VII.—Neutral Sodium, Potassium, and Ammonium Salts.
§ 116. The neutral salts of the alkalies are poisonous, if administered in sufficient doses, and the poisonous effect of the sulphate, chloride, bromide, iodide, tartrate, and citrate appears to depend on the specific action of the alkali metal, rather than on the acid, or halogen in combination. According to the researches of Dr. Ringer and Dr. Harrington Sainsbury,[126] with regard to the relative toxicity of the three, as shown by their effect on the heart of a frog—first, the potassium salts were found to exert the most poisonous action, next come the ammonium, and, lastly, the sodium salts. The highest estimate would be that sodium salts are only one-tenth as poisonous as those of ammonium or potassium; the lowest, that the sodium salts are one-fifth: although the experiments mainly throw light upon the action of the alkalies on one organ only, yet the indications obtained probably hold good for the organism as a whole, and are pretty well borne out by clinical experience.
[126] Lancet, June 24, 1882.
There appear to be four cases on record of poisoning by the above neutral salts; none of them belong to recent times, but lie between the years 1837-1856. Hence, the main knowledge which we possess of the poisonous action of the potassium salts is derived from experiments on animals.
§ 117. Sodium Salts.—Common salt in such enormous quantity as half a pound to a pound has destroyed human life, but these cases are so exceptional that the poisonous action of sodium salts is of scientific rather than practical interest.
§ 118. Potassium Salts.—Leaving for future consideration the nitrate and the chlorate of potassium, potassic sulphate and tartrate are substances which have destroyed human life.
Potassic Sulphate (K2SO4) is in the form of colourless rhombic crystals, of bitter saline taste. It is soluble in 10 parts of water.
Hydropotassic Tartrate (KHC4H4O6), when pure, is in the form of rhombic crystals, tasting feebly acid. It is soluble in 210 parts of water at 17°.
§ 119. Action on the Frog’s Heart.—Both excitability and contractility are affected to a powerful degree. There is a remarkable slowing of the pulsations, irregularity, and, lastly, cessation of pulsation altogether.
§ 120. Action on Warm-Blooded Animals.—If a sufficient quantity of a solution of a potassic salt is injected into the blood-vessels of an animal, there is almost immediate death from arrest of the heart’s action. Smaller doses, subcutaneously applied, produce slowing of the pulse, dyspnœa, and convulsions, ending in death. Small doses produce a transitory diminution of the force of arterial pressure, which quickly passes, and the blood-pressure rises. There is at first, for a few seconds, increase in the number of pulsations, but later a remarkable slowing of the pulse. The rise in the blood-pressure occurs even after section of the spinal cord. Somewhat larger doses cause rapid lowering of the blood-pressure, and apparent cessation of the heart’s action; but if the thorax be then opened, the heart is seen to be contracting regularly, making some 120-160 rhythmic movements in the minute. If the respiration be now artificially maintained, and suitable pressure made on the walls of the chest, so as to empty the heart of blood, the blood-pressure quickly rises, and natural respiration may follow. An animal which lay thirty-six minutes apparently dead was in this way brought to life again (Böhm). The action of the salts of potassium on the blood is the same as that of sodium salts. The blood is coloured a brighter red, and the form of the corpuscles changed; they become shrivelled through loss of water. Voluntary muscle loses quickly its contractility when a solution of potash is injected into its vessels. Nerves also, when treated with a 1 per cent. solution of potassic chloride, become inexcitable.
§ 121. Elimination.—The potassium salts appear to leave the body through the kidneys, but are excreted much more slowly than the corresponding sodium salts. Thus, after injection of 4 grms. of potassic chloride—in the first sixteen hours ·748 grm. of KCl was excreted in the urine, and in the following twenty-four hours 2·677 grms.
§ 122. Nitrate of Potash (KNO3).—Pure potassic nitrate crystallises in large anhydrous hexagonal prisms with dihedral summits; it does not absorb water, and does not deliquesce. Its fusing point is about 340°; when melted it forms a transparent liquid, and loses a little of its oxygen, but this is for the most part retained by the liquid given off when the salt solidifies. At a red-heat it evolves oxygen, and is reduced first to nitrite; if the heat is continued, potassic oxide remains. The specific gravity of the fused salt is 2·06. It is not very soluble in cold water, 100 parts dissolving only 26 at 15·6°; but boiling water dissolves it freely, 100 parts dissolving 240 of the salt.
