Collard de Martigny, bryonine acts on the stomach and on a wound exactly as the root itself, but more energetically. When introduced into the cavity of the pleura it causes rapid death by true pleurisy, ending in the effusion of fibrin.[1434]
Before bryony-root was expelled from medical practice, it was often known to produce violent vomiting, tormina, profuse watery evacuations, and fainting. Pyl mentions a fatal case of poisoning with it, which happened at Cambray in France. The subject was a man who took two glasses of an infusion of the root to cure ague, and was soon after seized with violent tormina and purging, which nothing could arrest, and which soon terminated fatally.[1435] Orfila quotes a similar case from the Gazette de Santé, which proved fatal within four hours, in consequence of a strong decoction of an ounce of the root having been administered, partly by the mouth and partly in a clyster, to repel the secretion of milk.[1436]
Of Poisoning with Colocynth.
Colocynth, or bitter-apple, is another very active and more common acrid derived from a plant of the same family, the Cucumis colocynthis. It is imported into this country in the form of a roundish, dry, light fruit, as big as an orange, of a yellowish-white colour, and excessively bitter taste. Its active principle is probably a resinoid matter discovered by Vauquelin, which is very soluble in alcohol and sparingly so in water, but which imparts even to the latter an intensely bitter taste.[1437] It is termed Colocynthin.
According to the experiments of Orfila, colocynth powder or its decoction produces the usual effects of the acrid vegetables on the stomach and on the subcutaneous cellular tissue. Three drachms proved fatal in fifteen hours to a dog through the former channel when the gullet was tied, and two drachms killed another when applied to a wound.[1438]
A considerable number of severe cases of poisoning with this substance have occurred in the human subject; and a few have proved fatal. Tulpius notices the case of a man who was nearly carried off by profuse, bloody diarrhœa, in consequence of taking a decoction of three colocynth apples.[1439] Orfila relates that of a rag-picker, who, attempting to cure himself of a gonorrhœa by taking three ounces of colocynth, was seized with vomiting, acute pain in the stomach, profuse diarrhœa, dimness of sight, and slight delirium; but he recovered under the use of diluents and local blood-letting.[1440] In 1823 a coroner’s inquest was held at London on the body of a woman who died in twenty-four hours, with incessant vomiting and purging, in consequence of having swallowed by mistake a tea-spoonful and a half of colocynth powder.[1441] M. Carron d’Annecy has communicated to Orfila the details of an instructive case, which also proved fatal. The subject was a locksmith, who took from a quack two glasses of decoction of colocynth to cure hemorrhoids, and was soon after attacked with colic, purging, heat in the belly, and dryness of the throat. Afterwards the belly became tense and excessively tender, and the stools were suppressed altogether. Next morning he had also retention of urine, retraction of the testicles and priapism. On the third day the retention ceased, but the other symptoms continued, and the skin became covered with clammy sweat, which preceded his death only a few hours. The intestines were red, studded with black spots, and matted together by fibrinous matter; the usual fluid of peritonitis was effused into the belly; the villous coat of the stomach was here and there ulcerated; and the liver, kidneys, and bladder also exhibited traces of inflammation.[1442]
Of Poisoning with Elaterium.
Elaterium, which is procured from a third plant of the cucurbitaceæ, the Momordica elaterium or squirting cucumber, possesses precisely the same properties with the two preceding substances. It appears, however, to be more active; for a single grain has been known to act violently on man. There can be no doubt that small doses will prove fatal; but its strength and consequently its effects are uncertain. British elaterium, which is the feculence that subsides in the juice of the fruit, is the most powerful; French elaterium, which is the extract of the same juice, is much weaker; and a still weaker preparation sometimes made is an extract of the juice of the whole plant. The plant itself is probably poisonous. But the only case in point with which I am acquainted is a singular instance of poisoning, apparently produced in consequence of the plant having been carried for some time betwixt the hat and head. A medical gentleman in Paris, after carrying a specimen to his lodgings in his hat, was seized in half an hour with acute pain and sense of tightness in the head, succeeded by colic pains, fixed pain in the stomach, frequent watery purging, bilious vomiting, and some fever. These symptoms continued upwards of twelve hours.[1443]
The active properties of this substance reside in a peculiar crystalline principle, discovered by Mr. Morries-Stirling, and named by him Elaterine. It is procured by evaporating the alcoholic infusion of elaterium to the consistence of thin oil, and throwing it into boiling distilled water; upon which a white crystalline precipitate is formed, and more falls down as the water cools. This precipitate when purified by a second solution in alcohol and precipitation by water, is pure elaterine. In mass it has a silky appearance. The crystals are microscopic rhombic prisms, striated on the sides. It is intensely bitter. It does not dissolve in the alkalis, or in water, is sparingly soluble in diluted acids, but easily soluble in alcohol, ether, and fixed oil. It has not any alkaline reaction on litmus.—It is a poison of very great activity. A tenth of a grain, as I have myself witnessed, will sometimes cause purging in man; and a fifth of a grain in two doses, administered at an interval of twenty-four hours to a rabbit, killed it seventeen hours after the second dose. The best British elaterium contains 26 per cent. of it, the worst 15 per cent.; but French elaterium does not contain above 5 or 6 per cent.[1444] These facts account for the great irregularity in the effects of this drug as a cathartic. The principle discovered by Mr. Morries-Stirling was also discovered about the same time by Mr. Hennell[1445] of London.
Of Poisoning with the Ranunculaceæ.
The natural family of the Ranunculaceæ abounds in acrid poisons. Indeed few of the genera included in it are without more or less acrid property.
The genus Ranunculus is of some interest to the British toxicologist, because many species grow in this country, and unpleasant accidents have been occasioned by them. The most common are the R. bulbosus, acris, sceleratus, Flammula, Lingua, aquatilis, repens, Ficaria, which are all abundant in the neighbourhood of this city. The Ranunculus acris is the only species that has been particularly examined. Five ounces of juice, extracted by triturating the leaves with two ounces of water, killed a stout dog in twelve hours when taken internally. Two drachms of the aqueous extract applied to a wound killed another in twelve hours by inducing the usual inflammation.[1446]
Krapf, as quoted in Orfila’s Toxicology, found by experiments on himself, that two drops of the expressed juice of the Ranunculus acris produced burning pain and spasms in the gullet and griping in the lower belly. A single flower had the same effect. When he chewed the thickest and most succulent of the leaves, the salivary glands were strongly stimulated, his tongue was excoriated and cracked, his teeth smarted, and his gums became tender and bloody.[1447] Dr. Withering alleges that it will blister the skin. A man at Bevay in the north of France, after swallowing by mistake a glassful of the juice which had been kept for some time as a remedy for vermin on the head, was seized in four hours with violent vomiting and colic, and expired in two days.[1448] The acridity of the genus ranunculus is entirely lost by drying, either with or without artificial heat. The R. acris, however, is far from being the most active species of the genus. The taste of the leaves of R. bulbosus, alpestris, gramineus, and Flammula, and also of the unripe germens of R. sceleratus, is much more pungent. The R. repens, Ficaria, auricomus, aquatilis, and Lingua, I have found to be bland.
The genus Anemone produces similar effects on the animal economy. The most pungent species I have examined are the A. pulsatilla, A. hortensis, and A. coronaria; the A. nemorosa and A. patens are less active; and the A. hepatica, as well as the A. alpestris, are bland. The powder of the A. pulsatilla causes itching of the eyes, colic and vomiting, if in pulverizing it the operator do not avoid the fine dust which is driven up; and Bulliard relates the case of a man who, in applying the bruised root to his calf for rheumatism, was attacked with inflammation and gangrene of the whole leg.[1449] The same author mentions an instance where violent convulsions were produced by an infusion of the A. nemorosa, and the person was for some time thought to be in great danger.[1450] The acridity of the anemone is retained under desiccation even in the vapour-bath; but is very slowly lost under exposure to the air, not entirely, however, in two months. The ripe fruit of the A. hortensis is bland. The activity of the anemones is owing to a volatile oil, which, when left for some time in the water with which it passes over in distillation is converted into a neutral crystalline body called anemonine, and a peculiar acid termed anemonic acid.[1451]
The Caltha palustris, or marsh marigold, a plant closely allied in external characters to the ranunculus, is considered by toxicologists a powerful acrid poison. Wibmer observes that it has an acrid, burning taste,[1452]—a remark which has been also made by Haller.[1453] On the continent the flower buds are said to be sometimes pickled and used for capers on account of their pungency. The following set of cases which happened in 1817 near Solingen will show that in some localities it possesses energetic and singular properties. The poison was taken accidentally by a family of five persons, in consequence of their having been compelled by the badness of the times to try to make food of various herbs. They were all seized half an hour after eating with sickness, pain in the abdomen, vomiting, headache, and ringing in the ears, afterwards with dysuria and diarrhœa, next day with œdema of the whole body, particularly of the face, and on the third day with an eruption of pemphigous vesicles as large as almonds, which dried up in forty-eight hours. They all recovered.[1454]
Notwithstanding these apparently pointed facts, however, I have no doubt that the marsh marigold is in some circumstances bland, and is commonly so in this country, or at least but feebly poisonous. Haller, in speaking of its acrid taste, adds that when young it is eaten with safety by goats. For my own part I have never been able to remark any distinct acridity in tasting it either before inflorescence, or in the young flower-buds, or in any part of the plant while in full flower. It produces a peculiar, disagreeable impression on the back of the tongue, when collected in dry situations; but never occasions that pungent acridity which so remarkably characterizes many species of ranunculus, anemone, and clematis.
The stavesacre, or Delphinium staphysagria, another plant of the same natural family, is interesting in a scientific point of view, because its properties have been distinctly traced to a peculiar alkaloid. The seeds, which alone have been hitherto examined, were analyzed by MM. Lassaigne and Feneulle, who, besides a number of inert principles, discovered in them an alkaloid, possessing in an eminent degree the poisonous qualities of the seeds. This alkaloid is solid, white, pulverulent but crystalline, fusible like wax, very bitter and acrid, almost insoluble in water, very soluble in ether and alcohol, and capable of forming salts with most of the acids.[1455] It has been named delphinia. It was also discovered about the same time by Brandes.[1456]
Orfila found that six grains of it diffused through water, introduced into the stomach of a dog and retained there with a ligature on the gullet, brought on efforts to vomit, restlessness, giddiness, immobility, slight convulsions, and death in two or three hours. The same quantity, if previously dissolved in vinegar, will cause death in forty minutes. In the former case, but not in the latter, the inner coat of the stomach is found to be generally red.[1457]
An ounce of the bruised seeds themselves killed a dog in fifty-four hours when introduced into the stomach, and two drachms applied to a wound in the thigh killed another in two days. In the former animal a part of the stomach was crimson-red; in the latter there was extensive subcutaneous inflammation reaching as high as the fourth rib.[1458]
Besides these four genera of the ranunculaceæ many other genera of the same natural order are equally energetic. The Clematis vitalba or traveller’s-joy is said to be acrid, but does not taste so: the C. flammula, however, is pungently acrid to the taste; it reddens and blisters the skin; and when swallowed excites inflammation in the stomach. The trollius or globe flower is also considered acrid; and its root in appearance, smell, and taste, has been said to resemble closely that of the black hellebore. The herb, however, in Scotland, has certainly none of the peculiar acrid pungency of the ranunculus, anemone, or clematis, but is on the contrary bland. Some other genera of equal power have been usually arranged with the narcotico-acrid poisons on account of their action on the nervous system; and probably some of the present group of acrids might with equal propriety be removed to the same class.
Of plants possessing acrid properties and interspersed throughout other natural families, the only species I shall particularly notice are the mezereon, cuckow-pint, gamboge, daffodil, jalap-plant, and savine.
Of Poisoning with Mezereon.
