Treatise on Poisons / In relation to medical jurisprudence, physiology, and the practice of physic

by Sir Robert Christison

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.

CHAPTER 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.

CHAPTER 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]]

CHAPTER 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]]

CHAPTER 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.

CHAPTER 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.

CHAPTER XXIV.
CLASS SECOND.
OF NARCOTIC POISONS GENERALLY.

The term narcotism has been used by different writers with different significations, but is now generally understood to denote the effects of such poisons as bring on a state of the system like that caused by apoplexy, epilepsy, tetanus, and other disorders commonly called nervous. Narcotic poisons, therefore, are such as produce chiefly or solely symptoms of a disorder of the nervous system.

The mode in which most narcotic poisons act has been well ascertained: they act on the brain or spine or both by entering the blood-vessels. Hence they are most active when most directly introduced into the blood, that is, when injected into the veins; and when they are applied to an entire membranous surface, their energy is in the ratio of its absorbing power. Thus, when injected into the chest, they act more rapidly than when swallowed. According to the generally received opinion, they are conveyed with the blood to the brain and spine on which they act. But, according to the views of Messrs. Morgan and Addison, they produce on the inner coats of the blood-vessels a peculiar impression, which is conveyed to the centre of the nervous system along the nerves.

The usual symptoms in man and the higher order of animals are giddiness, headache, obscurity or deprivation of the sight, stupor or perfect insensibility, palsy of the voluntary muscles or convulsions of various kinds, and towards the close complete coma. The symptoms of each poison are pretty uniform, when the dose is the same. But each has its own peculiarities, either in the individual symptoms, or in the mode in which they are combined together.

The morbid appearances they leave in the dead body are commonly insignificant. In the brain, where chiefly the physician is led from the symptoms to expect unnatural appearances, the organs are in general quite healthy. Sometimes, however, the veins are gorged with blood, and the ventricles and membranes contain serosity. The blood appears to be sometimes altered in nature; but the alteration is by no means invariable, and sometimes none is remarked at all. Many of the statements to be found in authors on the morbid appearances caused by narcotics are far from being accurate.

Before proceeding to notice the genera of this class in their order, some remarks must be premised on the principal diseases which resemble them in the symptoms and morbid appearances. Of these the only diseases of much consequence are apoplexy, epilepsy, inflammation of the brain, hypertrophy of the brain, inflammation of the spinal cord, and syncopal asphyxia.

Of the Distinction between Apoplexy and Narcotic Poisoning.

Of the Symptoms.—The symptoms of apoplexy are almost exactly the same as those of the narcotic poisons, namely, more or less complete abolition of sense and the power of motion, frequently combined with convulsions. This disease commonly arises from congestion or effusion of blood within the skull; but one variety of it, the nervous apoplexy of older authors, or simple apoplexy of the moderns, is believed to be an affection of the brain, unaccompanied by any recognizable derangement of structure.

Apoplexy and narcotic poisoning may be often distinguished by the following criterions:

1. Apoplexy is sometimes preceded at considerable intervals by warning symptoms, such as giddiness, headache, ringing in the ears, depraved vision, or partial palsy. But it is an error to suppose that warning symptoms always occur; nay, if we may trust the experience of M. Rochoux, they are by no means common: of sixty-three cases which came under his notice nine only had distinct precursory symptoms.[^[1625]] Poisoning with narcotics of course has not any precursory symptom except by fortuitous combination. And consequently, if warning symptoms have occurred, the presumption is, that the cause of death is a natural one.

2. Apoplexy attacks chiefly the old. It is not, however, confined to the old. On the trial of Captain Donnellan for poisoning Sir T. Boughton, Mr. John Hunter mentioned that he had met with two instances of death from apoplexy in young women; my colleague Dr. Alison has related to me a similar case; Professor Bernt has described another of a young girl who died apoplectic from extravasation of blood over the whole brain and in the ventricles also;[^[1626]] and Mr. Greenhow, a surgeon of London, has even noticed a case of apoplexy from effusion of blood over the surface of the brain in a child two years and a half old.[^[1627]] On this subject the treatise of Rochoux supplies excellent information: of his sixty-three cases sixty-one were above thirty years of age, two less than thirty, none younger than twenty.[^[1628]] It is plain, therefore, that apoplexy in young people is rare. On the other hand, a great proportion of cases of poisoning with the narcotics when they have been taken intentionally (and such cases are most likely to lead to medico-legal questions), has occurred among the young, especially of the female sex.

3. The next criterion is, that apoplexy occurs chiefly among fat people. But it is here mentioned only that the medical jurist may be cautioned against the belief that it is in all circumstances a correct criterion. Upon this particular Rochoux has furnished some satisfactory data. Among his sixty-three patients thirty were of an ordinary habit, twenty-three were of a thin, meager habit, and ten only were large, plethoric and fat.[^[1629]] In receiving this statement, however, it is necessary to consider, that although the vulgar idea, that most apoplectic people are fat, does not apply to persons in the rank of Rochoux’s patients, who were mostly hospital inmates, yet it may apply better to the upper ranks. For the same circumstances which predispose to apoplexy, namely, great strength, vigorous constitution and good digestive powers, likewise predispose to corpulency, so that whenever the condition of life permits the disposition to corpulency to be developed, the connexion of apoplexy with it will appear.

4. A fourth criterion is drawn from the relation which the appearance of the symptoms bears to the last article of food or drink that was taken. I believe that the effects of the common narcotics, in the cases where they prove fatal, begin not later than an hour, or at the utmost two hours, after they are taken; and in a great majority of instances they begin in a much shorter time, namely, in fifteen or thirty minutes. Hence if it can be proved that the nervous symptoms, under which a person died, did not begin till several hours after he took food, drink or medicine, it appears almost, if not absolutely certain, that a narcotic poison cannot have been the cause of death. To some narcotic, or rather narcotico-acrid poisons this rule certainly will not apply, such as the poisonous fungi and spurred rye; which seldom begin to act for several hours, sometimes for not less than a day and a half. Neither will the rule apply to poisoning with the deleterious gases, as their action has no connexion at all with eating or drinking. But these facts do not form a material objection to the rule laid down; because the circumstances under which cases of the kind occur are generally so apparent, as at once to point out their real nature to a careful inquirer.

In regard to apoplexy as the disease which resembles most closely the effects of the narcotics, it was formerly stated that this disease is apt to occur soon or immediately after taking a meal (p. [95]).[^[1630]] In the greater number of such cases, however, where the meal has been the exciting cause of the disease, the symptoms have begun immediately after, or even during a meal. This is very rarely the case with the symptoms of narcotic poisoning, and never happens in respect to those of the commonest of the narcotics, opium: An interval of 10, 15, 20 or 30 minutes always occurs. The deleterious gases and hydrocyanic acid, with its compounds, are the only familiar narcotic poisons which act more swiftly.

5. Another criterion relates to the progress of the symptoms. The symptoms of narcotic poisoning advance for the most part gradually: but those of apoplexy in general begin abruptly. Sometimes apoplexy commences at once with deep sopor. Narcotic poisoning never begins in that way, except in the instances of hydrocyanic acid and the narcotic gases; the sopor is at first imperfect, and it increases gradually, though sometimes very rapidly. Apoplexy, however, does not always begin with deep sopor; occasionally the sopor begins and increases like that of narcotism.

6. Although there is a great resemblance between the symptoms of apoplexy and those of narcotism, so far as regards their general features, there are particulars which are not indeed always present, but which when present will help to distinguish the one from the other. When the sopor of apoplexy is completely formed, it is rarely possible to rouse the patient to consciousness, and never, I believe, where the risk of confounding apoplexy with poisoning is greatest,—in the cases where death happens neither instantly, nor after the interval of a day, but in a few hours. On the other hand, in many cases of poisoning with the narcotics, and particularly with the commonest variety, opium, the person may be roused from the deepest lethargy, if he is spoken to in a loud voice, or forcibly shaken for some time, or if water is injected into his ear. Even in cases of poisoning with opium, however, the coma may have continued too long to admit of this temporary restoration to sense; the susceptibility of being roused is not so often remarked in other varieties of narcotic poisoning; and in some, such as poisoning with prussic acid, I am not aware that it has ever been remarked, at least in fatal cases.

There are some other symptoms which in special cases may help to distinguish narcotic poisoning from apoplexy. Thus in poisoning with opium convulsions are rare; in apoplexy they are common enough. Bloating of the countenance is likewise much more common in apoplexy than in poisoning with opium. In apoplexy, too, the pupil is generally dilated, while in poisoning with opium the pupil is almost always contracted. But such distinctions do not apply either to the narcotics as a class, or to all cases of any one kind of narcotic poisoning.

7. In the last place, a useful criterion may be derived from the duration of the symptoms in fatal cases. I believe few people die of pure narcotic poisoning who outlive twelve hours; and the greater number die much sooner,—in eight, or six hours. Apoplexy often lasts a whole day, or even longer. On the other hand, the narcotic poisons very rarely prove so rapidly fatal as apoplexy sometimes does. Apoplexy, according to the vulgar opinion, may prove fatal instantly or in a few minutes. The only late author of repute who maintains that opinion is M. Devergie. He mentions the case of an elderly man subject to somnolency, who, after complaining for a short time of headache, became suddenly pale, hung down his head, and expired immediately, and in whose body no other morbid appearance was found, except great congestion of the cerebral membranes.[^[1631]] The best modern pathologists, however, deny that apoplexy proves immediately fatal, and maintain with much apparent reason that when death is so sudden, the cause is commonly disease of the heart, and not apoplexy.[^[1632]] However this may be, it is at all events certain that apoplexy may occasion death in considerably less than an hour. Now the only narcotics in common use which can prove fatal so soon are the narcotic gases, and prussic acid. As to opium, the most common of the narcotic poisons, and by far the most important to the medical jurist, the shortest duration I have yet seen recorded is three hours. Apoplexy often proves fatal in a much shorter time.

From this enumeration of the criterions between apoplexy and the symptoms produced by narcotics, the toxicologist will conclude, that few cases can occur in which he will not be able to give a presumptive opinion of the real cause from the symptoms only,—that in many instances a diagnosis may be drawn with an approach to certainty,—and that on all occasions it will be possible to say without risk of error, whether there are materials for forming a diagnosis at all,—a point which is of great moment when the criterions are not universally applicable.

Of the Morbid Appearances.—The next subject of inquiry is the distinction between apoplexy and narcotic poisoning, as to the appearances after death. It has been already stated, that the narcotic poisons rarely produce very distinct morbid appearances,—that the greatest extent of unnatural appearance they cause in the brain is congestion of vessels,—and that the physical qualities of the blood appear to be altered, though not invariably.

Of Simple Apoplexy.—Apoplexy may, in the first place, occasion death without leaving any sign at all in the dead body. Cases of this sort were called nervous apoplexy by the older authors; but for the purpose of avoiding a name that involves a theory as to their nature, they have been more appropriately termed by Dr. Abercrombie simple apoplexy. At one time they were believed to be common. The researches of modern pathologists, however, have shown that they are rare, and that the apparent absence of morbid appearances may be often with justice ascribed to an insufficient examination; for it is not always easy to detect, without minute attention, two disorders little known till in recent times, and sometimes closely allied in their symptoms to apoplexy,—hypertrophy of the brain, and inflammation of its substance. On this account some have even gone so far as to deny altogether the existence of simple or nervous apoplexy; and M. Rostan, who is of this opinion, has supported it by the fact, that in the course of his pathological researches he had examined no less than 4000 heads, and never met with an instance of it.[^[1633]] But although this statement, made by so eminent a pathologist, is sufficient to prove the rarity of the disease, it does not establish its non-existence in the face of positive observations, made by others after the phenomena and effects of cerebral inflammation were well known.

Among the modern authorities to whom reference may here be made for examples of simple apoplexy, Dr. Abercrombie, M. Louis, my colleague Dr. Alison, and M. Lobstein, may be particularized. Dr. Abercrombie has seen four cases,[^[1634]] M. Louis has recorded three,[^[1635]] M. Lobstein one,[^[1636]] and Dr. Alison informs me, that he has seen one and got the particulars of another from the late Dr. Gregory. In several of these cases the individuals were at the time of the apoplectic seizure affected with other diseases, such as asthma, anasarca, or slight febrile symptoms; but in four of them the coma commenced during a state of perfect health. I have myself seen two of the former class, one occurring during convalescence from a slight pleurisy, the other terminating a complicated case of pulmonary emphysema and catarrh, diseased kidneys and anasarca. Reference may be also made under this head to several cases of apoplexy described in Corvisart’s Journal, as connected with the enormous accumulation of worms in the intestines. Such a connexion is said to be common on the coast of Brittany; and one striking instance is related of a young man, who, after an attack of headache, vomiting, and loss of speech, died comatose in two days, and in whose body no unnatural appearance could be seen except a prodigious mass of worms in the small intestines.[^[1637]]

In none of all the cases of apoplexy now under consideration was there found within the head any appearance corresponding with the symptoms, except occasionally a slight turgescence of vessels.

This form of apoplexy, then, is a very important affection in a medico-legal point of view. The possibility of its occurrence is in fact the chief obstacle, which, in many cases involving the question of poisoning with narcotics, prevents the physician from coming to a positive decision on a review merely of symptoms and appearances after death. Instances will occur where it is impossible to draw a diagnosis between the natural and the violent form of death. And indeed it might even be a fair subject of inquiry, whether death from at least some narcotic poisons, such as opium, is any thing else than death from simple apoplexy.

It may be mentioned,—although too much importance ought not to be attached to the fact, as forming the ground of a diagnosis in certain rapid cases of narcotic poisoning,—that of the instances of simple apoplexy referred to above none proved fatal in less than five hours. This was Dr. Gregory’s case. Dr. Alison’s proved fatal in seven hours; M. Louis’s cases in eight, nine, and ten hours; one of Dr. Abercrombie’s in eight hours; the three others in about twenty-four hours; and M. Lobstein’s in five days.

Another consideration is, that simple apoplexy is undoubtedly very rare, more particularly in persons who enjoy perfect health. Hence, although it is impossible to distinguish the effects of narcotics from this disease by the appearances in the body after death, yet, when the general evidence of poisoning is strong, and none of the medical circumstances are at variance with the supposition of narcotic poisoning, the evidence of poisoning, as judged of by the jury from the whole facts, medical and general, will be commonly sufficient,—so far as regards the possibility of death from simple apoplexy. For such a concurrence of circumstances as is here supposed can scarcely be outweighed by a mere possibility of death from so rare a natural disease.

It is worthy of remark, in reference to charges and suspicions of poisoning during a state of ill health, that simple apoplexy occurring in the course of a considerable period of indifferent health is far from uncommon. Such incidents, however, ought not to be confounded with narcotic poisoning, because the coma comes on gradually. From what I have myself frequently observed, cases of this nature are often connected with the granular disintegration of the kidneys, which has been brought under the notice of physicians by the able researches of Dr. Bright. I have related two instances of the kind,[^[1638]] and several others have been since published by Dr. James Arthur Wilson.[^[1639]] In none of these could there have been any risk of mistaking the phenomena for narcotic poisoning. But it may be well to advert to the subject here for the sake of turning the attention of the profession to the propriety of examining the state of the kidneys in all medico-legal cases of death in a state of coma.

Of Congestive Apoplexy.—Apoplexy may, in the second place, leave in the dead body no other sign but congestion of vessels within the head. This form or variety of apoplexy is so generally admitted, that it is hardly necessary to mention special instances. But, for the sake of those who may prefer special facts to general propositions, the two following cases by M. Rostan are referred to. One of his patients, without any precursory symptom, was suddenly deprived of sense, soon became delirious and comatose, and expired in a day and a half. The other, also without any previous symptom, became rapidly comatose, and died in twenty-four hours. In both the whole membranes were minutely injected with blood; and in one the whole brain had also a rose-red colour.[^[1640]] In regard to the diagnosis between such cases and poisoning with narcotics, it must be remembered, that congestion of the cerebral vessels is considered by many a common effect of such poisons, and that therefore the diagnosis cannot be rested on the appearances in the dead body. I have not perused a sufficient number of fatal cases of congestive apoplexy to enable me to attempt a diagnosis; but, so far as I have gone, it appears to me, that this form of the disease, which is not often fatal without extravasation also being produced, does not cause death till after an interval of nearly a day at least. Should this prove a general fact, it would form the ground of a diagnosis between congestive apoplexy and many forms of narcotic poisoning, which, if death ensues, prove fatal much sooner.

Of Serous Apoplexy.—Apoplexy may, in the third place, produce serous effusion on the external surface, and in the ventricles of the brain. This form of the disease, which has been named serous apoplexy, although not very uncommon as an insulated affection, is for the most part united with inflammation of the cerebral substance. Serous effusion is more frequently the termination of an inflammatory disorder of the brain, than of that deranged state which constitutes the apoplectic attack. But nevertheless it does occur in connexion with pure apoplexy, as may be seen, for example, on referring to Dr. Abercrombie’s work,[^[1641]] or to Bernt’s Contributions to Medical Jurisprudence,[^[1642]] or to the Hospital Reports of Dr. Bright.[^[1643]] In such cases the only appearances have been the effusion of an unusual quantity of serum on the surface of the brain, in its ventricles, and in the base of the skull. Cases of this sort agree very exactly as to the signs in the dead body with some cases of narcotic poisoning. When serous effusion is preceded by decided apoplectic symptoms, the disease, so far as I have been able to inquire, is always of several days’ duration. But sometimes the symptoms are to the very last obscure and different from those of apoplexy, as in an instance related by Dr. Abercrombie.[^[1644]]

Of Apoplexy from extravasation.—The last variety of apoplexy is that which leaves in the dead body extravasation of blood within the head. This, the most common of all its forms, is very rarely imitated by narcotic poisoning. A case, however, will be afterwards mentioned of extravasation produced apparently by poisoning with opium, another of extravasation caused by carbonic acid, another by poisonous fungus, and several by spirits. The existence, therefore, of extravasated blood is not absolutely certain proof, but supplies, in relation to most narcotics, a strong presumption of natural death.

Here it will be necessary to add a word or two of caution regarding what are called apoplectic cells or cavities, containing blood in the brain. If an apoplectic cell be found, it must not be at once considered as the cause of death. When blood is extravasated in the brain, the patient may gradually recover altogether, and the cell nevertheless continue full. Such persons often die of a subsequent attack of apoplexy, or of inflammation around the cell. We can say with certainty, that an apoplectic cell has been the occasion of death only when the blood is recent, or when it is surrounded by signs of recent inflammation.

So much, then, as to the criterions derived from morbid appearances within the skull, for distinguishing poisoning with narcotics from apoplexy.

It has been proposed to derive other criterions from the state of the blood. But on considering the effects of the individual poisons of the class, it will appear that the state of the blood is by no means characteristic.

It may be useful to conclude this view of the distinctions between poisoning and apoplexy with the particulars of an interesting case, in which the medical witnesses fell into an egregious error by disregarding the most palpable criterions. In 1841, an elderly gentleman at Chambéry in France, subject to apoplexy, one day after having made a hearty dinner and afterwards supped on bread, cheese, and white wine, was suddenly seized with staggering immediately after finishing his wine, and soon lost all consciousness. Emetics and stimulants restored his faculties so far as to enable him to say he felt better and had no pain; but the tongue and mouth were drawn to the left side, and there was great prostration. Four hours after his first seizure the countenance became livid; he again became unconscious and insensible; the twisting of the mouth increased; and the left arm presented spasmodic contraction. Blood-letting and other remedies were resorted to without avail; the pulse, previously strong and regular, became gradually feeble; and in six hours after his first illness he expired, without ever having had convulsions of any kind. On the body being examined seven days after death, great congestion was found in the vessels on the surface of the brain; on raising the brain, a dense dark clot of the size of a large egg escaped from the lower part of the ventricles; and an abundant extravasation of the same nature was found under the tentorium cerebelli.

It appears scarcely possible to find a more characteristic case than this of apoplexy from extravasation. The slight intermission in the symptoms was the only unusual circumstance. Yet because the inspectors remarked in various parts of the body a peculiar odour, which they could not at the time characterise, but which they afterwards thought was the odour of bitter almonds,—and misled by the sudden invasion of the symptoms instantly after a meal,—they gave their opinion that death had arisen from some narcotic poison; a chemical examination was made of various textures of the body (not, however, of the contents of the stomach), which yielded obscure and very doubtful indications of hydrocyanic acid; poisoning with hydrocyanic acid was accordingly declared to have been the cause of death; and, in defiance of an able report by Professor Orfila, pointing out the error of the primary witnesses, the nephew and heir of the deceased was condemned.[^[1645]] It is almost unnecessary to point out the impossibility of death having arisen in this case from hydrocyanic acid. The length of time the deceased survived, the want of convulsions, the presence of deflexion of the mouth and tongue, the intermission of the symptoms, and the morbid appearances, all clearly indicate that death in the way supposed was impossible; and the chemical evidence, which it would require too much space to analyze here, was proved by Orfila to be completely unsatisfactory.

Of the Distinction between Epilepsy and Narcotic Poisoning.

Of the Symptoms.—Epilepsy is distinguished from other diseases by the abolition of sense and by convulsions. It resembles closely the symptoms caused by prussic acid, and by some of the narcotic gases, such as carbonic acid gas and the asphyxiating gas of privies. It also bears the same resemblance to the effects of many narcotico-acrid poisons, such as belladonna, stramonium, hemlock, and others of the first group of that class, also camphor, cocculus indicus, and the poisonous fungi.

Epilepsy is in general a chronic disease, and for the most part ends slowly in insanity. But sometimes it proves fatal during a paroxysm. The circumstances by which an epileptic fit may be distinguished from narcotic poisoning are the following:

1. The epileptic fit is sometimes preceded by certain warnings, such as stupor, a sense of coldness, or creeping, or of a gentle breeze proceeding from a particular part of the body towards the head. Warnings, however, are by no means universal. M. Georget, indeed, has even stated that they do not occur in more than five cases in the hundred.[^[1646]] But this estimate probably underrates their frequency.

2. The symptoms of the epileptic fit almost always begin violently and abruptly. The individual is suddenly observed to cry out, often to vomit, and instantly falls down in convulsions. The effects of the narcotic poisons, if we except some cases of poisoning with hydrocyanic acid, the narcotic gases, and a few rare alkaloids, never begin otherwise than gradually, though their progress towards their extreme of violence is often rapid. This distinction is generally an excellent one. But it will not apply so well to some cases of epilepsy in which the convulsions are trivial. Esquirol says an epileptic fit may consist of nothing more than coma, with convulsive movements of the eyes, or lips, or chest, or a single finger.[^[1647]] Still even then the coma generally begins abruptly, so that if the case is seen from the beginning, it can hardly be mistaken for narcotic poisoning. Some forms of epilepsy, in which the fit is constituted merely by giddiness, staring, wandering of the mind, and imperfect loss of recollection,[^[1648]] might be confounded with the milder forms of narcotic poisoning. But collateral circumstances will scarcely ever be wanting to distinguish such cases from one another.

The varieties of narcotic poisoning which, in the violence and abruptness of their commencement, bear the closest resemblance to an epileptic attack, are some cases of poisoning with hydrocyanic acid or with the deleterious gases. Both of these varieties, however, when they begin so abruptly, are distinguished from a fatal paroxysm of epilepsy by the fourth characteristic to be mentioned presently; and besides, in abrupt cases of poisoning with hydrocyanic acid, the poison under certain conditions will be found in the body; while in sudden poisoning with the narcotic gases, the nature of the accident is rendered obvious to a cautious inquirer by the collateral circumstances.

3. As in apoplexy, so in epilepsy the patient in general cannot be roused by external stimuli. This, as already observed, is often, although certainly not always, practicable in cases of poisoning with narcotics. Sometimes, too, in the epileptic fit a partial restoration of consciousness may be effected by loud speaking, so that in reply to questions the patient will roll his eyes or move his lips. It is therefore to be understood in applying the present criterion, that it is only a safe guide when, as in many cases of poisoning with opium, the individual can be roused to a state of tolerably perfect consciousness.

4. When a person dies in a fit of epilepsy, the paroxysm generally lasts long, sometimes more than a day. So far as I have been able to ascertain (though on this point it must be confessed authors are singularly silent), it never proves fatal in a shorter time than several hours, unless there have been many previous fits; and even then it rarely proves fatal more rapidly. I have met with a case which, after many previous fits, proved fatal in little more than an hour.[^[1649]] In an instance mentioned by Mr. Clifton of irregularly recurring epilepsy, the patient after being exempt for four months was attacked twice a day for four days, and during an interval of ease fell down in the street and died. General congestion and excessive softening of the brain were found.[^[1650]] I have met with a case very like this, where death was owing to enormous extravasation of blood into the ventricles. So rapid a termination never occurs except after several paroxysms; and probably never without well-marked appearances in the dead body. The variety of poisoning with which epilepsy is most apt to be confounded, poisoning with hydrocyanic acid, has hitherto always proved fatal within three-quarters of an hour, and can probably never prove fatal so late as a whole hour after the symptoms begin, unless the dose has been small and given repeatedly. Poisoning with the gas of privies,—another variety, which sometimes imitates precisely a fit of epilepsy, appears not to prove fatal in its convulsive form later than two hours after the exposure.

5. M. Esquirol, a writer of high authority, says that epilepsy very rarely proves fatal in the first paroxysm. I suspect it may be said that the first paroxysm never proves fatal. For the cases considered and described as such have been either inflammation of the brain or its membranes, or hypertrophy of the brain, or inflammation of the spinal cord, or effusion of serum or blood into the spinal canal, or worms in the intestines,—all of which may be known by the morbid appearances. I have also seen cases of continued fever with typhomania and convulsions, which might have been considered by a careless observer examples of epilepsy fatal in the first fit. On the present characteristic it would be wrong to speak with confidence, as the question regarding the possible fatality of epilepsy in the first fit must depend greatly on the degree of extension given to the term epilepsy. I can only say, that in the course of reading I have not hitherto met with an instance fatal in the first paroxysm, which might not have been referred by the morbid appearances to one or other of the diseases mentioned above.

Of the Morbid Appearances.—With regard to the morbid appearances found in the bodies of epileptics, much difference of opinion prevails among pathologists. The most frequent are tumours within the cranium, excrescences from the bone or dura mater, concretions in the brain itself, or abscesses there, and effusion into the ventricles or on the surface of the brain. Other appearances which have also been remarked are probably little connected with the disease; and at all events have been often seen when epilepsy did not precede death.[^[1651]]

The morbid appearances connected with epilepsy are not always to be looked for within the head. The cause which produces the fit is often some irritation in distant organs.—The presence of worms in the intestines of children may occasion fatal epilepsy. It is believed also that they may cause fatal epilepsy even in adults; and whether their presence has been the cause of death or not, it is certain that they have been found enormously accumulated in the stomach or intestines of adult epileptic subjects.[^[1652]] The most recent information on this subject is furnished by M. Gaultier de Claubry. In a girl seven years old, who died of convulsions in six days, he found eleven lumbrici in the general cavity of the belly, and the coats of the stomach perforated with holes, in some of which other worms were sticking. In another child of the same age, who died in seven days of convulsions, he found thirty-six worms in the peritoneal sac, a great mass of them in the stomach, and twenty-seven making their way through holes in its coats.[^[1653]] In a singular case related by M. Lepelletier of a boy twelve years old, who died of convulsions in four days, the only morbid appearance found was a perforation of the gullet six lines in diameter, through which two lumbrici had made their way into a cavity in the middle right lobe of the lungs, while another was sticking in the hole, six more occupied the lower part of the gullet, and three lay in the stomach.[^[1654]]—The irritation of teething may also excite epilepsy, and in cases where it has proved fatal may be recognized by the redness and swelling of the gum, by the tooth being on the point of piercing the alveolar process, and by the turgescence of vessels around.[^[1655]]—A well-known but rather rare cause is the presence of some hard substance in the course of a nerve. This variety, like those already mentioned, may prove fatal in the fit, as appears from the following interesting case. A stout young woman became suddenly liable to epilepsy, and, after suffering repeated fits in the course of twenty months, died comatose in a paroxysm of thirty-three hours’ duration. The fits having always begun with acute pain in a particular part of the thigh, this part of the body was carefully examined, and a bony tumour as big as a nut was found on a branch of the sciatic nerve.[^[1656]]—Other appearances might likewise be here enumerated, which have been supposed the cause of symptomatic epilepsy.[^[1657]] But few of these have been so thoroughly ascertained as to be allowed much influence on a medico-legal opinion.

It cannot, I apprehend, be denied, that in many cases of epilepsy no decided morbid appearance is to be found in the body; and that in many others the appearances are either so equivocal as not to be satisfactorily recognized in any circumstances, or so hidden in their situation that they may escape notice, unless the inspector’s attention be drawn to the particular spot by a knowledge of the symptoms.

Hence in actual questions as to the occurrence of narcotic poisoning when the symptoms resemble epilepsy, it will be seldom possible to found on the absence of morbid appearances more than a presumptive opinion that death did not proceed from the natural cause. It is right to remember, however, that in considering the absence of morbid appearances in reference to the diagnosis of narcotic poisoning and epilepsy, the attention should be confined to cases of epilepsy which prove fatal during the fit. Now I suspect no such case ever occurs, at least in adults, without an adequate cause being discoverable in the dead body, either in the head, or in the course of some nerve, or in the accumulation of worms in the intestines. This statement must not be considered as made with confidence; but it deserves investigation.

From all that has now been said on the subject of epilepsy as a disease which imitates many varieties of narcotic poisoning, the medical jurist will probably arrive at the conclusion, that, although a diagnosis cannot always be drawn with certainty, yet in numerous cases the consideration of the symptoms and appearances after death will enable him to say positively that poisoning is out of the question, and in many others that poisoning is highly probable.

Of the Distinction between Meningitis and Narcotic Poisoning.

