ANTIMONY
Antimony, the Stibium of the ancients, is obtained from the native sulphide. Metallic antimony is of a bluish-white colour, crystalline and brittle. It melts at about 840° F., and is slowly volatilised at a white heat.
Two compounds of antimony—tartar emetic and chloride of antimony—are alone of any toxicological interest.
Fig. 32.—Photo-micrograph of crystals
of tartarated antimony, × 50.
(R. J. M. Buchanan.)
Tartar Emetic
Antimonium Tartaratum. Tartarated Antimony
Tartar emetic occurs as a white powder; sometimes, however, with a yellowish tint. It is soluble in about three parts of boiling water and fifteen of cold, and insoluble in alcohol.
The vinum antimoniale of the Pharmacopœia contains two grains of the salt in an ounce of wine.
Before 1856 poisoning by antimony was of rare occurrence, but since that year several cases of chronic poisoning have occurred, giving to this substance considerable importance.
Symptoms of Antimonial Poisoning
Acute.—Tartar emetic is an irritant poison, but possesses slight corrosive properties. When taken in large doses, two or three drachms, it gives rise to a metallic taste in the mouth, which is not easily removed. In most cases, violent vomiting follows immediately after the poison is swallowed, the vomiting continuing even after the stomach is emptied of its contents. In a few cases, however, even when a large dose has been taken, vomiting may be absent. Burning pain is felt at the pit of the stomach, accompanied with cramps in the belly and purging. There is considerable difficulty in swallowing, and the patient complains of tightness and constriction in the throat. The mouth and throat in some cases are excoriated, or covered with whitish aphthous-looking spots, which ultimately become brown or black. In some cases the thirst is intense; in others, absent or nearly so. Cramps in the lower extremities, almost amounting in some cases to tetanic spasms, followed by extreme depression, are generally the precursor of a fatal termination. The urine may be suppressed, as is the case in arsenical poisoning; in some cases it has even been increased. On this point, however, the statements of observers differ. Trousseau says that the urine is suppressed; Huseman that it is never suppressed. The skin is in some cases covered by a pustular eruption, not unlike that of smallpox. Dobie has recorded a case of poisoning by tartar emetic in which a comatose condition was present. In antimonial poisoning, even in the most desperate cases, there is always greater hope of recovery than in arsenical poisoning.
Fig. 33.—Photo-micrograph of crystals
of tartarated antimony, × 50.
(R. J. M. Buchanan.)
Chronic.—The symptoms which mark the chronic form of poisoning differ chiefly in being less intense and less rapid than in the acute. Chronic poisoning by small repeated doses is that form of poisoning which appears most in vogue of late years—as certain diseases, enteritis, etc., can be simulated by the administration of repeated small doses. The unfortunate victim complains of constant nausea and retching, with great depression. Food is objected to, as it only increases the vomiting. The matters vomited are at first merely mucus, but after a time they become mixed with bile. Each time the poison is repeated, the symptoms become aggravated. Emaciation gradually sets in, and the person dies from complete exhaustion, or from the effects of a larger dose than usual. Chronic poisoning has given rise to several errors in diagnosis, and the histories of recorded cases should put medical men on their guard. In all doubtful cases examine the urine.
Post-mortem Appearances.—The mucous membrane of the throat, gullet, and stomach is inflamed, and in some places softened and corroded. Aphthous-looking spots are not infrequently found on the mucous membrane of the stomach, and these may also be observed on the throat and on the small intestines. The liver has been found in some cases of chronic poisoning, where the fatal termination has been for some time retarded, enlarged, and its structure so soft as to be easily broken down. Fatty degeneration of the internal organs has been found after protracted fatal administration of the drug. It is stated that in Brunswick the fatty livers of the geese are produced by the judicious administration of antimony. The appearances above detailed may be more or less absent or present, according to the time that may have elapsed from the swallowing of the poison to the time at which death has occurred.
At the post-mortem examination on the body of Mr. Bravo, poisoned with tartar emetic in 1876, the mucous surfaces of the stomach and duodenum were found pale and yellowish. Ulcers were present in the cæcum, and the rest of the large intestine blood-stained, but not ulcerated. Stevenson records the post-mortem appearances of the bodies of three women poisoned by tartar emetic (B. M. J., 1903, vol. i. p. 873). They are of peculiar interest in reference to the preservative action of antimony upon the bodies of those poisoned by it. In the case of M. E. Marsh, upon whose body the examination was made eight days after death, there was no odour of putrefaction, the bowels were in a condition of acute catarrh and streaky congestion without ulceration.
The body of Bessie Taylor had been buried for twenty-one months; ordinary putrefactive changes were absent, and with the exception of the integuments, it was in a remarkably good state of preservation. The alimentary canal showed acute non-ulcerative gastro-enteritis, the stomach and duodenum were of a cinnabar-red colour, the jejunum also in patches. The ileum was covered with orange-red mucus in its lower portion, and there was an orange-coloured patch twelve inches above the ileo-cæcal valve. The patch on analysis was proved to contain antimonious sulphide. Similar orange patches were present in the colon and upper portion of the rectum. There were no ulcerations, but the mucous membrane of the intestines was of a dull cinnabar-red colour.