The mezereon and several other species of the genus Daphne to which it belongs are powerfully acrid. They belong to the natural order Thymeleæ. The active properties of the bark of mezereon have been traced to a very acrid resin; and those of the allied species, Daphne alpina, to a volatile, acrid acid.[1459]
The experiments of Orfila have been confined to a foreign species, the D. Gnidium or garou of the French. Three drachms of the powder of its bark retained in the stomach of a dog killed it in twelve hours; and two drachms applied to a wound killed another in two days.[1460] The action of the other species has not been so scientifically investigated; but fatal accidents have arisen from them when taken by the human species. Children have been tempted to eat the berries of the D. mezereon by their singular beauty; and some have died in consequence. Three such cases, not fatal, have been related by Dr. Grieve of Dumfries. Two of the children had violent vomiting and purging: in the third narcotic symptoms came on in five hours, namely, great drowsiness, dilatation of the pupils, extreme slowness of the pulse, retarded respiration, and freedom from pain.[1461] Vicat relates the case of a man who took the wood of it for dropsy, and was attacked with profuse diarrhœa and obstinate vomiting, the last of which symptoms recurred occasionally for six weeks.[1462] A fatal case, in a child about eight years of age, occurred a few years ago in this city. Linnæus in his Flora Suecica says that six berries will kill a wolf, and that he once saw a girl die of excessive vomiting and hæmoptysis, in consequence of taking twelve of them to check an ague.[1463] The D. laureola or spurge-laurel, a common indigenous species, abounding in low woods, is said by Withering to be very acrid, especially its root.[1464]
Of Poisoning with Cuckow-pint.
The Arum maculatum, or cuckow-pint, one of our earliest spring flowers, not uncommon in moist ground, under the shelter of woods, is one of the most violent of all acrid vegetables inhabiting this country. I have known acute burning pain of the mouth and throat, pain of the stomach and vomiting, colic and some diarrhœa, occasioned by eating two leaves. The genus possesses the same properties in other climates, the several species being everywhere among the most potent acrid poisons in their respective regions. The Arum seguinum, or dumb cane of the West Indies, is so active that two drachms of the juice have been known to prove fatal in a few hours.[1465] It is not a little remarkable that the acridity of the arum is lost not merely by drying, but likewise by distillation. I have observed that when the roots are distilled with a little water, neither the distilled water nor the residuum possesses acridity. Reinsch says he has eaten powder of arum root, which, though not acrid to the taste, produced severe burning of the throat not long after it was swallowed.[1466]
Of Poisoning with Gamboge.
The familiar pigment and purgative gamboge is one of the pure acrids, and possesses considerable activity. It appears from the researches of Orfila,[1467] some experiments by Schubarth,[1468] and various earlier inquiries quoted by Wibmer,[1469] that two drachms will kill a sheep; that a drachm and a half will kill a dog if retained by a ligature on the gullet, while much larger doses have little effect without this precaution, as the poison is soon vomited; that an ounce has little effect on the horse; that eighteen grains will prove fatal to the rabbit within twenty-four hours; and that the symptoms are such as chiefly indicate an irritant action. Orfila farther found that it produces intense spreading inflammation when applied to a recent wound, and in this way may occasion death as quickly and with as great certainty as when administered internally.
Gamboge in its action on man is well known to be one of the most certain and active of the drastic cathartics, from three to seven grains being sufficient to cause copious watery diarrhœa, commonly with smart colic. Larger doses will induce hypercatharsis. A drachm has proved fatal, as is exemplified by a case in the German Ephemerides where the symptoms were excessive vomiting, purging, and faintness.[1470]
Under this head are probably to be arranged the repeated cases, which have lately occurred in this country, of fatal poisoning with a noted quack nostrum, Morison’s pills. Almost every physician in extensive practice has met with cases of violent hypercatharsis occasioned by the incautious use of these pills; and three instances are now on record where death was clearly occasioned by them.[1471] No toxicologist will feel any surprise at such results, when he learns that one sort contains, besides aloes and colocynth, half a grain of gamboge, and another three times as much, in each pill; and that ten, fifteen, or even twenty pills are sometimes taken for a dose once or oftener in the course of the day.[1472] The symptoms in the cases alluded to were sickness, vomiting and watery purging, pain, tension, fulness, tenderness, and heat in the abdomen, with cold extremities and sinking pulse; and in the dead body the appearances were great redness of the stomach with softening of its villous coat, in the intestines softening and slate-gray coloration of the same coat, and in one instance intestinal ulceration.
Gamboge is one of the poisons whose energy seems to be irregularly modified by the co-existence of certain constitutional states in disease. Physicians in Britain cannot but be startled to hear of the practice, prevailing among the followers of Rasori in Italy, of administering this purgative in doses of a drachm and upwards in inflammatory diseases. But it is nevertheless undeniable, that it has been given to that extent in such circumstances, with no further consequence than brisk purging. Professor Linoli mentions two cases of inflammatory dropsy, in which he gave gamboge-powder in gradually increasing doses, till he reached in one instance an entire drachm, and in the other 86 grains. In the course of a month one of his patients got 1044 grains, and the other took 850 grains in twelve days. Both recovered from their dropsy, and the purging was never great.[1473]
Of Poisoning with Daffodil.
The common daffodil, the Narcissus pseudo-narcissus of botanists, though commonly arranged with the vegetable acrids, seems not entitled to a place among them. At least the experiments of Orfila rather tend to show that it acts through absorption on the nervous system. Four drachms of the aqueous extract of this plant secured in the stomach in the usual way killed a dog in less than twenty-four hours; and one drachm applied to a wound killed another in six hours. In both cases vomiting or efforts to vomit seemed the only symptom of note; and in both the stomach was found here and there cherry-red. The wound was not much inflamed.[1474]
Of Poisoning with Jalap.
Jalap, the powder of the root of the Ipomæa purga, and a common purgative, is an active poison in large doses; and this every one should know, as severe and even dangerous effects have followed its incautious use in the hands of the practical joker. Its active properties reside in a particular resinous principle. It contains a tenth of its weight of mixed resin, which, like the resin of euphorbium, has been separated by Drs. Buchner and Herberger into two, one possessing some of the properties of acids, the other some of the properties of bases; and the latter they consider the active principle, and have accordingly named Jalapine.[1475] Mr. Hume of London some time ago procured from the crude drug a powdery substance, to which he gave the same name, and which he conceived to be the active principle. His analysis has not been generally relied on by chemists; but it is not improbable that his principle differs little from that of the German chemists.
The action of jalap has been examined scientifically by M. Felix Cadet de Gassicourt, who found that it produced no particular symptom when injected into the jugular vein of a dog in the dose of twenty-four grains, or when applied to the cellular tissue in the dose of a drachm. But when rubbed daily into the skin of the belly and thighs it excited in a few days severe dysentery; when introduced into the pleura it excited pleurisy, fatal in three days; when introduced into the peritonæum it caused peritonitis and violent dysentery, fatal in six days; and when introduced into the stomach or the anus, the animals died of profuse purging in four or five days, and the stomach and intestines were then found red and sometimes ulcerated. Two drachms administered by the mouth proved fatal.[1476] Scammony, which is procured from another species of the same family, the Convolvulus scammonea, has been found by Orfila to be much less active. Four drachms given to dogs produced only diarrhœa.[1477]
Of Poisoning with Savin.
The leaves of the Juniperus sabina, or savin, have been long known to be poisonous. They have a peculiar heavy, rather disagreeable odour, and a bitter, acrid, aromatic, somewhat resinous taste. They yield an essential oil, which possesses all their qualities in an eminent degree.
A dog was killed by six drachms of the powdered leaves confined in the stomach. It appeared to suffer pain, died in sixteen hours, and exhibited on dissection only trivial redness of the stomach. Two drachms introduced into a wound of the thigh caused death after the manner of the other vegetable acrids in two days; and besides inflammation of the limb there was found redness of the rectum.[1478]
Savin is a good deal used in medicine for stimulating old ulcers and keeping open blistered surfaces; which may be done without danger, although it cannot be applied to a fresh wound without risk of diffuse inflammation. Both the powder and the essential oil are of some consequence in a medico-legal point of view, as they have been often used with the intent of procuring abortion. The oil is generally believed by the vulgar to possess this property in a peculiar degree. Doubts, however, may be entertained whether any such property exists independently of its operation as a violent acrid on the bowels. It has certainly been taken to a considerable amount without the intended effect; of which Foderé has noticed an unequivocal example. The woman took daily for twenty days no less than a hundred drops of the oil, yet carried her child to the full time.[1479] The powder has likewise been taken to a large extent without avail. A female, whose case is noticed by Foderé, took without her knowledge so much of the powder that she was attacked with vomiting, hiccup, heat in the lower belly, and fever of a fortnight’s duration; nevertheless she was not delivered till the natural time.[1480] There is no doubt, however, that if given in such quantity as to cause violent purging, abortion may ensue; but unless there is naturally a predisposition to miscarriage, the constitutional injury and intestinal irritation required to induce it are so great, as to be always attended with extreme danger, independent of the uterine disorder. Of this train of effects the following case, for which I am indebted to Mr. Cockson of Macclesfield, is a good illustration. A female applied to a pedlar to supply her with the means of getting rid of her pregnancy: and under his direction appears to have taken a large quantity of a strong infusion of savin-leaves on a Friday morning and again next morning. A very imperfect account was obtained of the symptoms, as no medical man witnessed them; but it was ascertained that she had violent pain in the belly and distressing strangury. On the Sunday afternoon she miscarried; and on the ensuing Thursday she died. Mr. Cockson, who examined the body next day, found extensive peritonæal inflammation unequivocally indicated by the effusion of fibrinous flakes,—the uterus presenting all the signs of recent delivery,—the inside of the stomach of a red tint, checkered with patches of florid extravasation,—and its contents of a greenish colour, owing evidently to the presence of a vegetable powder, as was proved by separating and examining it with the microscope. My colleague Dr. Traill has communicated to me the particulars of a similar case. A servant-girl, after being for some time in low spirits, was seized with violent colic pains, frequent vomiting, straining at stool, tenderness of the belly, dysuria and general fever; under which symptoms she died after several days of suffering. The stomach was inflamed, in parts black, and at the lower curvature perforated. The uterus with its appendages was very red, and contained a fine membrana decidua, but no ovum. The lower intestines were inflamed. There was found in the stomach a greenish powder, which, when washed and dried, had the taste of savin.
A singular case is quoted by Wibmer of a woman who died from taking an infusion of the herb for the purpose of procuring miscarriage, and in whom death seems to have been occasioned by the gall-bladder bursting in consequence of the violent fits of vomiting.[1481]
In a charge of wilful abortion the mere possession of oil of savin would be a suspicious circumstance, because the notion that it has the power of causing miscarriage is very general among the vulgar; while it is scarcely employed by them for any useful purpose. The leaves in the form of infusion are in some parts of England a popular remedy for worms; and the oil is used in regular medicine as an emmenagogue.
The following list includes all the other plants which have been either ascertained experimentally to belong to the present order, or are believed on good general evidence to possess the same or analogous properties.
By careful experiment Orfila has ascertained that the Gratiola officinalis, Rhus radicans and Rhus toxicodendron, Chelidonium majus and Sedum acre, possess them; and the following species are also generally considered acrid, namely, Rhododendron chrysanthum and ferrugineum, Pedicularis palustris, Cyclamen Europæum, Plumbago Europæa, Pastinaca sativa, Lobelia syphilitica and longiflora, Hydrocotyle vulgaris. To these may be added the common elder or Sambucus nigra, the leaves and flowers of which caused in a boy, once a patient of mine, dangerous inflammation of the mucous membrane of the bowels lasting for eight days.
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.
XXII. OF THE DELETERIOUS EFFECTS OF POISONOUS FISH
The species of fish which act deleteriously, either always or in particular circumstances, have also been commonly arranged in the present order of poisons.
The subject of fish-poison is one of the most singular in the whole range of toxicology, and none is at present veiled in so great obscurity. It is well ascertained that some species of fish, particularly in hot climates, are always poisonous,—that some, though generally salubrious and nutritive, such as the oyster and still more the muscle, will at times acquire properties which render them hurtful to all who eat them,—and that others, such as the shell-fish now mentioned, and even the richer sorts of vertebrated fishes, though actually eaten with perfect safety by mankind in general, are nevertheless poisonous, either at all times or only occasionally to particular individuals. But hitherto the chemist and the physiologist have in vain attempted to discover the cause of their deleterious operation.