Inflammation of the inner membranes of the brain, which constitutes the acute hydrocephalus or acute meningitis of authors, is not in general apt to cause much ambiguity; for its progress is commonly gradual, well-marked and less rapid than most cases of narcotic poisoning: and the appearances in the dead body, such as effusion of serum, lymph or pus on the outer surface of the brain or in the ventricles, are for the most part obvious.

Dr. Abercrombie, however, has described a form of it occurring among children during the existence of other diseases, particularly of the chest, which might be the cause of perplexity; for its course is sometimes finished within a day, its symptoms are delirium, convulsions and coma intermingled, and the only morbid appearance is congestion of vessels on the surface and in the substance of the brain.[^[1658]] The affection now alluded to imitates closely, both in its progress and in its signs after death, some varieties of poisoning with the vegetable narcotico-acrids, such as belladonna, stramonium, and hemlock. But the latter cases, when they prove fatal, seldom last nearly so long as a day, while the instances of meningitis under consideration rarely cause death within twenty-four hours. Dr. Abercrombie also notices a parallel disease occurring among adults; but it is in them always marked by a considerably longer, though often more obscure course.[^[1659]]

Dr. Bright takes notice of a similar affection under the title of “Arachnitis with excessive irritability” occurring chiefly among very intemperate people, but independently of previous disease. In general the disorder has a well-marked course of at least several days’ duration. But in two of the instances he has given the early stage was very obscure, the only symptoms having been headache and sickness of no great severity for four or five days; after which delirium came suddenly on, and was followed by coma, and by death within thirty-six or forty hours. The sole appearances found within the head were some serous effusion and vascularity on the surface of the brain and in the ventricles.[^[1660]] To these illustrations may be added the heads of a remarkable case which occurred here in the person of an eminent lawyer, and for the particulars of which I am indebted to Dr. Maclagan. For three days there had been occasional headache, not great enough to prevent him pursuing his ordinary avocations, yet becoming so troublesome on the morning of the third day as to induce him to have leeches applied. But next morning he was seized rather suddenly with quickly increasing coma, and in forty hours more he expired. In this instance the whole surface of the arachnoid membrane, both over the hemisphere and in the ventricles, was found lined with soft, yellowish-green lymph.

In such cases it is apparent that an inspection after death will often unfold their real nature, where the history of the symptoms may leave it in doubt. But even without an inspection it is not likely that a careful physician could mistake them for narcotic poisoning; for independently of other considerations, the severe symptoms are ushered in by a precursory stage of ill health, commonly indicating an obscure affection of the head, and such as no one but a careless observer could fail to discover and appreciate.

It is not improbable, however, that acute meningitis may seem to prove suddenly fatal, in consequence of its course being in a great measure latent. The following case reported by Mr. Davies of Somers Town, seems of this nature. A woman, who had previously complained only of slight headache, was attacked after breakfast with violent vomiting for half an hour, when she fell down, and immediately expired. After death there was found great gorging of the vessels of the cerebral membranes, with opacity and thickening of the pia mater and arachnoid coats, and an effusion of nearly five ounces of bloody serum under the dura mater.[^[1661]] Such a case might give rise to great perplexity in a charge of poisoning, until the examination of the body unfolded its true nature.

I should scarcely have thought it necessary to mention chronic meningitis among the diseases apt to imitate the effects of narcotic poisons, because it is commonly marked by a long and distinct course. But the following case, for which I am indebted to Dr. Arnoldi of Montreal, will show that, like other diseases of the head, chronic meningitis may be latent in its early stage, and may, after developing itself, terminate in a day, and then in some measure imitate poisoning with narcotics. A middle-aged female, subject for a twelvemonth to a purulent discharge from the left ear, and occasional headache, which was supposed to be rheumatic, was seized one morning with acute pain in the head, followed in a few hours by convulsions and tendency to coma; under which symptoms she died within twenty hours, although treated actively from the commencement. On dissection, the brain and pia mater were found healthy, except at the part corresponding with the petrous portion of the left temporal bone, where the brain was a little softened. The corresponding part of the temporal bone and the adjacent part of the occipital were completely denuded and covered with pus, which had established a passage for itself into the cavity of the ear.

Of the Distinction between Inflammation of the Brain and Narcotic Poisoning.

Inflammation of the brain itself, the ramollissement of French writers, occasionally excites symptoms not unlike those produced by some narcotic poisons; and in a few instances its course has appeared to be equally short. It requires particular notice, because the appearances left in the dead body are sometimes apt to escape observation.

This disease in its well-marked form has been noticed by various authors from Morgagni downwards. But the first regular accounts of it were given in 1818 by Dr. Abercrombie,[^[1662]] and in 1819 by M. Rostan[^[1663]] of Paris, and Professor Lallemand[^[1664]] of Montpellier. Its symptoms are allied to those of apoplexy and epilepsy. But the comatose state is generally preceded by delirium or imperfect palsy, and often by a febrile state of the circulation. Contraction of the voluntary muscles, once supposed to be a distinguishing sign of this disease, is neither essential nor peculiar to it. In the dead body it is recognized by the presence either of an abscess in the brain,—or more commonly of a nucleus of disorganized cerebral tissue surrounded by unnatural redness or softness,—or sometimes of a clot of blood surrounded by similar softening. Occasionally, when the disease kills in its early stage, nothing is found but redness of a part of the brain, and slight softening of the tissue, recognizable only by scraping it with the edge of the scalpel.

In the form in which it is commonly seen, and as described by Rostan and Lallemand from a great number of cases, it can hardly be confounded with the effects of narcotic poisons; for its course is much slower, being seldom less than several days when it proves fatal.[^[1665]] Yet in some instances it may prove fatal instantly. Lancisi notices the case of an Italian nobleman, who after an apoplectic fit became liable to frequent attacks of lethargy,—who at length died quite suddenly more than a year afterwards,—and in whose brain an organized clot was found, with extensive suppuration of the brain around it.[^[1666]] An unequivocal case of the same kind has been related by Mr. Dickson, a navy-surgeon. An elderly sailor, who for months before had done duty, eaten his rations, and drunk his grog as usual, suddenly dropped down while in the act of pulling his oar, and died at once; and after death there was found in the middle lobes of the brain an extensive abscess, which had made its way to the surface.[^[1667]] Such cases might, in certain circumstances, be mistaken for the effects of large doses of hydrocyanic acid; but the morbid appearances are of course quite characteristic. M. Louis has related an instance like the last two, but where the disease was altogether latent. His patient after a long illness died of diseased heart, the ventricles of which communicated together. He never had a symptom of disorder of the head; yet on dissection an extensive recent softening was found in the right corpus striatum and another in the right thalamus.[^[1668]]

None of the treatises I have seen on the subject make mention of a variety of this disease intermediate between suddenly fatal cases and those which last several days,—a form in which the patient’s illness endures for a few hours only, and which, both in the special symptoms and in their course, imitates exactly the effects of some narcotics. Two such cases have come under my notice, both of them judicial, poisoning having been suspected. One of them proved fatal in an hour and a half, the individual having previously been in excellent health; and the only appearance of disease was softening of a considerable part of the surface of the brain where it lies over the left orbit. The other was more remarkable in its circumstances. In November, 1822, a man, who had previously enjoyed excellent health, was found one morning in a low lodging-house in the Lawnmarket comatose, and convulsed; and he died seven hours afterwards. The neighbours spread a report, that the woman of the house had poisoned him, with the view of selling the body; and by an odd coincidence the police, when they went to apprehend the woman, found an anatomist hid in a closet. The body was judicially examined by Sir W. Newbigging and myself; and we found an ulcer on the forepart of the left hemisphere of the brain, and a small patch of softening on each middle lobe.

It is only in cases like the last two that the disease is likely to be mistaken for the effects of poison; and the morbid appearances will at once distinguish them. But it is requisite to remember that softening of the brain when not far advanced is apt to escape notice, as it is not necessarily attended with a change in the colour of the diseased part. In the first of the two cases I have related, the cause of death was very nearly assumed to have been simple apoplexy, when at length the true disorder was unexpectedly noticed. I presume, indeed, that strictly speaking, both of the cases which came under my notice ought to be considered as simple apoplexy excited by pre-existing ramollissement.

Of the Distinction between Hypertrophy of the Brain and Narcotic Poisoning.

This disease is not here mentioned, because its symptoms and progress resemble very closely those of poisoning with the narcotics; for it causes epileptic symptoms, which, besides that they are preceded for some time by other head affections, very seldom prove fatal in less than three days. But some notice of it is necessary, because the disease is rare and of recent discovery, so that the appearances left by it in the dead body may escape observation. Besides, the physician is at present imperfectly acquainted with it, and therefore, when a more extensive collection of cases shall have been made, it may be found to prove at times fatal so rapidly as to admit of being confounded with narcotic poisoning. Hypertrophy of the brain, it is true, is always a chronic or slow disease, but, like other diseases of the brain, its early stages may possibly be so completely latent that the patient may appear to die of a few hours’ illness. This, however, must be left to the determination of future experience. The most rapid case yet published proved fatal twenty-four hours after the first appearance of symptoms.

The appearances left in the body are increased density and firmness of the whole brain or a part of it,—flattening of the convolutions on their outer surface, so that their grooves are almost obliterated and the investing membrane uncommonly dry,—unusual emptiness of the blood-vessels of the brain and its membranes,—and a protrusion of the brain upwards on removal of the skull-cap, as if the organ were too large for its containing cavity.[^[1669]]

Some pathologists doubt the existence of hypertrophy of the brain as a distinct disease, and conceive that the appearance of flattening of the convolutions is produced by serum effused between the dura mater and arachnoid membrane. But this explanation will not account for those cases in which it is expressly stated that little or no fluid was to be found in any part of the brain or in the base of the skull.

Of the Distinction between Diseases of the Spinal Cord and Narcotic Poisoning.

It is not necessary to say much on the acute diseases of the spinal cord, which are apt to be confounded with the effects of narcotic poisons. The diseases are extravasation of blood into the spinal canal, inflammation of the membranes, and inflammation [ramollissement] of the cord itself. These disorders are commonly marked by obvious and characteristic symptoms, as well as a much slower course than that of the affections induced by narcotic poisons. But occasionally they approach closely the characters of some of the slow cases of narcotic poisoning,—palsy being absent, the leading symptoms consisting of delirium, convulsions, and coma, and the fatal event occurring within the third day. Dr. Abercrombie and M. Ollivier have related examples of the kind arising from extravasation of blood,[^[1670]] serous effusion,[^[1671]] and softening of the cord.[^[1672]] Such cases are exceedingly rare; but the possibility of their occurrence should impose on the medical jurist the necessity of examining the spine with care in all judicial cases of alleged narcotic poisoning, especially when death has not been rapid.

Of the Distinction between syncopal Asphyxia, and Narcotic Poisons.

The only other natural disease requiring notice under the present head is the Asphyxia Idiopathica of the late Mr. Chevallier. It may be the cause of embarrassment in questions regarding narcotic poisoning, when the course of the symptoms to their fatal termination is rapid, and was not witnessed by any person; for it causes death with equal rapidity, and its signs in the dead body are very obscure. It has been observed chiefly among women in the latter months of pregnancy, or soon after delivery; but it has also been known to attack the male sex. It generally commences during a state of perfect health, and is seldom preceded by any warning of danger. The person suddenly complains of slight sickness, giddiness, and excessive faintness, immediately seems to sleep or swoon away, and expires gently without a struggle. The only appearance of note found in the dead body is unusual flaccidity and emptiness of the heart.[^[1673]] But even these slight appearances are not constant; for in a case related by Rochoux of a woman who, while in a state of perfect health, suddenly grew pale, slipped off her chair, and died on the spot, the auricles of the heart contained a great deal of blood.[^[1674]] This singular disorder appears to consist of nothing else than a mortal tendency to fainting; and it may prove fatal either in the first fit of syncope, or after an hour and a half.—Under the same head are probably to be arranged the cases of sudden death described by M. Devergie under the title of Death by Syncope. He has given scarcely any account of the circumstances attending death; but it may be inferred from his classification of the cases that fainting immediately preceded it. In all of them he found blood in both sides of the heart; and the blood, contrary to what happens in other kinds of sudden death, had separated into clear serum, and fibrin free of colouring matter.[^[1675]]—Under the same head also may be noticed a denomination of cases, which, though alluded to before by various pathologists, were first distinctly characterized by M. Ollivier, where death is caused on a sudden, apparently by the disengagement of a large quantity of aëriform fluid from the blood in the heart and great vessels. Among the instances described by Ollivier, it appears that death repeatedly occurred quite suddenly while the individuals enjoyed sound health; and the only appearances of any note found in the body were tympanitic distension of the heart, absence of blood there and in the great vessels, and the existence of a gaseous fluid in numerous globules throughout the blood-vessels of the brain. The circumstances of death and the appearances in the dead body are much the same with those observed from the admission of air into the veins during surgical operations. A case of this kind, owing to its suddenness, might be confounded with the effects of the more active narcotic poisons, such as hydrocyanic acid, especially as its characters in the dead body might escape notice.[^[1676]]

Death often takes place from sudden syncope in organic diseases of the heart. Such cases may be confounded with the most rapid variety of poisoning with hydrocyanic acid; and if the duration of the symptoms preceding death is unknown, they may give rise to a suspicion of poisoning generally. But they are at once distinguished by the morbid appearances. A trivial organic derangement may be the occasion of instant death.

The genera comprehended in the class of narcotics are opium, henbane, lettuce-opium, solanum, hydrocyanic acid, and the deleterious gases. Of these genera the last is by no means a pure one, for it includes many gases which act as irritants only; but it is more convenient to consider them together, than to distribute them into separate classes. Some other vegetable substances besides henbane, lettuce-opium, and solanum, possess nearly the same properties; but as they likewise cause irritation, they are arranged more appropriately in the next class, the narcotico-acrids.

Most narcotic vegetables owe their poisonous properties to a peculiar principle, probably of an alkaline nature, and slightly different in each. This discovery was made with regard to opium in 1812; and the discovery of the active principle in that drug has been followed by the detection of analogous principles in most narcotics, as well as in many narcotico-acrids.

These principles are generally crystalline, soluble in alcohol and the acids, little soluble in water, free from mineral admixture, and entirely destructible by heat. When purified with the greatest care, they still retain decided alkaline properties; but on account of their number and the low power of neutralization their alkaline nature was long denied; and they have been conventionally styled alkaloids.

In their natural state they exist in combination with various ternary acids, some of which are peculiar; and they are likewise intimately blended, or more probably united chemically, with other inert principles of the vegetable kingdom, particularly resinous and extractive matters, to which they adhere with great obstinacy.

They are all highly energetic, and generally concentrate in themselves the leading properties of the substance from which they are obtained.

The experiments, which have led to the conclusion, that the narcotic poisons act on the brain by entering the blood-vessels, have been repeated with their alkaloids, and have yielded similar results. But the alkaloids are in equal quantities much more energetic than the crude poisons. Their effects indeed are truly formidable, and some well authenticated instances of their action appear hardly less marvellous than the most extravagant notions entertained in ancient times of the operation of poisons. One of them, the principle of nux vomica, which, however, does not belong to the present class, is so active that in all probability a man might be killed with the third part of a grain in less than fifteen minutes.

It is very difficult to detect some of the vegetable alkaloids; and it is fortunate, therefore, that they are rare, and not to be procured but by complex processes.

Chemical analysis does not by any means supply so good evidence of poisoning with the narcotics as it does of poisoning with the irritants. Their chemical properties are not very characteristic, and they are not well developed unless with a larger quantity of the poison than will usually be met with in medico-legal investigations. This remark, however, does not apply universally; and it is probable, that, as organic analysis goes on improving, better and more delicate processes will be discovered.

CHAPTER XXVII.
OF POISONING WITH OPIUM.

To the medical jurist opium is one of the most important of poisons; since there is hardly any other whose effects come more frequently under his cognizance. It is the poison most generally resorted to by the timid to accomplish self-destruction, for which purpose it is peculiarly well adapted on account of the gentleness of its operation. It has also been often the source of fatal accidents, which naturally arise from its extensive employment in medicine. It has likewise been long very improperly employed to create amusement. And in recent times it has been made use of to commit murder, and to induce stupor previous to the commission of robbery. Mr. Burnett, in his work on Criminal Law, has mentioned a trial for murder in 1800, in which the prisoners were accused of having committed the crime by poisoning with opium; and although a verdict of not proven was returned, there is little doubt that the deceased, an adult, was poisoned in the way supposed. A few years ago, a remarkable trial took place at Paris, where poisoning was alleged to have been effected by means of the alkaloid principle of opium; and the prisoner, a young physician of the name of Castaing, was condemned and executed.

In several parts of Britain during the last fifteen years many persons have been brought into great danger by opium having been administered as a narcotic to facilitate robbery; and some have actually been killed. In December, 1828, a conviction was obtained in the Judiciary Court of Edinburgh for this crime, in which instance the persons who had taken the opium recovered. A fatal case, which was strongly suspected to be of the same nature, was submitted to me by the sheriff of this county in 1828; but sufficient evidence could not be procured. In July, 1829, a man Stewart and his wife were condemned, and subsequently executed for the same crime, the person to whom they gave the opium having been killed by it. And about a year afterwards a similar instance occurred at Glasgow, for which a man Byers and his wife were condemned at the Autumn Circuit of 1831.

Section I.—Of the Chemical History and Tests of Opium.

Opium is the inspissated juice of the capsules of the Papaver somniferum. It has a reddish-brown colour, and a glimmering lustre on a fresh surface. It is soft and plastic when recent; but if pure, may be dried so as to become brittle. Its smell is strong and quite peculiar. It has a very bitter and most peculiar taste. In consequence of this taste one would suppose it no easy matter to administer opium secretly. The plan resorted to by thieves and robbers seems to be, to deaden the sense of taste by strong spirits, and then to ply the person with porter or ale drugged with laudanum, or the black drop, which possesses less odour.

The following account of the chemical history of opium will be confined in a great measure to the leading properties of the principles, in which its active qualities are concentrated, or which are likely by their chemical characters to supply proof of its presence.

The common solvents act readily on opium. Water dissolves its active principles even at low temperatures. So does alcohol. So particularly do the mineral and vegetable acids when much diluted. Ether removes from it little else than one of its active principles, narcotine. By the action of these agents are procured various preparations in common use. Laudanum is a spirituous infusion, and contains the active ingredients of a twelfth part of its weight of opium. Scotch Paregoric Elixir, a solution in ammoniated spirit, is only one-fifth of the strength of laudanum; and English Paregoric, tincture of opium and camphor for its chief ingredients, is four times weaker still. Wine of opium contains the soluble part of a sixteenth of its weight. The black drop and Battley’s sedative liquor are believed to be solutions of opium in vegetable acids, and to possess, the former four, the latter three times the strength of laudanum. But their strength has been greatly exaggerated; neither of them, according to my own experience, being above half what is supposed. The juice and infusion of the garden poppy are also powerfully narcotic, so as even to have caused death both when given by the mouth and in the way of injection.[^[1677]] Many other pharmaceutic preparations contain opium.

If opium be infused in successive portions of cold water, the water dissolves all its poisonous principles, and also a peculiar acid possessing characteristic chemical properties. These principles are separated by means of the alkalis, the alkaline carbonates, or the alkaline earths. The most important of them are morphia, the chief alkaloid of opium,—narcotine, a feeble poison, not an alkaloid,—a peculiar acid, termed meconic acid,—and a resinoid substance. Other crystalline principles also exist in opium, though apparently in too small proportion either to affect its action or to be available in medico-legal analysis as the means of detecting the drug. These are codeïa, meconine, narceïne, paramorphia, and porphyroxine.

Of the various principles now indicated it is necessary to notice here only morphia, narcotine, codeïa, porphyroxine and meconic acid. They require mention either as being active poisons, or because a knowledge of their leading characters may be useful in conducting a medico-legal analysis in a case of poisoning with opium.

Meconic acid, as procured by evaporation, is usually in little scales of a pale brown or yellowish tint, being rendered so by adhering resin or extractive matter; but when nearly colourless, it forms long, extremely delicate tabular crystals, which in mass have a fine silky appearance like spermaceti. 1. When heated in a tube, it is partly decomposed, and partly sublimed; and the sublimate condenses in filamentous, radiated crystals. 2. When dissolved even in a very large quantity of water, the solution acquires an intense cherry-red colour with the perchloride of iron. The sublimed crystals have the same property. Only one other acid is so affected, namely, the sulpho-cyanic, a very rare substance. It has been repeatedly stated,[^[1678]] that the redness produced by meconic acid may be distinguished by the effect of an alkali, which is said to bleach the colour produced by sulpho-cyanic acid, but to deepen the cherry-red tint occasioned by the meconic. This is not correct; an alkali added to the red solution of meconate of iron precipitates oxide of iron and renders the liquid colourless. The best distinction yet proposed is the following which has been suggested by Dr. Percy. Acidulate the red fluid with sulphuric acid, drop in a bit of pure zinc, and suspend at the mouth of the tube a bit of paper moistened with solution of acetate of lead: If the redness be caused by sulpho-cyanic acid, hydrosulphuric acid gas is evolved, and blackens the paper; but no such effect ensues, it the redness be owing to meconic acid.[^[1679]]—According to Dr. Pereira, solutions of the acetates, an infusion of white mustard, decoctions of Iceland moss, and of the Gigantina helminthocorton, besides other more rare substances, are reddened, like solution of meconic acid, by the salts of peroxide of iron.[^[1680]] 3. The solution of meconic acid gives a pale-green precipitate with the sulphate of copper, and, if the precipitate is not too abundant, it is dissolved by boiling, but reappears on cooling.

Of the Tests for Morphia and its Salts.—Morphia, when pure, is in small, beautiful, white crystals. Various forms have been ascribed to it; but in the numerous crystallizations I have made, it has always assumed when pure the form of a slightly flattened hexangular prism. It has a bitter taste, but no smell.

A gentle heat melts it, and if the fluid mass is then allowed to cool, a crystalline radiated substance is formed. A stronger heat reddens and then chars the fused mass, white fumes of a peculiar odour are disengaged, and at last the mass kindles and burns brightly.—Morphia is very little soluble in water. It is more soluble, yet still sparingly so, in ether. But its proper solvents are alcohol, or the diluted acids, mineral as well as vegetable. All its solutions are intensely bitter, and that in alcohol has an alkaline reaction.—From its solutions in the acids crystallizable salts may be procured; and morphia may be separated by the superior affinity of any of the inorganic alkalis; but it is easily redissolved by an excess of potash.—Morphia when treated with nitric acid is dissolved with effervescence, and becomes instantly orange-red, which, if too much acid be used, changes quickly to yellow. The coloration of morphia by nitric acid is a characteristic property; which, however, it possesses in common with some other alkaloids, such as brucia, and also strychnia when not quite pure. The change of colour is said by some chemists to depend on adhering resinoid matter, and not to be possessed by perfectly pure morphia; but this is a mistake. It is probable that some other vegetable substances besides the three alkaloids, morphia, brucia, and strychnia, may be turned orange-red by nitric acid. Dr. Pereira says that oil of pimento undergoes the same change.[^[1681]]—When suspended in water, in the form of fine powder and then treated with a drop or two of perchloride of iron containing little or no free hydrochloric acid, it is dissolved and forms a deep blue solution, the tint of which is more purely blue, the stronger the solution, and the purer the morphia. This is a property even more characteristic than the former, since no such effect is produced on any other known alkaloid. Like the effect of nitric acid, it is said not to be essential to morphia, but to depend on adhering resinoid matter; yet the blue colour is always strongly produced with powdered morphia of snowy-whiteness.—Another property by which morphia maybe also distinguished is the decomposition of iodic acid. A solution of iodic acid is turned brown either by morphia or its salts, owing to the formation of iodine; and the test is so delicate that it affects a solution containing a 7000th of morphia.[^[1682]] So many other substances, however, possess the property of disengaging iodine from iodic acid, that little importance can be attached to this criterion.

Acetate of Morphia is in some countries the common medicinal form for administering morphia; but it has been almost entirely superseded in this city by the hydrochlorate, since Dr. W. Gregory pointed out a cheap mode of procuring that salt in a state of purity.[^[1683]] The acetate is in confused crystals, often of a brownish colour from impurities. The stronger acids disengage acetic acid. The alkalis throw down morphia from its solution in water. Nitric acid and perchloride of iron act on it as on morphia itself.

Hydrochlorate of Morphia.—The muriate or hydrochlorate must be carefully attended to by the medical jurist, because it is extensively used in medical practice instead of opium. As now prepared, it is snowy-white and apparently pulverulent, but is in reality a congeries of filiform crystals. It decrepitates slightly when heated, then melts, and at the same time chars, exhaling a strong odour somewhat like that of truffles. Nitric acid and perchloride of iron act on it as on morphia. Boiling water dissolves fully its own weight, and very easily three-fourths of its weight of hydrochlorate of morphia; and on cooling down to 60° F. it retains seven parts per cent., and deposits the rest in tufts of beautiful filiform crystals. The solution commonly employed in medicine contains one per cent. of the salt. Nitric acid turns the solution yellow, acting distinctly enough when the water contains a hundredth, and perceptibly when it contains only a two-hundredth of its weight. Perchloride of iron strikes a deep blue with a solution containing a hundredth of its weight, very distinctly when the proportion is a two-hundredth, and even perceptibly when it is only a five-hundredth. A solution much more diluted than even the last has a strong bitter taste. When moderately concentrated, morphia is precipitated from it by the alkalis.

Of the preceding properties of morphia and its salts, those which constitute the most characteristic tests are the effects of perchloride of iron and of nitric acid on all of them, the effect of heat on morphia, and the effect of an alkali on its solutions in acids.

Of the Tests for Narcotine.—Narcotine is rather distinguished by negative than by positive chemical properties. When pure, it is in transparent colourless pearly crystals, which, as formed from alcohol, may be either very flat, oblique, six-sided prisms, or oblong four-sided tables obliquely bevelled on their sides. But when crystallized from sulphuric ether the crystals are prisms with a rhombic base. They fuse with heat, and concrete on cooling into a resinous-like mass. They are soluble in ether, and fixed oil, less so in alcohol, insoluble in water or the alkalis, very soluble in the diluted acids, but without effecting neutralization; and if perfectly pure, they do not undergo the changes produced on morphia by perchloride of iron or nitric acid. Few specimens of narcotic, however, are so pure as not to render nitric acid yellow. Care must be taken not to confound narcotine with morphia. When crystallized together from alcohol and not quite pure, narcotine forms tufts of pearly thin tabular crystals, while morphia is in short, thick, sparkling prisms.

Of Codeïa.—This substance is, like morphia, an alkaloid, capable of combining with acids. It differs from morphia and narcotine in being moderately soluble in water; and from this solution it may be crystallized in large crystals affecting the octaedral form. It is unnecessary to detail its chemical properties.

Of the Tests for Porphyroxine.—This principle is a neutral crystalline body, insoluble in water, soluble in alcohol and ether, and also soluble in weak acids, which part with it unchanged on the addition of an alkali. When heated with hydrochloric acid, a fine purple or rose-red solution is produced; whence its name. It is supposed that this property may be of use in medico-legal researches; and the following mode of developing it has been proposed by Dr. Merck, its discoverer.[^[1684]] Decompose the suspected fluid with caustic potash; agitate the mixture with sulphuric ether; dip a bit of white filtering paper repeatedly in the etherial solution, drying it after each immersion; then wet the paper with hydrochloric acid, and expose it to the vapour of boiling water; upon which the paper will become more or less acid.

Of the Process for detecting Opium in mixed fluids and solids.

Having stated these particulars of the chemical history of opium and its chief component ingredients, I shall now describe what has appeared to me the most delicate and satisfactory method of detecting it in a mixed state.

1. If there be any solid matter, it is to be cut into small fragments, water is to be added if necessary, then a little acetic acid sufficient to render the mixture acidulous, and when the whole mass has been well stirred, and has stood a few minutes, it is to be filtered, and evaporated at a temperature somewhat below ebullition to the consistence of a moderately thick syrup. To this extract strong alcohol is to be gradually added, care being taken to break down any coagulum which may be formed: and after ebullition and cooling, the alcoholic solution is to be filtered. The solution must then be evaporated to the consistence of a thin syrup, and the residue dissolved in distilled water and filtered anew.

2. Add now the solution of acetate of lead as long as it causes precipitation, filter and wash. The filtered fluid contains acetate of morphia, and the precipitate on the filter contains meconic acid united with the oxide of lead.

3. The fluid part is to be treated with hydrosulphuric acid gas, to throw down any lead which may remain in solution. It is then to be filtered while cold, and evaporated sufficiently in a vapour-bath. The solution in this state will sometimes be sufficiently pure for the application of the tests for morphia; but in most cases it is necessary, and in all advisable, to purify it still farther. For this purpose the morphia is to be precipitated with carbonate of soda; and the precipitate having been collected, washed, and drained on a filter, the precipitate and portion of the filter to which it adheres are to be boiled in a little pure alcohol. The alcoholic solution,—filtered, if necessary,—will give by evaporation a crystalline residue of morphia, which becomes orange-red with nitric acid, and blue with perchloride of iron. The latter property I have sometimes been unable to develope when the former was presented characteristically.

4. It is useful, however, to separate the meconic acid also; because, as its properties are more delicate, I have repeatedly been able to detect it satisfactorily, when I did not feel satisfied with the result of the search for morphia. Dr. Ure made the same remark in his evidence on the trial of Stewart and his wife. He detected the meconic acid, but could not separate the morphia. It may be detected in one of two ways,—by means of hydrosulphuric acid, or by sulphuric acid.

If the former method be chosen, suspend in a little water the precipitate caused by the acetate of lead (par. 2); transmit hydrosulphuric acid gas till the whole precipitate is blackened; filter immediately without boiling; then boil, and if necessary filter a second time. A great part of the impurities thrown down by the acetate of lead will be separated with the sulphuret of lead; and the meconic acid is dissolved. But it requires in general farther purification, which is best attained by again throwing it down with acetate of lead, and repeating the steps of the present paragraph. The fluid is now to be concentrated by evaporation at a temperature not exceeding 180° F., and subjected to the tests for meconic acid, more particularly to the action of perchloride of iron, when the quantity is small. If there is evidently a considerable quantity of acid, a portion should be evaporated till it yields crystalline scales; and these are to be heated in a tube to procure the arborescent crystalline sublimate formerly described. About a sixth of a grain of meconic acid, however, is required to try the latter test conveniently.