The body of Mary J. Spink was exhumed five years after burial, and presented a life-like aspect; there was no putrefactive odour, and no larvæ present. The stomach and intestines were of a cinnabar-red colour; there were no ulcerations; the intestines contained orange-coloured mucus.
Elimination of Antimony from the System
Antimony, taken in a large dose, or in small doses frequently repeated, appears to be rapidly absorbed, and then eliminated from the system by the kidneys. Dating from the time at which the poison was swallowed, it will be found in the organs of the body in the following order:—
1. Stomach and bowels, but slightly in the liver.
2. Absent from the stomach, but present in the liver, spleen, and kidneys—traces in the blood.
3. Present in the fat and bones, with traces in the liver, fæces, and urine.
4. The period required for its complete elimination from the vital organs varies from fifteen to thirty days.
In other words, the presence of antimony in the stomach and intestines points to the recent administration of the poison; and its absence from those organs, and presence in the others above mentioned, to a more remote period of administration. It has been suggested that in some cases the poison may be eliminated by the mucous membrane of the stomach. This assumption has been proved to be correct, for it has been shown that antimony may be found in the stomach after the inhalation of antimoniuretted hydrogen.
Fatal Dose.—It is impossible to state with certainty the exact amount of antimony—tartar emetic—which may prove fatal, as recoveries have taken place even after an ounce had been taken. Large doses are uncertain in their effects, as the severe vomiting which they produce generally helps to get rid of the poison. In small doses, death may result from the depressing action which it exerts over the heart.
Fatal Period.—From a few hours to several weeks, and even months.
Treatment.—Promote vomiting by the administration of warm water, or warm greasy water, or the stomach may be washed out with a syphon tube, unless the chloride of antimony is the poison, and then give tannic acid in drachm doses in warm water, or any vegetable infusion containing tannin—viz., tea, oak bark, or cinchona bark. Demulcent drinks may be administered, and warmth applied. Opium may be given to relieve pain, and stimulants for the depression.
The Detection of Antimony
Prepare the solutions of the liver and other solid organs, and also the contents of the stomach, as described under the detection of arsenic, using tartaric acid instead of hydrochloric acid. Through a portion of one of the solutions, obtained by filtration or dialysis, pass a current of sulphuretted hydrogen, which will produce, if antimony be present, an orange-coloured precipitate of the sulphide of antimony. The precipitated sulphide is dissolved by hot hydrochloric acid with the evolution of sulphuretted hydrogen; and if the resulting solution be poured into water, a white precipitate is formed of oxychloride of antimony, soluble in tartaric acid. Chloride of bismuth is precipitated when poured into water, but the precipitate is turned black by sulphide of ammonium, the antimonial orange-red; the precipitate of bismuth is not soluble in tartaric acid, the antimonial is soluble.
Marsh‘s and Reinsch‘s processes may also be used for the detection of antimony. The former is, however, open to the objection that antimony, when present in any quantity, rapidly precipitates on the zinc in the form of a flocculent black deposit, while the issuing gas is found to contain only traces of the metal.
Reinsch‘s process is, however, very delicate, and its application is in every respect similar to that in use for the detection of arsenic. The acid liquid should, however, be boiled down to a small bulk with the copper, before a conclusion is drawn as to the entire absence of the metal.
Table giving the Characteristic Reactions
of Antimonial and Arsenical Deposits
on Copper.
| Antimony. | Arsenic. | |
|---|---|---|
| The colour of the | Lustrous, with a violet hue. | Dark steel-grey colour, |
| deposit on copper | and lustrous. | |
| by Reinsch‘s | ||
| process is— | ||
| The coated copper | No effect, or only a | Well-marked sublimate |
| heated in the end | trifling white sublimate, | of octahedral crystals; |
| of a small tube. | non-crystalline, | is readily volatile. |
| non-volatile. If the | ||
| sublimate be dissolved | ||
| in solution of tartaric | ||
| acid and sulphuretted | ||
| hydrogen passed | ||
| through the solution, | ||
| the orange antimonious | ||
| sulphide is thrown down. |
It may be noted that mercury likewise yields a deposit on copper with Reinsch‘s process; but the coating is in this case either of a grey colour or white, and silvery on the application of friction. When the coated copper is heated in a glass tube, there is a sublimate of metallic mercury readily aggregating into globules on being rubbed with a glass rod. If the deposit is trifling in quantity, a magnifying-glass should be used to identify the metallic globules. This test at once distinguishes a deposit on copper due to mercury from that produced under similar conditions by arsenic or antimony.
Quantitative Analysis.—Take a measured quantity of the suspected liquid and precipitate thoroughly with sulphuretted hydrogen. Wash, dry, and weigh precipitate. One hundred parts equal 202.78 parts of crystallised tartar emetic.
Recapitulation of the Leading Facts
with regard to Poisoning
with Antimony.