A good account of the poisonous fishes of the tropics has been given by Dr. Chisholm[1510] and by Dr. Thomas;[1511] and some farther observations on the same subject have been published by Dr. Fergusson.[1512] These essays may be consulted with advantage. On the effects of poisonous muscles several interesting notices and essays have been written, among which may be particularized one by Dr. Burrows[1513] of London, another by Dr. Combe of Leith,[1514] and the observations of Professor Orfila, including some cases from the Gazette de Santé, and from the private practice of Dr. Edwards.[1515] Of all the sources of information now mentioned, that which appears to me the most comprehensive and precise, is the essay of Dr. Combe, who has collected many facts previously known, added others equal in number and importance to all the rest put together, and weighed with impartiality the various inferences which have been or may be drawn from them. The succeeding remarks will be confined to a succinct statement of what appears well established.
In this work, however, the poisonous fishes of the West Indies and other tropical countries may be laid aside, because we are still too little acquainted with the phenomena of their action to be entitled to investigate its cause, and they are objects of much less interest to the British medical jurist than the fish-poison of his own coast.
There is little doubt that some of the inhabitants of the sea on the coast of Britain are always poisonous. Thus it is well known that some of the molluscous species irritate and inflame the skin wherever they touch it,—a fact which is familiar to every experienced swimmer. The fishermen of the English coast are also aware that a small fish known by the name of Weever (Trachinus vipera, Cuv.) possesses the power of stinging with its dorsal fin so violently as to produce immediate numbness of the arm or leg, succeeded rapidly by considerable swelling and redness; and indeed an instance of this accident, which happened at Portobello on the Firth of Forth, has been mentioned to me by Mr. Stark, author of the Elements of Natural History, who witnessed the effects of the poison. But our knowledge of the poisons of that class is too imperfect to require more particular notice.
Of fishes which are commonly nutritive, but sometimes acquire poisonous properties, by far the most remarkable is the common Muscle. Opportunities have often occurred for observing its effects,—so often, indeed, that its occasional poisonous qualities have become an important topic of medical police, and in some parts, as in the neighbourhood of Edinburgh and Leith, it has of late been abandoned by many people as an article of food, although generally relished, and in most circumstances undoubtedly safe. This result originated in an accident at Leith in 1827, by which no fewer than thirty people were severely affected and two killed.
Of the Symptoms and Morbid Appearances caused by Poisonous Muscles.
The effects of poisonous muscles differ in different cases. Sometimes they have produced symptoms of local irritation only. Thus Foderé mentions the case of a sailor in Marseilles, who, in consequence of eating a large dish of them, died in two days, after suffering from vomiting, nausea, pain in the stomach, tenesmus, and quick contracted pulse. The stomach and intestines were found after death red and lined with an abundant tough mucus.[1516] One of the cases described by Dr. Combe, which, however, terminated favourably, is of the same nature. The patient had severe stomach symptoms from the commencement, attended with cramps and ending in peritonitis, which required the frequent use of the lancet.
But much more commonly the local effects have been trifling, and the prominent symptoms have been almost entirely indirect and chiefly nervous. Two affections of this kind have been noticed. One is an eruptive disease resembling nettle-rash, and accompanied with violent asthma; the other a comatose or paralytic disorder of a peculiar description.
Of the former affection several good examples have been recorded in different numbers of the Gazette de Santé.[1517] In these the number of muscles eaten was generally small; in one instance ten, in another only six. Nay, in a case related with several others by Möhring in the German Ephemerides, the patient only chewed one muscle and swallowed the fluid part, having spit out the muscle itself.[1518] The symptoms have usually commenced between one and two hours after eating, and rapidly attained their greatest intensity. In the patient who was affected by ten muscles the first symptoms were like those of violent coryza; swelling and itching of the eyelids, and general nettle-rash followed; and the eruption afterwards gave place to symptoms of urgent asthma, which were removed by ether. In other cases the symptoms of asthma preceded the eruption. In one instance the eruption did not appear at all. The swelling has not been always confined to the eyelids, but, on the contrary, has usually extended over the whole face. All the patients were quickly relieved by ether. The eruption, though generally called nettle-rash, is sometimes papular, sometimes vesicular, but always attended with tormenting heat and itchiness. Several cases of this kind have been related by Möhring. The eruption was preceded by dyspnœa, lividity of the face, insensibility, and convulsive movements of the extremities. All recovered under the use of emetics.[1519] This affection, however, may prove fatal. In the cases of two children related by Dr. Burrows, the symptoms began, as in Möhring’s cases, with dyspnœa, nettle-rash, and swelling of the face, combined with vomiting and colic; but afterwards the leading symptoms were delirium, convulsions, and coma; and death took place in three days.
In these children it is worthy of remark, that none of the symptoms began till twenty-four hours after eating. In Möhring’s cases, on the contrary, the symptoms began in a few minutes.
The other affection is well exemplified in the correct delineations of Dr. Combe. The following is his general summary of the cases, which, with the exception of the instance of peritonitis already alluded to, were all singularly alike in their leading features.—“None, so far as I know, complained of anything peculiar in the smell or taste of the animals, and none suffered immediately after taking them. In general, an hour or two elapsed, sometimes more; and then the bad effects consisted rather in uneasy feelings and debility, than in any distress referable to the stomach. Some children suffered from eating only two or three; and it will be remembered that Robertson, a young and healthy man, only took five or six. In two or three hours they complained of a slight tension at the stomach. One or two had cardialgia, nausea, and vomiting; but these were not general or lasting symptoms. They then complained of a prickly feeling in their hands; heat and constriction of the mouth and throat; difficulty of swallowing and speaking freely; numbness about the mouth, gradually extending to the arms, with great debility of the limbs. The degree of muscular debility varied a good deal, but was an invariable symptom. In some it merely prevented them from walking firmly, but in most of them it amounted to perfect inability to stand. While in bed they could move their limbs with tolerable freedom; but on being raised to the perpendicular posture, they felt their limbs sink under them. Some complained of a bad coppery taste in the mouth, but in general this was an answer to what lawyers call a leading question. There was slight pain of the abdomen, increased on pressure, particularly in the region of the bladder, which suffered variously in its functions. In some the secretion of urine was suspended, in others it was free, but passed with pain and great effort. The action of the heart was feeble; the breathing unaffected; the face pale, expressive of much anxiety; the surface rather cold; the mental faculties unimpaired. Unluckily the two fatal cases were not seen by any medical person; and we are therefore unable to state minutely the train of symptoms. We ascertained that the woman, in whose house were five sufferers, went away as in a gentle sleep; and that a few minutes before death, she had spoken and swallowed.”[1520] She died in three hours. The other fatal case was that of a dock-yard watchman, who was found dead in his box six or seven hours after he ate the muscles.
The inspection of the bodies threw no light on the nature of these singular effects. No appearance was found which could be called decidedly morbid. The stomach contained a considerable quantity of the fish half digested.
Dr. Combe’s narrative agrees with that of Vancouver, four of whose sailors were violently affected, and one killed in five hours and a half, after eating muscles which they had gathered on shore in the course of his voyage of discovery.[1521]
In closing this account, allusion may be briefly made to a case related by Dr. Edwards, which differs from all the preceding. The symptoms were uneasiness at stomach, followed by epileptic convulsions, which did not entirely cease for a fortnight. Dr. Edwards imputed the illness to muscles; but it must be observed that this is a solitary instance of simple convulsions arising from such a cause.[1522] The case deserves particular attention, because a suspicion of intentional poison might have been excited by the circumstances in which it occurred. The individual, a young man, was attacked soon after eating in company with another, who was about to marry his mother, and with whom on that account he lived on bad terms.
Of the Source of Poison of Muscles.
Various opinions have been formed as to the cause or causes of the poisonous qualities of some muscles.
The vulgar idea that the poisonous principle is copper, with which the fish becomes impregnated from the copper bottoms of vessels, is quite untenable. Copper does not cause the symptoms described above. I analyzed some of the muscles taken from the stomach of one of Dr. Combe’s patients, without being able to detect a trace of copper. Others have arrived at the same result in former cases. The only instance indeed to the contrary is a late analysis by M. Bouchardat; who does not mention the quantity of copper he detected, or what was the source of the poisonous fish.[1523]
The theory which ascribes their effects to changes induced by decay is equally untenable. In Dr. Burrows’s two cases the muscles appear to have been decayed; yet he very properly refuses to admit this fact as explanatory of their operation. And, indeed, it rather complicates than facilitates the explanation; as it shows that the poison differs from animal poison generally, in not being destroyed by putrefaction. Dr. Combe’s inquiries must satisfy every one, that in the Leith cases decay was out of the question, and I may add my testimony to the statement: the muscles taken from the stomach of one of his fatal cases, and likewise others obtained in the shell, and brought to me for analysis, were perfectly fresh.
By some physicians, and especially by Dr. Edwards, their poisonous effects have been referred to idiosyncrasy on the part of the persons who suffer. It can hardly be doubted that this is the cause in some instances. It was formerly mentioned that muscles, oysters, crabs, and even the richer sorts of vertebrated fishes, such as trout, salmon, turbot, holibut, herring, mackerel, are not only injurious to some people, while salutary to mankind generally, but likewise that this singular idiosyncrasy may be acquired. A relation of mine for many years could not take a few mouthfuls of salmon, trout, herring, turbot, holibut, crab, or lobster, without being attacked in a few minutes or hours with violent vomiting; yet at an early period of life, he could eat them all with impunity; and at all times he has eaten without injury cod, ling, haddock, whiting, flounder, oysters, and muscles. Among the cases which have come under Dr. Edwards’s notice in Paris, there is one evidently of the same nature. In two others, the idiosyncrasy existed in regard to the muscle, and although in both of these the affection induced was slight, there is no doubt but idiosyncrasy will also account even for some instances of the severe disorders specified above. In particular, it appears sometimes to operate in the production of nettle-rash and asthma; for in the instance quoted from the Gazette de Santé, as arising from ten muscles, it happened that the father of the patient partook very freely of the same dish without sustaining any harm whatever; and in each of three distinct accidents mentioned by Möhring, it appeared that other individuals had eaten of the same dish with equal impunity.[1524]
But idiosyncrasy will not account for all the cases of poisoning with muscles, oysters, and other fish. For, passing over other less unequivocal objections, it appears that, when the accident related above happened at Leith, every person who ate the muscles from a particular spot was more or less severely affected; and an important circumstance then observed for the first time was, that animals suffered as severely as man, a cat and a dog having been killed by the suspected article.
Another theory ascribes the poisonous quality to disease in the fish; but no one has hitherto pointed out what the disease is. The poisonous muscles at Leith were large and plump, and seemed to have been chosen on account of their size and good look. Dr. Coldstream, however, at the time a pupil of this University, and a zealous naturalist, thought the liver was larger, darker, and more brittle than in the wholesome fish, and certainly satisfied me that there was a difference of the kind. But whether this was really disease or merely a variety of natural structure, our knowledge of the natural history of the fish hardly entitles us to pronounce.
Considering the failure of all other attempts to account for the injurious properties acquired by muscles, it is extraordinary that no experiments have been hitherto made with the view of discovering in the poisonous fish a peculiar animal principle. It certainly seems probable, that the property resides in a particular part of the fish or in a particular principle. In 1827, I made some experiments on those which caused the fatal accident at Leith, but without success. My attention was turned particularly to the liver; but neither there nor in the other parts of the fish could I detect any principle which did not equally exist in the wholesome muscle. This result, however, should not deter others, any more than it would myself, from a fresh investigation; for the want of a sufficient supply prevented me from making a thorough analysis; and the reader will presently find an instance related, where another singular poison, sometimes contained in sausages and in cheese, was, after repeated failures, at length traced successfully to the real cause by the hand of the analytic chemist.
M. Lamouroux, in a letter to Professor Orfila, conjectures that the poison may be a particular species of Medusa, and enters into some ingenious explanations of his opinion. But it is not supported by any material fact, and seems to be surrounded by insuperable difficulties.[1525] It is not a new conjecture; for Möhring mentions in his paper formerly quoted, that several writers before him had conceived such a cause might afford an explanation of the phenomena.[1526]
Little or no light is thrown on this singular subject by the nature of the localities in which the poisonous muscle has been found. Even on this point we possess little information. Both in Dr. Burrows’s and Dr. Combe’s cases the fish was attached to wood. At Leith they were taken from some Memel fir logs, which formed the bar of one of the wet-docks, and had lain there at least fifteen years. From the stone-walls of the dock in the immediate vicinity of this bar muscles were taken which proved quite wholesome. It is impossible, however, to attach any importance to these facts; for Dr. Coldstream informs me, that he examined muscles which were attached to the fir piles of the Newhaven Chain-pier, about a mile from Leith, and found them wholesome. In the latter animals the liver was not large, as in the poisonous muscles of Leith. Lamouroux states, but I know not on what authority, that muscles never become poisonous unless they are exposed alternately to the air and the sea in their place of attachment, and unless the sea flows in gently over them without any surf,—these conditions being considered by him requisite for the introduction of the poisonous Medusæ into the shell.