If the method of separating meconic acid by means of sulphuric acid be preferred, the precipitate formed by acetate of lead is to be treated with weak sulphuric acid, which forms insoluble sulphate of lead, and disengages the meconic acid. The liquid obtained by filtration is then to be evaporated as above, to obtain crystals, which are to be examined by the tests for meconic acid. Orfila thinks this method more delicate than the mode by hydrosulphuric acid gas. I am inclined from my own experiments to doubt his statement.

5. If there be a sufficiency of the original material, Merck’s process for detecting porphyroxin may be tried [see p. [534]]. But I doubt whether this process is sufficiently delicate for medico-legal purposes.

I wish I could add my testimony to the opinion, expressed on a remarkable occasion by Professor Chaussier, in favour of the delicacy of the tests for morphia and its compounds, that they might be detected “jusqu’à une molécule.”[^[1685]] In one sense this statement may be correct. Morphia, separated from the complex mixture of principles with which it is combined in opium, may be detected in extremely small quantities. Accordingly, M. Lassaigne has supplied, for the discovery of acetate of morphia in mixed fluids, an excellent process, whence the chief part of the three first paragraphs of the preceding method for opium are borrowed; and from the facts stated by him in his paper,[^[1686]] as well as from the experimental testimony of Professor Orfila,[^[1687]] it appears that Lassaigne’s process will furnish strong indications, if not absolute proof of the presence of that salt, in the proportion of two grains to eight ounces of the most complex mixtures. Hence the search for acetate of morphia in a suspected case is by no means hopeless. But the detection of acetate of morphia is an object of small moment, compared with the detection of morphia in its natural state of combination in opium. Now my own observations lead me to entertain serious doubts, whether the best method of operating hitherto known could be successfully applied to the detection of the equivalent opium in complex mixtures. By the process I have recommended it is easy to procure, from an infusion of ten grains of opium in four ounces of water, satisfactory proof of the presence of morphia by the action of ammonia, perchloride of iron and nitric acid, and equally distinct proof of the presence of meconic acid by perchloride of iron, as well as sulphate of copper. But on proceeding to apply the process to organic mixtures, I have found that when the soluble part of ten grains of opium was mixed with four ounces of porter or milk, I could develope no property of morphia but its bitterness, and no indication of meconic acid but the action of perchloride of iron. MM. Larocque and Thibierge, it is right to add, have in similar circumstances found the process somewhat more delicate.[^[1688]]

It is of great consequence, however, to remark, that in cases of poisoning with opium, the medical jurist will seldom have the good fortune to operate even upon so large a proportion of the poison as in my experiments; because the greater part of it disappears from the stomach before death. This will not happen always, as may be seen from various cases mentioned afterwards in the section on the morbid appearances caused by opium. But, according to my own observations, the poison will often disappear in a short time, so far as to render an analysis abortive. Thus in the case of a young woman who died five hours after taking not less than two ounces of laudanum, I could apply to the fluid, procured from the contents of the stomach, by paragraphs 1, 2, and 3 of my process, only the test of its taste, which had the bitterness of morphia. In the case of another young woman, whose stomach was emptied by the stomach-pump four hours after she took two ounces of laudanum, I could obtain from the evacuated fluid, when properly prepared, only the indications of the presence of morphia supplied by its bitterness and the imperfect action of nitric acid,—and the indication of the presence of meconic acid supplied by the imperfect action of perchloride of iron. In a third case, where the stomach was evacuated two hours after seven drachms of laudanum had been swallowed, even the first portions of fluid withdrawn had not any opiate odour, and did not yield any indication of the presence even of meconic acid. Now, on the one hand, the quantity taken in these instances is rarely exceeded in cases of poisoning with laudanum; and, on the other hand, the interval during which it remained in the stomach subject to vital operations is considerably less than the average in medico-legal, and above all in fatal cases. It may be laid down, therefore, as a general rule, that in poisoning with opium the medical jurist, by the best methods of analysis yet known, will often fail in procuring satisfactory evidence, and sometimes fail to obtain any evidence at all, of the existence of the poison in the contents of the stomach. In a case published by Dr. Bright from the experience of Mr. Walne of London, it is stated that the matter removed from the stomach only half an hour after an ounce and a half of laudanum had been taken, while the stomach was empty, did not smell of opium.[^[1689]] This case is quoted to put the reader on his guard. But at the same time it does appear extremely improbable that the whole opium had disappeared from the stomach in so short a time, and much more likely that it might have been found by analysis in the matter first withdrawn.

I have taken some pains to establish the proposition laid down above, because in a matter of such importance it is always essential, that the medical inspector know the real extent of his resources; and it has appeared to me that, greatly as the hand of the chemist has been strengthened by late discoveries in vegetable analysis, his power has been overrated both by his scientific brethren, and by the medical profession generally. I am happy to find, since the first publication of these remarks, that they coincide with the experience and opinion of so eminent an authority as Professor Buchner; who has observed that a chemical analysis must often fail to detect opium where there could be no doubt of its having been administered in large quantity.[^[1690]]

It is of moment to add, that in two of the instances mentioned above the odour of laudanum was perceived in the subject of analysis,—faintly, however, and only for a few hours after it was removed from the stomach. Although the peculiar odour of opium is a delicate criterion of its presence, it does not follow that it should be preferred to an elaborate chemical analysis. For it is a test of extreme uncertainty. There is in the contents of the stomach such a complication of odours, that with a rather delicate sense of smell, I have sometimes been unable to satisfy myself of the presence of the opiate odour where others were sure it existed. At the same time the medical jurist should not neglect it as a subsidiary test. It is always strongest and most characteristic, first, when the stomach is just opened, or the contents just withdrawn, and again, when the fluid, in the course of preparation, as directed in paragraph 1 (p. [535]), is just reaching the point of ebullition. The latter odour is somewhat different from the former, yet quite peculiar, and such as every chemist must have remarked on boiling an infusion of opium. It is further to be observed, that although the odour of opium is a very delicate test of its presence even in complex organic mixtures, chemical analysis may be successful, where this character fails. Dr. Morehead of the Bombay service, in applying my process to the fluid withdrawn by the stomach-pump, detected morphia both by nitric acid and perchloride of iron, although he could not detect any odour of opium in the fluid.[^[1691]]

So much for the delicacy of the process. As to its precision,—from what I have myself witnessed, as well as from the experience of Dr. Ure, it will often happen in actual practice, that the only indication of opium to be procured by the process consists in the deep red colour struck by perchloride of iron with the meconic acid. Now, will this alone constitute sufficient proof of the presence of opium? On the whole, I am inclined to reply in the affirmative. Sulpho-cyanic acid, it is true, has the same effect, and this acid has been proved by Professors Gmelin and Tiedemann to exist in the human saliva,[^[1692]]—a fact which was called in question by Dr. Ure in his evidence on the trial of the Stuarts, but which at the time I had verified, and which Dr. Ure has since been compelled by experiments of his own to admit.[^[1693]] But it must be very seldom possible to procure a distinct blood-red coloration from the saliva, after it has been mixed with the complex contents of the stomach, and subjected to the process of analysis detailed above;[^[1694]] and the check proposed by Dr. Percy (p. [532]) will distinguish it.

Section II.—Of the Action of Opium, and the Symptoms it excites in Man.

The symptoms and mode of action of opium have been long made the subject of dispute, both among physicians and toxicologists; and in some particulars our knowledge is still vague and insufficient.

Under the head of general poisoning, some experiments were related, from which it might be inferred that opium has the power of stupefying or suspending the irritability of the parts to which it is immediately applied. The most unequivocal of these facts, which occurred to Dr. Wilson Philip, was instant paralysis of the intestines of a dog, when an infusion of opium was applied to their mucous coat;[^[1695]] another hardly less decisive was palsy of the hind-legs of a frog, observed by Dr. Monro Secundus, when opium was injected between the skin and the muscles;[^[1696]] and a third, which has been remarked by several experimentalists, is immediate cessation of the contractions of the frog’s heart when opium is applied to its inner surface.[^[1697]]

The poison has also powerful constitutional or remote effects, which are chiefly produced on the brain. Much discussion has arisen on the question, whether these constitutional effects are owing to the conveyance of the local torpor along the nerves to the brain, or to the poison being absorbed, and so acting on the brain through the blood. The question is not yet settled. It appears pretty certain, however, that the poison cannot act constitutionally without entering the blood-vessels; although it is not so clear, that after it has entered them, it acts by being carried with the blood to the brain. The newest doctrine supposes that it enters the blood-vessels, and produces on their inner coat an impression which is conveyed along the nerves.

According to the experiments of Professor Orfila, it is more energetic when applied to the surface of a wound than when introduced into the stomach, and most energetic of all when injected into a vein.[^[1698]] The inference generally drawn from these and other analogous experiments[^[1699]] is, that the blood transmits the poison in substance to the brain. They certainly, however, do not prove more than that the poison must enter the blood before it acts.

The old doctrine, that the blood-vessels have no concern with its action, and that it acts only by conveyance along the nerves of a peculiar local torpor arising from its direct application to their sentient extremities, has been long abandoned by most physiologists as untenable. But some have adopted a late modification of this doctrine, by supposing that opium may act both by being carried with the blood to the brain, and by the transmission of local torpor along the nerves. They believe, in fact, that opium possesses a double mode of action,—through sympathy as well as through absorption. It would be fruitless to inquire into the grounds that exist for adopting or rejecting this doctrine, because sufficient facts are still wanting to decide the controversy. So far as they go, however, they appear adverse to the supposition of a conveyance of impressions along the nerves, without the previous entrance of the poison within the blood-vessels. The difficulties, in the way of the theory of the sympathetic action of opium, would be removed by the doctrine of Messrs. Morgan and Addison. According to their views, the experiments, which appear at first sight to prove that this substance operates by being carried with the blood to the part on which it acts, are easily explained by considering that the opium makes a peculiar impression on the inside of the vessels, which impression subsequently passes along the nerves to the brain.[^[1700]] But, as stated in the introductory chapter on the physiology of poisoning, this theory requires support.

The effects of opium, through whatever channel it may produce them, are exerted chiefly on the brain and nervous system. This appears from the experiments of a crowd of physiologists, as well as from the symptoms observed a thousand times in man. In animals the symptoms are different from those remarked in man. Some experimentalists have indeed witnessed in the higher orders of animals, as in the human subject, pure lethargy and coma. But the latest researches, among the rest those of M. Orfila, show that much more generally it causes in animals hurried pulse, giddiness, palsy of the hind-legs, convulsions of various degrees of intensity, from simple tremors to violent tetanus, and a peculiar slumber, in the midst of which a slight excitement rouses the animal and renews the convulsions. These symptoms are produced in whatever way the poison enters the body, whether by the stomach, or by a wound, or by direct injection into a vein, or by the rectum. In man, convulsions are sometimes excited; but much more commonly simple sopor and coma.

According to the inquiries of M. Charret, which were extended to every class of the lower animals, opium produces three leading effects. It acts on the brain, causing congestion, and consequently sopor; on the general nervous centre as an irritant, exciting convulsions; and on the muscles as a direct sedative. It is poisonous to all animals,—man, carnivorous quadrupeds, the rodentia, birds, reptiles, amphibious animals, fishes, insects, and the mollusca. But of its three leading effects some are not produced in certain classes or orders of animals. In the mammalia, with the exception of man, there is no cerebral congestion induced, and death takes place amidst convulsions. In birds there is some cerebral congestion towards the close; but still the two other phenomena are the most prominent.[^[1701]]

It has been rendered probable, by what is stated above, that opium enters the blood. The question, therefore, naturally arises, whether its presence there can be proved by chemical analysis? But considering the imperfection of the processes for detecting it when mixed with organic substances, no disappointment ought to be felt if this proof should fail in regard to so complex a fluid as the blood. The only person who has represented himself successful in the search is M. Barruel of Paris. He examined the urine and blood of a man under the influence of a poisonous dose of laudanum, amounting to an ounce and a half; and procured indications of morphia in both. When three ounces of urine were boiled with magnesia, and the insoluble matter was collected, washed, dried, and boiled, in alcohol, the residue of the alcoholic solution formed a white stain, which became deep orange-red on the addition of nitric acid. The blood was subjected to a more complex operation. One pound and ten ounces of it were bruised in a mortar, diluted with two pounds of water, strongly acidulated with sulphuric acid, boiled, filtered, and washed. The filtered fluid was saturated with chalk, and the excess of carbonic acid driven off by heat. The fluid was then filtered again, and after being washed with water, was acted on by diluted acetic acid. The acetic solution left on evaporation a residue which was repeatedly acted on by alcohol; and the residue of the alcoholic solutions was treated with pure alcohol and carbonate of lime. The new solution when filtered and evaporated left several small white stains, which became orange-red with nitric acid.[^[1702]] These results have been since contradicted by M. Dublanc. He in vain sought for morphia in the blood and urine of people who were taking acetate medicinally, or of animals that were killed by it.[^[1703]] Barruel’s results are also at variance with some pointed experiments of M. Lassaigne, who could not detect any acetate of morphia even in blood drawn from a dog twelve hours after thirty-six grains were injected into the crural vein;[^[1704]] nor any in the liver or venous blood of a dog poisoned with eight ounces of Sydenham’s laudanum.[^[1705]]

In investigating the effects of opium and its principles on man, the natural order of procedure is to consider in the first place those of opium itself in its various forms.

The effect of a small dose seems to be generally in the first instance stimulating: the action of the heart and arteries is increased, and a slight sense of fulness is caused in the head. This stimulus differs much in different individuals. In most persons it is quite insignificant. In its highest degree it is well exemplified by Dr. Leigh in his Experimental Inquiry, as they occurred to a friend of his who repeatedly made the experiment. If in the evening when he felt sleepy, he took thirty drops of laudanum, he was enlivened so that he could resume his studies; and if, when the usual drowsiness approached, which it did in two hours, he took a hundred drops more, he soon became so much exhilarated, that he was compelled to laugh and sing and dance. The pulse meanwhile was full and strong, and the temporal arteries throbbed forcibly. In no long time the customary torpor ensued. The stimulant effect of opium given during a state of exhaustion is also well illustrated by Dr. Burnes in his account of Cutch. “On one occasion,” says he, “I had made a very fatiguing night march with a Cutchee horseman. In the morning, after having travelled above thirty miles, I was obliged to assent to his proposal of haulting for a few minutes, which he employed in sharing a quantity of about two drachms of opium between himself and his jaded horse. The effect of the dose was soon evident on both, for the horse finished a journey of forty miles with great apparent facility, and the rider absolutely became more active and intelligent.”[^[1706]]

By repeating small doses frequently, the stimulus may be kept up for a considerable time in some people. In this way are produced the remarkable effects said to be experienced by opium-eaters in the east. These effects seem to be in the first instance stimulant, the imagination being rendered brilliant, the passions exalted, and the muscular force increased; and this state endures for a considerable time before the usual stage of collapse supervenes. A very poetical, but I believe also a faithful, picture of the phenomena now alluded to is given in the Confessions of an English Opium-eater,—a work well known to be founded on the personal experience of the writer. It is singular that our profession should have observed these phenomena so little, as to be accused by him of having wholly misrepresented the action of the most common drug in medical practice. In reply to this charge the physician may simply observe, that he seldom administers opium in the way practised by the opium-eater; that when given in the usual therapeutic mode it rarely causes material excitement; that some professional people prefer giving it in frequent small doses, with the view of procuring its sedative effect, and undoubtedly do succeed in attaining their object; that in both of these medicinal ways of administering it, excitement is occasionally produced to a great degree and of a disagreeable kind; that the latter phenomena have been clearly traced to idiosyncrasy; and therefore that the effects on opium-eaters are probably owing either to the same cause, or to the modifying power of habit. This much at all events is certain,—that in persons unaccustomed to opium it seldom produces material excitement in a single small dose, and does not always cause continuous excitement when taken after the manner of the opium-eater. The effect of a full medicinal dose of two or three grains of solid opium, or forty or sixty grains of the tincture, is to produce in general a transient excitement and fulness of the pulse, but in a short time afterwards torpor and sleep, commonly succeeded in six, eight, or ten hours by headache, nausea, and dry tongue.

The symptoms of poisoning with opium, administered at once in a dangerous dose, begin with giddiness and stupor, generally without any previous stimulus. The stupor rapidly increasing, the person soon becomes motionless and insensible to external impressions; he breathes slowly; generally lies still, with the eyes shut and the pupils contracted; and the whole expression of the countenance is that of deep and perfect repose. As the poisoning advances, the features become ghastly, the pulse feeble and imperceptible, the muscles excessively relaxed, and, unless assistance speedily arrive, death ensues. If recovery take place, the sopor is succeeded by prolonged sleep, which commonly ends in twenty-four or thirty-six hours, and is followed by nausea, vomiting, giddiness, and loathing of food.

The period which elapses between the taking of the poison and the commencement of the symptoms is various. A large quantity, taken in the form of tincture, on an empty stomach, may begin to act in a few minutes; but for obvious reasons it is not easy to learn the precise fact as to this particular. Dr. Meyer, late medical inspector at Berlin, has related a case of poisoning with six ounces of the saffron tincture of opium, where the person was found in a hopeless state of coma in half an hour,[^[1707]] and M. Ollivier has described another instance of a man who was found completely soporose at the same distance of time after taking an ounce and a half of laudanum.[^[1708]] In these cases, the symptoms must have begun in ten or fifteen minutes at farthest. In a case noticed by M. Desruelles the sopor was fairly formed in fifteen minutes after two drachms of solid opium were taken.[^[1709]] For the most part, however, opium, taken in the solid form, does not begin to act for half an hour or even almost a whole hour,—that period being required to allow its poisonous principles to be separated and absorbed by the bibulous vessels. It is singular that an interval of an hour was remarked in a case where the largest quantity was taken which has yet been recorded. The patient swallowed eight ounces of crude opium; but in an hour her physician found her able to tell connectedly all she had done; and she recovered.[^[1710]] In some rare cases the sopor is put off for a longer period: thus, in a case mentioned in Corvisart’s Journal, there seems to have been no material stupor till considerably more than an hour after the person took two ounces and a half of the tincture with a drachm of the extract.[^[1711]]

The result of almost universal observation, however, is, that in pure poisoning with opium the commencement of the symptoms is not put off much beyond an hour. Such being the fact, it is extremely difficult to account for the following extraordinary case, which was communicated to me by Dr. Heude, of the East India Company’s service. A man swallowed an ounce and a half of laudanum, and in an hour half as much more, and then lay down in bed. Some excitement followed, and also numbness of the arms and legs. But he continued so sensible and lively seven hours after the first dose was taken, that a medical gentleman, who saw him at that time and got from him a confession of what he had done, very naturally did not believe his story. It was not till at least the eighteenth hour that stupor set in; but two hours later, when Dr. Heude first saw him, he laboured under all the characteristic symptoms of poisoning with opium in an aggravated degree. The stomach-pump brought away a fluid quite free of the odour of opium. In seven hours more, under assiduous treatment, after having been in an almost hopeless state of insensibility, he had recovered so far as to be safely left in charge of a friend; and eventually he got quite well. No particular cause could be discovered for the long apparent suspension of the usual effects of opium.

Although the symptoms are very rarely postponed beyond an hour in pure poisoning with this substance, there is some reason for thinking that the interval may be much longer, if at the time of taking the opium the person be excited by intoxication from previously drinking spirits. Mr. Shearmen has related a striking case of an habitual drunkard, who took two ounces of laudanum while intoxicated to excitement with beer and spirits, and had no material stupor for five hours, during which period vomiting could not be induced. Five hours afterwards, he was found insensible, and he eventually died under symptoms of poisoning with opium.[^[1712]]

The most remarkable symptom in the generality of cases of poisoning with opium is the peculiar sopor. This state differs from coma, in as much as the patient continues long capable of being roused. It may be difficult to rouse him; but unless death is at hand, this may be commonly accomplished by brisk agitation, tickling the nostrils, loud speaking, or the injection of water into the ear. The state of restored consciousness is always imperfect, and is speedily followed again by lethargy when the exciting power is withheld.—It has been already remarked, that the possibility of thus interrupting the lethargy caused by opium is in general a good criterion for distinguishing the effects of this poison from apoplexy and epilepsy.

It was observed, in describing the mode of action of opium, that convulsions, although very frequently produced by it in animals, are rarely caused in man. It is not easy to account for this difference. Orfila has endeavoured to explain it, by supposing that convulsions are produced only by very large doses; but there are many facts incompatible with that supposition.

While convulsions are certainly not common in the human subject, yet when they do occur they are sometimes violent. Tralles mentions that he had himself several times seen convulsions excited in children by moderate doses.[^[1713]] The Journal Universel contains the case of a soldier who took two drachms of solid opium, and died in six hours and a half, after being affected with locked-jaw and dreadful spasms.[^[1714]] A case is related in the Medical and Physical Journal of a young man, who, three hours after swallowing an ounce of laudanum, was found insensible, with the mouth distorted, the jaws fixed, and the hands clenched; and who, soon after the insensibility was lessened by proper remedies, was seized with spasms of the back, neck, and extremities, so violent as to resemble opisthotonos.[^[1715]] Another good case of the kind is related by Mr. M’Kechnie, where the voluntary muscles were violently convulsed in frequent paroxysms, and affected in the intervals with subsultus, for three hours before the sopor came on.[^[1716]] Two instances of convulsions alternating with sopor are shortly related by Dr. Bright.[^[1717]] The convulsions sometimes assume the form of permanent spasm, which may affect the whole muscles of the body, as in a case related in Corvisart’s Journal.[^[1718]]—Another rare symptom of poisoning with opium is delirium. It appears to occur occasionally along with convulsions, as happened in Mr. M’Kechnie’s case, and in one related by M. Ollivier.[^[1719]]

The state of the pulse varies considerably. In an interesting case described by Dr. Marcet it is mentioned that the pulse was 90, feeble and irregular; and such appears to be its most common condition when the dose has been so large as seriously to endanger life.[^[1720]] Frequently, however, it is much slower; and then it is rather full than feeble, just as in apoplexy. In cases where convulsions occur, it is for the most part hurried, and does not become slow till the coma becomes pure. In Mr. M’Kechnie’s case the pulse was at first 126; but when the convulsions ceased, and pure sopor supervened, it fell to 55. It always becomes towards the close very feeble, and at length imperceptible.

The respiration is almost always slow. In Dr. Marcet’s case, as in some others, it was stertorous; but this is not common. On the contrary, it is more frequently soft and gentle, as it has been in all the cases I have witnessed; and sometimes it can hardly be perceived at all, even in persons who eventually recover, as in an instance of recovery recorded by Dr. Kinnis.[^[1721]]

The pupils are always at least sluggish in their contractions, often quite insensible;—sometimes, it is said, dilated:[^[1722]] but much more commonly contracted, and occasionally to an extreme degree. In the case last noticed, they were no bigger than a pin’s head. The pupils have been so invariably found contracted in all recent cases of poisoning with opium, that some doubt arises whether they are ever otherwise, and whether the earlier accounts, which represent them to have been dilated, may not be incorrect, and the result of hasty observation.

The expression of the countenance is for the most part remarkably placid, like that of a person in sound natural sleep. Occasionally there is an expression of anxiety mingled with the stupor. The face is commonly pale. Sometimes, however, it is flushed;[^[1723]] and in rare cases the expression is furious.[^[1724]]

In moderately large doses opium generally suspends the excretion of urine and fæces; but it promotes perspiration. In dangerous cases the lethargy is sometimes accompanied with copious sweating. In a fatal case, which I examined judicially, the sheets were completely soaked to a considerable distance around the body.

A remarkable circumstance, which has been noticed by a late author, is the sudden death of leeches applied to the body. The patient was a child who had been poisoned by too strong an injection of poppy-heads.[^[1725]]

In some instances the symptoms proper to poisoning with opium become complicated with those which belong rather to organic affections of the brain, in consequence of such affections being suddenly developed through means of the cerebral congestion occasioned by the poison. Thus, in a case related in Corvisart’s Journal, there were convulsions and somnolency on the third day, and palsy of one arm for four days; and for nearly two months afterwards the patient complained of occasional attacks of weakness and numbness, sometimes of one extremity, sometimes of another.[^[1726]] Here the brain must have sustained some more permanent injury than usual.—A more remarkable illustration once occurred to Dr. Elliotson. A young man, seven hours after swallowing two ounces of laudanum, presented the usual effects of opium, such as contracted pupils, redness of the features, a frequent feeble pulse, coldness of the integuments, and stupor, from which he could be roused without particular difficulty. The stomach-pump brought away a fluid which had not any odour of opium; powerful stimulants were given, such as ether, ammonia and brandy; and he was kept constantly walking between two men. In an hour and a half, when sensibility had been materially restored, his head suddenly dropped down upon his breast, and he fell down dead. The sinuses and veins of the brain were turgid, and a moderately thick layer of blood was effused over the arachnoid membrane.[^[1727]]—Under the same head must be arranged the following extraordinary case related by Pyl. That author admits it as one of simple poisoning, with a complete remission of the symptoms for several days. But the possibility of such a remission must be received with great hesitation. It is well known that most of the symptoms may be dispelled by vigorous treatment, and the patient nevertheless relapse immediately if left to himself, and even die. This is acknowledged on all hands. Pyl, however, admits the possibility of a much more complete and longer interval. His case is shortly as follows. A man who had taken a large quantity of opium, and became very dangerously ill, was made to vomit in twelve hours, and regained his senses completely. The bowels continued obstinately costive; but he had for some days no other symptom referrible to the poison; when at length the whole body became gradually palsied and stiff, and he died on the tenth day. No importance can be attached to a solitary case differing so widely from every other. The only way in which opium could cause death in such a manner, must be by calling forth some disposition to natural disease. Pyl’s case was probably one of supervening ramollissement, or inflammation of the substance of the brain.[^[1728]]

Notwithstanding the purely narcotic or nervous symptoms, which opium produces in a vast proportion of instances, there is no doubt that it also excites in a few rare cases those of irritation. Thus, although it generally constipates the bowels, it has been known to induce diarrhœa or colic in particular constitutions. In the first volume of the Medical Communications, it is observed by Michaëlis that both diarrhœa and diuresis may be produced by it. The soldier, whose case was quoted as having been accompanied with convulsions, had acute pain in the stomach for some time after swallowing the poison; and in the case just quoted from Corvisart’s Journal, the accession of somnolency was attended with excruciating pain of two days’ duration.

Another and more singular anomaly is the spontaneous occurrence of vomiting. Sometimes a little vomiting immediately succeeds the taking of the poison. This may not interrupt, however, the progress of the symptoms;[^[1729]] but more commonly it is the means of saving the person’s life, as in a striking case described by Petit of an English officer,[^[1730]] who, in consequence of vomiting immediately after taking two ounces of laudanum, had only moderate somnolency. At other times vomiting occurs at a much later period. Pyl, in his Essays and Observations, gives a case in which, some hours after thirty grains were swallowed, vomiting took place spontaneously, and recurred frequently afterwards; in the same paper is an account of another case by the individual himself, who attempted to commit suicide by taking a large dose of laudanum, but was disappointed in consequence of the poison being spontaneously vomited after the sopor had fairly set in;[^[1731]] and a similar case is related by M. Mascarel, where, after seven ounces of Sydenham’s laudanum had been taken, vomiting occurred spontaneously, and was followed only by inconsiderable stupor.[^[1732]]—Vomiting is a common enough symptom after the administration of emetics, or subsequent to the departure of the somnolency.[^[1733]]

The ordinary duration of a fatal case of poisoning with opium is from seven to twelve hours. Most people recover who outlive twelve hours. At the same time fatal cases of longer duration are on record: Réaumur mentions one which proved fatal in fifteen hours,[^[1734]] Orfila another fatal in seventeen hours,[^[1735]] Leroux another fatal in the same time,[^[1736]] Alibert another fatal in nearly twenty-four hours.[^[1737]] An instance has even been related, which appeared to prove fatal not till towards the close of the third day;[^[1738]] but the whole course of the symptoms was in that case so unusual, that some other cause must have co-operated in occasioning death. Sometimes, too, death takes place in a shorter time than seven hours; six hours is not an uncommon duration; I once met with a judicial case, which could not have lasted above five hours; an infirmary patient of my colleague, Dr. Home, died in four hours; in the 31st volume of the Medical and Physical Journal, there is one which proved fatal in three hours.[^[1739]] This is the shortest I have read of.

The dose of opium requisite to cause death has not been determined. Indeed it must vary so much with circumstances, that it is almost vain to attempt to fix it. Pyl relates a case, quickly fatal, where the quantity taken was 60 grains;[^[1740]] Lassus an instance of death from 36 grains;[^[1741]] Wildberg has related a fatal case caused by little more than half an ounce of the Berlin tincture,[^[1742]] which contains the soluble matter of forty grains; and Mr. Skae has mentioned a case fatal in about thirteen hours, where the dose seems to have been well ascertained not to have exceeded half an ounce of common laudanum, or about twenty grains of opium.[^[1743]] Dr. Paris, without quoting any particular fact, says four grains may prove fatal.[^[1744]] I should have felt some difficulty in admitting this statement, as I have repeatedly known persons, unaccustomed to opium, take three or four grains without any other effect than sound sleep. But I have been favoured with the particulars of a case by Mr. W. Brown of this city, where a dose of four grains and a half, taken by an adult along with nine grains of camphor, was followed by the usual signs of narcotism, and death in nine hours. The man took the opium for a cough at seven in the morning; at nine his wife found him in a deep sleep, from which she could not rouse him; nothing was done for his relief till three in the afternoon, when Mr. Brown found him labouring under all the usual symptoms of poisoning with opium, contracted pupils among the rest; and death ensued in an hour, notwithstanding the active employment of remedies. On examining the body no morbid appearance was found of any note except fluidity of the blood,—a common appearance in those who have died of the effects of this drug.