A solution of nitrate of potash, when treated with a zinc couple (see “Foods,” p. 566), is decomposed, the nitrate being first reduced to nitrite, as shown by its striking a red colour with metaphenylene-diamine, and then the nitrite farther decomposing, and ammonia appearing in the liquid. If the solution is alkalised, and treated with aluminium foil, hydrogen is evolved, and the same effect produced. As with all nitrates, potassic nitrate, on being heated in a test-tube with a little water, some copper filings, and sulphuric acid, evolves red fumes of nitric peroxide.
§ 123. Statistics.—Potassic nitrate, under the popular name of “nitre,” is a very common domestic remedy, and is also largely used as a medicine for cattle. There appear to be twenty cases of potassic nitrate poisoning on record—of these, eight were caused by the salts having been accidentally mistaken for magnesic sulphate, sodic sulphate, or other purgative salt; two cases were due to a similar mistake for common salt. In one instance, the nitrate was used in strong solution as an enema, but most of the cases were due to the taking of too large an internal dose.
§ 124. Uses in the Arts, &c.—Both sodic and potassic nitrates are called “nitre” by the public indiscriminately. Sodic nitrate is imported in large quantities from the rainless districts of Peru as a manure. Potassic nitrate is much used in the manufacture of gunpowder, in the preservation of animal substances, in the manufacture of gun cotton, of sulphuric and nitric acids, &c. The maximum medicinal dose of potassium nitrate is usually stated to be 30 grains (1·9 grm.).
§ 125. Action of Nitrates of Sodium and Potassium.—Both of these salts are poisonous. Potassic nitrate has been taken with fatal result by man; the poisonous nature of sodic nitrate is established by experiments on animals. The action of the nitrates of the alkalies is separated from that of the other neutral salts of potassium, &c., because in this case the toxic action of the combined nitric acid plays no insignificant part. Large doses, 3-5 grms. (46·3-77·2 grains), of potassic nitrate cause considerable uneasiness in the stomach and bowels; the digestion is disturbed; there may be vomiting and diarrhœa, and there is generally present a desire to urinate frequently. Still larger doses, 15-30 grms. (231·5-463 grains), rapidly produce all the symptoms of acute gastro-enteritis—great pain, frequent vomiting (the ejected matters being often bloody), with irregularity and slowing of the pulse; weakness, cold sweats, painful cramps in single muscles (especially in the calves of the legs); and, later, convulsions, aphonia, quick collapse, and death.
In the case of a pregnant woman, a handful of “nitre” taken in mistake for Glauber’s salts produced abortion after half-an-hour. The woman recovered. Sodic nitrate subcutaneously applied to frogs kills them, in doses of ·026 grm. (·4 grain), in about two hours; there are fibrillar twitchings of single groups of muscles and narcosis. The heart dies last, but after ceasing to beat may, by a stimulus, be made again to contract. Rabbits, poisoned similarly by sodic nitrate, exhibit also narcotic symptoms; they lose consciousness, lie upon their side, and respond only to the sharpest stimuli. The breathing, as well as the heart, is “slowed,” and death follows after a few spasmodic inspirations.
Sodic nitrite was found by Barth to be a more powerful poison, less than 6 mgrms. (·1 grain) being sufficient to kill a rabbit of 455·5 grms. (7028 grains) weight, when subcutaneously injected. The symptoms were very similar to those produced by the nitrate.
§ 126. The post-mortem appearances from potassic nitrate are as follows:—An inflamed condition of the stomach, with the mucous membrane dark in colour, and readily tearing; the contents of the stomach are often mixed with blood. In a case related by Orfila, there was even a small perforation by a large dose of potassic nitrate, and a remarkable preservation of the body was noted.
It is believed that the action of the nitrates is to be partly explained by a reduction to nitrites, circulating in the blood as such. To detect nitrites in the blood, the best method is to place the blood in a dialyser, the outer liquid being alcohol. The alcoholic solution may be evaporated to dryness, extracted with water, and then tested by metaphenylene-diamine.
§ 127. Potassic Chlorate (KClO3).—Potassic chlorate is in the form of colourless, tabular crystals with four or six sides. About 6 parts of the salt are dissolved by 100 of water at 15°, the solubility increasing with the temperature, so that at 100° nearly 60 parts dissolve; if strong sulphuric acid be dropped on the crystals, peroxide of chlorine is evolved; when rubbed with sulphur in a mortar, potassic chlorate detonates. When the salt is heated strongly, it first melts, and then decomposes, yielding oxygen gas, and is transformed into the perchlorate. If the heat is continued, this also is decomposed, and the final result is potassic chloride.