Of Poisonous Oysters.
Oysters sometimes acquire deleterious properties analogous to those acquired by muscles. But fewer facts have been collected regarding them. M. Pasquier has mentioned some cases which occurred not long ago at Havre, in consequence apparently of an artificial oyster-bed having been established near the exit of the drain of a public necessary. But I have not been able to consult his work.[1527] Another instance of their deleterious operation occurred a few years ago at Dunkirk. At least an unusual prevalence of colic, diarrhœa, and cholera was believed to have been traced to an importation of unwholesome oysters from the Normandy coast. Dr. Zandyk, the physician who was appointed to investigate the matter, found that the suspected fish contained a slimy water, and that the membranes were retracted from the shell towards the body of the animal.[1528] Dr. Clarke believes that even wholesome oysters have a tendency to act deleteriously on women immediately after delivery. He asserts that he has repeatedly found them to induce apoplexy or convulsions; that the symptoms generally came on the day after the oysters were taken; and that two cases of the kind proved fatal.[1529] I am not aware that these statements have been since confirmed by any other observer.
Of Poisonous Eels.
Eels have also been at times found in temperate climates to acquire poisonous properties. Virey mentions an instance where several individuals were attacked with violent tormina and diarrhœa a few hours after eating a paté made of eels from a stagnant castle-ditch near Orleans; and in alluding to similar accidents having previously happened in various parts of France, he adds that domestic animals have been killed by eating the remains of the suspected dish.[1530]
XXIII. OF POISONING BY VENOMOUS SNAKES
Another entire group of poisons allied to the acrid vegetables in their action, but infinitely more energetic, comprehends the poisons of the venomous serpents. If we were to trust the impressions the vulgar entertain of the effects of the bite of serpents, the poisons now mentioned would be considered true septics or putrefiants; for they were once universally believed, and are still thought by many, to cause putrefaction of the living body. This property has been assigned them probably on no other grounds, except that they are apt to bring on diffuse subcutaneous inflammation, which frequently runs on to gangrene. But there are some serpents, especially among those of hot climates, which appear also to act remotely on the centre of the nervous system, and to occasion death through means of that action.
The present group of poisons is of little consequence to the British medical jurist, as an opportunity of witnessing their effects in this country is seldom to be found. The viper is the only poisonous snake known in Britain, where its poison is hardly ever so active as to occasion death.[1531]
This serpent, like all the other poisonous species, is provided with a peculiar apparatus by which the poison is secreted, preserved, and introduced into the body of the animal it attacks. The apparatus consists of a gland behind each eye, of a membranous sac at the lateral and anterior part of the upper jaw, and of a hollow curved tooth surrounded and supported by the sac. The cavity of the tooth communicates with that of the sac, and terminates near the tip, in a small aperture, by which the poison is expelled into the wound made by the tooth.
The symptoms caused by the bite of the viper are lancinating pain, which begins between three minutes and forty minutes after the bite, and rapidly stretches up the limbs,—swelling, at first firm and pale, afterwards red, livid and hard,—tendency to fainting, bilious vomiting, sometimes convulsions, more rarely jaundice,—quick, small, irregular pulse,—difficult breathing, cold perspiration, dimness of vision, and injury of the mental faculties. Death may ensue. A case is related in Rust’s Magazin of a child twelve years old, who died two days after being bitten in the foot;[1532] another instance is briefly noticed in the French Bulletins of Medicine, of a person forty years old, dying also in two days;[1533] Dr. Wagner of Schlieben mentions his having met with two instances where persons bit on the toes died before assistance could be procured;[1534] and notice has been taken in Hufeland’s Journal of a girl, eleven years old, having been killed in three hours at Schlawe in Prussia.[1535] In the last case burning in the foot, which was the part bitten, then severe pain in the belly, inextinguishable thirst, and vomiting, preceded a fit of laborious breathing, which ushered in death. The most remarkable instance, however, of death from the bite of the European viper is one lately described by Dr. Braun, as having been occasioned in the Dutchy of Gotha by the Coluber Chersea [Kreuzotter of the Germans]. A man, who represented himself to be a snake-charmer, insisted on showing his skill before Dr. Lenz, a naturalist of Schnepfenthal; and putting the head of a viper belonging to this gentleman’s collection into his mouth, he pretended to be about to devour it. Suddenly he threw the snake from him, and it was found that he had been bitten near the root of the tongue. In a few minutes he became so faint that he could not stand, the tongue swelled a little, the eyes became dim, saliva issued from the mouth, rattling respiration succeeded, and he died within fifty minutes after being bitten.[1536] A French writer observes that the common viper of France is not very deadly; but that the bite of the red viper may occasion death in a few hours.[1537]
The activity of the poison of the viper depends on a variety of circumstances. When kept long confined, the animal loses its energy; and after it has bitten repeatedly in rapid succession, its bite ceases for some time to be poisonous, as the supply of poison is exhausted. It appears also to be most active in hot and dry climates. Those cases are always the most severe in which the symptoms begin soonest; and the danger increases with the number of bites. An important observation made by Dr. Wagner is that danger need not be dreaded except when the bite is inflicted on small organs such as the fingers or toes, because larger parts cannot be fully included between the animal’s jaws, and fairly pierced by its fangs, but can only be scratched. The properties of the fluid contained in the reservoir do not cease with the animal’s life; nay they continue even when the fluid is dried and preserved for a length of time. It may be swallowed in considerable quantity without causing any injury whatever. In the course of some experiments lately made in Italy, a pupil of Professor Mangili swallowed at once the whole poison of four vipers without suffering any inconvenience; and that of six vipers was given to a blackbird, that of ten to a pigeon, and that of sixteen to a raven, with no other effect beyond slight and transient stupor.[1538]
For the most recent account of the far more terrible effects of the cobra di capello and rattlesnake, the reader may refer to the authorities below.[1539]
It was stated above that the poison of the viper retains its activity when dried. I have had an opportunity of observing this in regard to the poison of the cobra di capello, which is said to be preserved in India by simply squeezing out the contents of the poison-bag, and drying the liquid in a silver dish exposed to the sun. The specimen in my possession, for which I am indebted to Mr. Wardrop of London, has the appearance of small fragments of gum-arabic. It had been kept for fifteen years when I tried its effects on a strong rabbit. A grain and a half dissolved in ten drops of water, having been introduced between the skin and muscles of the back, the animal in eight minutes became very feeble and averse to stir, so that it remained still even when placed in irksome postures; occasional slight twitches of the limbs supervened; at length it became extremely torpid, and breathed slowly by means of the abdominal muscles and diaphragm alone; and in twenty-seven minutes it died exhausted, without any precursory insensibility. The heart contracted readily, when irritated nine minutes after death; so that the poison seemed to operate by causing muscular paralysis, and consequently arresting the respiration.
There might also be arranged in an appendix to the present group of poisons those insects whose sting is poisonous. The European insects known to have a poisonous sting, are chiefly the scorpion, tarantula, bee and wasp; of which the last two only are natives of Britain.
The poison of these insects occasions diffuse cellular inflammation, which always ends in resolution. It is said, however,[1540] and it may be readily believed, that death has been sometimes caused in consequence of a whole hive attacking an intruder and covering his body with their stings. In an old French journal is shortly noticed the case of a peasant who died soon after being stung over the eye by a single bee.[1541] A more probable story has been told in the Gazette de Santé of a gardener who died of inflammation of the throat, in consequence of being stung there by a wasp while he was eating an apple, in which it had been concealed.[1542] But the same accident has often occurred without any material danger.
The treatment of poisoning by venomous serpents need not be detailed here. The subject is introduced merely to mention that the treatment of poisoned wounds by the application of cupping-glasses has been lately resorted to with success for curing the bite of the viper. A patient of M. Piorry, two hours after being bitten, had all the constitutional symptoms strongly developed, such as slow, very feeble pulse, nausea, vomiting, and swelling of the face. When a cupping-glass was applied for half an hour, the general symptoms ceased and did not return. Next day diffuse inflammation began; but it was checked by leeches.[1543] An equally successful case is related in the Calcutta Transactions by Mr. Clarke.[1544]
XXIV. OF POISONING BY DISEASED AND DECAYED ANIMAL MATTER
Another and much more important group of poisons, that may be arranged in the present order, comprehends animal matter usually harmless or even wholesome, but rendered deleterious by disease or decay. These poisons are formed in three ways, by morbid action local or constitutional, by ordinary putrefaction, and by modified putrefaction.
Of Animal Matter rendered Poisonous by Diseased Action.
Under the first variety might be included the latent poisons by means of which natural diseases are communicated by infection, contact, and inoculation. Such poisons, however, being usually excluded from a strict toxicological system, the only varieties requiring notice are the animal poisons engendered by disease, and which do not produce peculiar diseases, but merely inflammation. Several species of this kind may be mentioned, comprehending the solids and fluids in various unhealthy states of the body.
One of these poisons, contained in the blood and perhaps in some of the secretions of overdriven cattle, arises under circumstances in which the body seems to deviate little from its natural condition. A good account of the effects thus induced has been given in an essay on the subject by Morand.[1545] From the cases he describes it follows, that the flesh of such animals is wholesome enough when cooked and eaten; but that if the blood or raw flesh be applied to a wound or scratch, nay even sometimes to the unbroken skin, a dangerous and often fatal inflammation is excited, which at times differs little from diffuse cellular inflammation, and at other times consists of a general eruption of gangrenous boils, the pustules malignes of the French. The deleterious effects occasionally observed to arise from offal are probably analogous in their nature and their cause. On this subject Sir B. Brodie has made some remarks which tend to show that the application of various kinds of offal to wounds, and especially pricks of the fingers with spiculæ of bone from the hare, may cause an obstinate chronic erysipelas of the hand.[1546] I have met with a case of this nature, where the affection was erratic erythema of the hand.
Another species of poison, allied to the preceding in its effects and equally obscure in its nature, includes certain fluids of the human body after natural death, which are probably modified, if not even formed altogether, by morbid processes during life. Such poisons are the most frequent source of the dreadful cellular inflammation, often witnessed as the consequence of pricks received during dissection by the anatomist. On this interesting but obscure subject, much minute information will be found in the works quoted below.[1547]
It is still a matter of question among pathologists what these poisons are, and in what circumstances they spring up. By some their baneful properties have been suspected to arise from the operation of particular diseases on natural or morbid secretions;[1548] and although the precise diseases inducing these properties, and the precise fluids which acquire them have by no means been satisfactorily ascertained, it appears well established that no fluid possesses them more frequently or in a higher degree than the serum effused into the cavities of the chest and belly by recent inflammation of the serous membranes of these cavities. By others the origin of the poison is suspected to be wholly independent of diseased action in the living body and to lie merely in certain changes effected in healthy secretions by decay. And as the accidents produced by this poison have occurred chiefly during the dissection of bodies recently dead, it is supposed to exist only for a short time at the commencement of decay, and to disappear in the farther progress of putrefaction.
But whatever may be its nature and origin, we are well enough acquainted with its effects; which are diffuse inflammation and violent constitutional excitement, quickly passing to a state resembling typhoid fever. Sometimes the inflammation spreads steadily towards the trunk from the part to which the poison was applied; sometimes the inflammation around the injury is trifling and limited, but a similar inflammation appears in or near the axilla, and subsequently on other parts of the body; and the latter form of disease is always attended with the highest constitutional derangement and with the greatest danger.