It is more important than may at first sight be imagined to acquire an approximative knowledge of the smallest fatal dose. For, in consequence of the dread entertained of opium by many unprofessional persons, it is currently believed to be much more active than it is in reality; and instances of natural death have been consequently imputed to medicinal doses taken fortuitously a short time before. The facts stated above comprehend the only precise information I have been able to collect as to the smallest fatal doses in adults. I may add some farther observations, however, on the smallest fatal doses in children. Very young children are often peculiarly sensible to the poisonous action of opium, so that it is scarcely possible to use the most insignificant doses with safety. Sundeling states in general terms that extremely small doses are very dangerous to infants on account of the rapidity of absorption. This opinion is amply supported by the following cases.—An infant three days old got by mistake about the fourth part of a mixture containing ten drops of laudanum. No medical man was called for eleven hours. At that time there was great somnolency and feebleness, but the child could be roused. The breathing being very slow, artificial respiration was resorted to, but without advantage: the child died in twenty-four hours, the character of the symptoms remaining unchanged to the last. At the inspection of the body, which I witnessed, no morbid appearance was found.—Of the same kind was a case communicated to me by Dr. Simson of this city, where the administration of three drops of laudanum in a chalk mixture, for diarrhœa, to a stout child fourteen months old, was followed by coma, convulsions, and death in about six hours. Dr. Simson satisfied himself, as far as that was possible, that the apothecary who made up the mixture did not commit a mistake.—Dr. Kelso of Lisburn met with a similar case in an infant of nine months, who died in nine hours after taking four drops.[^[1745]]—My colleague, Dr. Alison, tells me he has met with a case where an infant a few weeks old died with all the symptoms of poisoning with opium after receiving four drops of laudanum, and that he has repeatedly seen unpleasant deep sleep induced by only two drops.—These remarks being kept in view, it will, I suspect, be difficult to go along with an opinion against poisoning expressed by a German medico-legal physician in the following circumstances. A child’s maid, pursuant to a common but dangerous custom among nurses, gave a healthy infant, four weeks old, an anodyne draught to quiet its screams. The infant soon fell fast asleep, but died comatose in twelve hours. There was not any appearance of note in the dead body; and the child was therefore universally thought to have been killed by the draught. But the inspecting physician declared that to be impossible, as the draught contained only an eighth of a grain of opium and as much hyoscyamus.[^[1746]] In the first edition of this work an opinion was expressed to the same purport. But the facts stated above throw doubt on its accuracy, and rather show that the dose was sufficient in the circumstances to occasion death.

A very important circumstance to attend to in respect to the dose of opium required to prove fatal is the influence of constitutional circumstances in rendering this drug unusually energetic. In some persons this peculiar anomaly exists always, even during a state of health. Thus, I am acquainted with a gentleman on whom seven drops of laudanum act with great certainty as a hypnotic. In such a one doses, which are safely taken by many, might prove dangerous.

It is more usual, however, to meet with this anomaly in the course of some diseases. These have not yet been satisfactorily indicated. I have several times, however, met with unusually energetic action from medicinal doses in elderly persons affected with severe habitual catarrh; and in one instance death occurred after a dose of twenty-five drops in the advanced stage of acute catarrh supervening on its chronic form, the symptoms being those of poisoning with opium, succeeding apparently a state of comfortable sleep.—A case seemingly of the same nature, where the dose was fifteen drops of Battley’s Sedative Liquor, occurred at Islington in 1841. An elderly lady, in delicate health, and affected severely with asthma, which for ten days prevented her from sleeping, got from a neighbouring druggist a draught of Battley’s solution, syrup, and camphor-mixture. Next morning she was found insensible and livid in the face, with cold extremities and contracted pupils; and she died about twelve hours after taking the draught. There was no sign of natural disease in the dead body to account for death. The druggist was absurdly blamed for giving such a dose to a frail old lady; for the dose was not more than would be generally given in such circumstances. This case was communicated to me by the druggist in question.—Another of the like kind has been communicated to me by Mr. Garstang of Clitheroe. An elderly female, long subject to severe cough, having enjoyed a comfortable night’s rest after a dose of a preparation containing half a grain of opium, took in the morning the equivalent of two grains and a half, or three grains at the utmost, and fell asleep soon after. In no long time, her husband, alarmed because he could not rouse her, sent for Mr. Garstang, who found her husband labouring under all the symptoms of poisoning with opium; and, notwithstanding active treatment, she died six hours after the second dose. Her husband took half a grain with her the evening before, but experienced no effect from it at all. Not the slightest ground could exist in this case for suspecting either foul play or pharmaceutic error.—As a farther illustration, the following incident deserves notice, which occurred last year in London, and was communicated to me by Dr. G. Johnson, a former pupil. A little girl, five years and a half old, affected with violent cough, got a mixture containing opium, which was repeated six, thirteen, and twenty-six hours afterwards. She slept soundly after each dose, and awoke readily after the first three; but after the fourth she had more stupor and much uneasiness; in which state, but with at least one interval of sensibility, she died in nine hours more, or thirty-five hours after the first dose. According to the prescriber’s intention, the child ought to have taken only two minims of laudanum in all; but, according to a rough analysis by Mr. Alfred Taylor, each dose contained an eighth of a grain of opium, or a trifle more. In either view it is impossible that doses so small, and so distant, could produce these effects in ordinary circumstances.

Such cases are important in several respects, but especially because they naturally give rise to suspicions of an over-dose of opium having been incautiously given, and thus to misrepresentations injurious to the druggist or medical attendant. In the last case a Coroner’s Jury brought in the preposterous verdict, that death was caused by “too much opium ordered without due instructions.”

It is scarcely necessary to add, that the dose required to prove fatal is very much altered by habit. Those who have been accustomed to eat opium are obliged gradually to increase the dose, otherwise its usual effects are not produced. Some extraordinary, but I believe correct information on this subject, is contained in the confessions of an English opium-eater. The author took at one time 8000 drops daily, or about nine ounces of laudanum.

An important topic relative to the effects of opium on man is its operation on the body when used continuously in the manner practised by opium-eaters. This subject was brought forcibly under my notice in 1831, in consequence of a remarkable civil trial, in which I was concerned as a medical witness,—that of Sir W. Forbes and company against the Edinburgh Life Assurance Company. The late Earl of Mar effected insurances on his life to a large amount while addicted to the vice of opium-eating; which was not made known at the time to the insurance company. He died two years afterwards of jaundice and dropsy. The company refused payment, on the ground that his lordship had concealed from them a habit which tends to shorten life; and Sir W. Forbes and company, who held the policy of insurance as security for money lent to the earl, raised an action to recover payment.

In consequence of inquiries made on this occasion, I became for the first time aware of the frequency of the vice of opium-eating among both the lower orders and the upper ranks of society; and at the same time satisfied myself, that the habit is often easily concealed from the most intimate friends,—that physicians even in extensive practice seldom become acquainted with such cases,—that the effects of the habit on the constitution are not always what either professional persons or the unprofessional would expect,—and generally that practitioners and toxicologists possess little or no precise information on the matter. In what is about to be offered on the subject, some facts will be stated which appear to me interesting, and may induce others to contribute their knowledge towards filling up so important a blank in medico-legal toxicology.

The general impression is, that the practice of opium-eating injures the health and shortens life. But the scientific physician in modern times has seen so many proofs of the inaccuracy of popular impressions relative to the operation of various agents on health and longevity,[^[1747]] that he will not allow himself to be hastily carried along in the present instance by vague popular belief. The general conviction of the tendency of opium-eating to shorten life has obviously been derived in part from the injurious effects which opium used medicinally has on the nervous system and functions of the alimentary canal,—and partly on the reports of travellers in Turkey and Persia, who have enjoyed opportunities of watching the life and habits of opium-eaters on a great scale. The statements of travellers, however, are so vague that they cannot be turned to use with any confidence in a scientific inquiry. Chardin, one of the earliest (1671) and best of modern travellers in Turkey, merely says the opium-eater becomes rheumatic at fifty, and “never reaches an extreme old age;”[^[1748]] and his successors have seldom been more precise,—no one having given information as to the diseases which it tends to engender. By far the greater number of authorities, however, agree in representing the practice to be hurtful. Mr. Madden, a recent and professional authority, even alleges that it is very rare for an opium-eater at Constantinople to outlive his thirtieth year, if he began the practice early. On the other hand, a few late observers deny altogether the accuracy of these statements. To this number belongs Dr. Burnes of the Bombay army; whose opinion is worthy of notice, because he had ample opportunities of observation during his residence in Cutch and at the Court of Sinde for several years prior to 1831. From what he there witnessed, Dr. Burnes is inclined to think “it will be found in general that the natives do not suffer much from the use of opium,”—that “this powerful narcotic does not seem to destroy the powers of the body, nor to enervate the mind to the degree that might be imagined.”[^[1749]] Dr. Macpherson of the Madras army, who had occasion to observe the effects of the parallel practice of opium-smoking in China, coincides in opinion with Dr. Burnes. He says, “were we to be led away by the popular opinion that the habitual use of opium injures the health and shortens life, we should expect to find the Chinese a shrivelled, emaciated, idiotic race. On the contrary, although the habit of smoking opium is universal among rich and poor, we find them to be a powerful, muscular, and athletic people, and the lower orders more intelligent and far superior in mental acquirements to those of corresponding rank in our own country.”[^[1750]]

The familiar effects of the medicinal use of opium in disordering the nervous system and the digestive functions constitute a better reason, than the loose statements of eastern travellers, for the popular impression of the danger of its habitual and long-continued use. Yet this consideration ought not to be allowed too much weight; because the functions of the nervous system and of digestion may be deranged by other causes, for example by hysteria, without necessarily and materially shortening life. It is desirable therefore to appeal if possible to precise facts.

The following is a summary of twenty-five cases, the particulars of which I have obtained from various quarters. The general result rather tends to throw doubt over the popular opinion.—1. A lady about thirty, in good health, has taken it largely for twenty years, having been gradually habituated to it from childhood by the villany of her maid, who gave it frequently to keep her quiet. 2. A female who died of consumption at the age of forty-two, had taken about a drachm of solid opium for ten years, but had given up the practice for three years before her death, and led in other respects a licentious life from an early age. 3. A well-known literary author, about sixty years of age, has taken laudanum for thirty-five years, with occasional short intermissions, and sometimes an enormous quantity, but enjoys tolerable bodily health. 4. A lady, after being in the practice of drinking laudanum for at least twenty years, died at the age of fifty,—of what disease I have been unable to learn. 5. A lady about fifty-five, who enjoys good health, has taken opium many years, and at present uses three ounces of laudanum daily. 6. A lady about sixty gave it up after using it constantly for twenty years, during which she enjoyed good health; and subsequently she resumed it. 7. Lord Mar after using laudanum for thirty years, at times to the amount of two or three ounces daily, died at the age of fifty-seven of jaundice and dropsy; but he was a martyr to rheumatism, and besides lived rather freely. 8. A woman, who had been in the practice of taking about two ounces of laudanum daily for very many years, died at the age of sixty or upwards. 9. An eminent literary character, who died about the age of sixty-three, was in the practice of drinking laudanum to excess from the age of fifteen; and his daily allowance was sometimes a quart of a mixture consisting of three parts of laudanum and one of alcohol. 10. A lady, who died lately at the age of seventy-six, took laudanum in the quantity of half an ounce daily for nearly forty years. 11. An old woman died not long ago at Leith at the age of eighty, who had taken about half an ounce of laudanum daily for nearly forty years, and enjoyed tolerable health all the time. 12. Visrajee, a celebrated Cutchee chief, mentioned by Dr. Burnes, had taken opium largely all his life, and was alive when Dr. Burnes drew up his Narrative, at the age of eighty, “paralyzed by years, but his mind unimpaired.”[^[1751]]

For the particulars of the remaining cases I am indebted to Dr. Tait, surgeon of police in this city. 13. M. C., a ruddy, healthy-looking woman, sixty years of age, has taken laudanum for twenty-five years to the extent of half an ounce daily in a single dose. 14. M. H., a flabby, dissipated-looking woman of thirty-six, has taken for ten years thirty grains of opium daily in three doses. 15. M. T., a widow, forty-eight years of age, who takes twice daily a dose of one fluidrachm of laudanum, and has done so for fourteen years, cannot observe any permanent injury except diminution of appetite. 16. Mrs. G., aged twenty-four, has taken a single dose of sixty drops regularly at bed-time for five years, and has not suffered in health in any respect, except that she is costive. 17. F. S., a thin, sallow woman of forty-six years of age, has taken a fluidrachm of laudanum three times a day for ten years, cannot take food without it, but is so well as to be able to get up regularly at six in the morning. 18. H. S., a shrivelled old-looking woman, who for thirty-eight years had taken daily towards a drachm of opium in one dose, and who latterly was strong, lively, and of good appetite, died recently at the age of sixty-nine. 19. Mrs. S., who has taken about a scruple of opium for twenty-one years, is a tall, active, old-looking woman of fifty-seven, enjoys good health when she uses the opium, but suffers from an affection like delirium tremens, when she cannot get her usual quantity. 20. M. A., aged thirty-one, has taken half a drachm of opium daily in two doses for ten years, was a thin, drunken, starved-looking prostitute some years ago, but, having reformed her ways, is now “a fine-looking, bouncing woman,” younger in appearance than formerly, and not liable to any suffering either before or after her doses, except that she cannot take food without them. 21. Miss M., who has taken ten grains of opium three times a day for five years, is a healthy, florid young woman of twenty-seven, liable to costiveness, and, when without her opium, to languor and want of appetite, but otherwise free of complaint. 22. Mrs. ——, a plump, hale-looking old lady of seventy, has taken opium for six and twenty years, and for some years to the extent of a drachm daily in two doses. She thinks her health improved by it, and has suffered no inconvenience except merely costiveness, and always aversion to food till she gets her dose. 23. J. B., aged 23, has taken laudanum since she was fourteen, and some time past to the amount of an ounce or ten drachms in three or four doses daily. She has only menstruated twice since first using the laudanum, has bilious vomiting once a month, and looks older than her years, but is otherwise quite healthy, and has two children. 24. Mrs. M’C., a ruddy young-looking woman of forty-two, has taken opium during two years for cough and pain in the stomach, latterly to the extent of ten grains twice a day. She has never menstruated since, but has enjoyed better health, and in particular has a good appetite after her dose, and has got entirely quit of a former tendency to constipation. 25. An army officer’s widow, fifty-five years old, healthy and young-looking, although subject to costiveness and rather defective appetite, has taken laudanum for eleven years, and latterly opium to the extent of fifteen grains morning and evening.

These facts tend on the whole rather to show, that the practice of eating opium is not so injurious, and an opium eater’s life not so uninsurable, as is commonly thought; and that an insured person, who did not make known this habit, could scarcely be considered guilty of concealment to the effect of voiding his insurance. But I am far from thinking,—as several represent who have quoted this work,—that what has now been stated can with justice be held to establish such important inferences; for there is an obvious reason, why in an inquiry of this kind those instances chiefly should come under notice where the constitution has escaped injury, cases fatal in early life being more apt to be lost sight of, or more likely to be concealed.

Meanwhile, insurance companies and insurance physicians ought to be aware, that not a few persons in the upper ranks of life are confirmed opium-eaters without even their intimate friends knowing it. And the reason is, that at the time the opium-eater is visible to his friends, namely, during the period of excitement, there is frequently nothing in his behaviour or appearance to attract particular attention. From the information I have received, it appears that the British opium-eater is by no means subject to the extraordinary excitement of mind and body described by travellers as the effect of opium-eating in Turkey and Persia; but that the common effect merely is to remove torpor and sluggishness, and make him in the eyes of his friends an active and conversible man. The prevailing notions of the nature of the excitement from eating opium are therefore very much exaggerated. Another singular circumstance I have ascertained is, that constipation is by no means a general effect of the continued use of opium. In some of the cases mentioned above no laxatives have been required; and in others a gentle laxative once a week is sufficient.

In the civil suit regarding Lord Mar’s insurances, the insurance company was at first found not entitled to refuse payment,—not, however, on the ground that the habit of opium-eating is harmless to longevity,—but chiefly on a technical ground, implying that they did not make inquiry into his habits with the care usually observed by insurance companies, and were therefore to be understood as accepting the life at a venture. A new trial was granted by the court on the ground of the judge’s charge having been not according to evidence; but on this occasion the parties compromised the case.[^[1752]]

The previous remarks on the symptoms of poisoning with opium in man have been confined to its effects when swallowed. But it was mentioned under the head of its mode of action, that this poison has been known to act with energy upon animals through every channel by which it can be introduced into the system. It is natural to expect that the same will be the case with man also.

The only other modes in which poisoning with opium is reported to have been produced in man, besides administration by the mouth, have been by injections into the anus, by application to the skin deprived of its cuticle, perhaps even also to the unbroken skin, and by its introduction into the external opening of the ear.

In the Journal de Chimie Médicale, an instance is shortly noticed of a lady who was poisoned by the administration of too strong an anodyne injection prepared by herself from fresh poppy-heads. She recovered.[^[1753]]

It is generally believed in France that opium acts more energetically through the medium of the rectum, than through the stomach. Orfila in particular has endeavoured to establish this proposition by experiments on animals, and quotations from cases recorded by some authors of its action upon man.[^[1754]] But neither the experiments nor the quotations appear to me satisfactory; and the rule they go to support is completely at variance with the practice pursued in the medicinal administration of the drug in Britain. It is the custom to give at least twice as much in an enema as in a draught. I have given by injection, without producing more than the usual somnolency, one drachm and even two drachms by measure of laudanum, a dose which, were Orfila’s statement correct, would prove fatal.

As to the action of opium through the skin when deprived of its cuticle, I am not acquainted with any fatal case of the kind, but have no doubt that such may happen. One of my friends very nearly lost his life in the way alluded to. He had applied an opium-poultice to the scrotum to allay the violent irritation caused by a blister, and fell into a state of profound sopor, which was luckily interrupted by a visitor, so that the cause was discovered before it was too late. An instance of the same kind has also been published by M. Pelletan. A child two months old very nearly perished, in consequence of a cerate containing fifteen drops of laudanum having been kept for twenty-four hours on a slight excoriation produced by a fold of the skin. When the cause of illness was discovered, the child had been for some hours almost completely insensible, with a slow, obscure pulse, and occasional convulsions.[^[1755]]

But perhaps opium may in some circumstances act even through the unbroken skin. It has certainly been often applied in this way to relieve local pain without avail. Yet on the other hand its effect is at times unequivocal; and the following incidents seem to show, that it may even prove fatal, both when the skin is healthy, and in certain diseased states of the integuments. A young dramatic writer in Paris was directed by his father, a physician, to apply over the stomach a poultice moistened with a few drops of laudanum. The patient, in order to relieve his pain more quickly, poured the whole contents of the bottle over the poultice, and soon fell into a deep sleep. Prompt assistance was obtained, but proved of no avail, and death is said to have ensued with great rapidity.[^[1756]] A soldier affected with erysipelas of the leg, had a linseed poultice applied, which his surgeon ordered to be sprinkled with 15 drops of laudanum. Next morning the patient was found in a state of deep sopor, accompanied with convulsive twitches of the muscles of the face and limbs; and in no long time he expired. His soporose state turned the surgeon’s attention to the poultice, which he found coloured yellow and smelling strongly of opium; and on removing it he discovered that it was completely soaked with laudanum, which the attendant had carelessly poured on it to the extent of an ounce. The patient died notwithstanding all the remedies which his state called for; and the viscera were found quite healthy; but in many places the blood is said to have had a strong odour of opium.[^[1757]]

In an instance reported by M. Tournon of Bordeaux, death is supposed to have arisen from the introduction of opium into the external opening of the ear, as a remedy for ear-ache. It is possible that fatal poisoning may thus be induced by laudanum too freely and frequently renewed: but it seems very unlikely that death was owing to opium in the instance in question, since it was used in the solid form, and in the quantity of four grains; so that the dose was small, and absorption must have been very slow. The account merely states that the patient fell asleep, but his sleep was that of death.[^[1758]]

Of the Action of Morphia, Narcotine, Codeïa, and Meconic Acid.

The action and symptoms caused by two active principles of opium, morphia, and narcotine, have been examined by many experimentalists.

The action of morphia is nearly the same as that of opium, but more energetic. In its solid state it has little effect, being nearly insoluble. But when dissolved in olive oil, or in alcohol, or in weak acids, it excites in animals the same symptoms as opium. Experimentalists are not yet agreed as to its power. The trial of Castaing gave rise to a physiological inquiry by three French physicians, Deguise, Dupuy, and Leuret, who assigned to it feeble properties; but more reliance is usually placed in the experiments of Orfila, who found that one part of morphia is equal in energy to two parts of the watery extract, and to four parts of crude opium. The observations I have made on the medicinal effects of morphia and its muriate, lead me to believe that half a grain is fully equal in power to three grains of the best Turkey-opium. Probably those who have observed but slight effects from it have accidentally used narcotine instead of it; for at one time they were often confounded together.

On man morphia acts like opium; it produces somnolency. It was at one time thought that in medicinal doses it does not produce either the disagreeable subsequent or idiosyncratic effects of opium; Magendie made some observations to this purport;[^[1759]] and Dr. Quadri of Naples was led to the same conclusion.[^[1760]] Others, however, have doubted the accuracy of these authors, and opposite results appear to have been procured by some. My own experience with the muriate of morphia inclines me to concur in opinion with Magendie and Quadri.

The effects of morphia on man in fatal doses have hitherto been observed in a few cases only. An instance, which was the occasion of a criminal trial at Aberdeen in 1842, has been communicated to me by Dr. Traill, who was consulted in the case on the part of the crown. A schoolmaster gave ten grains of the muriate to a girl immediately after she came out of an epileptic fit. In fifteen minutes she seemed to fall asleep; she continued in this state for some hours before it was discovered that she was in a state of stupor, from which she could not be roused; and she expired twelve hours after the poison was administered. A similar case occasioned by ten grains, and also fatal, occurred at Cheltenham in 1839.

Orfila relates the particulars of the case of a young Parisian graduate, who swallowed twenty-two grains for the purpose of self-destruction. In ten minutes he felt heat in the stomach and hindhead, with excessive itchiness; in three hours and a half he had also a sense of pricking in the eyes, with dimness of vision; and in an hour more he for the first time felt approaching stupor. Half an hour afterwards, when the people of the house entered his room he could not see them, though he was sensible enough to be able to reply to their inquiries, that he lay in bed because he had not slept the night before. Soon after this he fell into a state of profound stupor and lost all consciousness. In thirteen hours he was visited by Orfila, who found him cold, quite comatose, and affected with locked-jaw; the pupils were feebly dilated, the pulse 120, the breathing hurried and stertorous, the belly tense and tympanitic; and there were occasional convulsions, with intense itching of the skin. By means of copious venesection, sinapisms, ammoniated friction, stimulant clysters, ice on the head, and acidulous drinks, he was gradually roused, so that in six hours he recognised his physician. In the subsequent night and following day he had difficult and scanty micturition, with pain in the kidneys and bladder, and difficulty in swallowing; but these symptoms went off during the second night; and on the third morning he was quite well.[^[1761]] The itching of the skin remarked in this case is considered by M. Bally an invariable symptom of the operation of morphia even in medicinal doses.[^[1762]] It is not, however, always produced.

Another case, which occurred at Lunéville, is very remarkable in its circumstances. A young man addicted to opium-eating, but who had left off the practice for a twelvemonth, took first ten grains, and in ten minutes forty grains more of acetate of morphia. In five minutes he had excessive general feebleness and a sense of impending dissolution, which forced him to confess what he had done. In fifteen minutes more M. Castara, who describes the particulars, found him motionless, almost comatose, and breathing laboriously. The limbs were flaccid, the pupils contracted, the face and lips livid, the skin warm and moist, the pulse full and hard, and deglutition impossible. Tartar-emetic was ordered, but could not be administered. He was then bled at the arm to eighteen ounces; upon which he started as from sleep, rubbed his eyes, said every thing turned round him, and that he could not see the people present. When left to himself he quickly fell into a calm slumber; but if kept awake, he told collectedly all that happened before he became comatose. He complained chiefly of intense itching and a general sense of bruising. In an hour, by keeping him constantly roused, consciousness was almost restored, and this without vomiting having been produced, though two grains of tartar-emetic had been swallowed and three administered by the rectum. In four hours after he swallowed the poison he vomited freely and had diarrhœa. He then steadily recovered, the sleepiness continued all next day, and the itching of the skin even longer.[^[1763]]

M. Julia-Fontenelle met with a case of poisoning with this alkaloid, in consequence of its having been administered with a clyster in the form of sulphate. The subject was a child five years old, the dose five grains, the symptoms those of apoplexy, and death supervened within twenty-four hours.[^[1764]]

Another case worthy of particular mention is that of the French gentleman who was supposed to have been poisoned by Dr. Castaing. It is not a pure one, for besides the symptoms of a consumptive complaint under which he had laboured for some time, there were circumstances in his last illness which indicated the administration of other deleterious substances. About thirty-six hours before his death, however, they were exactly such as might be expected from a large dose of morphia. About five minutes after the administration of a draught by the prisoner, the gentleman was attacked with convulsions, and not long afterwards his physician found him quite insensible, unable to swallow, bathed in a cold sweat, with a small pulse, a burning skin, the jaws locked, the neck rigid, the belly tense, and the limbs affected with spasmodic convulsions. In this state he seems to have continued till his death. The only appearances found in the dead body, which bore any relation to the poison suspected, were congestion of blood and serous effusion in the vessels of the cerebral membranes. If morphia was the cause of death, it is highly probable that, besides what was administered thirty-six hours before he died, several doses were given subsequently; otherwise, from what is known of the action of opium, the narcotism could scarcely have lasted uninterruptedly for so long a period.[^[1765]]

For the following extraordinary case I am indebted to one of my pupils, Mr. Clark of Montrose: A woman took one morning by mistake ten grains of pure muriate of morphia, which had been prepared not long before by Mr. Clark in my laboratory, and was freed of codeïa. The mistake having been discovered almost immediately, means were taken to prevent any ill effects from the accident, and within half an hour after the poison was swallowed, the stomach was completely cleared by the stomach-pump. At this time she was quite sensible. But stupor quickly came on after the poison was evacuated, and deep imperturbable coma gradually formed, so that nothing could rouse her in the slightest degree except cold affusion of the head and chest, which caused faint signs of returning consciousness. Before night she expired, though all the usual remedies were resorted to. An inspection of the body was not obtained, which is much to be regretted, since without it the case is quite obscure. I do not know a single instance of fatal coma from opium where the proper remedies were resorted to before the stupor commenced; and death in such circumstances is so inconceivable, that we must ascribe the result in this case to apoplexy, either incidentally concurring, or brought on by the operation of the poison.

Morphia, like opium, may occasion serous effects when too freely applied to a blistered surface. In a case related by M. Dupont, four-tenths of a grain of acetate of morphia, applied to a blister on the side, caused in twenty minutes dimness of vision, vomiting, and delirium; and though it was then removed, the patient had afterwards continued vomiting, dilated pupils, and great feebleness of the pulse. Recovery took place, but the patient was not quite free of incoherence next day.[^[1766]] The dose here was so small, and the symptoms were so unlike the usual effects of morphia, that doubts arise whether the case was really one of poisoning.

The effects of narcotine have been examined experimentally by Magendie and Orfila; but their results do not coincide. According to Orfila it is not easy to poison dogs with it, as it excites vomiting and is discharged. But when the gullet is tied, the animal dies in two, three or four days, without any remarkable symptom but languor and hard breathing.[^[1767]] In these experiments it was dissolved in olive oil; it does not act at all in the solid state. Magendie found that it produces in dogs a state like reverie, accompanied with convulsions. They lie still except when convulsed, and they are apparently asleep or dreaming; but they are really alive to external objects, and even in a state of acute irritability. In short, he considers the symptoms to constitute an aggravated form of the subsequent and idiosyncratic effects caused by opium on man. Vinegar, he says, destroys altogether the poisonous properties of narcotine. According to Orfila it only weakens them. Muriatic acid would seem to annihilate them entirely; for Orfila found no effect in dogs from forty grains dissolved in water with the aid of muriatic acid; and Bally gave sixty grains in like manner to a patient without injury.[^[1768]] Forty grains dissolved by sulphuric acid, proved fatal to a dog in twenty-four hours.[^[1769]]

Narcotine, like other narcotic poisons, is more powerful when introduced at once into the blood, but produces nearly the same effects as when it is swallowed. Orfila found that a single grain was as powerful through the former, as eight grains through the latter channel.[^[1770]] Dieffenbach observed that half a grain dissolved in water by means of a drop or two of hydrochloric acid killed cats in five minutes when injected into a vein, and always produced congestion within the head, and extravasation on the surface of the cerebellum. A remarkable circumstance observed in the course of his experiments was, that leeches, applied to a rabbit under the influence of narcotine, died immediately in convulsions; and that a portion of the blood of the same rabbit when injected into the vein of another produced drowsiness, languor, and pandiculation for nearly a day.[^[1771]]

The effects of narcotine on man have not been much inquired into. From the only researches on the subject I have yet seen, those of Dr. Wibmer of Munich, it appears to be but a feeble poison. He found by experiment on himself, that two grains dissolved in olive oil produced merely slight transient headache; that eight grains dissolved by means of muriatic acid had no effect at all; and that the same quantity of solid narcotine occasioned temporary headache, and in twenty-eight hours a singular state of excitement, with trembling of the hands, restlessness, and inability to fix the thoughts on any object. These effects went off in a few hours.[^[1772]]

The effects of codeïa have been examined by Dr. Kunkel. He found that twelve grains, dissolved in water and introduced into the stomach, killed a rabbit in three minutes; that six grains in solution when injected into the cellular tissue occasioned death in little more than two hours; that the same quantity administered by the mouth sometimes had little effect; that when given in powder its action was very feeble; and that the symptoms were excitement of the pulse, convulsions, and tetanus, without any tendency to sopor or somnolency.[^[1773]] Hence codeïa is conceived to be a stimulant of the nervous system, and consequently the cause of the excitant effects sometimes produced by opium. It may be doubted, however, whether its proportion in opium is sufficient for explaining these effects.