§ 128. Uses.—Potassic chlorate is largely used as an oxidiser in calico printing, and in dyeing, especially in the preparation of aniline black. A considerable quantity is consumed in the manufacture of lucifer matches and fireworks; it is also a convenient source of oxygen. Detonators for exploding dynamite are mixtures of fulminate of mercury and potassic chlorate. It is employed as a medicine both as an application to inflamed mucous membranes, and for internal administration; about 2000 tons of the salt for these various purposes are manufactured yearly in the United Kingdom.
§ 129. Poisonous Properties.—The facility with which potassic chlorate parts with its oxygen by the aid of heat, led to its very extensive employment in medicine. No drug, indeed, has been given more recklessly, or on a less scientific basis. Wherever there were sloughing wounds, low fevers, and malignant sore throats, especially those of a diphtheritic character, the practitioner administered potassic chlorate in colossal doses. If the patient died, it was ascribed to the malignity of the disease—if he recovered, to the oxygen of the salt; and it is possible, from the light which of recent years has been thrown on the action of potassic chlorate, that its too reckless use has led to many unrecorded accidents.
§ 130. Experiments on Animals.—F. Marchand[127] has studied the effects of potassic chlorate on animals, and on blood. If either potassic chlorate or sodic chlorate is mixed with fresh blood, it shows after a little while peculiar changes; the clear red colour at first produced passes, within a few hours, into a dark red-brown, which gradually becomes pure brown. This change is produced by a 1 per cent. solution, in from fifteen to sixteen hours; and a 4 per cent. solution at 15° destroys every trace of oxyhæmoglobin within four hours. Soon the blood takes a syrupy consistence, and, with a 2-4 per cent. solution of the salt, passes into a jelly-like mass. The jelly has much permanence, and resists putrefactive changes for a long time.
[127] Virchow’s Archiv. f. path. Anat., Bd. 77, Hft. 3, S. 455, 1879.
Marchand fed a dog of 17 kilos. in weight with 5 grms. of potassic chlorate for a week. As there were no apparent symptoms, the dose was doubled for two days; and as there was still no visible effect, lastly, 50 grms. of sodic chlorate were given in 5 doses. In the following night the dog died. The blood was found after death to be of a sepia-brown colour, and remained unaltered when exposed to the air. The organs were generally of an unnatural brown colour; the spleen was enormously enlarged; the kidneys were swollen, and of a dark chocolate brown—on section, almost black-brown, the colour being nearly equal, both in the substance and in the capsule. A microscopical examination of the kidney showed the canaliculi to be filled with brownish cylinders consisting of altered blood. A spectroscopic examination of the blood showed weak hæmoglobin bands, and a narrow band in the red. With farther dilution, the hæmoglobin bands vanished, but the band in the red remained. The diluted blood, when exposed to the light, still remained of a coffee-brown colour; and on shaking, a white-brown froth was produced on the surface.
A second experiment in which a hound of from 7-8 kilos. in weight was given 3-5 grm. doses of potassic chlorate in sixteen hours, and killed by bleeding seven to eight hours after the last dose, showed very similar appearances. The kidneys were intensely congested, and the peculiar brown colour was noticeable.
§ 131. Effects on Man.—I find in literature thirty-nine cases recorded, in which poisonous symptoms were directly ascribed to the action of chlorate of potassium; twenty-eight of these terminated fatally. A quadruple instance of poisoning, recorded by Brouardel and L’Hôte,[128] illustrates many of the points relative to the time at which the symptoms may be expected to commence, and the general aspect of potassic chlorate poisoning. The “supérieure” of a religious institution was in the habit of giving, for charitable purposes, a potion containing 15 grms. (3·8 drms.) of potassic chlorate, dissolved in 360 c.c. (about 121⁄2 ozs.) of a vegetable infusion.
[128] Annales d’Hygiène publique, 1881, p. 232.
This potion was administered to four children—viz., David, aged 21⁄2; Cousin, aged 31⁄2; Salmont, 21⁄2; and Guérin, 21⁄2. David took the whole in two and a half hours, the symptoms commenced after the potion was finished, and the child died five and a half hours after taking the first dose; there were vomiting and diarrhœa. Cousin took the medicine in seven hours; the symptoms also commenced after the last spoonful, and the death took place eight and a half hours from the first spoonful. The symptoms were mainly those of great depression; the lips were blue, the pulse feeble, there was no vomiting, no diarrhœa. Salmont took the medicine in nine hours, and died in twelve. There was some diarrhœa, the stools were of a green colour. Guérin took the whole in two hours, the symptoms commenced in four hours; the lips were very pale, the gums blue. Death took place in four days.