Another singular poison, unequivocally the product of disease, and which acts as a local irritant, is the flesh or fluids of animals affected at the time of their death with a carbuncular disorder, denominated in Germany Milzbrand, and analogous to the pustule maligne of the French. The disease, so far as I know, has not received a vulgar name in the English language, being fortunately rare in Britain. It is a constitutional and epidemic malady, which sometimes prevails among cattle on the continent to an alarming extent, and is characterized by the eruption of large gangrenous carbuncles on various parts of the body. This distemper has the property of rendering the solids and fluids poisonous to so great a degree, that not only persons who handle the skin, entrails, blood, or other parts, but even also those who eat the flesh, are apt to suffer severely. The affection thus produced in man is sometimes ordinary inflammation of the alimentary canal, or cholera;[1549] more commonly a disorder precisely the same as the pustule maligne;[1550] but most frequently of all an eruption of one or more large carbuncles resembling those of the original disease of cattle.[1551] It is often fatal. The carbuncular form has been known to cause death in forty-eight hours.[1552] It is an interesting fact, for the knowledge of which we are indebted to M. Dupuy, that the carbuncle of cattle may be caused by applying to a wound the blood or spleen of an animal killed by gangrene of the lungs.[1553]
A poison analogous to the former in its nature, which has sometimes occasioned severe and even fatal effects in man is the matter of glanders, a contagious disease to which the horse is peculiarly subject, and which is communicated probably by means of a morbid secretion from the nostrils. This disease has been propagated to man by infection; at least instances have been related where grooms attending glandered horses, although they had no external injury through which inoculation could take place, were attacked with profuse fetid discharge from the nostrils, a pustular eruption on the face, and colliquative diarrhœa, which has sometimes ended fatally in a few days.[1554] In other instances inoculation of the hand with the blood of the glandered horse has produced alarming diffuse inflammation, and a carbuncular eruption.[1555]
It appears probable, that some peculiar circumstances with which we are not yet acquainted must concur with the operation of the poisons now under review, before they can take effect. At least unequivocal facts have been published which show, that the fluids and solids, as well as the emanations of animals infected and even killed by glanders or the pustule maligne, may be often handled and breathed with impunity. Such is the result of a careful inquiry made under the direction of the Parisian Board of Health into the nuisance occasioned by the great Nackery of Montfaucon.[1556] Parent-Duchatelet, the author of an elaborate report on the subject, considers it clearly established that neither the workmen nor the horses connected with the establishment, nor the tanners who are supplied with hides from it, have ever presented a single instance of disease referrible to the operation of diseased animal matter. Yet upwards of twelve thousand horses are annually flayed there, and among these it is calculated that at least three thousand six hundred are affected with carbuncle, glanders, or farcy.[1557]
Of Animal Matter rendered Poisonous by common Putrefaction.
The second mode in which animal matters, naturally wholesome or harmless, may acquire the properties of irritant poisons, is by their undergoing ordinary putrefaction.
The tendency of putrefaction to impart deleterious qualities to animal matters originally wholesome has been long known, and is quite unequivocal. To those who are not accustomed to the use of tainted meat, the mere commencement of decay is sufficient to render meat insupportable and noxious. Game, only decayed enough to please the palate of the epicure, has caused severe cholera in persons not accustomed to eat it in that state. The power of habit, however, in reconciling the stomach to the digestion of decayed meat is inconceivable. Some epicures in civilized countries prefer a slight taint even in their beef and mutton; and there are tribes of savages still farther advanced in the cultivation of this department of gastronomy, who eat with impunity rancid oil, putrid blubber, and stinking offal. How far putrefaction may be allowed to advance without overpowering the preservative tendency of habit, it is not easy to tell. But with the present habits of this and other civilized nations, the limit appears very confined.
Putrid animal matter when injected into the veins of healthy animals proves quickly fatal; and from the experiments of Gaspard and Magendie,[1558] together with the more recent researches of MM. Leuret and Hamont,[1559] the disease induced seems to resemble closely the typhoid fever of man.
Similar effects were observed by Magendie, when dogs were confined over vessels in which animal matter was decaying, so that they were obliged always to breathe the exhalations.[1560] These discoveries throw some light on the question regarding the tendency of putrid effluvia to engender fever in man; and notwithstanding many well ascertained facts of an opposite import, they show that, probably in peculiar circumstances, decaying animal matter may excite epidemic fevers. A detailed investigation of this important topic would be misplaced here, as it belongs more to medical police than to medical jurisprudence; but the two works quoted below are referred to for examples, in my opinion, of the unequivocal origin of continued fever in the cause now alluded to;[1561] and other instances of the like kind will be found in the Report of the Parliamentary Commission on the Health of Towns.
Another affection sometimes brought on by putrid exhalations is violent diarrhœa or dysentery, of which a remarkable instance lately occurred in the person of a well-known French physician, M. Ollivier. While visiting a cellar where old bones were stored, he was seized with giddiness, nausea, tendency to vomit and general uneasiness; and subsequently he suffered from violent colic with profuse diarrhœa, which put on the dysenteric character and lasted for three days.[1562] Chevallier, in noticing this accident, mentions his having been affected somewhat in the same way when exposed to the emanations of dead bodies; and it is a familiar fact that medical men, who engage in anatomical researches after long disuse, are apt to suffer at first from smart diarrhœa.
The same remark must be applied here as at the close of the observations in the last section. Without peculiar concurring circumstances no bad effect results. This will follow from many facts illustrative of the innocuous nature of various trades where the workmen are perpetually exposed to the most noisome putrid effluvia. But no facts of the kind are so remarkable as those collected in regard to the establishment at Montfaucon by Parent-Duchatelet, who makes it appear that this most abominable concentration of the worst of all possible nuisances is not merely not injurious to the health of the men and animals employed in and around it, but actually even preserves them from epidemic or epizootic diseases.[1563]
The effects of putrid animal matter when applied to wounds have been investigated experimentally by Professor Orfila; who found that putrid blood, bile, or brain, caused death in this way within twenty-four hours,—producing extensive local inflammation of the diffuse kind, and great constitutional fever. In man also several instances of diffuse cellular inflammation have been observed as the consequence of pricks received during the dissection of putrid bodies. The disease, as formerly observed, certainly arises in general from pricks received in dissecting recent bodies. At the same time, a few cases have been traced quite unequivocally to inoculation with putrid matter;[1564] and if any doubts existed on this point, the experiments of Orfila would remove them.
M. Lassaigne has examined chemically the putrid matter formed by keeping flesh long in close vessels, and has found it to consist of carbonate of ammonia, much caseate of ammonia, and a stinking volatile oil,—the last of which is probably the poisonous ingredient.
Of Animal Matter rendered Poisonous by Modified Putrefaction.
The third way in which animal matters naturally wholesome may become irritant poisons, is by their undergoing a modified putrefaction.
It is probable that many common articles of food occasionally become poisonous in this way; but none are so liable to acquire injurious properties as certain articles much used in Germany, namely, a particular kind of sausage, a particular kind of cheese, and bacon. The last two species of poison have been occasionally observed in France, and probably occur in Britain also. But the first has been hitherto met with only in some districts of Germany.
The best account yet given of the sausage-poison is contained in two essays published by Dr. Kerner,[1565] in a Thesis by Dr. Dann,[1566] and in a prize-essay by Dr. W. Horn.[1567] It has at various times committed great ravages in Germany, especially in the Würtemberg territories, where 234 cases of poisoning with it occurred between the years 1793 and 1827; and of that number no less than 110 proved fatal.[1568]
The symptoms of poisoning seldom begin till twenty-four, or even forty-eight hours, after the noxious meal, and rather later than earlier. The tardiness of their approach seems owing to the great indigestibility of the fatty matter with which the active principle is mixed. The first symptoms are pain in the stomach, vomiting, purging, and dryness of the mouth and nose. The eyes, eyelids, and pupils then become fixed and motionless; the voice is rendered hoarse, or is lost altogether; the power of swallowing is much impaired; the pulse gradually fails, frequent swoonings ensue, and the skin becomes cold and insensible. The secretions and excretions, with the exception of the urine, are then commonly suspended; but sometimes profuse diarrhœa continues throughout. The appetite is not impaired; fever is rarely present; and the mind continues to the last unclouded. Fatal cases end with convulsions and oppressed breathing between the third and eighth day. In cases of recovery the period of convalescence may be protracted to several years. The chief appearances in the dead body are signs of inflammation in the mucous membrane of the alimentary canal,—such as whiteness and dryness of the throat, thickening of the gullet, redness of the stomach and intestines; also croupy deposition in the windpipe; great flaccidity of the heart; and a tendency in the whole body to resist putrefaction. In a set of cases which occurred so lately as 1841, there was found after death abscesses in the tonsils, dark bluish redness of the membrane of the pharynx, windpipe and bronchial ramifications, gorging of the pulmonary air-tubes and condensation of the pulmonary tissue itself, dark redness of the fundus of the stomach, with circumscribed softening, a dark gray, red, or black appearance of the mucous coat of the intestines, accumulation of greenish-yellow fæces in the colon, brittleness of the liver, and enlargement of the spleen.[1569]
The article which is apt to occasion these baneful effects is of two sorts, the white and the bloody sausage (leberwürste, blut-würste). Both are of large size, the material being put into swine’s stomachs; and they are cured by drying and smoking them in a chimney with wood-smoke. Those which have been found to act as poisons possess an acid reaction, are soft in consistence, have a nauseous, putrid taste, and an unpleasant sweetish-sour smell, like that of purulent matter. They are met with principally about the beginning of spring, when they are liable to be often alternately frozen and thawed in the curing. Those sausages only become poisonous which have been boiled before being salted and hung up. They are poisonous only at a particular stage of decay, and cease to be so when putrefaction has advanced so far that sulphuretted-hydrogen is evolved. The central part is often poisonous when the surface is wholesome.
Various opinions have been entertained of the cause of the deleterious qualities thus contracted. In recent times the principle has been supposed to be pyroligneous acetic acid, hydrocyanic acid, or cocculus indicus. Dr. Kerner, however, has shown that none of these notions will account for the phenomena; and at first conceived he had proved the poisonous principle to be a fatty acid analogous to the sebacic acid of Thenard, and originating in a modified process of putrefaction. From the poisonous sausage he procured by double decomposition an acid similar in chemical properties to that obtained from fat by destructive distillation; and by experiments on animals he thought he observed, that the acid procured in either way produced symptoms analogous to those of poisoning with the deleterious sausage. Subsequently, however, he changed his views in some measure; and he now considers that the poison is a compound one, consisting of a fatty acid analogous to the sebacic, and of a volatile principle.[1570] The results obtained by Dr. Dann coincide with the last opinion. Dann infers from his researches that the poisonous principle does not necessarily reside in an acid, but is an acrid empyreumatic oil, which when pure is not active, but is rendered so by uniting with various fatty acids.[1571]
The results lately obtained by Buchner after an elaborate and careful analysis are somewhat different and probably nearer the truth. He first ascertained that the product of the distillation of fat has no analogy with the sausage-poison. He found it to consist of animalized acetic acid, and a fetid empyreumatic oil, the former of which has no injurious effect on animals, while the latter, though an active poison, is purely narcotic in its operation. On next examining a sausage sent to him from Würtemberg, which had violently affected four individuals and killed one of them in six days, he remarked that the poisonous principle is not soluble in water, or capable of being distilled over with it; and that cold alcohol removes a granular fatty matter, which, when purified by distilled water, has a yellowish colour, a peculiar nauseous smell, and a disagreeable oleaginous taste, followed by extraordinary dryness of the throat for several hours. Although it does not possess an acid reaction on litmus, it forms a soap with alkalis, and is separated again by acids unchanged; and consequently it may be considered a fatty acid, to which Buchner proposes to give the name of Botulinic acid [Würst-fett-saüre]. It concentrates in itself the poisonous properties of the crude sausage. Thirty grains of it, which formed three-fourths of the whole product of a single sausage, were given in two doses to a puppy with an interval of a day between them. For some hours after the second dose no apparent effect was produced. But gradually the animal became dull, lay in the same spot, wasted rapidly away notwithstanding a vigorous appetite, and died of exhaustion on the thirteenth day. Half a grain causes insupportable dryness in the throat, which does not go off for several hours.[1572] With these results the contemporaneous and unconnected researches of Dr. Schumann accord very remarkably. Alcohol boiled on the poison-sausage deposited on cooling a fatty matter, which, when washed with distilled water, possessed all the properties specified by Buchner, as characterizing his fatty acid, and acted on animals in the same way as the sausage-poison.[1573]
The poison of cheese has been for some time more generally known. Dr. Henneman has published an interesting essay on several cases which happened at Schwerin in 1823.[1574] Another account of a similar accident which happened at Minden in 1825 has been published in Rust’s Magazin.[1575] But by far the best information on the subject is to be obtained from two papers in Horn’s Archiv,—the one by Professor Hünefeld of Greifswald, describing the phenomena as he witnessed them in that city in 1827, and containing an elaborate chemical analysis and physiological experiments, by means of which he conceives he has discovered the deleterious principles contained in the cheese,[1576]—the other by Dr. Westrumb of Hameln, who investigated the particulars of seven cases which came under his notice in 1826, and with the aid of Sertürner, the chemist, traced the properties of the poison to almost the same principles with those indicated by the researches of Hünefeld.[1577] Besides the cases which have given origin to these papers, others have occurred throughout Germany in the same period; and during the third quarter of last century this kind of poisoning was so common, that several of the German states investigated the subject, and legislative enactments were passed in consequence.