Meconic acid is inert. Sertuerner, indeed, thought the meconate of soda acted as a powerful poison in some experiments made on himself and on dogs; but more careful researches have since proved that he was misled by some error. Sömmering found that ten grains of meconic acid or meconate of soda had no effect whatever on dogs.[^[1774]] Subsequently, in consequence of two people having died suddenly at Turin after taking each a grain of the acid, some careful experiments were made by Drs. Feneglio and Blengini, who gave eight grains to dogs, crows, and frogs, and four grains to various men, without remarking any injurious effects whatever.[^[1775]]

The distilled water of opium was formerly considered an active poison; but Orfila found it nearly or altogether inert. Two pounds introduced into the stomach of a dog, and two ounces and a half injected into a vein, had no effect whatever.[^[1776]]

Section III.—Of the Morbid Appearances caused by Opium.

In discussing this subject the appearances in the best marked cases will be first noticed; and then some account; will be given of the variations to which they are liable.

In Knape’s Annals there is a good example of the most aggravated state of the appearances left by opium. It is the case of an infant who was killed in the course of a night by a decoction of poppy-heads. There was much lividity over the whole back part of the body. All the sinuses and vessels of the brain were gorged with fluid blood; and a good deal of serosity was found in the ventricles and base of the skull. The pharynx was red. The lungs were distended, and so gorged with fluid blood, that it ran out in a stream when they were cut. The cavities of the heart contained the same fluid blood. There was some redness in the villous coat of the stomach and intestines; and poppy-seeds were found in the stomach. Although the body had been kept only two days in the month of February, the belly emitted a putrid odour when it was laid open.[^[1777]]

In commenting upon these appearances, it may be first remarked, that turgescence of the vessels in the brain, and watery effusion into the ventricles, and on the surface of the brain, are generally met with. Dr. Bright mentions an instance where unusual turgescence was found, and on the surface of the brain a spot of slight ecchymosis as big as a crown piece.[^[1778]] I have seen turgescence of vessels and serous effusion in one instance to a considerable extent: each ventricle contained three drachms of fluid, the arachnoid membrane on the surface of the brain was much infiltered, and the vessels both in the substance and on the surface of the brain were considerably gorged with blood. But congestion and effusion are by no means universal: in a case I examined judicially in November, 1822, which proved fatal in about seven hours, there was neither unusual congestion nor effusion. In the remarks on the diseased appearances caused by the narcotics generally, it was observed that extravasation of blood is a very rare effect of opium. A good example of the kind, however, is related by Mr. Jewel of London. It was the case of a young married female, who died eight hours after taking two ounces of laudanum. Several clots were found in the substance of the brain, one of which, in the anterior right lobe, was an inch long.[^[1779]] A similar case, which occurred to Dr. Elliotson, has been mentioned already at p. [546]. There is little doubt that poisoning with opium may cause extravasation, by developing a disposition to apoplexy; but considering the very great rarity of this appearance in persons killed by opium, it may reasonably be questioned whether extravasation can be produced without some predisposition co-operating.

The lungs are sometimes found gorged with blood, as in many cases of apoplexy. They were so in the soldier mentioned in the Journal Universel, who died in convulsions. They were in the same state in a patient of Dr. Home, a man who died in the Infirmary here in 1825, four hours after taking two ounces of laudanum in six ounces of whisky; and likewise in the case quoted from Pyl, in which sixty grains of solid opium were taken. But this appearance is not more constant than congestion in the brain. Orfila never found it in dogs, and in three cases I have examined the lungs were perfectly natural. Perhaps they are more usually turgid when death is preceded by convulsions. They were particularly so in the case of the soldier above mentioned, and likewise in another case of the same nature recorded in Rust’s Magazin.[^[1780]]

The stomach, as in Knape’s case, is occasionally red, and in the woman mentioned by Lassus, who died after swallowing thirty-six grains, it is said to have been inflamed. But even redness is rare, and decided inflammation probably never occurs. In four cases I have examined, the villous coat was quite healthy; and it was equally so in another related in Knape and Hecker’s Register.[^[1781]]

Lividity of the skin is almost always present more or less, and sometimes it is excessive. In one of the cases I examined it was universal over the depending surface of the body.

It has been said that the blood is always fluid. This certainly appears to be very generally the case. For example, the blood was fluid in the case of the soldier who died in convulsions, in Dr. Home’s patient, in four adults I have examined, in Dr. Traill’s case of death from morphia, and likewise in Pyl’s case. But at the same time this condition of the blood is not invariable: In the case related in Knape and Hecker’s Register, it was coagulated in the left cavities of the heart; in another related by Petit in Corvisart’s Journal, there were clots in both ventricles;[^[1782]] and in the case of the first infant mentioned in page [549], clots were also found in both ventricles. In Alibert’s case a large fibrinous concretion was found in the heart, clearly showing that the blood had coagulated after death as usual.

It appears that the body is often apt to pass rapidly into putrefaction. In one of the cases I examined, although the body had been kept only thirty hours in a cool place in the month of December, the cuticle was easily peeled off, the joints were flaccid, and an acid smell was exhaled. In Réaumur’s case, that of a young man who died in fifteen hours, in consequence of his companions in a drunken frolic having mixed a drachm of opium in his wine, the body soon became covered with large blue stains, and gave out an insupportable odour. A French physician has related in the Journal de Médecine a still more pointed case of a lady who died seven hours after taking a large quantity of laudanum by mistake, and whose body was so far gone in putrefaction fourteen hours after death, that the dissection could not be delayed any longer. The hair and cuticle separated on the slightest friction, and the stomach, intestines, and large vessels were distended with air.[^[1783]]

It is doubtful whether this is a constant appearance or not. In one case I examined, the body was free from putrefaction forty-eight hours after death.

Although opium is generally believed to suspend all the secretions and excretions but the sweat, instances have been met with where a great collection of urine was found in the bladder after death. In a paper on the signs of death by opium, in Augustin’s Repertorium, it is stated that Welper of Berlin always found the bladder full of urine, and the kidneys gorged with blood, both in man and animals.[^[1784]] I am not prepared to say how far this is a common condition, as the state of the urinary organs is seldom noticed in published cases.

In the examination of the dead body unequivocal evidence will sometimes be procured by the discovery of a portion of the poison in the stomach. But it must not always be concluded that opium has not been swallowed, because the sense of smell, chemical analysis, and experiments on animals fail to detect it. For, as previously remarked, the opium may not remain in the stomach after death, though a large quantity was swallowed, and not vomited. This may arise from two causes. It may be all absorbed, as will often happen when it has been taken in the liquid form: or it may be partly absorbed and partly decomposed by the process of digestion. But in one or other of these ways it may certainly disappear, and that in a very few hours only. Several instances to this effect have been already mentioned (pp. [57], 537). These remarks are important, because the fact is generally believed to be the reverse. Dr. Paris, in his work on Medical Jurisprudence, has tended to propagate the misconception, by asserting that in all fatal cases opium may be detected in the stomach;[^[1785]] and in the last edition of his Toxicology, Orfila has overrated the facility and frequency with which an analysis may be conducted successfully. [See p. [538].]

At the same time there is no doubt that the poison may sometimes be found in the stomach. In Knape and Hecker’s Register there is the case of a girl who died about eight hours after taking half an ounce of laudanum; and the reporters found that an extract prepared from the contents of the stomach caused deep sleep in frogs, chickens, and dogs, and threw some of them into a comatose state, which proved fatal.[^[1786]] Wildberg has related a very interesting case of a young lady of Berlin, who had been seduced, and finding herself pregnant, swallowed about half an ounce of laudanum in the evening, and died during the night. In this instance the contents of the stomach had a narcotic odour, and their extract when given to a young dog caused excessive sleep, reeling, palsy of the legs, convulsions, and death.[^[1787]]

M. Petit has related another case fatal in about ten hours, where the contents of the stomach had the smell of opium; and their alcoholic extract had a bitter taste, and killed guinea-pigs, with symptoms of narcotism.[^[1788]] In a case related by Mayer in Rust’s Magazin, which also proved fatal after an interval of ten hours, the poison, which in this instance was the saffron-tincture, was distinctly detected in the stomach by a strong odour of opium and saffron.[^[1789]] In a case where the patient lived between thirteen and fourteen hours, that of the individual for whose murder Stewart and his wife were executed at Edinburgh, Dr. Ure succeeded in detecting meconic acid in the contents of the stomach, which had been removed by the pump about three hours after the opium was swallowed.[^[1790]] In another case published by Mr. Skae of this city, where death was caused by half an ounce in thirteen hours, without any attempt having been made to evacuate the stomach, the contents of that organ, treated according to the process at p. [534], yielded evident indications of morphia, and obscure evidence of meconic acid.[^[1791]] Lastly, it may be added that in Dr. Traill’s case of poisoning with ten grains of muriate of morphia, when the contents of the stomach were decomposed by magnesia, a solution was obtained from the precipitate by rectified spirit, which, when concentrated, had the strong bitter taste of morphia, and became yellow with nitric acid; and yet the individual survived no less than twelve hours.

An important fact, ascertained by MM. Orfila and Lesueur, is that neither opium nor the salts of morphia undergo decomposition by being long in contact with decaying animal matter. Even after many months they may be discovered; at least the putrefaction of the matter with which they are mingled does not add any impediment in the way of their discovery. It is only necessary to observe that the alkaloid may be rendered insoluble by the evolution of ammonia, which separates it from its state of combination.[^[1792]]

Section IV.—Of the Treatment of Poisoning with Opium.

The treatment of poisoning with opium, owing partly to the numerous cases that have been published, and partly to the experiments of Orfila on the supposed antidotes,—is now well understood.

The primary object is to remove the poison from the stomach. This is proper even in the rare cases in which vomiting occurs spontaneously. It is by no means easy to remove all the opium by vomiting, especially if it was taken in the solid state; for it becomes so intimately mixed with the lining mucus of the villous coat, that it is never thoroughly removed till the mucus is also removed, which is always effected with difficulty.

The removal of the poison is to be accomplished in one of three ways, by emetics administered in the usual manner, by the stomach-pump, or by the injection of emetics into the veins.

By far the best emetic is the sulphate of zinc in the dose of half a drachm or two scruples, which may be repeated after a short interval, if the first dose fails to act. In order to insure its action it is of great use to keep the patient roused as much as possible,—a point which is often forgotten.—The sulphate of copper has been used by some as an emetic; but it is not so certain as the sulphate of zinc. Besides, as it is a much more virulent poison, it may prove injurious, if retained long in the stomach. In Dr. Marcet’s case the patient, after recovering from the lethargic symptoms, suffered much from pain in the throat and stomach, occasioned probably by the sulphate of copper which he took remaining some time undischarged. Tartar emetic, from the uncertainty of its action when given in considerable doses, is even worse adapted for such cases. This is illustrated by a case in the seventh volume of the Medical and Surgical Journal, the same which has already been referred to as exemplifying the occasional occurrence of convulsions and delirium in poisoning with opium. A scruple of tartar emetic was administered to cause vomiting, but to no purpose. When it had remained fifteen minutes, sulphate of zinc was also given, and with immediate effect. But the patient, after recovering from the sopor, was attacked with pains in the stomach and bowels, and with tenesmus, which lasted several days.

Emetics should be preferred for evacuating the stomach, provided the case be not urgent. Even then, however, they sometimes fail altogether. The best practice in that case is to endeavour to remove the poison with the stomach-pump; and this in urgent cases should be the first remedy employed. The treatment by the stomach-pump has now become so generally known, that it is unnecessary to describe it particularly. It was recommended in this country by the late Dr. Monro in his lectures; but does not appear to have been tried by him. In 1803 it was first published by Renault in his treatise on the counter-poisons of arsenic; and he had tried it on animals.[^[1793]] But the first person who used it in an actual case of poisoning with opium was Dr. Physick of Philadelphia. He saved the life of a child with it in 1812; and not long afterwards his countryman, Dr. Dorsey, cured two other individuals.[^[1794]] More lately it was again proposed in London by Mr. Jukes, who does not appear to have been acquainted with these prior trials and experiments. Although he cannot be considered in the light of a discoverer, the profession is much indebted to him for having recalled their attention to this treatment, and for having by his success and activity fairly established its reputation. An account will be seen of his apparatus and of several cases in the Medical and Physical Journal for September and November, 1822. In using the stomach-pump care must be taken not to injure the stomach by too forcible suction.—When it is not at hand, Mr. Bryce of this city recommended the substitution of a long tube with a bladder attached. After the stomach has been filled with warm water from the bladder, the tube is to be turned down so as to act upon the contents of the stomach as a syphon. Dr. Alison cured a patient in this way.[^[1795]]

Another method of removing opium from the stomach, which has been practised successfully where the patient could not be made to submit to the common treatment, is the injection of tartar-emetic into the rectum. A case is related by Dr. Roe of New York where this treatment proved successful. Fifteen grains in half a gallon of water excited free vomiting, and ten grains more renewed it. Care was taken to insure the discharge of the whole tartar-emetic by a subsequent purgative injection.[^[1796]]

The last method for removing opium from the stomach is a desperate one, which can only be recommended when emetics by the mouth have utterly failed, and when a stomach-pump or Mr. Bryce’s substitute, cannot be procured. It is the injection of an emetic into the veins. Tartar-emetic answers best for this purpose, and its effect is almost certain. A grain is the dose. While injecting it, care must be taken by the operator not to introduce air into the vein.

The next object in conducting the treatment of poisoning with opium is to keep the patient constantly roused. This alone is sufficient when the dose is not large, and the poison has been discharged by vomiting; and in every case it forms, next to the evacuation of the stomach, the most important of the treatment.

The best method of keeping the patient roused is to drag him up and down between two men, who must be cautioned against yielding to his importunate entreaties and occasional struggles to get free and rest himself. For the sopor returns so rapidly, that I have known a patient answer two or three short questions quite correctly on being allowed to stand still, and suddenly drop the head in a state of insensibility while standing. The duration of the exercise should vary according to circumstances from three, to six, or twelve hours. When he is allowed at length to take out his sleep, the attendants must ascertain that it is safe to do so by rousing him from time to time; and if this should become difficult, he must be turned out of bed again and exercised as before.

It appears from some cases published not long ago by Mr. Wray[^[1797]] and Dr. Copland,[^[1798]] and more lately also by Dr. Bright,[^[1799]] that the most insensible may be roused to a state of almost complete consciousness for a short time, by dashing cold water over the head and breast. This treatment can never supersede the use of emetics: and as its effect is but temporary, it ought not to supersede the plan of forced exercise. But it appears to be an excellent way to insure the operation of emetics. If the emetic is about to fail in its effect, cold water dashed over the head restores the patient for a few moments to sensibility, during the continuance of which the emetic operates. Dashing cold water over the head may perhaps be dangerous in the advanced stage, when the body is cold and the breathing imperceptible; but the most desperate remedies may be then tried, as the patient is generally in almost a hopeless state. In one of the cases mentioned by Dr. Bright from the experience of Mr. Walne, complete recovery was accomplished, mainly by cold affusion of the head, where there appeared reason to believe that more than an ounce and a half of laudanum had disappeared from the stomach before evacuating remedies were used.—This treatment seems to have been first proposed in 1767 by a German physician, Dr. Gräter.[^[1800]] A suggestion, which is probably an improvement, has been recently made by Dr. Boisragon of Cheltenham, to alternate the use of cold with that of warm water, applied to children in the shape of warm bath, and to adults in the form of warm-sponging and the foot-bath. The alternating impression of heat and cold may act better as a stimulant than either agent singly; and the occasional employment of heat prevents the risk of collapse from too continuous exposure to cold. Dr. Boisragon saved in this way two cases in very unpromising circumstances.[^[1801]]

In some cases internal stimulants have been given with advantage, such as assafœtida, ammonia, camphor, musk, &c. It is always useful to stimulate the nostrils from time to time, by tickling them or holding ammonia under the nose; but the application should be neither frequent nor long continued, as the ammonia may cause deleterious effects when too freely inhaled. Pulling the hair and injecting water into the ears are also powerful modes of rousing the patient.

Venesection has been recommended and successfully used by some physicians. If the stomach be emptied, and the patient kept roused, as may almost always be done when means are resorted to in time, venesection will be unnecessary. Sometimes, however, when the pulse is full and strong, it may be prudent to withdraw blood; and it certainly appears that in most cases where this remedy has been employed the sensibility began to return almost immediately after. This is very well shown in a case of poisoning with opium related by Mr. Ross[^[1802]] in the Edinburgh Medical Journal, in another described in the same journal by Mr. Richardson,[^[1803]] and also in two cases of poisoning with acetate of morphia mentioned in a former page. Sometimes, on the contrary, it has seemed injurious, probably because it was not had recourse to till the patient was moribund. It is a sound general rule that blood-letting ought not to be resorted to until the poison is thoroughly removed from the stomach; for it favours absorption. And yet facts are not wanting to show that this rule, now generally admitted since the researches of Magendie on absorption, is not infallible. Dr. Young of the United States has given the particulars of a case where imperturbable coma was formed, together with puffing stertorous respiration, in consequence of an ounce of laudanum having been swallowed,—and where recovery took place, without the poison having been removed at all, simply under the employment of three blood-lettings to the amount of twenty-eight ounces altogether, of cold to the head, and of sinapisms to the legs.[^[1804]]

Galvanism has been sometimes resorted to, but seldom with decided advantage. I saw it tried, with dubious utility, a few years ago in an urgent case which was treated in the Edinburgh Infirmary. Six ounces of laudanum had been swallowed, but most of it was removed in three-quarters of an hour by the stomach-pump. A stage of deep sopor followed, after which sensibility was restored, and maintained for four hours by forced exercise. A state of pure and extreme coma then ensued, during which galvanism was for some time of great service, in rousing the patient. Gradually, however, it ceased to have any effect of the kind. Recovery took place eventually under the use of external and internal stimuli. Mr. Erichsen of the University-College Hospital, London, has related a case, in which electro-magnetism was of undoubted service. The usual symptoms had been occasioned by an ounce of laudanum. The poison had been withdrawn by the stomach-pump, when unavailing attempts were made to restore sensibility by means of various stimulants. At length several electro-magnetic shocks were passed from the forehead to the upper part of the spine, with the effect of speedily eliciting signs of consciousness; in twenty minutes the patient could answer questions and walk a little; and eventually complete recovery took place.[^[1805]]

In desperate circumstances artificial respiration may be used with propriety. After the breathing has been almost or entirely suspended the heart continues to beat for some time; and so long as its contractions continue, there is some hope that life may be preserved. But it is essential for the continuance of the heart’s action, that the breathing be speedily restored to a state of much greater perfection than that which attends the close of poisoning with opium. It is not improbable that the only ultimate cause of death from opium is suspension of the respiration, and that if it could be maintained artificially so as to resemble exactly natural breathing, the poison in the blood would be at length decomposed and consciousness gradually restored. The following is an interesting example by Mr. Whately, in which artificial respiration proved successful. A middle-aged man swallowed half an ounce of crude opium and soon became lethargic. He was roused from this state by appropriate remedies, and his surgeon left him. But the poison not having been sufficiently discharged, he fell again into a state of stupor; and when the surgeon returned, he found the face pale, cold and deadly, the lips black, the eyelids motionless, so as to remain in any position in which they were placed, the pulse very small and irregular, and the respiration quite extinct. The chest was immediately inflated by artificial means, and when this had been persevered in for seven minutes, expiration became accompanied with a croak, which gradually increased in strength till natural breathing was established. Emetics were then given, and the patient eventually recovered.[^[1806]]—Dr. Ware of Boston (U. S.) has more lately described another case, where artificial respiration was employed with marked advantage, and would probably have saved the patient’s life in very unfavourable circumstances, but for the disease on account of which the opium was given.[^[1807]]—Another has been lately described by Mr. C. J. Smith of Madras. The patient was not seen for four hours, and received no benefit from the ordinary remedies during the next hour and a half. Artificial respiration was then resorted to and maintained for nearly five hours with an hour of interval; and this measure certainly seems to have brought the case to a favourable termination under most unpromising circumstances.[^[1808]]—Dr. Watson of Glasgow has mentioned to me the particulars of an instructive base in the person of an infant three weeks old, in whom, after the breathing had stopped and the heart had nearly ceased to beat, the occasional inflation of the chest with the breath at intervals of two or three minutes restored for a time the action both of the heart and lungs, and eventually accomplished recovery. On physiological principles it appears probable, that this simple mode of procedure may prove more frequently successful than might at first be thought.

It would be a fruitless task to examine into the merits of the numerous antidotes which have from time to time been proposed for poisoning with opium. Professor Orfila has examined many of them with great care, such as vinegar, tartaric acid, lemonade, infusion of coffee, decoction of galls, solution of chlorine, camphor, diluents; and he has found them all useless before the poison is expelled from the stomach, with the single exception of decoction of galls. As he remarked that this fluid throws down the active principles of an infusion of opium, and subsequently found that such a mixture acts more feebly on the animal system than the opiate infusion itself, he thinks the decoction of galls may with propriety be used as an imperfect antidote, till the poison can be evacuated from the stomach.[^[1809]] His experiments, however, do not assign to it very material activity as a remedy; and certainly the whole efforts of the physician ought in the first instance to be directed to the removal of the opium, and to keeping the patient roused. When the opium has been completely removed, the vegetable acids and infusion of coffee have been found useful in reviving the patient, and subsequently in subduing sickness, vomiting, and headache; but till the poison is completely removed the administration of acids is worse than useless, provided the opium was given in the solid state, because its solution in the juices of the stomach is accelerated. It has been maintained that iodine, chlorine, and bromine are all antidotes for poisoning with the vegetable alkaloids.[^[1810]] Some notice will be taken of this statement in the chapter on Nux Vomica. It has also been lately alleged in the United States that opium has no effect when given with acetate of lead; and an hospital case is reported as having occurred at New York, where the poison was swallowed in this way to the extent of thirty grains, without any injurious effect.[^[1811]] There must have been some mistake here, however. When given with acetate of lead in medicinal doses, opium exerts its usual sedative and anodyne action; and indeed there is no chemical or physiological reason why it should not do so.

CHAPTER XXVIII.
OF POISONING WITH HYOSCYAMUS, LACTUCA, AND SOLANUM.

Of Poisoning with Hyoscyamus.—Of the narcotic poisons none bears so close a resemblance to opium in its properties as the hyoscyamus or henbane. Several species are poisonous; but the only one that has been examined with care is the H. niger, from which the extract of the apothecary is prepared.

The hyoscyamus has been analyzed by various chemists, and found to contain a peculiar alkaloid, in which the properties of the plant are concentrated. It is named hyoscyamia. This substance in its pure state, as first obtained by MM. Geiger and Hesse, is a solid body, in fine silky crystals, without odour, of a strong acrid taste like tobacco, partially volatilizable with boiling water, entirely volatilizable alone at a somewhat higher heat, very soluble in alcohol and ether, but sparingly so in water.[^[1812]]

Farther, hyoscyamus, like many other narcotic vegetables, stramonium, digitalis, opium, tobacco, and hemlock, has been found by Mr. Morries Stirling to yield by destructive distillation an empyreumatic oil of great activity. Its poisonous properties, however, are not essential to the oil, but reside in a volatile principle which may be detached by weak acetic acid. The relation of this principle to hyoscyamia has not been ascertained; but it is an active poison, small doses producing in rabbits, convulsions, coma, and speedy death.[^[1813]]

Runge proposes as evidence of poisoning with hyoscyamus, in common, however, with stramonium and belladonna, to concentrate a solution of the contents of the stomach, and apply it to a cat’s eye to dilate the pupil. Dilatation, he says, was even produced by an extract obtained from the urine of a rabbit which had been fed some time on hyoscyamus.[^[1814]]

According to the experiments of Professor Orfila, the juice or extract procured from the leaves, stems, and especially the root, produces in animals a state of sopor much purer than that caused by opium. It is most active when injected into the jugular vein, less so when applied to the cellular tissue, and still less when introduced into the stomach. Except occasional paralysis of the heart, indicated by florid blood in its left cavities, no morbid appearance is to be found in the dead body. Six drachms of the pharmaceutic extract of the leaves killed a dog in two hours and a quarter when swallowed; and three drachms killed another in four hours through a wound in the back. Its action appears to be exerted through the medium of the blood-vessels, and is purely narcotic.[^[1815]]

It is probable that the activity of this plant is much affected by season; and the energy of its preparations varies greatly with the manner of obtaining them. The information, however, which is at present possessed on these two points is vague, because the influence of the two circumstances has seldom been viewed carefully apart.

The leaves, from which the pharmaceutic preparations of hyoscyamus are obtained, are commonly held to be most active during the inflorescence of the plant in the second summer of its existence. On general principles this appears probable; but there are no satisfactory experiments on the subject, even the late researches of Mr. Houlton having left much still to be determined.[^[1816]]

Orfila has made some important remarks as to the effect of season and vegetation on the energy of the root as a poison. The root he maintains is the most active part of the plant; but in the spring it is nearly inert. Thus the juice of three pounds of the root collected near the end of April, when the plant has hardly begun to shoot, killed a dog in somewhat less than two days; while a decoction of an ounce and a half collected on the last day of June, when the plant was in full vegetation, proved fatal in two hours and a half.

The extract of the leaves, procured from different shops, was found by Orfila to vary greatly in point of strength, some samples being absolutely inert.[^[1817]] The causes of these differences have been ascertained experimentally by Brandes to be, that the herb loses its active principle in part by decomposition in the process of simple desiccation, and also when long kept; and that the greater part is also similarly decomposed in preparing an extract, unless the process be finished quickly, and at a low heat.

The seeds of hyoscyamus are poisonous, as well as the leaves and root. Indeed the whole plant is so. The seeds contain much more hyoscyamia than the leaves.

The effects of hyoscyamus on man differ somewhat from those on animals, and vary greatly with the dose.

In medicinal doses it commonly induces pleasant sleep. This indeed has been denied by M. Fouquier, who infers from his experiments that it never causes sleep, but always headache, delirium, nausea, vomiting, and feverishness.[^[1818]] I have certainly seen it sometimes have these effects; but much more generally it has acted as a pleasant hypnotic and anodyne.

Its effect in large doses have been well described by M. Choquet as they occurred in two soldiers who ate by mistake the young shoots dressed with olive oil. They presently became giddy and stupid, lost their speech, and had a dull, haggard look. The pupils were excessively dilated, and the eyes so insensible that the eyelids did not wink when the cornea was touched. The pulse was small and intermitting, the breathing difficult, the jaw locked, and the mouth distorted by risus sardonicus. Sensibility was extinct, the limbs were cold and palsied, the arms convulsed, and there was that singular union of delirium and coma which is usually termed typhomania. One of the men soon vomited freely under the influence of emetics, and in a short time got quite well. The other vomited little. As the palsy and somnolency abated, the delirium became extravagant, and the patient quite unmanageable till the evening of the subsequent day, when the operation of brisk purgatives restored him to his senses. In two days both were fit for duty.[^[1819]]

In a treatise on vegetable poisons, Mr. Wilmer has related the history of six persons in a family, who were poisoned by eating at dinner the roots of the hyoscyamus by mistake instead of parsneps. Several were delirious and danced about the room like maniacs, one appeared as if he had got drunk, and a woman became profoundly and irrecoverably comatose. Emetics could not be introduced into the stomach, stimulant clysters had no effect, external stimuli of every kind failed to rouse her, and she expired next morning at six.[^[1820]] The roots in this instance were gathered in the winter time,—a fact, which does not quite coincide with the conclusions of Orfila, that the plant must be in full vegetation before the energy of the root is considerable.

From these and other cases, the abstracts of which are to be seen in Orfila’s Toxicology, or in Wibmer’s Treatise on the Operation of Medicines and Poisons, it follows that hyoscyamus in a poisonous dose causes loss of speech, dilatation of the pupil, coma, and delirium, commonly of the unmanageable, sometimes of the furious kind. In general a stage of delirium precedes coma; and sometimes as the coma passes off, delirium returns for a time. It has been known to act powerfully in the form of clyster.[^[1821]] It has also been known to act with considerable energy even through the sound skin, as appears from a case which occurred to Wibmer. He was called to a lady affected with great stupor, dilated pupils, flushed face, loss of speech, full hard pulse, and swelling of the abdomen; and he found that these symptoms were owing to several ounces of henbane leaves having been applied to the belly in a poultice, on account of strangury and tympanitis. She was still capable of being roused by speaking loudly close to her ear; and under proper treatment she recovered.[^[1822]]

Henbane seldom causes any distinct symptoms of irritant poisoning. In several, however, of the cases related by the older modern authors some pain in the belly, a little vomiting, and more rarely diarrhœa, appear to have occurred.[^[1823]] Plenck quotes, from a Swedish authority, an instance of its having produced burning in the stomach, intense thirst, watching, delirium, depraved vision, and next day a crowded eruption of dark spots and vesicles, which disappeared on the supervention of a profuse diarrhœa.[^[1824]] The same author alludes to cases where it proved fatal; but this event is rare in the present day, obviously because the precursory stage of delirium gives an opportunity of removing the poison, before the stage of coma is formed. A fatal case, which occurred to Mr. Wibmer, has been mentioned above; and another has been related in Pyl’s Magazin. Two boys a few minutes after eating the seeds were attacked with convulsions and heat in the throat; and one of them, who could not be made to vomit, died in the course of the ensuing night.[^[1825]]

The accidents it has occasioned have commonly arisen from the individuals confounding the root with that of the wild chicory or with the parsnep, the latter of which it somewhat resembles.