There was an autopsy in the case of David only. The stomach showed a large ecchymosis on its mucous membrane, as if it had been burnt by an acid; the spleen was gorged with blood, and its tissue friable; the kidneys do not seem to have been thoroughly examined, but are said to have been tumefied. Potassic chlorate was discovered by dialysis. In the cases of the children just detailed, the symptoms appear to be a mixture of the depressing action of the potassium, and irritant action of the chlorate.
§ 132. In adults, the main symptoms are those of nephritis, and the fatal dose for an adult is somewhere about an ounce (28·3 grms.), but half this quantity would probably be dangerous, especially if given to a person who had congestion or disease of the kidneys.
Dr. Jacobi[129] gives the following cases.
[129] Amer. Med. Times, 1860.
Dr. Fountain in 1858, experimenting on himself, took 29·2 grms. (8·7 drms.) of potassic chlorate; he died on the seventh day from nephritis. A young lady swallowed 30 grms. (8·5 drms.), when using it as a gargle; she died in a few days from nephritis. A man, thirty years of age, died in four days after having taken 48 grms. (12·3 drms.) of sodic chlorate in six hours. The shortest time in which I can find the salt to have been fatal, is a case related by Dr. Manouvriez, in which a woman took 45 grms., and died in five hours. The smallest dose which has proved fatal is one in which an infant three years old was killed by 3 grms. (46·3 grains).
Jacobi considers that the maximum dose to be given in divided doses during the twenty-four hours, to infants under three, should be from 1-1·5 grm. (15·4-23·1 grains), to children from three years old, up to 2 grms. (30·8 grains); and adults from 6-8 grms. (92·6-123·4 grains).
§ 133. Elimination.—Potassic chlorate is quickly absorbed by mucous membranes, and by the inflamed skin, and rapidly separated from the body by the action of the kidneys. Wöhler, as early as 1824, recognised that it in great part passed out of the body unchanged, and, lately, Isambert, in conjunction with Hirne,[130] making quantitative estimations, recovered from the urine no less than 95 per cent. of the ingested salts. Otto Hehner has also made several auto-experiments, and taking 21⁄2 drms., found that it could be detected in the urine an hour and a half afterwards. At that time 17·23 per cent. of the salt had been excreted, and, by the end of eleven hours, 93·8 per cent. was recovered. It is then difficult to believe that the salt gives any oxygen to the tissues, for though it is true that in all the investigations a small percentage remains to be accounted for, and also that Binz,[131] making experiments by mixing solutions of potassic chlorate with moist organic substances, such as pus, yeast, fibrin, &c., has declared that, at a blood heat the chlorate is rapidly reduced, and is no longer recognisable as chlorate—yet it may be affirmed that potassic chlorate is recovered from the urine as completely as anything which is ever excreted by the body, and that deductions drawn from the changes undergone by the salt in solutions of fibrin, &c., have only an indirect bearing on the question.
[130] Gaz. Méd. de Paris, 1875, Nro. 17, 35, 41, 43.
[131] Berlin klin. Wochenschr., xi. 10, S. 119, 1874.
§ 134. The essential action of potassic chlorate seems to be that it causes a peculiar change in the blood, acting on the colouring matter and corpuscles; the latter lose their property as oxygen carriers; the hæmoglobin is in part destroyed; the corpuscles dissolved. The decomposed and altered blood-corpuscles are crowded into the kidneys, spleen, &c.; they block up the uriniferous canaliculi, and thus the organs present the curious colouring seen after death, and the kidneys become inflamed.
Detection and Estimation of Potassic Chlorate.
§ 135. Organic fluids are best submitted to dialysis; the dialysed fluid should then be concentrated and qualitative tests applied. One of the best tests for the presence of a chlorate is, without doubt, that recommended by Fresenius. The fluid to be tested is acidulated with a few drops of sulphuric acid; sulphate of indigo added sufficient to colour the solution blue, and finally a few drops of sulphurous acid. In presence of potassic or sodic chlorate, the blue colour immediately vanishes. This method is capable of detecting 1 part in 128,000; provided the solution is not originally coloured, and but little organic matter is present.