For a long time the prevalent belief was that the cheese acquired an impregnation from copper vessels used in the dairies; and accordingly the Austrian, Wirtemberg and Ratesberg States prohibited the use of copper for such purposes. This opinion, however, was proved by chemical analysis to be untenable; and the inquiries of Hünefeld and Sertürner, have now rendered it probable that the poisonous property of the cheese resides in two animal acids, analogous, if not identical, with the caseïc and sebacic acids.
The mode in which the formation of these acids is accounted for is as follows. According to the researches of Proust the sharp peculiar taste of old cheese is owing to the gradual conversion of the curd or casein into the caseate of ammonia, which in sound cheeses is always united with the excess of alkali. In the cheese in question (barscher-käse, quark-käse, hand-käse) the curd, before being salted, is left for some time in a heap to ferment, in consequence of which it becomes sour and afterwards ripens faster. But if the milk has been curdled with vinegar,—if the acid liquor formed while it ferments is not carefully drained off,—if the fermentation is allowed to go too far,—if too little salt is used in preserving the curd,—or if flour has been mixed with the curd, the subsequent ripening or decaying of the cheese follows a peculiar course, and a considerable excess of caseïc acid is formed, as well as some sebacic acid.
The poisonous cheeses, according to Westrumb, present no peculiarity in their appearance, taste or smell. But Hünefeld says that they are yellowish-red, soft, and tough, with harder and darker lumps interspersed, that they have a disagreeable taste, redden litmus, and becomes flesh-red instead of yellow, under the action of nitric acid.
The symptoms they cause in man appear to be nearly the same with those produced by the poisonous sausage, and usually commence, according to Hünefeld, in five or six hours, according to Westrumb in half an hour. They constitute various degrees and combinations of gastro-enteric inflammation. In the most severe of Hünefeld’s cases the quantity taken did not exceed four ounces, and was sometimes only an ounce.
The same author found that a drachm and a half of the caseïc acid, which he procured from the cheese, killed a cat in eight minutes, and the same quantity of the sebacic acid another in three hours. His experiments, however, are not quite conclusive of the fact that these acids are really the poisonous principles, as he has not extended his experimental researches to the caseïc and sebacic acids prepared in the ordinary way. His views will probably be altered and simplified, if future experiments should confirm the late inquiries of Braconnot, who has stated that Proust’s caseïc acid is a modification of the acetic, combined with an acrid oil.[1578] Westrumb procured analogous results with those of Hünefeld when he gave to animals the acid fat which he separated in the course of his analysis.
The poisonous cheese has been hitherto met with chiefly in some parts of Germany. From information communicated to me by Dr. Swanwick of Macclesfield, there is some reason to think that a parallel poison is occasionally met with in Cheshire, among the small hill-farms, where the limited extent of the dairies obliges the farmer to keep the curd for several days before a sufficient quantity is accumulated for the larger cheeses.—I am indebted to Mr. Wilson of Lockerby for the particulars of a set of cases, which seem to have been owing to some obscure poison in cheese. A gentleman, an hour after eating the suspected cheese, was seized with extreme weakness and severe vomiting for four hours, then with general soreness and a mercurial taste in the mouth, and afterwards with tenesmus, bloody stools, soreness of the gums, and cramps in the limbs; from which symptoms he did not recover for four weeks. Five other members of his household suffered similarly, but less severely, and also the shop-boy who ate a little while selling it. None of the ordinary mineral poisons could be detected in it.—It is hardly necessary to add, that analogous properties may be imparted to cheese by the intentional or accidental addition of other poisons of a mineral nature. This subject has been already alluded to in the section upon lead.
As connected, though indeed but remotely, with the cheese-poison, some notice may be here taken of a peculiar mode in which it has been supposed that milk may acquire the properties of an acrid poison. It has been several times remarked on the continent, that the milk even of the cow, but more particularly that of the ewe and goat, may act like a violent poison, although no mineral or other deleterious impregnation could be detected in it; and these effects have been variously and vaguely ascribed to the animal having been diseased, or to its having fed on acrid vegetables, which pass into the milk without injury to its health, because though poisonous to most animals, they are not so to the Ruminantia. This singular topic cannot be thoroughly investigated, as precise facts are still wanting. But the two following examples of the accident alluded to may be mentioned. One occurred at Aurillac, a village in France. Fifteen or sixteen customers of a particular dealer in goats’ milk were at one and the same time attacked with all the symptoms of violent cholera; and about twenty-four hours afterwards the goat too was taken ill with the same affection, and died in three days.[1579] The other instance occurred at Hereford in Westphalia. Six people of a family, after partaking of goat’s butter-milk, were simultaneously attacked with violent vomiting, tension of the epigastrium, and retraction of the lower belly; and several of them suffered so severely as even to have been thought by their physician, Dr. Bonorden, to be in danger.[1580] Dr. Westrumb has alluded to similar cases in his memoir on the poison of cheese, and has proved that the ordinary explanations of them are far from satisfactory. Among other judicious observations he remarks, that the poison has been generally believed to arise sometimes from the cattle having fed on the Euphorbia esula, a species of spurge; that, according to Viridet in his Tractatus de Prima Coctione, l. i. c. 15, certain fields in the neighbourhood of Embrim were of necessity abandoned by the shepherds, because the milk of their cows was rendered useless by the abundance of that plant among the herbage; but that he himself has found cattle will not touch it so long as grass and other wholesome vegetables are to be found in the pasturage.[1581] Professors Orfila and Marc, who were appointed by the Society of Medicine of Paris to report upon the accident at Aurillac, state, that in parallel cases which had been referred to them by the police at Paris they had been unable to detect any mineral poison; that none of the received explanations are in their opinion satisfactory; and that they are disposed to ascribe the poisonous alteration of the milk to new principles formed by a vital process.
Another common article of food, which has occasionally produced similar effects with the poisonous sausages and cheese, is bacon. Dr. Geiseler has related an accident which occurred in a family of eight persons, and which he traced to this cause. The symptoms were almost exactly the same with those described by Kerner, with the addition, however, of delirium and loss of recollection; and in two they were so violent as seriously to endanger life. The father of the family alone escaped, having stewed his bacon, while the rest ate it raw.[1582] His escape might have arisen from the fatty acid having been decomposed, or the acrid oil expelled, by the heat. It is not improbable that other varieties of cured meat may also become poisonous. Cadet de Gassicourt mentions, that he had been frequently desired by the police to examine cured meat which had produced symptoms of poisoning at Paris,[1583] and Orfila makes the same remark in his Lectures on Medical Jurisprudence.[1584] As the meat always came from the shops of meat-curers, and did not contain any mineral poison, it probably owed its qualities to the same ingredient as the bacon in Geiseler’s cases. A full and interesting account of an accident of the kind has also been given by M. Ollivier, of which the following is an analysis. Three members of a family at Paris, on the day after eating a ham-pie, were seized with shivering, cold sweats, violent pain in the stomach, frequent vomiting, burning thirst, excessive tenderness of the belly, profuse purging, and colic; but they all recovered under antiphlogistic treatment. On subsequent inquiry it appeared that about the same period other customers of the pastry-cook who supplied the pie had been similarly affected; and consequently an investigation was made into the cause under the authority of the police. After a very careful analysis, however, by MM. Barruel and Ollivier, it was clearly made out, that the pie did not contain a trace of any of the common mineral poisons; and therefore the only conclusion Ollivier conceived it possible to draw was, that the ham had acquired the properties of the poisonous sausage or cheese of Germany.[1585] Two similar reports have been since published, one by MM. Lecanu, Labarraque, and Delamorlière, another by Chevallier; and both agree in ascribing the poisonous effects to the decay of the meat, the ordinary poisons having been sought for in vain. In the cases examined by Chevallier, the article was a sort of sausage, called in Paris “Italian Cheese,” and made of scraps of various kinds of meat, especially pork.[1586] M. Boutigny has published an account of a similar accident which befel a great number of people at a festival in France. He could not find any of the ordinary poisons in the meat, which had been taken chiefly in the form of sausages; and being consequently persuaded that the suspected articles were wholesome, he dined on stuffed turkey, sold by the dealer who had supplied them. But he was seized with chilliness, contracted pulse, cold sweating, lividity of the countenance, great anxiety, and then with vomiting and purging; after which he slowly recovered.[1587]
Other articles of food have been occasionally observed to act injuriously on the health. Thus M. Ollivier has given an account of a whole family having been apparently poisoned with mutton under the influence of modified decay. Six individuals were attacked soon after dinner with vomiting, purging, colic, tenderness of the belly, extreme prostration, and a small hurried pulse. Four of them died within eight days. General inflammatory redness, with some extravasation under the mucous coat, was found throughout the whole course of the small intestines. No trace could be detected of any of the ordinary poisons; and Ollivier was therefore led to ascribe the accident to some peculiar change produced in stewed mutton, which all the individuals had partaken of at dinner.[1588] In 1839 a singular accident happened at Zurich, which was ascribed to decayed veal and ham. On a fete-day 600 people, who had dined upon cold roast-veal and ham in a wooden erection, were all taken ill with shivering, giddiness, headache, burning fever, diarrhœa and vomiting; some had delirium, others a fœtid salivation and even ill-conditioned ulcers of the mouth; and in the worst cases collapse of the countenance, involuntary stools, and extreme prostration preceded death. On dissection the alimentary mucous membrane was found softened and the intestinal follicles ulcerated. The cause was supposed to have been satisfactorily traced to incipient putrefaction of the veal and ham, which constituted the fundamental part of the repast.[1589] Effects somewhat similar have been observed from spoiled goose-grease, used in dressing food. Dr. Siedler has related four cases where violent symptoms were thus induced. Two adults and two children, after eating a dish seasoned with goose-grease, were seized with giddiness, prostration of strength, anxiety, sweating,—burning pain in the lower belly, aggravated by pressure,—violent vomiting, in one case sanguinolent,—involuntary stools, and urine, and dilatation of the pupil. In one of the adults there was also complete insensibility, with imperceptible pulse for six minutes. No metallic poison could be found. The grease was acid, and of a repulsive odour; and three ounces given to a dog acted violently and in the same manner.[1590] Another article of food which has appeared occasionally to produce parallel effects is smoked sprats. An instance of their injurious operation is briefly described in the work quoted below;[1591] and Dr. O’Shaughnessey informed me some years ago, that, while in London, he met with the case of a female, advanced in pregnancy, who after eating smoked sprats, in which she remarked a disagreeable sharp taste, was attacked with severe colic, sickness, vomiting of food mixed with streaks and clots of blood, and some diarrhœa. Putrid pickled salmon has occasioned death in this country;[1592] and I may mention that I have known most violent diarrhœa occasioned in two instances by a very small portion of the oily matter about the fins of kipper or smoked salmon, so that I have no doubt a moderate quantity would produce serious effects.
Although these illustrations of the effects of modified putrefaction in rendering wholesome meat noxious have been taken in a great measure from continental experience, this has been done rather because the subject has been more fully and accurately investigated there, than because similar poisons are unknown in Britain. The defective system of medical police in this country would allow such accidents as those mentioned above to pass sometimes without notice, and almost always without scientific examination; but it must not therefore be supposed that they are wholly unknown.