Of the other species of the hyoscyamus, the H. albus has been known to cause symptoms precisely the same with those above described. Professor Foderé has given a good example of its effects on man, as they occurred in the crew of a French corvette in the Archipelago. The plant was boiled and distributed among the whole ship’s company, as several of the sailors said they knew it to be eatable and salubrious. But in no long time they were all seized with giddiness, vomiting, convulsions, colic, purging, and delirium of the active kind. They were all soon relieved by emetics and purgatives.[^[1826]]

Dr. Archibald Hamilton has described a case of the same nature, which was caused by the seeds of this plant. A young medical student, who took about twenty-five grains of the seeds, was seized in half an hour with lassitude and somnolency, and successively with dryness of the throat, impeding deglutition, convulsive movements of the arms, incoherency, total insensibility of the skin, and loss of recollection. These symptoms continued about twelve hours, and then slowly receded.[^[1827]]

Three other species, the H. aureus, physaloides and scopolia are represented by Orfila to be equally deleterious.

The alkaloid hyoscyamus possesses in an intense degree the active properties of the plant. It has not been hitherto examined in this respect with much care. But extremely minute quantities produce excessive enlargement of the pupil, when put within the eyelids in the form of neutral salt.

Treatment.—The treatment of poisoning with hyoscyamus consists in removing the poison, diminishing cerebral congestion, and restoring sensibility. It is therefore substantially the same as in poisoning with opium, except that general or local evacuation of blood is more frequently required, in consequence of the greater tendency of hyoscyamus to induce determination of blood towards the head and congestion there. It has been lately alleged by an Italian author that a large dose of lemon-juice is an immediate antidote for the effects of too large a medicinal dose, even when the poison was administered in the form of injection.[^[1828]] This does not seem probable.

Of Poisoning with Lactuca.

Allied in its effects, but greatly inferior in power to opium and hyoscyamus, is the Lactuca virosa, together with the Lettuce-opium, or inspissated juice of L. sativa, and L. virosa.

Orfila found that three drachms of the extract of L. virosa introduced into the stomach of a dog killed it in two days, without causing any remarkable symptom; that two drachms applied to a wound in the back induced giddiness, slight sopor, and death in three days; and that thirty-six grains injected in a state of solution into the jugular vein caused dulness, weakness, slight convulsions, and death in eighteen minutes.[^[1829]] This poison, therefore, like other narcotics, acts through absorption. But it is far from being energetic. The extract is very uncertain in strength,—as may indeed be inferred from the variable nature of the processes by which it is prepared.

Lactucarium, the inspissated juice, especially that obtained from L. virosa, is obviously a more active preparation than the extract. Doses of no great magnitude kill small animals. But there is a want of good observations on its effects and energy as a poison.

Of Poisoning with Solanum.

Different species of solanum, a genus of the same natural order with the hyoscyamus, have been considered by Orfila to possess the same properties, though in a much feebler degree. The S. dulcamara or bittersweet has been erroneously believed by some to possess distinct narcotic properties.[^[1830]] M. Dunal found that a dog might take 180 of the berries or four ounces of the extract without any inconvenience, and quotes an experiment on the human subject where thirty-two drachms of extract were taken in two doses also without injury.[^[1831]] If it has any power at all, therefore, it must possess too little to be entitled to the name of a poison. Chevallier says he knew an instance of a druggist’s apprentice being attacked with deep somnolency for ten hours after carrying a large bundle of it on his head;[^[1832]] but some other cause may be justly suspected to have here been in operation. The S. nigrum or common nightshade has been made the subject of experiment by Orfila, who found its extract to possess nearly the power and energy of lettuce-opium.[^[1833]] The following seems a genuine case of poisoning with the berries of this species. Three children near Nantes in France were seized with severe headache, giddiness, colic, nausea, and vomiting. One of them then had excessive dilatation of the pupils, sweating and urgent thirst; loss of voice, stertorous breathing, and tetanic spasms ensued; and in twelve hours he died. Another had swelling of the face, alternate contraction and dilatation of the pupils, repeated vomiting, and eventually coma; but he recovered. The third was similarly, but more slightly affected, and also recovered. The children who recovered pointed out the berries they had eaten; which were found to be those of S. nigrum.[^[1834]] The S. fuscatum is rather more active, fifteen berries having caused hurried breathing and vomiting.[^[1835]] The S. mammosum is also probably an active species, the capsule of the berries having been known to excite vomiting, giddiness, and confusion of mind.[^[1836]] In the S. nigrum and dulcamara, M. Desfosses discovered in 1821 a peculiar alkaloid, which induces somnolency in animals, but is not a very active poison.[^[1837]]

It has been supposed by some that the tubers of Solanum tuberosum, the common potato, may acquire in certain circumstances poisonous qualities of no mean energy. Dr. Kabler of Prague has described the cases of four individuals in a family who were seized with alarming narcotic symptoms after eating potatoes which had begun to germinate and shrivel. The father of the family, who had eaten least of them all, appeared as if tipsy, and soon became insensible. The mother and two children became comatose and convulsed. All had vomited before becoming insensible. They recovered under the use of ether, frictions, and coffee; and in two hours were out of danger.[^[1838]]

An alkaloid has been indicated by several chemists in various species of solanum. The most recent account, that of Otto, represents it to be a pearly, white, pulverulent substance, alkaline in reaction, and capable of uniting with acids. One grain of sulphate of solania killed a rabbit in six hours, and three grains a stronger rabbit in nine hours,—the symptoms being those of narcotic poisoning.[^[1839]]

Violent effects have often been assigned to the genus Solanum, in consequence of its similarity to a powerful poison, the Atropa belladonna; which indeed is described by the older authors under the name of Solanum furiosum. It will be noticed among the Narcotico-acrid Poisons.

CHAPTER XXIX.
OF POISONING WITH HYDROCYANIC ACID.

The poisons, whose energy depends on the presence of the prussic or hydrocyanic acid, are of great interest to the physiologist as well as the medical jurist. Some of them are natural productions, derived from the leaves, bark, fruit-kernels, and roots of certain plants; others are formed artificially by complex chemical processes. The species to be here noticed are the hydrocyanic acid itself, and the essential oils and distilled waters of the bitter almond, cherry-laurel, peach-blossom, cluster-cherry, mountain-ash, and bitter cassava. These poisons have for some time attracted great attention on account of their extraordinary power. And indeed in rapidity of action, or the minuteness of the quantity in which they operate, no poison surpasses and very few equal them. They are exceedingly interesting to the medical jurist, because, as they are now generally known, their effects often become the subject of medico-legal investigation: they have been repeatedly taken by accident; they have often been resorted to for committing suicide; and they have likewise been employed as the instruments of murder. A remarkable instance occurred in England towards the close of last century, where murder was committed with the cherry-laurel water; and two cases have been tried in England where death arose from hydrocyanic acid, and the prisoners were charged with administering it, but were found not guilty. These cases will be noticed presently.

Of the Hydrocyanic Acid.
Section I.—Of its Chemical History and Tests.

This singular substance was discovered some time ago by Scheele; but Gay-Lussac was the first who obtained it in a state of purity. It is familiarly known to chemists under two forms,—as a pure acid, and diluted with water.

The pure acid is liquid, limpid, and colourless. It has an acrid, pungent taste, and a very peculiar odour, which, when diffused through the air, has a very distant resemblance to that of bitter almonds, but is accompanied with a peculiar impression of acridity on the nostrils and back of the throat. It is an error, however, to suppose, as is very generally done, that the odour is the same with that of the almond. It boils at 80°; freezes at 5°; and is very inflammable. I have kept it unchanged for a fortnight in ice-cold water; but at ordinary temperatures it decomposes spontaneously, and becomes brown, sometimes in an hour, and commonly within twelve hours. On this account it is extremely improbable that a case will ever happen, in which the medical jurist will have to examine it in its concentrated form.

When united with water it forms the acid discovered by Scheele, and now kept in the druggist’s shop. In this state it has the same appearance, taste, and smell as the pure acid; but it is less volatile, does not burn, and may be preserved long without change, if excluded from the light. In consequence of its volatility, however, it becomes weak, unless kept with great care; many samples of it also undergo decomposition, and deposit brown flakes, if not excluded from the light; and hence the acid of the shops is very variable in point of strength. The acid prepared by decomposing the solution of the ferro-cyanate of potass by sulphuric acid may be kept for years, even exposed to diffuse light, without being decomposed at all. A French physician made some experiments not long ago on the uncertainty of the strength of the medicinal acid; and he found that he could swallow a whole ounce of one sample, and a drachm of a stronger sample, without sustaining any injury; but on trying some which had been recently prepared by Vauquelin, he was immediately taken ill, as will be related presently, and narrowly escaped with his life.[^[1840]]—The acid of commerce differs much in strength, according to the process by which it has been prepared, and independently of decomposition by keeping. The medicinal acid long used in this country is intended to be an imitation of that of Vauquelin, which contains 3·3 per cent.;[^[1841]] but the London College of Physicians, in adopting it in their last Pharmacopœia, improperly altered the strength to 2 per cent. That of Giese, which keeps well, is of the same strength as the first; that of Schrader contains only one per cent.; that of Göbel 2·5 per cent.; that of Ittner 10 per cent.;[^[1842]] that of Robiquet 50 per cent.[^[1843]] Of the alcoholic solutions the best known are that of Schrader, which contains about 1·5 per cent. of pure acid,—that of the Bavarian Pharmacopœia, which contains 4 per cent.,—that of Duflos, 9 per cent.,—that of Pfaff, 10 per cent.,—and that of Keller, 25 per cent.[^[1842]] These statements are necessary for understanding the cases of poisoning published in foreign works.

The tests for hydrocyanic acid has been examined by M. Lassaigne of Paris, by Dr. Turner of London, and by Professor Orfila. They are its odour, the salts of copper, the salts of iron, and nitrate of silver.

The peculiar odour of the acid is a very characteristic and delicate test of its presence. According to Orfila, the smell is perceptible when no chemical reagent is delicate enough to detect it.[^[1844]] But I doubt the accuracy of this statement, and may farther observe, that I have known some persons nearly insensible of any smell, even in a specimen which was tolerably strong. Hence, when the odour is resorted to as a test, it ought to be tried by several persons.

Sulphate of copper forms with hydrocyanic acid, when rendered alkaline with a little potass, a greenish precipitate, which becomes nearly white, on the addition of a little hydrochloric acid. The purpose of the hydrochloric acid is to redissolve some oxide of copper thrown down by the potass. The precipitate is then the cyanide of copper. This test, according to Lassaigne, will act on the poison when dissolved in 20,000 parts of water. But as the precipitate is not coloured, the test is an insignificant one compared with the next.

If the acid be rendered alkaline by potass, the salts of the mixed peroxide and protoxide of iron produce a grayish-green precipitate, which, on the addition of a little sulphuric acid, becomes of a deep prussian blue colour. Common green vitriol answers very well for this purpose. The salts of the peroxide of iron will also often answer, because, unless carefully prepared, they are never altogether free of protoxide. But the salts of the pure peroxide of iron have no such effect. They cause with the potass a brownish precipitate, which is redissolved on the addition of sulphuric acid, leaving the solution limpid. Mr. Ilott of Bromley has pointed out to me, that the iron test does not act on a weak solution of hydrocyanic acid, if there be an excess of ammonia present, either such from the first, or disengaged by potash from muriate of ammonia; that the blue precipitate is produced by driving off the ammonia with heat; but not by neutralizing it with an acid.

The nitrate of silver is a delicate and characteristic reagent for hydrocyanic acid. A white precipitate, the cyanide of silver, is produced in a very diluted solution; and this precipitate is distinguished from the other white salts of silver, by being insoluble in nitric acid at ordinary temperatures, but soluble in that acid at its boiling temperature. In this action it is necessary to observe that something more is accomplished than simple solution; the cyanide is decomposed, nitrate of silver is formed, and hydrocyanic acid is disengaged by the ebullition. A more characteristic property is, that the precipitate when dried and heated emits cyanogen gas; which is easily known by the beautiful rose-red colour of its flame.[^[1845]]

Sometimes it is necessary to determine the strength of diluted hydrocyanic acid; because, on account of its tendency to decomposition, doubts may be entertained whether a mixture which contains it is strong enough to be dangerously poisonous. According to Orfila, the best method of ascertaining the strength either of a pure solution or of a mixture in syrup, is to throw down the acid with the nitrate of silver and dry the precipitate; a hundred parts of which correspond to 20·33 of pure hydrocyanic acid.

Process for Mixed Fluids.—Some important observations have been made by MM. Leuret and Lassaigne on the effect of mixing animal matters with hydrocyanic acid. The most material of their results are, that if the body of an animal poisoned with the acid is left unburied for three days, the poison can no longer be detected; and that if it is buried within twenty-four hours the poison may be found after a longer interval, but never after eight days. The reason is either that the acid volatilizes, or that it is decomposed. The possibility thus indicated of detecting the poison in the body some days after death has been since confirmed by actual examination in a medico-legal case. In a case of poisoning with hydrocyanic acid, followed by dismemberment of the body for the purpose of concealment, distinct proof of the presence of the poison seven days after death was obtained by the second of the succeeding processes, although the trunk of the body had never been buried, but had been for some time lying in a drain.[^[1846]]

For detecting the poison in mixed fluids Orfila has lately advised the following process. The fluid may be treated with animal charcoal without heat. The colour being thus generally destroyed, the test will sometimes act as usual. Or, without this preparation, a slip of bibulous paper moistened with pure potass, may be immersed in the suspected fluid for a few minutes, and then touched with a solution of sulphate of iron: upon which the usual blue colour will be produced on the paper. If neither of these methods should answer, the fluid is to be distilled.[^[1847]]

Distillation of the fluid is on the whole the best mode of procedure. It was proposed some time before by Lassaigne and Leuret for detecting the poison in the stomach after death. The steps of their process, which appears to me the best yet proposed, are as follows. The contents after filtration are to be neutralized with sulphuric acid if they are alkaline, in order to fix the ammonia which may have been disengaged by putrefaction; the product is then to be distilled from a vapour-bath till an eighth part has passed over into the receiver; and the distilled fluid is to be tested with the sulphate of iron in the usual way.[^[1848]] Orfila maintains that from hydrocyanized syrup only two-thirds of the acid can be distilled over; and cautions the analyst against estimating quantity by such means.[^[1849]] M. Ossian Henry has proposed to condense the acid in distillation by a much more complex process, which consists in obtaining it in the first instance in the form of cyanide of silver.[^[1850]] But with a good refrigeratory there is no difficulty in condensing every particle of acid with no other aid than cold water.

By this process Lassaigne could detect the poison in a cat or dog killed by twelve drops and examined twenty-four or forty-eight hours after death.[^[1851]] But Dr. Schubarth has objected to it,—and the same objection will apply to every process in which heat is used,—that hydrocyanic acid may be formed during distillation by the decomposition of animal matter.[^[1852]] His objection, however, appears only to rest on conjecture or presumption at farthest; and I doubt whether, supposing the distillation to go on slowly in the vapour-bath, the heat is sufficient to bring about the requisite decomposition. The force of the objection must be decided by future researches.

It is worthy of remark that hydrocyanic acid is apt to be formed in the course of the changes produced by various agents in organic matters. These are probably more numerous than the toxicologist is at present exactly aware of. An instance of its formation in the course of the decay of unsound cheese has been ascertained lately by Dr. Witling;[^[1853]] and another example will be mentioned under the head of spurred rye.

Cyanide of Potassium.—The only compound of hydrocyanic acid which requires notice is the cyanide of potassium. This is, when pure, a white salt, bitter, not decomposable by a red heat unless in contact with air, very soluble in water, and sparingly so in rectified spirit. Its watery solution restores the blue of reddened litmus, and does not precipitate lime-water: the mixed sulphates of the two oxides of iron form with it Prussian blue: nitrate of silver causes a white precipitate insoluble in cold nitric acid, but disappearing when the acid is boiled: sulphate of copper causes an apple-green precipitate, which becomes white on the addition of hydrochloric acid: chloride of platinum or perchloric acid will indicate the potash. In a complex organic mixture it is difficult to detect the potash; but hydrocyanic acid may be obtained from it by distilling the suspected fluid with tartaric acid.[^[1854]]

Section II.—Of the Action of Hydrocyanic Acid and the Symptoms it excites in Man.

The effects of hydrocyanic acid on the animal system have been examined by several physiologists. The best experiments with the concentrated acid are those of M. Magendie; who says that, if a single drop be put into the throat of a dog, the animal makes two or three deep hurried respirations, and instantly drops down dead; that it causes death almost as instantaneously when dropped under the eyelid; and that when it is injected into the jugular vein, the animal drops down dead at the very instant, as if struck with a cannon ball or with lightning.[^[1855]]

On repeating these experiments in order to determine less figuratively the shortest period which elapses before the poison begins to operate, as well as the shortest time in which it proves fatal,—two points it will presently be found important to know,—I remarked that a single drop, weighing scarcely a third of a grain, dropped into the mouth of a rabbit, killed it in eighty-three seconds, and began to act in sixty-three seconds,—that three drops weighing four-fifths of a grain, in like manner killed a strong cat in thirty seconds, and began to act in ten,—that another was affected by the same dose in five and died in forty seconds,—that four drops weighing a grain and a fifth did not affect a rabbit for twenty seconds, but killed it in ten seconds more,—and that twenty-five grains, corresponding with an ounce and a half of medicinal acid, began to act on a rabbit as soon as it was poured into its mouth, and killed it outright in ten seconds at farthest. Three drops injected into the eye acted on a cat in twenty seconds, and killed it in twenty more; and the same quantity dropped on a fresh wound in the loins acted in forty-five and proved fatal in 105 seconds. Dr. A. T. Thomson says he has seen the concentrated acid kill a strong dog in two seconds.[^[1856]] Mr. Blake on the other hand alleges that all the accounts which represent the action of the poison to begin in less than ten seconds are exaggerated, because he could never find it to act more quickly, even when thirty minims of concentrated acid were injected at once into the femoral vein.[^[1857]] But it is impossible that any negative results can outweigh positive observations, especially when made, as mine were, expressly with the view of ascertaining the shortest interval. In the slower cases enumerated above there were regular fits of violent tetanus; but in the very rapid cases the animals perished just as the fit was ushered in with retraction of the head. In rabbits opisthotonos, in cats emprosthotonos, was the chief tetanic symptom.—The practical application of these experiments will appear presently.

Of all the forms in which the pure acid can be administered, that of vapour appears the most instantaneous in operation. M. Robert found, that when a bird, a rabbit, a cat, and two dogs were made to breathe air saturated with its vapour, the first died in one second, the second also in a single second, the cat in two, one dog in five, and the other dog in ten seconds.[^[1858]]

The effects of the diluted acid are the same when the dose is large, but somewhat different when inferior doses are given. These effects have been observed by many physiologists; but the most accurate and extensive experiments are those of Emmert published in 1805,[^[1859]] those of Coullon in 1819,[^[1860]] and those of Krimer in 1827.[^[1861]] They found that when an animal is poisoned with a dose not quite sufficient to cause death, it is seized in one or two minutes with giddiness, weakness and salivation, then with tetanic convulsions, and at last with gradually increasing insensibility; that after lying in this state for some time, the insensibility goes off rapidly and is succeeded by a few attacks of convulsions and transient giddiness; and that the whole duration of such cases of poisoning sometimes does not exceed half an hour, but may extend to a whole day or more.—When the dose is somewhat larger the animal perishes either in tetanic convulsions or comatose; and death for the most part takes place between the second and fifteenth minute. I have seen the diluted acid, however, prove fatal with a rapidity scarcely surpassed by the pure poison. Thus in an experiment with Vauquelin’s acid, made on a strong cat at the same time with the second and third of the experiments with the pure acid detailed above, I found that thirty-two grains, which contain one of real acid, began to act in fifteen seconds, and proved fatal in twenty-five more. According to Schubarth’s experiments death may be sometimes delayed for thirty-two minutes;[^[1862]] but if the animal survives that interval, it recovers. He farther states, that during the course of the symptoms the breath exhales an odour of hydrocyanic acid.[^[1863]] Coullon once saw a dog die after nineteen hours of suffering; but cases of this duration are exceedingly rare.[^[1864]] When the dose is very large Mr. Macaulay, as will afterwards be mentioned (p. [590]), has found death take place in a few seconds, exactly as when the pure acid is given.

The body presents few morbid appearances of note. The brain is generally natural. Yet occasionally its vessels are turgid; and Schubarth once found even an extravasation of blood between its external membranes in the horse.[^[1865]] The heart and great vessels are distended with black blood, which is commonly fluid, but occasionally coagulated as usual. The lungs, according to Schubarth, are sometimes pale, but much more generally injected and gorged with blood.[^[1866]] The pure acid, according to Magendie, exhausts the irritability of the heart and voluntary muscles so completely, that they are insensible even to the stimulus of galvanism.[^[1867]] The diluted acid has not always this effect. In the experiments of Coullon the heart and intestines contracted, and the voluntary muscles continued contractile, after death as usual.[^[1868]] So too Mr. Blake remarked both by inspection of the body after death, and by means of the hæmadynamometer during life, that, when the poison is introduced directly into a vein, so as to prove fatal in forty-five seconds, the contractions of the heart, though irregular, are not materially impaired in energy.[^[1869]] On the other hand Schubarth states that the heart is never contractile, although the intestines and voluntary muscles retain their contractility.[^[1870]] The reason of these discrepant statements is that, as I have had occasion to observe, a considerable difference really prevails in experiments conducted under circumstances apparently the same. In eight experiments on cats and rabbits with the pure acid the heart contracted spontaneously, as well as under stimuli, for some time after death, except in the instance of the rabbit killed with twenty-five grains, and one of the cats killed by three drops applied to the tongue. In the last two the pulsations of the heart ceased with the short fit of tetanus which preceded death; and in the rabbit, whose chest was laid open instantly after death, the heart was gorged and its irritability utterly extinct. The later researches of Dr. Lonsdale likewise show great varieties in the condition of the heart; and he has been led to conclude that the diluted acid does not perceptibly influence the heart, while the pure acid enfeebles it, if introduced into the stomach, but arrests it, if injected into the windpipe.[^[1871]]

The experiments of Emmert, Coullon, and Krimer show that the diluted acid acts most energetically through the serous membranes, and next upon the stomach; that it also acts with energy on the cellular tissue; that it has no effect when applied to the trunks or cut extremities of nerves, or to a fissure made in the brain or spinal marrow; that its action is prevented when the vessels of any part are tied before the part is touched with the poison; that its action is not prevented by previously dividing the nerves; and that it may sometimes be discovered in the blood after death by chemical analysis,[^[1872]] and frequently by the smell when analysis cannot succeed in separating it.[^[1873]] These results favour the supposition that hydrocyanic acid acts through the medium of the blood-vessels. But the extreme rapidity of its operation in large doses is usually considered incompatible with an action through the blood, or any other channel except direct conveyance along the nerves. The tremendous rapidity of action indicated by the experiments of Magendie, or of Mr. Macaulay (p. [543]), of M. Robert, as well as in some of those performed by myself,—certainly appears rather inconsistent with the notion, that the acid must enter the blood-vessels before producing its effects.

This acid acts on the brain and also on the spine independently of its action on the brain. Its action on both is clearly indicated by the combination of coma with tetanus. The independent action on the spine is well shown by the following experiment of Wedemeyer. In a dog the spinal cord was divided at the top of the loins, so that no movement took place when the hind-legs were pricked: hydrocyanic acid being then introduced into a wound in the left hind-leg, symptoms of poisoning commenced in one minute, and the hind-legs were affected with convulsions as well as the fore-legs.[^[1874]]

Hydrocyanic acid affects all animals indiscriminately. From the highest to the lowest in the scale of creation all are killed by it; and all perish nearly in the same manner. Such is the result of a very extensive series of experiments by Coullon.

It is scarcely necessary to observe that hydrocyanic acid acts energetically as a poison, through whatever channel it is introduced into the body. Whether it be swallowed, or injected into the rectum, or dropped into the eye, or applied to a fresh wound, or inhaled in the form of vapour, its action is exerted with tremendous energy. Perhaps it may even act through the sound skin. It has not, hitherto, indeed, been found to affect animals in this way, evidently because their skin is too thick and impermeable. But M. Robiquet informed me that once, while he was making some experiments on the tension of its vapour, his fingers, after being some time exposed to it, became affected with numbness, which lasted several days; I have repeatedly remarked the same effect when handling tubes which contained the concentrated acid; and Emmert found that the essential oil of bitter almond, applied to the uninjured skin of the back of a rabbit, produced the usual symptoms and death: and that the peculiar odour of the poison was quite distinct after death in the deep-seated muscles of the back.[^[1875]]

This substance is poisonous in all its chemical combinations. Coullon remarked that two drops of the hydrocyanate of ammonia killed a sparrow in two minutes.[^[1876]] Robiquet and Magendie found that a hundredth part of a grain of the cyanide of potassium killed a linnet in thirty seconds, and five grains a large pointer in fifteen minutes;[^[1877]] Orfila has related an instance of death in the human subject within an hour after the administration of six grains of cyanide of potassium in an injection;[^[1878]] and in a recent experimental investigation the same author found that this salt produces all the effects of hydrocyanic acid.[^[1879]] Schubarth killed a dog in twenty minutes with twenty drops of the diluted acid neutralized by ammonia,[^[1880]] and another in three hours with twenty-five drops neutralized by potass. These facts are a sufficient answer to a statement made by Mr. Murray of London, to the effect, that a considerable dose of the acid may be given without injury to a rabbit,[^[1881]] if previously rendered alkaline by ammonia. But, nevertheless, as will be seen under the head of the treatment, ammonia, as Mr. Murray stated, is a good antidote when administered after the poison as a stimulant.

The ferro-cyanates, or prussiates, do not possess deleterious properties. These salts were at one time considered compounds of hydrocyanic acid with a double oxidized base, oxide of iron being one. Thus the prussiate of potass was considered a compound of hydrocyanic acid with potass and oxide of iron. But since the investigations of Mr. Porrett, it has been admitted that there is only one base, potash; and that it is in union with a hydracid, called ferro-cyanic acid, the radicle of which is a ternary body composed of carbon, azote, and iron. The physiological effects of this substance, which have been examined by many experimentalists, are favourable to Porrett’s opinion; for although some have found it poisonous, all agree in assigning it very feeble properties, and some have not been able to discover in it any deleterious quality at all. Coullon observes that Gazan killed a dog with two drachms, and Callies another with three drachms of the salt met with in commerce.[^[1882]] Schubarth found that half an ounce had not any material effect on dogs, even when vomiting did not occur for half an hour;[^[1883]] and Callies, who found the salt of commerce somewhat poisonous, also remarked, that when it was carefully prepared, several ounces might be given without harm.[^[1884]] D’Arcet once swallowed half a pound of a solution without any injury.[^[1885]] Similar results were obtained previously with smaller doses by Wollaston, Marcet,[^[1886]] and Emmert,[^[1887]] as well as afterwards by Dr. Macneven,[^[1888]] and Schubarth,[^[1889]] who found that a drachm or even two drachms might be taken with impunity by man and the lower animals.

The sulpho-cyanic acid, another substance analogous in chemical nature to the ferro-cyanic, was once supposed like it to be a poison of great activity, but this is doubtful. Professor Mayer of Bonn ascertained that a drachm and a half of a moderately strong solution of the acid sometimes killed a rabbit in ninety seconds when injected into the windpipe, and that the same quantity of a solution of sulpho-cyanate of potassa might occasion death in the course of four hours; but that some rabbits took half an ounce of the former and three drachms of the latter without material harm, both when administered through the windpipe, when injected into the rectum, and when introduced into the stomach by a gullet-tube. In the fatal cases death took place under symptoms of oppressed breathing, rarely attended with convulsions; and extensive traces of irritation were found in the alimentary canal.[^[1890]] Dr. Westrumb of Hameln, however, seems to have found it more active in the form of sulpho-cyanate of potassa. Two scruples in an ounce of water produced in a dog spasmodic breathing, convulsions, efforts to vomit, and death in seven minutes; and forty grains killed another in less than two hours. In the latter animal he detected the poison by the sulphate of iron in the blood, lungs, liver, spleen and kidneys.[^[1891]] Some experiments by Soemering would even make it out to be a poison of very great energy; for half a drachm of concentrated sulpho-cyanic acid given to a dog occasioned immediate death; and the same quantity of sulpho-cyanate of potassa killed another in one minute.[^[1892]]

Cyanic and cyanous acids are not poisonous, according to the experiments of Hünefield;[^[1893]] but cyanogen is a powerful poison, as will be mentioned under the head of the Narcotic Gases.

The symptoms of hydrocyanic acid observed in man are very similar to those witnessed in animals.

Coullon has given a good account of the effects of small doses as ascertained by experiment on himself. When he took from 20 to 86 drops of a diluted acid, he was attacked for a few minutes with nausea, salivation, hurried pulse, weight and pain in the head, succeeded by a feeling of anxiety, which lasted about six hours.[^[1894]] Such symptoms are apt to be induced by too large medicinal doses. Another remarkable symptom which has been sometimes observed during its medicinal use is salivation with ulceration of the mouth. Dr. Macleod thrice had occasion to remark this in patients who had been using the drug for about a fortnight, and twice in one individual; and Dr. Granville says he had also twice witnessed the same effect.[^[1895]]

As to the effects of fatal doses, it is probable that in man, as in animals, two varieties exist. When the dose is very large, death will in general take place suddenly, without convulsions. But for obvious reasons the symptoms in such cases have not been hitherto witnessed.