The urine can be examined direct, but if it contain albumen, the blue colour may disappear and yet chlorate be present; if too much sulphurous acid be also added, the test may give erroneous results. These are but trivial objections, however, for if the analyst obtains a response to the test, he will naturally confirm or disprove it by the following process:—
The liquid under examination, organic or otherwise, is divided into two equal parts. In the one, all the chlorine present is precipitated as chloride by silver nitrate in the usual way, and the chloride of silver collected and weighed. In the other, the liquid is evaporated to dryness and well charred by a dull red heat, the ash dissolved in weak nitric acid, and the chlorides estimated as in the first case. If chlorates were present, there will be a difference between the two estimations, proportionate to the amount of chlorates which have been converted into chlorides by the carbonisation, and the first silver chloride subtracted from the second will give an argentic chloride which is to be referred to chlorate. In this way also the amount present may be quantitatively estimated, 100 parts of silver chloride equalling 85·4 of potassic chlorate.
Toxicological Detection of Alkali Salts.
(See also ante, [p. 121].)
§ 136. Sodium, in combination, especially with chlorine, and also with sulphuric, carbonic, and phosphoric acids, is found in the plasma of the blood, in the urinary secretion, in the pancreatic juice, in human bile, and in serous transudations, &c. Potassium, in combination, is especially found in the red blood-corpuscles, in the muscles, in the nervous tissues, and in milk. Ammonia, in combination with acids, is naturally found in the stomach, in the contents of the intestine; it is also a natural constituent of the blood in small traces, and in a corpse is copiously evolved from putrefactive changes.
It hence follows, that mere qualitative tests for these elements in the tissues or fluids of the body are of not the slightest use, for they are always present during the life of the healthiest individual, and can be found after death in persons dying from any malady whatever. To establish the fact of a person having taken an unusual dose of any of the alkali salts, by simply chemical evidence, it must be proved that the alkalies are present in unusual quantities or in an abnormal state of combination.
In cases of rapid death, caused by sodic or potassic salts, they will be found in such quantity in the contents of the stomach, or in matters vomited, that there will probably be no difficulty in coming to a direct conclusion; but if some time has elapsed, the analyst may not find a sufficient ground for giving a decided judgment, the excretion of the alkali salts being very rapid.
In most cases, it will be well to proceed as follows:—The contents of the stomach are, if necessary, diluted with distilled water, and divided into three parts, one of which is submitted to dialysis, and then the dialysed liquid evaporated to a small bulk and examined qualitatively, in order to ascertain whether a large amount of the alkaline salts is present, and in what form. In this way, the presence or absence of nitrate of potassium or sodium may be proved, or the iodide, bromide, sulphate, and chlorate detected.
To find, in this way, nitrate of potassium, a coarse test is preferable to the finer tests dependent upon conversion of the nitrate into nitrites or into ammonia, for these tests are so delicate, that nitrates may be detected in traces; whereas, in this examination, to find traces is of no value. Hence, the old-fashioned test of treating the concentrated liquid in a test-tube with copper filings and then with sulphuric acid, and looking for the red fumes, is best, and will act very well, even should, as is commonly the case, some organic matters have passed through the dialyser.
Chlorates are indicated if the liquid is divided into two parts and tested in the manner recommended at [p. 127]. If present in any quantity, chlorates or nitrates may be indicated by the brilliant combustion of the organic matter when heated to redness, as also by the action of strong sulphuric acid on the solid substances—in the one case, yellow vapours of peroxide of chlorine being evolved—in the other, the red fumes already mentioned of nitric peroxide.
With regard to a substance such as the hydro-potassic tartrate, its insolubility in water renders it not easy of detection by dialysis; but its very insolubility will aid the analyst, for the contents of the stomach may be treated with water, and thus all soluble salts of the alkalies extracted. On now microscopically examining the insoluble residue, crystals of bitartrate, if present, will be readily seen. They may be picked up on a clean platinum wire and heated to redness in a Bunsen flame, and spectroscopically examined. After heating, the melted mass will have an alkaline reaction, and give a precipitate with platinic chloride. All other organic salts of potassium are soluble, and a white crystal giving such reaction must be hydro-potassic tartrate.
Ammonium Salts.—If the body is fresh, and yet the salts of ammonium present in large amount, it is safe to conclude that they have an external origin; but there might be some considerable difficulty in criminal poisoning by a neutral salt of ammonium, and search for it in a highly putrid corpse. Probably, in such an exceptional case, there would be other evidence. With regard to the quantitative separation and estimation of the fixed alkalies in the ash of organic substances, the reader is referred to the processes given in “Foods,” p. 99, et seq., and in the present work, [p. 121].