The following incident, which happened a few years ago on the Galloway coast, is an instance of poisoning not less alarming than any of those which have occurred in Germany. In the autumn of 1826 four adults and ten children ate at dinner a stew made with meat taken from a dead calf, which was found by one of them on the sea shore, and of which no history could be procured. For three hours no ill effect followed. But they were then all seized with pain in the stomach, efforts to vomit, purging, and lividity of the face, succeeded by a soporose state like the stupor caused by opium, except that when roused the patient had a peculiar wild expression. One person died comatose in the course of six hours. The rest, being freely purged and made to vomit, eventually got well; but for some days they required the most powerful stimulants to counteract the exhaustion and collapse which followed the sopor. The meat, they said, looked well enough at the time it was used. Yet the remains of the fish which formed the noxious meal had a black colour and nauseous smell; and the uncooked flesh had a white, glistening appearance, and was so far decayed that its odour excited vomiting and fainting.[1593] It is much to be regretted that this accident was not properly inquired into. The only conjecture which the facts will warrant as to the cause of the poisonous quality of the meat is, that in consequence of having lain long in the water, the flesh had begun to undergo the adipocirous putrefaction; and that in the course of the changes thus induced the meat became impregnated with some poisonous principle, like that of the German sausages, or cheese.
An accident of a similar nature, for the particulars of which I am indebted to Dr. Swanwick of Macclesfield, occurred at Stockport in the summer of 1830. A family of five persons took for dinner broth made of beef, which, owing to its black colour, the master of the family had previously said to his wife he thought bad and unfit for use. In the course of some hours two boys were attacked with sickness and vomiting, but appear to have got soon well, probably owing to the early discharge of the poison. Next morning a washerwoman who had dined with the family was seized with violent pain in the bowels, diarrhœa, racking pains and weakness in the limbs; and she did not recover for ten days. On the evening of the second day the master of the house was similarly affected, and was ill for a fortnight. And a day later his wife was also seized with a similar disorder, preceded by soreness of the throat and tongue and difficulty of swallowing, and ending fatally in fourteen days. The last person was previously in delicate health, and subject to disorder in the stomach and bowels. The investigation made by the police authorities into the circumstances of this accident was extremely imperfect: but there seems little reason to doubt that unsound meat was the cause.
I am not sure under what head to arrange the following observations, communicated to me by Dr. M’Divitt of Canterbury, and of which he has since published a detailed account.[1594] But they may be mentioned, perhaps not inappropriately, in the present place; and at all events they deserve careful attention, as referring to a description of cases which may be mistaken for other kinds of poisoning.
It is well known that pork in all forms, but especially when fresh, is apt to cause indigestion in many persons who are not accustomed to it. But Dr. M’Divitt has shown by a number of interesting cases, that even in those habituated to its use, it may, from unascertained causes, excite symptoms closely allied to those of irritant poisoning. The effects sometimes begin within three hours, the symptoms being those of an affection of the stomach, such as sudden violent pain in the epigastrium, difficult breathing, irregularity of the pulse, great prostration and alarm, coldness of the extremities and vomiting. If a longer period elapses,—and sometimes no injury accrues for many hours, or even a whole day,—the symptoms indicate an affection of the abdomen, namely, pain in the region of the duodenum, or of the sigmoid flexure of the colon, with the other symptoms just enumerated, but which ere long become attended with more pungent pain, tension and tenderness of the belly, frequency of the pulse, and ineffectual straining to evacuate the bowels. In the less urgent and slower cases of this nature there is little or no vomiting. Sometimes nettle-rash appears. Stimulants, opiates, and blood-letting are of no avail; and the only useful remedies are emetics and cathartics, which speedily put an end to the symptoms by removing their cause. In all the cases related by the author the pork was either fresh or recently salted, fatter than usual, but not ill preserved or otherwise faulty in any appreciable respect. In every instance the individuals had eaten pork often before without injury; and on several occasions others ate without harm the same pork which seemed deleterious.
XXV. OF POISONING BY MECHANICAL IRRITANTS
The fifth order of the irritant class of poisons includes mechanical irritants.
These substances have not properly speaking any poisonous quality; but occasion symptoms like those of poisoning, and even sometimes death itself, in consequence of their mechanical qualities only. They have therefore been excluded from every toxicological system proposed in recent times; but in a medico-legal work on poisoning it would be wrong to pass them without notice.
The most important of the mechanical irritants are those which cause injury by reason of their roughness, sharpness, or size.
Many instances have occurred of persons having swallowed fragments of steel, copper, iron, broken glass, or entire prune-stones, cherry-stones, and the like,—who not long afterwards were attacked with signs of inflammation, or some other abdominal disease, and were carried off by it as by the administration of poison. The disorders thus induced are almost always of a chronic or lingering kind, and commonly depend on gradual perforation of the intestines by the foreign body pressing on the coats. In general the illness ends in inflammation of the peritonæum. Sometimes the irritating substance perforates the skin and muscles as well as the intestines, and escapes outwardly; and a few individuals have even recovered under these circumstances. An excellent account of the ordinary course of such accidents is given in the London Medical and Physical Journal. The person swallowed a chocolate bean, and after experiencing many uneasy sensations throughout the belly for several days, was attacked with peritonitis and died.[1595] Mr. Howship has related the particulars of the case of a woman, died after two years of constant suffering, in consequence of having swallowed a large quantity of cherry-stones.[1596] Dr. Marcet has also described the case of a sailor who died in a similar way after swallowing several large clasp-knives.[1597] Thus too, although it is a familiar fact, that needles and pins are in general swallowed with impunity, death nevertheless sometimes arises from this cause. Guersent mentions the case of a child who died in the course of two months of frequent vomiting caused by swallowing a pin, which was found after death pinning the stomach, as it were, to the liver.[1598] Dupuytren relates the case of a woman, who, after swallowing an incredible number of needles and pins, became very lean and was confined to bed by the excruciating pain excited on motion by the needles and pins escaping through the skin. There were seldom less than fifty tumours or abscesses on various parts of the body; and Dupuytren, on opening about a hundred of these, invariably found one or more needles or pins in each. She laboured under general debility, irritative fever, and marasmus, and at length died hectic. After death many hundred pins and needles were found among the muscles and viscera.[1599] Many other examples might be referred to, but these will suffice for information on the ordinary effects of mechanical irritants of the kind under consideration.
From the case of Dr. Marcet and other similar facts, it appears that large and even angular bodies do not always cause serious mischief, nay, that they have been frequently swallowed without any material injury. Dr. Marcet’s sailor in the course of his life had repeatedly swallowed several clasp-knives in quick succession: and nevertheless recovered perfectly after some days of slight illness. As to prune and cherry-stones, buttons, coins, needles, pins, and the like, they have been very often taken, and even sometimes in large quantities, without any harm. It is indeed extraordinary, and almost incredible, if the facts were not authenticated beyond the possibility of a doubt, how much mechanical irritation the alimentary canal has been subjected to, without sustaining any injury. Mr. Wakefield mentions that a man, who was committed to the House of Correction, swallowed seven half-crowns, to prevent the prison authorities from depriving him of them. He suffered no inconvenience for twenty months; when, after an attack of sickness, slight bowel-complaint, and general tenderness of the belly, he discharged them all at one evacuation.[1600] Many singular instances to the same effect have been related in the various medical journals of Europe. At the head of the list, however, may be placed the following, which is related by the late Professor Osiander of Göttingen, in his work on Suicide.
A young German nobleman tried to kill himself in a fit of insanity by swallowing different indigestible substances, but without success. He never suffered any particular inconvenience except a single attack of vomiting daily, though in the course of seven months after being detected he passed the following articles by stool—150 pieces of sharp, angular glass, some of them two inches long—102 brass pins—150 iron nails—three large hair pins, and seven large chair-nails—a pair of shirt-sleeve buttons—a collar-buckle, half of a shoe-buckle, and three bridle-buckles—half a dozen sixpenny pieces—three hooks, and a lump of lead—three large fragments of a currycomb, and fifteen bits of nameless iron articles, many of them two inches in length.[1601]
Before such articles occasion serious harm, it is necessary that some cause coincide, by means of which the foreign bodies are detained long in the same part of the intestines; otherwise the irritation they produce is too trivial to excite disease.
The only substance of this kind which it is necessary to particularize is pounded glass. A common notion prevails that pounded glass is an active poison. There is no doubt, indeed, that it does possess some irritant properties even when finely pulverized; for it titillates and smarts the nostrils, and inflames the eyes. There is also little doubt that when swallowed in fragments of moderate size, especially if the stomach is empty, it may wound the viscera. But it is in this way only that it has any action when swallowed, and even then its effects are by no means uniformly serious. It can have no chemical action on the stomach; it cannot act through absorption, as it is quite insoluble: and when finely pulverized, it cannot easily wound the villous coat of the alimentary canal, on account of the abundance and viscidity of the lubricating mucus.
Accordingly, M. Lesauvage ascertained that 2½ drachms of the powder may be given to a cat at once without hurting the animal,—that in the course of eight days seven ounces might be given to a dog without any bad consequence, although the period chosen for administering it was always some time before meals,—and that even when the glass was in fragments a line in length, no symptoms of irritation were induced. Relying indeed on these results he himself swallowed a considerable number of similar fragments; and did not sustain any injury.[1602] Caldani likewise, an Italian physician, after some experiments on animals, gave a boy fifteen years old several drachms of pounded glass, without observing any bad effects; and at his request Mandruzzato repeated his experiments on animals, and himself swallowed on two successive days two drachms and a half each day without sustaining any injury.[1603]
Similar observations have been made by others also. Dr. Turner of Spanish Town, Jamaica, has informed me, that an attempt was made there by a negro to poison a whole family by administering pounded glass; but, although a large quantity was taken by seven persons, none of them suffered any inconvenience. Not long ago the occurrence of a similar case at Paris gave rise to a careful investigation of the whole subject by Baudelocque and Chaussier. A young man, Lavalley, married a girl who was pregnant by him; but it was agreed that she should live with her father till her delivery was over. A month after the marriage Lavalley invited his wife and father-in-law to dinner; and his wife ate heartily boiled pork, bloody-sausages, and roast-veal, and subsequently drank coffee with brandy in it. On returning home in the evening she became unwell, continued so all night, next morning was seized with violent pain in the stomach and vomiting, and died in convulsions. The period of her death is not mentioned in the report I have seen. A suspicion of poisoning having arisen after burial, the body was disinterred in forty-two days; and, although it was much decayed, black points and patches could be distinguished in many parts of the bowels, together with a quantity of broken down glass. The medical inspectors accordingly declared that she had died of poisoning with pounded glass; and the husband was imprisoned. Baudelocque and Chaussier, who were consulted, ascribed the black patches to putrefaction or venous congestion, and declared that in whatever way the glass had got into the bowels, she had not died of poisoning with the substance, as pounded glass is not deleterious.[1604] A similar opinion as to the properties of pounded glass was more lately given by Professor Marc, when consulted on a case of attempted poisoning, in which the person against whom the attempt was made felt the rough particles in his mouth while taking the second spoonful of soup in which the glass was contained.[1605]
This opinion certainly appears to be in general true. At the same time instances are not wanting to render it probable, that pounded or broken glass is occasionally hurtful. Thus, passing over the more doubtful examples recorded by the older authors, we have the two following cases related by good authorities in the most modern times. One has been published by Mr. Hebb of Worcester. A child, eleven months old, died of a few days’ illness in very suspicious circumstances. On Mr. Hebb being requested by the coroner to examine the body, he found the inside of the stomach lined with a tough layer of mucus streaked with blood; the villous coat was highly vascular, and covered with numberless particles of glass of various sizes, some of which simply touched, while others lacerated it; and no other morbid appearance could be detected in the body.[1606] The other case is described by Portal. A man undertook for a wager to eat his wine-glass, and actually swallowed a part of it. But he was attacked with acute pain in the stomach, and subsequently with convulsions. Portal made him eat a surfeit of cabbage; and having thus enveloped the fragments, administered an emetic, which brought away the glass and vegetables together.[1607] The same feat has undoubtedly been sometimes accomplished with impunity. For example, in the Edinburgh Medical and Surgical Journal, an instance is related of a man who champed and swallowed three-fourths of a drinking-glass without suffering any harm; and the person mentioned by Osiander swallowed many pieces of glass, and sustained no inconvenience (p. 503). But these facts will not altogether outweigh the equally pointed narratives of Portal and Mr. Hebb. And, on the whole, the medical jurist must come to the conclusion, that broken and pounded glass, though generally harmless, may sometimes prove injurious or even fatal.[1608] Powdered glass, however, is probably inert.