The most complete account of the symptoms from fatal doses when convulsions occur, is given in a case reported by Hufeland of a man, who, when apprehended for theft, swallowed an ounce of alcoholized acid, containing about forty grains of the pure acid. He was observed immediately to stagger a few steps, and then to sink down without a groan, apparently lifeless. A physician, who instantly saw him, found the pulse gone and the breathing for some time imperceptible. After a short interval he made so forcible an expiration that the ribs seemed drawn almost to the spine. The legs and arms then became cold, the eyes prominent, glistening, and quite insensible; and after one or two more convulsive expirations he died, five minutes after swallowing the poison.[^[1896]]

In Horn’s Journal is recorded another case which also proved fatal in five minutes, with precisely the same symptoms.[^[1897]] A short notice of what appears to have been a similar case is given in the Annales de Chimie. The person was a chemist’s servant, who swallowed a large quantity of the alcoholic solution by mistake for a liqueur, the poison having been accidentally left on the table by her master, who had been showing it as a curiosity to some friends. No account is given of the symptoms, farther than that she died apoplectic in two minutes.[^[1898]] To these cases may be also added a short notice of the French physician’s case mentioned at the commencement of this chapter. It will convey a good idea of the operation of the poison when not quite sufficient to kill. Very soon after swallowing a tea-spoonful of the diluted acid he felt confusion in the head, and soon fell down insensible, with difficult breathing, a small pulse, a bloated countenance, dilated insensible pupils, and locked jaw. Afterwards he had several fits of tetanus, one of them extremely violent. In two hours and a half he began to recover his intellects and rapidly became sensible; but for some days he suffered much from ulceration of the mouth and violent pulmonary catarrh, which had evidently been excited by the ammonia given for the purpose of rousing him. This gentleman had eructations with the odour of the acid three or four hours after he took it; and during the earlier symptoms the same odour was exhaled by his breath.[^[1899]] The hydrocyanic odour of the breath is of course an important distinguishing character, which would appear, from the observations of Dr. Lonsdale on animals,[^[1900]] to occur more frequently than might be supposed from the silence observed on the subject by the reporters of cases.

Hydrocyanic acid is not considered a cumulative poison,—that is, the continued use of frequent small doses is not believed to possess the power recognised in iodine, mercury, and foxglove, of gradually and silently accumulating in the body, and then suddenly breaking out with dangerous or fatal violence. The frequent experience of practitioners in this and other countries seems to prove that hydrocyanic acid possesses no such property. It is right at the same time to mention, that a case published by Dr. Baumgärtner of Freyburg has been thought by some[^[1901]] to establish the reverse. A man had taken for two months, on account of chronic catarrh, ten drops of Ittner’s acid daily in doses of one grain, without experiencing the slightest toxicological effect. At length he was found one morning in bed apparently labouring under the poisonous operation of the acid. He had headache, blindness, dilated insensible pupil, feeble irregular pulse, occasional suspension of the breathing, and rapidly increasing insensibility. The cold affusion and ammonia were immediately resorted to, and at first with advantage. But in no long time spasms commenced in the toes, and gradually affected the rest of the body, till at length violent fits of general tetanus were formed, lasting for six or ten minutes, and alternating in the intervals with coma. Venesection was next resorted to; after which the spasms were confined to the jaw and eyes. Delirium succeeded, but was removed by a repetition of the blood-letting. At four in the afternoon he was tolerably sensible; during the night delirium returned; at ten next morning he recovered his sight; and on the subsequent morning he had no complaint but headache and pain in the eyes.[^[1902]] This case differs so much from every other in the collateral circumstances, as well as in duration, that, although the symptoms themselves correspond with those of poisoning with hydrocyanic acid, we may justly suspect either some other cause, or the accidental administration of too large a dose. It ought, however, to turn the attention of practitioners to the possibility of this poison acting by the accumulation of the effects of small doses frequently repeated for a great length of time.

The period within which hydrocyanic acid usually proves fatal is fixed with considerable accuracy, not only by the cases observed in the human subject, but likewise by the experiments of many physiologists, and more especially those of Schubarth (p. [583]). It is probable that very large doses occasion death in a few seconds; and at all events a few minutes will suffice to extinguish life when the dose is considerable; but if the individual survive forty minutes, he will generally recover. In the course of a dreadful accident which happened a few years ago in one of the Parisian hospitals, when seven epileptic patients were killed at one time by too large doses of the medicinal acid, it was found that several did not die for forty-five minutes.[^[1903]] But the researches of Schubarth would certainly justify the expectation that recovery will take place under active treatment when the patient survives so long.—These facts may be highly important in the practice of medical jurisprudence.

The period within which it begins to operate ought also to be accurately ascertained for the same reason. Indeed in a very interesting trial, which took place a few years ago in this country, the fate of the prisoner depended in a great measure on the question, within how short a time the effects of this poison must show themselves?[^[1904]] The nature of the case was as follows: An apothecary’s maid-servant at Leicester who was pregnant by her master’s apprentice, was found one morning dead in bed; and she had obviously been poisoned with hydrocyanic acid. Circumstances led to the suspicion that the apprentice was accessary to the administration of the poison. On the other hand, it was distinctly proved that the deceased had made arrangements for a miscarriage by artificial means on the night of her death; and it was therefore represented, on the part of the prisoner, that she had taken the poison of her own accord. But the body was found stretched out in bed in a composed posture, with the arms crossed over the trunk, and the bed-clothes pulled smoothly up to the chin; and at her right side lay a small narrow-necked phial, from which about five drachms of the medicinal prussic acid had been taken, and which was corked and wrapped in paper. There naturally arose a question, whether the deceased, after drinking the poison out of such a vessel, could, before becoming insensible, have time to cork up the phial, wrap it up, and adjust the bed-clothes?[^[1905]] To settle this point, experiments were made at the request of the judge, by Mr. Macaulay, Mr. Paget, and several other medical men of Leicester; and on the trial they, with the exception of Mr. Paget, gave it as their opinion, founded on the experiments, that the supposed acts of volition, although within the bounds of possibility, were in the highest degree improbable. The chief experiments were three in number, from which it appeared that one dog was killed with four drachms in eight seconds, another with four drachms in seven seconds, and another with four drachms and a half in three seconds; but in other experiments the interval was greater.—For these particulars I am indebted to Mr. Macaulay.

In the first edition of this work I expressed my concurrence with the majority of the witnesses. But some facts, which came subsequently under my notice, led me to think that this concurrence was given rather too unreservedly. I still adhere so far to my original views as to think it improbable that, if the deceased, after swallowing the poison, had time to cork the phial, wrap it in paper, pull up the bed-clothes, and place the bottle at her side, the progress of the symptoms could have been so rapid and the convulsions so slight, as to occasion no disorder in the appearance of the body and the bed-clothes,—and I still likewise think, that after swallowing so large a dose it was improbable she could have performed all the successive acts of volition mentioned above—with ordinary deliberation. But I am informed on good authority, that some gentlemen interested in the case found by actual trial, that all the acts alluded to might be accomplished, if gone about with promptitude, within the short period, which, in some of their experiments, the witnesses found to elapse, before the action of the poison commenced. And such being the fact, we ought not perhaps to attach too great importance to the other argument I have employed,—the probability of disorder in the body and bed-clothes from the convulsions; for if the poisoning commenced very soon, the convulsions might have been slight. The results of my own experiments related in p. [582], although on the whole confirmatory of those of Mr. Macaulay and his colleagues, are nevertheless sufficient to prove that large doses occasionally do not begin to operate with such rapidity as was observed in their experiments; for in one instance four drops of concentrated acid, equivalent to two scruples of medicinal acid, did not begin to act on a rabbit for twenty seconds; and certainly, for so small an animal, two scruples are as large a dose as five drachms for a grown-up girl.

The two following cases will throw some farther light on the time within which this poison begins to act on man when taken in large quantity. The first case shows, that even when an enormous dose is taken, a few simple voluntary acts may be executed before the symptoms begin. In this instance which is related by Dr. Gierl of Lindau, the dose was no less than four ounces of the acid of the Bavarian Pharmacopœia, which contains four per cent. of pure acid, and is equivalent to five ounces at least of that commonly used in Britain and France. The subject, an apothecary’s assistant, was found dead in bed, with an empty two-ounce phial on each side of the bed,—the mattrass, which is used in Germany instead of blankets, pulled up as high as the breast,—the right arm extended straight down beneath the mattrass,—and the left arm bent on the elbow.[^[1906]] The second case proves that, although one or two acts of volition may be accomplished, the interval is so very brief that these acts can only be of the simplest kind. An apothecary’s apprentice-lad was sent from the shop to the cellar for some carbonate of potass; but he had not been a few minutes away, when his companions heard him cry in a voice of great alarm, “Hartshorn! Hartshorn!” On instantly rushing down stairs, they found him reclining on the lower steps and grasping the rail; and he had scarcely time to mutter “Prussic acid!” when he expired,—not more than five minutes after leaving the shop. On the floor of the cellar an ounce-phial was found, which had been filled with the Bavarian hydrocyanic acid, but contained only a drachm. It appeared that he had taken the acid ignorantly for an experiment; and from the state of the articles in the cellar, it was evident that, alarmed at its instantaneous operation, he had tried to get at the ammonia, which he knew was the antidote, but had found the tremendous activity of the poison would not allow him even to undo the coverings of the bottle.[^[1907]]

When the quantity of the poison is small, a much longer interval may elapse before the commencement of its action. Thus, when the dose is barely short of what is required to occasion death, the effects may be postponed even for fifteen minutes, as in a case which occurred to Mr. Garson of Stromness.[^[1908]] This, so far as I am at present aware, is the extreme limit of interval hitherto observed.

In the trial related above the prisoner Freeman was found Not Guilty.

It is important to fix, if possible, the smallest fatal dose of hydrocyanic acid. This will vary with particular circumstances, such as the strength of the individual, and the fulness or emptiness of the stomach at the time. The cases of the Parisian epileptics, who were killed each by a draught containing two-thirds of a grain of pure acid,[^[1909]] will supply pointed information. For, on the one hand, considering the long time they survived, it is not probable that a dose materially less would have a fatal effect on man. And on the other hand repeated instances of recovery have been observed, where the dose was as great or even greater. Thus Dr. Geoghegan had a patient who recovered from a state of extreme danger after taking two-thirds of a grain;[^[1910]] and Mr. Banks of Lowth met with a case of recovery in similar circumstances, where the dose was very nearly a whole grain.[^[1911]]

It is almost unnecessary to add, that in man, as in animals, this poison will act violently, through whatever channel it may be introduced into the body. It has not been positively ascertained to act with force through the unbroken skin. The chemist Scharinger indeed was supposed to have been killed in consequence of accidentally spilling the acid on his naked arm;[^[1912]] but this was in all probability a mistake. Should the skin be freely exposed to the air it seems reasonable to expect that the poison will evaporate before it could act with energy; but if confined by pledgets or otherwise, a different result might ensue. Through every other surface, however, besides the unbroken skin, hydrocyanic acid acts with very great power; and it is in particular important to remember that its power is very great when inhaled, so that dangerous accidents have ensued even from its vapour incautiously snuffed up the nostrils. I have known a strong man suddenly struck down in this way; a French physician, M. Damiron, has related the case of an apothecary who remained insensible for half an hour subsequently to the same accident;[^[1913]] and cases of the kind are more apt to occur than might at first view be thought, because, contrary to what is generally believed and stated in chemical as well as medico-legal works, its smell is for a few seconds barely perceptible, and never of the kind which these accounts would lead one to anticipate. Accidental death may readily arise from its action on a wound or an abraded surface. Sobernheim mentions that Mr. Scharring, a druggist at Vienna, was poisoned in consequence of a phial of the acid breaking in his hand and wounding it; and he expired in an hour.[^[1914]]

The only case with which I am acquainted of poisoning with the artificial compounds of hydrocyanic acid is that formerly alluded to as having been occasioned by the cyanide of potassium. Six grains dissolved in a clyster amounting to six ounces, occasioned general convulsions, palpitations, slow laboured breathing, coldness of the limbs, dilated pupil, fixing of the eyeballs, and death in one hour,—phenomena much the same with those produced by the acid itself.[^[1915]]—Another case has been published, in which a French physician, ignorant of the correct dose, prescribed a potion with three grains of cyanide of potassium twice a day. Immediately after the first dose the patient was seized with the usual symptoms of poisoning with hydrocyanic acid; and expired in three-quarters of an hour.[^[1916]] In noticing the first of these cases, Orfila draws the attention of practitioners particularly to the fact, that not long before a similar dose of a sample of cyanide, which had been moist for some time, was twice administered with impunity. The reason is that the cyanide of potassium undergoes decomposition when acted on by water, or when long kept.

Section III.—Of the Morbid Appearances produced by Hydrocyanic Acid.

Under this head the appearances in a special case will first be mentioned, and then the varieties to which they are liable.

In Hufeland’s case [p. [587]] the inspection was made the day after death. The eyes were still glistening, like those of a person alive; but the countenance was pale and composed like one asleep. The spine and neck were stiff, the belly drawn in, the back alone livid. The body generally, the blood even within the head, and especially the serous cavities, exhaled a hydrocyanic odour, so strong as to irritate the nostrils. The blood was every where very fluid, so that two pounds flowed from the incision in the scalp and twelve ounces from that of the dura mater; and it had a glimmering bluish appearance, as if Prussian blue had been mixed with it. The vessels of the brain were gorged, the substance of the brain natural, and the left ventricle distended with half an ounce of serum. The villous coat of the stomach was red, easily removed with the nail, and gangrenous.[^[1917]] The intestines were reddish, and the liver gorged. The lungs were also turgid, and to such a degree in the depending parts as to resemble the liver. The arteries and left cavities of the heart were empty, the veins and right cavities distended.

In commenting on this description it is first to be remarked, that the blood, as in the preceding case, is generally altered in nature. Ittner, who made some good experiments on the subject, found it in animals black, viscid, and oily in consistence.[^[1918]] Emmert found it fluid and of a cochineal colour. In a case related by Mertzdorff of an apothecary’s apprentice, who was found dead in bed after swallowing three drachms and a half of diluted acid,[^[1919]] in the case recorded in Horn’s Archiv, and in that related by Dr. Gierl, it was fluid. It was also perfectly fluid every where in the bodies of the seven epileptic patients poisoned at Paris. Yet this state is not invariable. Coullon, though his results tally in general with those of Ittner and Emmert, has given some experiments in which the blood coagulated after flowing from the body;[^[1920]] and in the case of an apothecary related in Rust’s Journal it was found coagulated in the heart.[^[1921]]

In the next place, Magendie and other physiologists have observed that, as in Hufeland’s case, the blood and cavities of the body in animals exhale a hydrocyanic odour, even though the quantity taken was small. The blood did so likewise in the heart of the apothecary just mentioned as well as throughout the whole body in the case described in Horn’s Journal. The odour, however, is not always present. For example, there was none in the case of another German apothecary, who poisoned himself with an ounce, as recorded in a later volume of Rust’s Journal;[^[1922]] neither was there any odour in the blood in Mertzdorff’s case, although it was strong in the stomach; nor in the blood nor any other part of the body in the Parisian epileptics. It also appears from an experiment by Schubarth,[^[1923]] and from a case by Leuret where life was prolonged above fifteen minutes,[^[1924]]—that the odour may be distinct in the blood, brain, or chest, when hardly any is to be perceived in the stomach. Schubarth has inquired with some care into the circumstances under which the hydrocyanic odour may, or may not, be expected. He states, as the result of his researches, that if the dose is sufficient to cause death within ten minutes, the peculiar odour will always be remarked in the blood of the heart, lungs, and great vessels, provided the body have not been exposed to rain or to a current of air, and the examination be made within a moderate interval,—for example, twenty-one hours for so small an animal as a dog; but that, if the dose is so small that life is prolonged for fifteen, twenty-seven, or thirty-two minutes, then even immediately after death it may be impossible to remark any of the peculiar odour, evidently because, as already mentioned, the acid is rapidly discharged by the lungs; and that even when the dose is large enough to cause death in four minutes, the smell may not be perceived if the carcase has been left in a spacious apartment for two days, or exposed to a shower for a few hours only. These facts explain satisfactorily why no odour could be perceived in the bodies of the Parisian epileptics; for they lived from half an hour to forty-five minutes. The poison may exist in the stomach, though not appreciable by the sense of smell. In Chevallier’s case mentioned above, the contents of the stomach had not any odour of hydrocyanic acid; which, however, was evident to the sense of smell, and plainly indicated by various tests, in the fluid obtained by distilling the contents.

The presence of this odour in the blood may be accounted strong evidence of poisoning with hydrocyanic acid, if it is unequivocal to the sense of several individuals. An exhalation of the same kind is occasionally formed by natural processes in the excrement. Itard once remarked in a case of inflammation of the intestines, and again in a case of inflamed liver, a strong smell of bitter almonds in the fæces, although no medicine containing hydrocyanic acid had been given.[^[1925]] Mr. Taylor mentions that he once observed a sort of hydrocyanic odour in the brain of a person who died of natural disease.[^[1926]] These facts will render the inspector cautious, but can scarcely throw a doubt over evidence derived from an unequivocal hydrocyanic odour in the blood.

Few successful attempts have yet been made to detect the acid in the blood by chemical analysis. The odour may be present, although chemical analysis fails in eliciting any indication. This follows from the observations of Dr. Lonsdale,[^[1927]] as well as of various authors quoted by him in his paper. The cyanide of potassium has been detected by Mayer not merely in the blood, but likewise in the serous secretions and sundry soft solids.[^[1928]]

In most instances,—for example, in the Parisian epileptics, the state of the brain, as to turgescence of vessels, has corresponded with the description given by Hufeland. Venous turgescence and emptiness of the arterial system are commonly remarked throughout the whole body. Thus in the epileptic patients, the heart and great arteries were empty; the great veins gorged; the spleen gorged, soft, and pultaceous; the veins of the liver gorged; and the kidneys of a deep violet colour, much softened, and their veins gorged with black blood.

It is impossible that hydrocyanic acid could cause gangrene of the stomach, which is said to have been witnessed in Hufeland’s case. But there are often signs of irritation in that organ. The villous coat has been found red in animals; it was shrivelled, and its vessels were turgid with black blood in the instance of the apothecary mentioned in the fourteenth volume of Rust’s Journal; in Mertzdorff’s case it was red and checkered with bloody streaks; and in the case related by Dr. Gierl, where four ounces were swallowed, it was dark-red, as it were tanned or steeped in spirits, and easily separated from the subjacent contents. The contents of the stomach have in every instance had a strong hydrocyanic odour, except in the cases of the Parisian epileptics, and in those related by Leuret and by Chevallier. According to the experiments of Lassaigne and Schubarth, formerly noticed, it is not to be looked for when the body has been kept a few days, more especially if the individual lived some time. Dr. Lonsdale generally found it eight or nine days after death in animals, which had been either buried during that time, or kept in an apartment at the temperature of 50° F.[^[1929]] In a case which occurred not long ago in London the poison was found in the stomach five days after death. A coroner’s inquest had terminated in a verdict of natural death. But suspicions having arisen, that the man had poisoned himself in anticipation of a charge of forgery, another inquiry was made; when the odour of hydrocyanic acid was evolved from the contents of the stomach, and the distilled water obtained from them yielded decisive chemical evidence of its being present.[^[1930]] It is important to observe, in reference to the evidence of hydrocyanic acid in the stomach, that here, as in the instance of the blood, the odour may be strong, and yet the poison may not be discoverable by analysis. This fact rests on the united testimony of Coullon, Vauquelin, Leuret, Turner, and Dr. Lonsdale; the last of whom mentions that he could not detect it chemically after the fourth day in the bodies of some animals, in which it was perceptible by its odour even four or five days later.[^[1931]] It is possible, however, that these failures to detect the poison by analysis may have sometimes arisen from imperfections in the method of analysis employed; for it was detected by the process formerly mentioned in the stomach of the apothecary last alluded to, in Chevallier’s case, though not perceptible to the smell, and frequently by Lassaigne in animals.

Mertzdorff remarked both in his case of poisoning with hydrocyanic acid, and likewise in a parallel instance of poisoning with the essential oil of bitter almonds,[^[1932]] a singular appearance in the bile, the colour of which was altered to deep blue.

Coullon and Emmert say they have observed, that the bodies of animals resist putrefaction. The latter in particular mentions, that he had left them several days in a warm room without perceiving any sign of decay. This certainly would not à priori be expected, considering the state of the blood. And it is not universal; for in one instance, the case of Mertzdorff, putrefaction commenced within thirty hours after death. In the Parisian epileptics, the bodies passed through the usual stage of rigidity.

It appears that even long after death the eye, as in Hufeland’s case, has a peculiar glistening and staring expression, so as to render it difficult to believe that the individual is really dead; and this appearance has been considered by Dr. Paris so remarkable, as even alone to supply “decisive evidence of poisoning by hydrocyanic acid.”[^[1933]] But the accuracy of this opinion may be questioned. The appearance is indeed very general in cases of poisoning with preparations containing hydrocyanic acid. Besides occurring in the case of Hufeland, and in that which gave occasion to Dr. Paris’s statement, it was witnessed by Mertzdorff, and in the instance described in Horn’s Journal. But it is not a constant appearance; for it was not observed in the seven Parisian epileptics. Neither is it peculiar; for death from carbonic acid has the same effect; I have remarked it six hours after death in a woman who died of cholera; and it has been observed in cases of death during the epileptic paroxysm.

Section IV.—Of the Treatment of Poisoning with Hydrocyanic Acid.

Much attention has been lately paid to the treatment of this variety of poisoning; and the object of those who have studied it has naturally been the discovery of an antidote.

An antidote to hydrocyanic acid must either be a substance which renders it immediately insoluble, or one which exerts upon the body an action contrary to that excited by the poison, that is, a powerful stimulant action on the nervous system. Hence all such remedies as oil, milk, soap, coffee, treacle, turpentine, at one time thought serviceable, are quite inert.[^[1934]]

Antidotes have hitherto been chiefly sought for among the powerful, diffusible stimulants. And it is plain, that even although a chemical antidote were known, a stimulant antidote is indispensable also, because the mischief done, before the poison can be rendered inert, is generally sufficient to cause death, unless counteracted by treatment.

Of the diffusible stimulants, ammonia is considered by many the most energetic antidote. The first who made careful experiments with it was Mr. John Murray of London; and he was so convinced of its efficacy, that he expressed himself ready to swallow a dose of the acid large enough to prove fatal, provided a skilful person were beside him to administer the antidote.[^[1935]] The favourable results obtained by Murray were afterwards confirmed by M. Dupuy.[^[1936]] Afterwards, however, the efficacy of ammonia was called in question. Orfila stated in the third edition of his Toxicology that he had several times satisfied himself of the complete inutility of this as well as many other antidotes.[^[1937]] And Dr. Herbst of Göttingen made some careful experiments, from which he concludes that ammonia, though useful when the dose of poison is not large enough to kill, and even capable of making an animal that has taken a fatal dose jump up and run about for a little, yet will never save its life.[^[1938]] But farther experiments by Orfila have led him to modify his former statement, and to admit, that, although liquid ammonia is of no use when introduced into the stomach, yet if the vapour from it is inhaled, life may sometimes be preserved, provided the dose of the poison be not large enough to act with great rapidity. He remarked, that when from eight to fourteen drops of the medicinal acid were given to dogs of various sizes, they died in the course of fifteen minutes if left without assistance, but were sometimes saved by being made to inhale ammoniacal water, and recovered completely in little more than an hour.[^[1939]] As this is very nearly the conclusion to which Mr. Murray was led by his experiments performed in 1822, it is rather extraordinary, that his name, as the undoubted discoverer of the remedy, has never been mentioned by the Parisian Professor. Buchner, it is right to add, had found this remedy useful in the same year in which Mr. Murray’s experiments were made.[^[1940]] A gentleman who took an over-dose of two drachms of hydrocyanic acid while using it medicinally, and who seems to have been in great danger, owed his recovery to the assiduous use of carbonate of ammonia held to the nostrils, and spirit of ammonia internally. Relief was obtained immediately.[^[1941]] Orfila suggests an important caution,—not to use a strong ammoniacal liquor, otherwise the mouth, air-passages, and even the alimentary canal may be attacked with inflammation,—as indeed happened to the French physician whose case was formerly mentioned. The strong aqua ammoniæ should be diluted with several parts of water.

Another remedy of the same kind with ammonia as to action is chlorine. This substance was first proposed as a remedy in 1822 by Riauz, a chemist of Ulm, who found that, when a pigeon, poisoned with hydrocyanic acid, was on the point of expiring, it immediately began to revive, on being made to breathe chlorine, and in fifteen minutes was able to fly away.[^[1942]] Buchner repeated Riauz’s experiments and arrived at the same results. More lately M. Simeon, apothecary to the hospital of St. Louis at Paris, apparently without being acquainted with the observations of the German chemists, was likewise led to suppose, that this gas might prove a useful antidote;[^[1943]] and MM. Cottereau and Vallette have formed the same conclusion.[^[1944]] Orfila in his paper already quoted expresses his conviction, that this remedy is the most powerful antidote of all hitherto proposed. His experiments have convinced him, that animals, which have taken a dose of poison sufficient to kill them in fifteen or eighteen minutes, will be saved by inspiring water impregnated with a fourth part of its volume of chlorine, even although the application of the remedy be delayed till the poison has operated for four or five minutes. In some of his experiments he waited till the convulsive stage of the poisoning was passed, and the stage of flaccidity and insensibility had supervened; yet the animals were obviously out of danger ten minutes after the chlorine was first applied, and recovered entirely in three-quarters of an hour.[^[1945]]

The last remedy of this nature which deserves notice is the cold affusion. This was first recommended by Dr. Herbst of Göttingen, who, on account of the success he witnessed from it in animals, considers it the best remedy yet proposed. When the dose of the poison was insufficient to prove fatal in ordinary circumstances, two affusions he found commonly sufficient to dispel every unpleasant symptom. When the dose was larger, it was necessary to repeat the effusion more frequently. Its efficacy was always most certain when resorted to before the convulsive stage of the poisoning was over; yet even in the stage of insensibility and paralysis it was sometimes employed with success. In the latter instance the first sign of amendment was renewal of the spasms of the muscles. Many experiments are related by the author in support of these statements. But the most decisive is the following. Two poodles of the same size being selected, hydrocyanic acid was given to one of them in repeated small doses till it died. The whole quantity administered being seven grains of Ittner’s acid, this dose was given at once to the other dog. Immediately it fell down in convulsions, violent opisthotonos ensued, and in half a minute the convulsive stage was followed by flaccidity, imperceptible respiration, and failing pulse. The cold affusion was immediately resorted to, but at first without any amendment. After the second affusion, however, the opisthotonos returned, and was accompanied by cries; and on the remedy being repeated every fifteen minutes, the breathing gradually became easier and easier, the spasms abated, and in a few hours the animal was quite well.[^[1946]] Professor Orfila repeated Dr. Herbst’s experiments, with analogous results; but he considers the cold affusion inferior to chlorine.[^[1947]]—It is probably advantageous to apply the cold water rather in the form of cold douche to the head and spine than to the body at large. Dr. Robinson of Sunderland found that rabbits, which had taken doses adequate to occasion death, might be saved by pouring on the hindhead and along the spine cold water impregnated with common salt and nitre.[^[1948]] A case, which seems to have been cured in this way, has been published by Mr. Banks of Lowth. A young woman took by mistake a solution containing very nearly a grain of real acid, and immediately became insensible and convulsed. Ordinary stimulants were of no use. But in fifteen minutes, when the convulsions had ceased, and she lay in a state of complete coma and general paralysis, the cold douche on the head first renewed the convulsions, then strengthened the pulse and restored some appearance of consciousness, and finally roused her, so that in a few hours she was quite well.[^[1949]]

It is probable, that bleeding from the jugular vein deserves more attention as a remedy than it has yet received. The right side of the heart is almost invariably found much gorged with blood in animals examined at the moment of death; and the contractions of the heart, in such circumstances imperfect or arrested altogether, have often been observed by experimentalists to be instantly restored on promptly removing the state of turgescence. Accordingly Dr. Cormack found that a dog, at the point of death after receiving a fatal dose of the acid, was speedily roused and eventually saved by bleeding from the jugular vein.[^[1950]] And in a careful inquiry by Dr. Lonsdale, it was ascertained that the turgescence of the heart might be effectually diminished in this way, and that recovery might frequently be accomplished when the poison was otherwise amply sufficient to have occasioned speedy death.[^[1951]] In a case treated by Magendie, that of a young lady poisoned by too large a medicinal dose, the chief remedies were ammonia and blood-letting from the jugular vein; and she recovered.[^[1952]]

Few observations have hitherto been made on the chemical antidotes for hydrocyanic acid, or those substances which render it innoxious by converting it into an insoluble compound. It is plain that several probable antidotes of this kind exist. But toxicologists have been apparently deterred from trying them by the fearful rapidity with which the poison acts, and the consequent improbability that in practice any such antidote can be administered in time. It has lately been shown, however, by Messrs. T. and H. Smith of this city, that the effects of a fatal dose may be warded off by the timely administration of the reagents necessary for converting the acid into Prussian blue. They found that if a solution of carbonate of potash followed by a solution of the mixed sulphates of iron be given to animals very soon after the administration of a dose of thirty drops of the Edinburgh medicinal acid, containing three per cent. of real acid, recovery in general takes place, and sometimes little inconvenience seems to be sustained. The solutions they used were one of 144 grains of carbonate of potash in two ounces of water, and another composed of a drachm and a half of sulphate of protoxide of iron, together with two drachms of the same salt converted into sulphate of sesquioxide by means of sulphuric and nitric acids in the usual way. About 52 minims of each of these solutions will remove the whole acid contained in 100 grains of the Edinburgh medicinal acid; but for certainty, three or four times as much should be used,—which may be done with perfect safety.[^[1953]]

On the whole, then, it appears that the proper treatment of a case of poisoning with hydrocyanic acid consists in the cold affusion applied to the head and spine, the inhalation of diluted ammonia or chlorine, venesection at the jugular vein, and the administration of carbonate of potash and the mixed sulphates of iron, if aid has been obtained in good time.