Another variety of injury from the mechanical irritants is inflammation from hot liquids, such as melted lead or boiling water. These, when swallowed, may unquestionably cause serious mischief, and even death; and the symptoms they induce are exactly those of the irritant poisons properly so called.
The effects of boiling water have been investigated experimentally by Dr. Bretonneau of Tours; and the results illustrate forcibly the observations which have been repeatedly made in the course of this work, respecting the slight constitutional derangement caused by such poisons as have merely a local irritating power. He found that when boiling water was injected in the quantity of eight ounces into the stomach of dogs, it excited inflammation, passing on to gangrene, both in the villous and muscular coats. The symptoms, however, were trifling. For a day or two the animals appeared languid; but in three days they generally became lively and playful, one of them actually lined a bitch, and it was only on strangling them and examining the bodies, that the extent of the mischief was discovered.[1609]
I am not aware that any such case have hitherto occurred in man. Death from drinking boiling water, indeed, is not an uncommon accident, particularly in Ireland and some parts of England, where children, who are in the habit of drinking cold water from the tea-kettle, have swallowed boiling water by mistake. It appears, however, that in these instances death is not owing to inflammation of the gullet and stomach, but to inflammation of the upper part of the windpipe,—the water never passing lower than the pharynx. The best information on this subject is contained in an interesting paper by Dr. Hall.[1610] He has there given the particulars of four cases which came under his notice; from which it follows that the disease induced is always cynanche laryngea, proving fatal by suffocation. Two of his patients died suffocated; another, while in imminent danger, was relieved by tracheotomy, but died afterwards of exhaustion; the fourth recovered suddenly during a fit of screaming, when apparently about to be choked; and it was supposed that the vesicles around the glottis had been burst by the cries.
Pouring melted lead down the throat was a frequent mode of despatching criminals and prisoners in former ages. Only one authentic case is to be found on record of death from this cause in modern times. It occurred at the burning of the Eddistone light-house. A man, while gazing up at the fire with his mouth open, received a shower of melted lead from the building, and expired after twelve days of suffering. Seven ounces and a half of lead had reached the stomach; and the stomach was severely burnt, and ulcerated.[1611]
In concluding the Irritant Poisons, and before proceeding to the next class, the Narcotics, it is necessary to observe, that besides the substances which have been treated of, there are others not usually considered poisons, and some that are even used daily for seasoning food, which, nevertheless, when taken in large quantities, will prove injurious and even occasion all the chief symptoms of the active irritants. These substances connect the true poisons with substances which are inert in regard to the animal economy.
It is impossible to particularize all the articles of the kind now alluded to. But in illustration, I may refer in a few words to six common substances, pepper, Epsom salt, alum, cream of tartar, sulphate of potash, and common salt.
Pepper, which is daily used by all ranks with impunity, will nevertheless cause even dangerous symptoms when taken in large quantity. In Rust’s Journal is noticed the case of a man affected with a tertian ague, who after taking between an ounce and a half and two ounces of pepper in brandy, was attacked with convulsions, burning in the throat and stomach, great thirst, and vomiting of every thing he swallowed. His case was treated as one of simple gastritis, and he recovered.[1612]
A very striking instance, which may be arranged under the present head, has also been related to me, of apparent poisoning with Epsom salt. A boy ten years old took two ounces of this laxative partly dissolved, partly mixed in a tea-cupful of water; and had hardly swallowed it before he was observed to stagger and become unwell. When the surgeon saw him half an hour after, the pulse was imperceptible, the breathing slow and difficult, the whole frame in a state of extreme debility, and in ten minutes more the child died without any other symptom of note, and in particular without any vomiting. The circumstances having been investigated judicially, it appeared that the substance taken was pure Epsom salt; that the father, who was doatingly fond of the child, gave the laxative on account of a trifling illness which he supposed might arise from worms; and that on the most careful inspection of the body, no morbid appearance whatever could be found in any part of it. For the particulars of this singular case, I am indebted to Dr. Dewar of Dunfermline, the medical inspector under the sheriff’s warrant. It shows that in certain circumstances even the laxative neutral salts may be irritating enough to cause speedy death.
Of the same nature probably are the cases which have lately led some to ascribe poisonous properties to sulphate of potash, a purgative salt at one time in common use. About three years ago several instances of apparent poisoning with this substance occurred in Paris; and one of them proved fatal. This was the case of a woman, recently delivered, who got 100 grains every fifteen minutes till she had taken six doses. Immediately after the first dose she was seized with severe pain in the stomach, nausea, vomiting, numbness, and cramps in the arms and legs, then with dyspnœa and severe purging, and in two hours she expired. The stomach and intestines were emphysematous, but otherwise healthy; and the stomach contained sulphate of potash, but not a trace of any of the common poisons. The stock of this salt in the shop where it had been purchased was found to be perfectly pure.[1613]—A remarkable case of the same kind lately led to a criminal trial in London. A man Haynes was charged with attempting to procure abortion by giving his wife sulphate of potash. It was proved that on two successive evenings he gave her a dose of two ounces of the salt; that she was seized after the first dose with excessive and alarming sickness, from which, however, she soon recovered without apparent harm; but that after the second dose she had violent vomiting and profuse purging, of which she died in five hours, without any alteration in the symptoms, except that she became insensible for five minutes before death. The whole gastro-intestinal mucous membrane was bright red, the vessels of the brain were much congested, and between two and three ounces of blood had escaped from the neighbourhood of the occipital sinus. The salt had been swallowed in a single tumbler of water, so that part of it was undissolved. Mr. Brande, who analyzed the sample which had been used, found it free of all the ordinary irritant poisons. Mr. Coward of Hoxton, to whom I owe the particulars of this singular case, was of opinion, along with other medical gentlemen concerned in it, that death arose from apoplexy brought on by the violent and unceasing vomiting.
Another cathartic, undoubtedly in general very mild in its action, the bitartrate of potash, has also proved fatal, when taken in immoderate quantity. Thus, a man, endeavouring to quench his thirst and cool his stomach the morning after he had been drunk, ate a quarter of a pound of this salt in lumps at once, and a good deal more throughout the day afterwards. He was in consequence attacked with incessant vomiting, frequent purging, and other signs of irritation in the alimentary canal. He died on the third day; and the stomach and bowels were found much inflamed.[1614]
Even common salt has been known to act as a poison when taken in large quantity. A striking instance of the kind occurred in London in September, 1828. A man, who had been in the custom of exhibiting various feats of gluttony, proposed to some of his comrades one afternoon to sup a pound of common salt in a pint of ale, and actually finished his nauseous dish, but not without being warned of his imprudence by an attack of vomiting in the middle of it. He was soon after seized with all the symptoms of irritant poisoning, and died within twenty-four hours. The stomach and intestines were found after death excessively inflamed.[1615] This remarkable case is not without its parallel. In 1839, a girl in the North of England died in consequence of taking upwards of half a pound of salt as a vermifuge.[1616] Not long ago I met with an instance of somewhat similar, but less violent effects. A student having taken upwards of two ounces of salt as an emetic, dissolved in a small quantity of water, was seized with acute burning pain in the stomach, tenderness in the epigastrium and great anxiety, without any vomiting until he drank a large quantity of warm water as a remedy. Before I saw him he had vomited freely, but still suffered severe, intermitting pain, which was removed by a large dose of muriate of morphia.
In France, though not hitherto, so far as I know, in Britain, several instances have occurred of extensive sickness in particular districts, which have been traced to the accidental adulteration of common salt with certain deleterious articles. In an investigation conducted by M. Guibourt, in consequence of several severe accidents having been produced apparently by salt in Paris and at Meaux, oxide of arsenic was detected;[1617] and this discovery was subsequently confirmed by MM. Latour and Lefrançois, who ascertained that the proportion of arsenic was sometimes a quarter of a grain per ounce.[1618] Another singular adulteration which appears fully more frequent is with hydriodate of soda. At a meeting of the Parisian Academy of Medicine in December, 1829, a report was read by MM. Boullay and Delens, subsequent to an inquiry by M. Sérullas, into the nature of a sample of salt which appears to have occasioned very extensive ravages. In 1829, various epidemic sicknesses in certain parishes were suspected to have arisen from salt of bad quality. In the month of July no less than 150 persons in two parishes were attacked, some with pain in the stomach, nausea, slimy and even bloody purging, others with tension of the belly, puffiness of the face, inflammation of the eyes and swelling of the legs; and in several parishes in the Department of the Marne a sixth part of the population was similarly affected. The salt being suspected to be the source of the mischief, as it had an unusual smell which some compared to the effluvia of marshy ground, M. Sérullas analyzed it, and after him MM. Boullay and Delens; and both analyses indicated the presence of a hundredth of its weight of hydriodate of soda, besides a little free iodine.[1619] Subsequently, in reference to the discovery of arsenic by other chemists in different samples of suspected salt, M. Sérullas repeated his analysis, but could detect none of that poison.[1620] Still more lately the whole subject has been investigated with great care by M. Chevallier.[1621] M. Barruel states that he observed the occasional adulteration of salt with some hydriodate accidentally in 1824, while preparing experiments for Professor Orfila’s lectures. He found it in two samples from different grocers’ shops in Paris.[1622] No satisfactory explanation has yet been given of the source of the adulteration with arsenic; but the presence of hydriodate of soda has been traced to the fraudulent use of impure salt from kelp [see p. 160].
Some difference of opinion prevails among toxicologists in regard to the alleged deleterious qualities of alum. On the whole it scarcely appears so active as to deserve the name of a poison; yet, like other salts, it may in large doses do serious injury. It merits particular mention among the present description of substances, partly on account of a trial at Paris, where dangerous effects were alleged to have been produced by it, and partly for the physiological inquiries made on that occasion. A druggist supplied a lady by mistake with powder of burnt alum instead of gum-arabic; and the lady, who had long laboured under chronic derangement of the stomach and bowels, took a single dose of a solution containing between ten and twenty grains of the salt. She immediately complained of acute pain in the stomach and gullet, burning in the mouth, and nausea; the symptoms of a severe attack of inflammation in the stomach and bowels ensued; and she was not considered out of danger for several days. The druggist was accordingly prosecuted, and heavy damages claimed. The attending physician ascribed the symptoms to the alum. But Marc and Orfila, who were consulted, declared that this was impossible except on the supposition that the lady had a very unusual sensibility of the stomach to irritating substances;—that it was a common thing to give three, four, and even five times the quantity in the treatment of diseases, without any such consequences resulting;—and that at the very time of the inquiry a physician in Paris was using it to the amount of six or eight drachms in a day. From an experimental inquiry conducted by Professor Orfila it appears, that large doses of calcined alum, such as one or even two ounces, excite in dogs little more than one or two attacks of vomiting, even although retained between ten and thirty minutes,—that one ounce will not excite any marked symptoms though secured in the stomach by a ligature,—but that two ounces given in the same way prove fatal in five hours, under symptoms of excessive exhaustion and insensibility.[1623] A similar inquiry was instituted about the same time by M. Devergie, who seems, however, to have remarked more activity in alum than is indicated by Orfila’s experiments. He infers that two ounces may sometimes kill dogs, even though they vomit freely; that half that quantity is fatal if the gullet be tied; that calcined alum is more active than a solution of the salt; that it is a corrosive or irritant; and that probably man is more sensible to its operation than the lower animals.[1624] Whatever may be thought of the effects of alum on the animal body when administered in large doses, it is plain from its frequent medicinal use as an internal astringent that it is not poisonous when given in small doses, like that taken by the patient in the trial alluded to. I may add that it appears very doubtful whether any injury accrues from the long-continued use of very small doses. Bakers, it is well known, are in the practice of using it in minute proportion for improving the whiteness of bread; and it has been imagined that chronic disorders of the stomach and bowels may consequently originate, by reason of its constipating tendency. These fears, however, are not borne out by facts. Either the quantity is insufficient to do harm in the way supposed; or the constitution becomes accustomed to the continual operation of the salt, and does not suffer.