It is right to remember, however, that on account of the dreadful rapidity of this variety of poisoning, it will rarely be in the physician’s power to resort to any treatment soon enough for success;—and farther, that his chance of success must generally be feeble even though the case be taken in time, because when hydrocyanic acid is swallowed by man, the dose is commonly so large as not to be counteracted by any remedies.

On the Vegetable Substances which contain Hydrocyanic Acid.

Hydrocyanic acid exists in several plants; which are consequently poisonous. I have considered it advisable to describe their effects separately from those of the pure acid.

The plants which have been thoroughly examined and found to yield it belong chiefly to the division Drupaceæ, of Decandolle’s Natural Family the Rosaceæ. These are the bitter almond, cherry-laurel, bird-cherry, and peach. The leaves and seeds of the nectarine and apricot, and the seeds of the plum and cherry, have the same taste with these four, and therefore will certainly be found to contain the acid also. The same inference may be drawn from the taste of some pomaceous seeds; and accordingly I have obtained a hydrocyanated oil from the seeds of the New York pippin, and those of the white-beam-tree, the Pyrus aria. The poison procured from these sources exists in two forms,—as a distilled water, and as an essential oil. Further, the acid has been discovered to constitute the active poison of the juice of the Janipha manihot, or bitter cassava [see p. [457]].

The distilled waters yield hydrocyanic acid, as is shown by the blue precipitate they give with potass and the mixed sulphates of iron. They have a powerful, peculiar, grateful odour, which is usually likened to that of pure hydrocyanic acid. But the smell really bears very little resemblance to that of hydrocyanic acid, and is not owing to its presence: the odour remains equally strong after the acid is thrown down by the test now mentioned. The active part of the distilled water may be separated in the form of a volatile oil. This is colourless at first, afterwards yellowish or reddish, acrid, bitter, heavier than water, and very volatile. The essential oil of the bitter almond has been carefully examined by various chemists. Vogel, by subjecting it twice to distillation from caustic potass, procured hydrocyanate of potass in the residue; and a volatile oil was distilled over, which no longer contained hydrocyanic acid, but nevertheless had the odour of the original oil.[^[1954]] This purified oil he considered equally poisonous with that which contains hydrocyanic acid, a single drop of it having killed a sparrow; and his opinion was confirmed by the experiments of Professor Orfila. But according to some careful experiments by Stange,[^[1955]] which have been amply confirmed by Dr. Göppert of Breslau,[^[1956]] and also by MM. Robiquet and Boutron-Charlard,[^[1957]]—if the purified oil retains active poisonous properties, this must be owing to the acid not having been entirely removed. Göppert in particular remarked that twenty-five drops of the purified bitter-almond oil, cherry-laurel oil, or bird-cherry oil had very little effect on rabbits, not more indeed than the same quantity of the common essential oils. The purified oil, according to all these chemists, possesses the odour of the original oil, as Vogel first stated.

Of the Bitter Almond.

The bitter almond was once extensively used in medicine, and is still much employed by confectioners for flavouring puddings, sweetmeats, and liqueurs. It is the kernel of the fruit of the Amygdalus communis. This species has two varieties, the dulcis and the amara; which differ from one another in the fruit only. The fruit of the former yields the sweet, and of the latter the bitter almond. The bitter almond is the smaller of the two. The two plants, according to Murray, are convertible into each other,—the sweet variety becoming bitter by neglect,—the bitter becoming sweet by cultivation, or certain modes of management not well known,—and the seed of either variety producing plants of both.[^[1958]] These statements as to the mutual convertibility of the two varieties require confirmation.

The bitter almond depends for its activity on the essential oil, which is common to all the vegetable poisons belonging to the present tribe. According to the researches of Robiquet and Boutron-Charlard, followed up by Liebig, the oil does not, like common essential oils, exist ready formed in the almond, but is only produced when the almond-pulp comes in contact with water. It cannot be separated by any process whatever from the almond without the co-operation of water,—neither, for example, by pressing out the fixed oil, nor by the action of ether, nor by the action of absolute alcohol. After the almond is exhausted by ether, the remaining pulp gives the essential oil as soon as it is moistened; but if it is also exhausted by alcohol, the essential oil is entirely lost. The reason is that alcohol dissolves out a peculiar crystalline principle, named amygdalin, which, with the co-operation of water, forms the essential oil by reacting on a variety of the albuminous principle in the almond, called emulsion or synoptase.

In some respects, therefore, the essential oil of almonds is quite peculiar in its nature, and quite different from the common essential or volatile oils.—The presence of hydrocyanic acid in it is easily proved by dissolving it with agitation in water, and treating the solution with caustic potass, followed by the mixed sulphates of iron and sulphuric acid.—The quantity of essential oil which may be procured from the bitter almond amounts, according to Krüger of Rostock, to four drachms from five pounds or a ninety-sixth part.[^[1959]] The quantity of hydrocyanic acid in the oil varies considerably: Schrader got from an old sample 8·5 per cent., from a new sample 10·75;[^[1960]] but Göppert got from another specimen so much as 14·33 per cent.[^[1961]]

Effects on Animals.—The bitter almond is a powerful poison, which acts in the same way as hydrocyanic acid, but likewise excites at times vomiting and other signs of irritation. The first good experiments on it are those related in Wepfer’s treatise on the Cicuta; but its properties seem to have been known even to Dioscorides. The symptoms it induces in animals are trembling, weakness, palsy, convulsions, often of the tetanic kind, and finally coma. But frequently it occasions vomiting before these symptoms begin, and the animal in that way may escape.[^[1962]] According to Orfila, twenty almonds will kill a dog in six hours by the stomach if the gullet be tied; and six will kill it in four days when applied to a wound.[^[1963]]

The essential oil is not much inferior in activity to the pure hydrocyanic acid. A single drop of it applied by Sir B. Brodie on the tongue of a cat caused violent convulsions and death in five minutes.[^[1964]] But more generally a larger dose, or about seven drops, has been found necessary to kill a middle-sized dog. Five drops, according to Göppert, will kill a rabbit in six minutes. When entirely freed of hydrocyanic acid, it becomes, as already mentioned, not more poisonous than common volatile oils.

Symptoms in Man.—The effects of the almond and of the oil upon man are equally striking with those of hydrocyanic acid.

In small doses the bitter almond produces disorder of the digestive organs, nausea, vomiting, and sometimes diarrhœa. These symptoms are occasionally brought on by the small quantities used for flavouring sweetmeats, if the confectioner has not been careful in compounding them. Virey says that accidents occasionally happen to children at Paris from their eating freely of macaroons, which are sometimes too strongly flavoured with the bitter almond.[^[1965]] In this country accidents from the same cause may be with justice apprehended, as confectioners now generally use, not the bitter almond, but its essential oil, which is distilled for the purpose in London, and sold in the druggists shops under the name of peach-nut oil. Göppert suggests that this oil ought to be freed of its hydrocyanic acid by repeated distillation with caustic potassa, because the flavour is not in the least injured by the process, while its activity as a poison is greatly lessened.

In peculiar constitutions the minutest quantity, even a single almond, will cause a state resembling intoxication, succeeded by an eruption like nettle-rash. The late Dr. Gregory was subject to be affected in this way. Other vegetable bitters had the same effect on him, but none so remarkably as bitter almonds. They caused first sickness, generally tremors, then vomiting, next a hot fit with an eruption of urticaria, particularly on the upper part of the body. At the same time the face, and head swelled very much, and there was generally a feeling like intoxication. The symptoms lasted only for a few hours. The rash did not alternately appear and disappear as in common nettle-rash.[^[1966]] A lady of my acquaintance is liable to be attacked with urticaria even from eating the sweet almond.

The quantity of bitter almonds which may be eaten with impunity is unknown; but Wibmer mentions an experimentalist who took half an ounce without any other effect besides headache and sickness.[^[1967]] Two cases of death in the human subject from eating them have been quoted by Coullon from the Journal de Médecine of Montpellier. One is a doubtful case, but the other is unequivocal. A bath-woman gave her child the “expressed juice” of a handful of bitter almonds to cure worms. The child, who was four years old, was immediately attacked with colic, swelling of the belly, giddiness, locked jaw, frothing at the mouth, general convulsions, and insensibility, and died in two hours.[^[1968]] Murray, however, asserts in his Apparatus Medicaminum that the expressed juice is sweet and not poisonous.[^[1969]] But this apparent contradiction is easily explained by referring to the chemical relations of the almond,—the oil expressed without water being free from essential oil, while the milky fluid expressed from the pulp beat up with water is strongly impregnated with it.—Another case was published not long ago by Mr. Kennedy of London; but the symptoms were imperfectly ascertained. The person, a stout labourer, appeared to have eaten a great quantity of bitter almonds, which were subsequently found in the stomach. He was seen to drop down while standing near a wall; soon after which the surgeon who was sent for found him quite insensible, with the pulse imperceptible, and the breath exhaling the odour of bitter almonds; and death took place in no long time.[^[1970]]

Coullon has noticed many other instances where alarming symptoms were produced by this poison, but were dissipated by the supervention of spontaneous vomiting.

The effects of small doses of the oil have been tried by Sir B. Brodie on himself; and a fatal case of poisoning with it has been recorded by Mertzdorff. In the course of his experiments Sir B. Brodie once happened to touch his tongue with the end of a glass rod which happened to be dipped in the oil; and he says he had scarcely done so before he felt an uneasy, indescribable feeling in the pit of the stomach, great feebleness of his limbs, and loss of power to direct the muscles, so that he could hardly keep himself from falling. These sensations were quite momentary.[^[1971]]

Mertzdorff’s case is interesting, not only as being accurately related, but likewise on account of the exact resemblance of the symptoms to those observed in the celebrated case of Sir Theodosius Boughton, which will presently be mentioned. A hypochondriacal gentleman, 48 years old, swallowed two drachms of the essential oil. A few minutes afterwards, his servant, whom he sent for, found him lying in bed, with his features spasmodically contracted, his eyes fixed, staring, and turned upwards, and his chest heaving convulsively and hurriedly. A physician, who entered the room twenty minutes after the draught had been taken, found him quite insensible, the pupils immoveable, the breathing stertorous and slow, the pulse feeble and only 30 in a minute, and the breath strongly impregnated with the odour of bitter almonds, death ensued ten minutes afterwards.[^[1972]] A fatal case occurred lately in London, where the individual, intending to compound a nostrum for worms with beech-nut oil, got by mistake from the druggist peach-nut oil, which is nothing else than the oil of bitter almond.—A singular case of recovery from a very large dose of this poison has been lately published by M. Chevasse. A shopkeeper, who swallowed half an ounce by mistake for spirit of nitric ether, had an attack of spontaneous vomiting, which was forthwith encouraged by sulphate of zinc. He nevertheless became pale and convulsed; the pulse disappeared; and delirious muttering ensued, with risus sardonicus, sparkling of the eyes, and panting respiration. Recovery, however, took place under the use of brandy and ammonia.[^[1973]]

The morbid appearances are the same as in poisoning with the pure acid. In Mertzdorff’s case the whole blood and body emitted a smell of almonds; putrefaction had begun, though the inspection was made twenty-nine hours after death; the blood throughout was fluid, and flowed from the nostrils and mouth; the veins were every where turgid; the cerebral vessels gorged; the stomach and intestines very red.—In the case from the Medical and Physical Journal of poisoning with the almond itself, the vessels of the brain were much gorged, and the eyes glistening and staring as if the person had been alive.

Of the Cherry-Laurel.

The cherry-laurel, or Cerasus lauro-cerasus, was at one time much used for flavouring liqueurs and sweetmeats. But it is now less employed than formerly, as fatal accidents have happened from its having been used in too large quantity. The custom, however, has not been altogether abandoned; for there is an account in an English newspaper in 1823 of two persons killed by ratifia’d brandy, which had been flavoured with this plant; and Dr. Paris has mentioned an instance of several children at an English boarding-school having been dangerously affected by a custard flavoured with the leaves.[^[1974]] Almost every part of the plant is poisonous, especially the leaves and kernels; but the pulp of the cherry is not. The flower has a totally different odour from the leaves. The healthy vigorous shoots in the early part of summer, and the inner bark, both then and in autumn, smell strongly of the bitter almond when broken across. The kernels of the seeds have a strong taste of bitter almonds.—The plant yields a distilled water and an essential oil, which Robiquet found to have all the chemical properties of the oil of bitter almond.[^[1975]]—A very peculiar source of danger in using the leaves of this plant, for imparting a ratafia flavour to sweetmeats and liqueurs, is that the proportion of oil varies excessively according to the age of the leaf. It abounds most in the young undeveloped leaves, and diminishes gradually afterwards. Hence, the leaves being evergreen and outliving more than two summers, the young leaves in May or June contain, as I have found, nearly ten times as much oil as the old ones at the same moment.

Cherry-laurel oil, according to Schrader, contains 7·66 per cent. of hydrocyanic acid;[^[1976]] but according to Göppert, a specimen supposed to be genuine gave only 2·75 per cent.[^[1977]] It is probably therefore a weaker poison than the oil of bitter almond. The latest experiments made with this oil are those of some Florentine physicians, performed at the laboratory of the Marquess Rodolphi, and described by Professor Taddei.[^[1978]] Sixteen drops put on the tongue of rabbits killed them in nine, fifteen, or twenty minutes; and ten or twelve drops injected in oil into the anus killed them in four minutes. The symptoms were slow breathing, palsy of the hind-legs, then general convulsions; and death was preceded by complete coma. A very extraordinary appearance was found in the dead body,—blood extravasated abundantly in the trachea and lungs.

The cherry-laurel water, prepared by distillation from the leaves of this plant, was long the most important of the poisons which contain the hydrocyanic acid, as it was the most common before the introduction of the acid itself into medical practice. Water dissolves by agitation 3·25 grains of oil per ounce; which may be considered the proportion in a saturated distilled water. The water contains, according to Schubarth, only 0·25 per cent. of hydrocyanic acid;[^[1979]] according to Schrader[^[1980]] only half as much; and by long keeping even that small proportion will gradually disappear, as I have ascertained by experiment. Hence its strength must vary greatly,—a fact which will explain the very different effects of the same dose in different instances.

From experiments on animals by a great number of observers, it appears that, whether it is introduced into the stomach, or into the anus, or into the cellular tissue, or directly into a vein, it occasions giddiness, palsy, insensibility, convulsions, coma, and speedy death;—that the tetanic state brought on by the pure acid, is not always so distinctly caused by cherry-laurel water;—and that tetanus is most frequently induced by medium doses.

The attention of physicians was first called to this poison by an account, published by Dr. Madden in the Philosophical Transactions for 1737, of several accidents which occurred at Dublin in consequence of strong ratifia’d brandy having been prepared with it. Foderé has also given an account of two cases, caused by servants having stolen and drunk a bottle of it, which they mistook for a cordial.[^[1981]] Being afraid of detection, they swallowed it quickly, and in a few minutes expired in convulsions. Murray has noticed several others in his Apparatus Medicaminum.[^[1982]] In most of these cases the individuals suddenly lost their speech, fell down insensible, and died in a few minutes. Convulsions do not appear to have been frequent. Coullon has also related an instance where a child seems to have been killed by the leaves applied to a large sore on the neck.[^[1983]]

The dose required to occasion these effects, and more especially to prove fatal, has not been determined with care. It must vary with the age of the sample used. It will vary also according as the water has been filtered or not; for what is not filtered often presents undissolved oil suspended in it or floating on its surface. One ounce has proved fatal;[^[1984]] and half an ounce has caused only temporary giddiness, loss of power over the limbs, stupor, and sense of pressure in the stomach.[^[1985]]

The appearances found in the dead body have varied. In general the blood has been fluid. The smell of bitter almond has commonly been distinct in the stomach.

The cherry-laurel water has attracted much attention in this country, in consequence of being the poison used by Captain Donnellan for the murder of Sir Theodosius Boughton. The trial of Donnellan, the most important trial for poisoning which ever took place in Britain, has given rise to some discrepance of opinion both among barristers and medical men, as to the sufficiency of the evidence by which the prisoner was condemned.[^[1986]] For my part, taking into account the general, as well as medical circumstances of the case, I do not entertain a doubt of his guilt.

Leaving the general evidence out of view, however, as foreign to the objects of the medical jurist’s regard, it must be admitted that the medical evidence, taken by itself, was defective. It may be summed up shortly in the following terms:—Sir Theodosius was a young man of the age of twenty, and in perfect health, except that he had a slight venereal complaint of old standing, for which he occasionally took a laxative draught. On the morning of his death, his mother, Lady Boughton, remarked, while giving him his draught, that it had a strong smell of bitter almonds. Two minutes after he took it, she observed a rattling or gurgling in his stomach; in ten minutes more he seemed inclined to doze; and five minutes afterwards she found him quite insensible, with the eyes fixed upwards, the teeth locked, froth running out of his mouth, and a great heaving at his stomach and gurgling in his throat. He died within half an hour after swallowing the draught. The body was examined ten days after death, and the inspectors found great congestion of the veins every where, gorging of the lungs, and redness of the stomach. But the examination was unskilfully conducted. For the head was not opened; the fæces were allowed to rush from the intestines into the stomach; and, as a great quantity of fluid blood was found in each cavity of the chest, the subclavian veins must have been divided during the separation of the clavicles. Very little reliance, therefore, can be placed in the evidence from the inspection of the body.[^[1987]]

On comparing these particulars with what has been said above regarding the effects of hydrocyanic acid and this whole genus of poisons, it will be seen that every circumstance coincides precisely with the supposition of poisoning with the cherry-laurel water. The symptoms were exactly the same as in Mertzdoff’s case of poisoning with the essential oil of almonds (p. [604]). When to this are added, the smell of the draught, which Lady Boughton could hardly mistake, the rarity of apoplexy in so young and healthy a person as Sir Theodosius, and the improbability of either that or any other disease of the head proving fatal so quickly,—the conclusion at which, in my opinion, every sound medical jurist must arrive is, that poisoning in the way supposed was very probable. But I cannot go along with those who think that it was certain; nor is it possible to see on what grounds such an opinion can be founded, when the general or moral circumstances are excluded.

The medical evidence in Donnellan’s case has been much canvassed, and especially that of Mr. John Hunter. It would be foreign to the plan hitherto pursued in this work to analyze and review what was said by him and his brethren. But I must frankly observe, that Mr. Hunter’s evidence does him very little credit, and that his high professional eminence is the reverse of a reason for palliating his errors, or treating them with the lenity which they have experienced from his numerous critics.

Of the Peach, Cluster-Cherry, Mountain-Ash, &c.

Little need be said of the other plants formerly mentioned among those which yield hydrocyanic acid, and act on the system in consequence of containing that substance.

The Amygdalus persica or peach is the most active of them. Most parts of the plant exhale the odour of the bitter-almond, but particularly the flowers and kernels. According to the chemical researches of M. Gauthier, the fresh young shoots of the peach collected in July contain, weight for weight, even more essential oil than the bitter almond, or cherry-laurel leaves; for 250 grains yielded nearly five grains of it or two per cent.; and he found the oil may be easily procured by distilling the shoots without addition till the product begins to pass over clear.[^[1988]] The kernels of the peach, when distilled with water, yield nearly one grain of hydrocyanic acid per ounce.[^[1989]]

Coullon has collected two instances of poisoning with the peach-blossom. One is the case of an elderly gentleman, who swallowed a sallad of the flower to purge himself. Soon afterwards he was seized with giddiness, violent purging, convulsions, and stupor; and he died in three days. Here the poison must have proved fatal by inducing true apoplexy in a predisposed habit; at least poisoning with hydrocyanic acid never lasts nearly so long. The other, a child eighteen months old, after taking a decoction of the flowers to destroy worms, perished with frightful convulsions, efforts to vomit, and bloody diarrhœa.[^[1990]] The peach-blossom would therefore appear to be rather a narcotico-acrid, than a narcotic.—Peach-leaves are represented to have produced even purely irritant effects. A man, who took a decoction of a handful boiled in a quart of water down to a third,—when of course no hydrocyanic acid could remain,—was attacked with tightness in the chest, a sense of suffocation, violent colic, pain in the stomach and frequent desire to vomit, followed by a hard pulse, restlessness, and flushing of the face. But he recovered slowly under the use of fomentations and opiates.[^[1991]]

The bark of the Prunus padus, or cluster-cherry, a native of this country, owes its poisonous qualities to the same substance as the preceding plants. Heumann found that the distilled water obtained from two ounces of bark in March contains two grains of acid, two ounces of developed leaves half a grain, and two ounces of the seed a trifle less.[^[1992]] Its distilled water has the odour of bitter almonds, contains the same essential oil with that of the bitter almond, and yields more hydrocyanic acid than the cherry-laurel water.[^[1993]] The oil, according to Schrader, contains 9·25[^[1994]] per cent. of hydrocyanic acid, according to Göppert only 5·5 per cent.[^[1995]] Bremer, who has examined this plant with great care, found that both the distilled water and the essential oil kill mice when put into the mouth, eye, nose, ear, anus, or a wound; and that half an ounce of the water killed a dog in twelve minutes.[^[1996]] The fruit is also poisonous. It has a nauseous taste, but communicates a pleasant flavour to spirituous liquors. The kernels yield by expression a transparent, fixed oil, concrete at 41° F., which contains a small quantity of the essential oil; and the cake which is left yields so much of the latter, that, as we are informed by M. Chancel of Briançon, a handful has proved fatal to cows in a short time.[^[1997]] In these kernels, as in the bitter almond, the essential oil does not exist ready formed, but is developed only in consequence of the contact of water; and hence, if the fixed oil by expression contains a little of it, as Chancel says, this must arise from the kernels having been moist when squeezed.

The Sorbus aucuparia, mountain-ash, or Rowan-tree as it is called in Scotland, has been lately added to the list of plants which abound in the same poisonous principle. M. Grassmann of St Petersburgh has found that many parts of this tree, such as the flowers and the bark of the trunk and branches, contain more or less of the peculiar essential oil; and that the root in particular contains so much in the month of May as to smell strongly of it when broken across, and to yield a distilled water which holds fully as much hydrocyanic acid as that procured from an equal weight of cherry-laurel leaves.[^[1998]]

Several other plants of the same natural order possess similar though weaker properties, such as the Prunus avium, or black-cherry, or mazzard, the Prunus insititia, or bullace, the Prunus spinosa, or sloe, the Amygdalus nana, or dwarf-almond, and even the leaves and kernels of the common cherry, the Cerasus communis. Twelve ounces of cherry kernels distilled with water, yield, according to Geiseler, seven grains of hydrocyanic acid.[^[1999]] I have no doubt, from my experiments, that the seeds of Pyrus malus, the apple, Pyrus aria, the white-beam, and also, if the taste may be taken for a criterion, the whole seeds of the Pomaceæ, yield by distillation with water a large quantity of hydrocyanic acid.

CHAPTER XXX.
OF POISONING WITH CARBAZOTIC ACID.

A substance long known to chemists by the name of indigo-bitter, which is procured by the action of nitric acid on indigo, silk, and other azotized substances, and which has been found to consist chiefly of a peculiar acid, termed by Liebig, from its composition, the carbazotic acid, appears to be a pure narcotic poison of considerable activity.[^[2000]] It is in the form of shining crystals, of an excessively bitter taste, and of a yellow colour so singularly intense that it imparts a perceptible tint to a million parts of water. The pure crystals are composed of carbon, azote, and oxygen.

The only account I have seen of the physiological properties of this substance is a full analysis by Buchner in his Toxicology, of some interesting experiments by Professor Rapp of Tübingen.[^[2001]] He found that sixteen grains in solution, when introduced into the stomach, killed a fox, ten grains a dog, and five grains a rabbit, in an hour and a half; that the injection of a watery solution into the windpipe occasioned death in a few minutes; that the introduction of it into the cavity of the pleura or peritonæum occasioned death in several hours; that a watery solution of ten grains injected into the jugular vein of a fox killed it instantaneously, and in like manner five grains affected a dog in three minutes and killed it in twenty-four hours; and that thirty grains applied to a wound killed a rabbit. The symptoms remarked from its introduction into the stomach of the fox were in half an hour tremors, grinding of the teeth, constant contortion of the eyes and convulsions, in an hour complete insensibility, and death in half an hour more. In the dog there was also remarked an attack of vomiting and feebleness of the pulse.

In the dead body no particular alteration of structure was remarked. The heart, examined immediately after death from the introduction of the poison into the stomach, was found much gorged and motionless; but the irritability of the voluntary muscles remained. The stomach was not inflamed, but dyed yellow. A very interesting appearance was dyeing of various textures and fluids throughout the body. In the fox killed by swallowing sixteen grains the conjunctiva of the eyes, the aqueous humour, the capsule of the lens, the membranes of the arteries, in a less degree those of the veins, the lungs, and in many places the cellular tissue, had acquired a lemon-yellow colour. The dog killed in the same manner presented similar appearances, also those killed by injection of the poison into the pleura or peritonæum; and in the latter animals the urine was tinged yellow. In a rabbit killed by the application of the poison to a wound the same discoloration was also every where remarked, together with yellowness of the fibrin of the blood. But no yellowness could be seen any where in the dog, which died in twenty-four hours after receiving five grains into the jugular vein. In no instance was there any yellow tint perceptible in the brain or spinal cord.

These facts form an interesting addition to the physiology of poisons. They supply unequivocal proof that this substance is absorbed in the course of its operation, and furnish strong presumption that other poisons, which act on organs remote from the place where they are applied, and which have been sought for without success in the blood, as well as in other fluids and solids throughout the body, have not been detected, merely because the physiologist does not possess such simple and extremely delicate means of searching for them.

The researches of Professor Rapp have been arranged under the title of carbazotic acid, because this acid forms the most prominent substance in the matter with which his experiments appear to have been made. But it is right to state, that the article actually used was, if I understand correctly the abstract given by Buchner, not the pure crystals, but the yellow fluid, from which the crystals are procured, and which contains also a resinous matter and artificial tannin.—The bitter principle of Welther produced by the action of nitric acid on silk, and that formed by Braconnot by the action of the same acid on aloes, appear to be impure carbazotic acid.

CHAPTER XXXI.
OF THE POISONOUS GASES.

The subject of the poisonous gases is one of great importance in relation to medical police, as well as medical jurisprudence. They are objects of interest to the medical jurist, because their effects may be mistaken for those of criminal violence, and because they have even been resorted to for committing suicide. They are interesting as a topic of medical police, since some trades expose the workmen to their influence.

It has hitherto been chiefly on the continent that use has been made of the deleterious gases for the purpose of self-destruction. Osiander mentions, that Lebrun, a famous player on the horn, suffocated himself at Paris in 1809 with the fumes of sulphur; and that an apothecary at Pyrmont killed himself by going into the Grotto del Cane there, which, like that near Naples, is filled with carbonic acid gas.[^[2002]] Many instances have lately occurred in France of suicide caused by the emanations from burning charcoal in a close chamber.

But these poisons come under the notice of the medical jurist chiefly because their effects may be mistaken for those of other kinds of violent death. Several mistakes of this nature are on record. Zacchias mentions the case of a man, who was found dead in prison under circumstances which led to the suspicion, that he had been privately strangled by the governor. But Zacchias proved this to be impossible, and ascribed death to the fumes from a choffer of burning charcoal left in the room.[^[2003]] A more striking instance of the kind occurred a few years ago at London. A woman, who inhabited a room with other five people, alarmed the neighbours one morning with the intelligence that all her fellow-lodgers were dead. On entering the room they found two men and two women actually dead, and another man quite insensible and apparently dying. This man, however, recovered; and as it was said that he was too intimate with the woman who gave the alarm, a report was spread that she had poisoned the rest, to get rid of the man’s wife, one of the sufferers. She was accordingly put in prison, various articles in the house were carefully analysed for poison, and an account of the supposed barbarous murder was hawked about the streets. At last the man who recovered remembered having put a choffer of coals between the two beds, which held the whole six people; and the chamber having no vent, they had thus been all suffocated.[^[2004]]—The following is a similar accident not less remarkable in its circumstances. Four people in Gerolzhofen in Bavaria, were found one morning in bed, some dead, others comatose; and only one recovered. A neighbour who had supped with them, but slept at home, did not suffer. The stomach and intestines were found very red and black; and the coats of the stomach brittle. The contents of the stomach, the remains of their supper, and the wine were analysed without any suspicious substance being found. A little smoke having been noticed in the room by those who first entered it, the stove and fuel were examined, but without furnishing any insight into the cause of the accident. At last the cellar was examined, and then it was found that one of the sufferers had heated a copper vessel there so incautiously, that the fire communicated with the unplastered planks of the floor above. The planks had burnt with a low smothered flame, and the vapours passed through the crevices in the floor.[^[2005]]

What Irrespirable Gases are Poisonous?

Some gases act negatively on the animal system by preventing the access of respirable air to the lungs; others are positively poisonous. The first point, therefore, is to ascertain which are negatively, and which positively hurtful.

M. Nysten, who has made the most connected train of experiments on this subject, conceived that a gas will not act through any other channel besides the lungs, if it exerts merely a negative action:—and that, on the contrary, it certainly possesses a direct and positive power, if it has nearly the same effects, in whatever way it is introduced into the body.[^[2006]] He therefore thought the best way to ascertain the action of the gases would be, to inject them into the blood,—conceiving that, after allowance is made for the mere mechanical effects of an aëriform body, the phenomena would point out the true operation of each.

His first object then was to learn what phenomena are caused by the mechanical action of atmospheric air. He found that four cubic inches and a half, injected into the jugular vein of a dog, killed it immediately amidst tetanic convulsions, by distending the heart with frothy blood;—that a larger quantity introduced, gradually caused more lingering death, with symptoms of oppressed breathing, which arose from gorging of the lungs with frothy blood;—and that a small quantity, injected into the carotid artery towards the brain, occasioned speedy death by apoplexy, which arose from the brain being deprived by means of the air of a due supply of its proper stimulus, the blood. Numerous experimental inquiries have been since made on this subject, the latest of which, those of Dr. Cormack, coincide with the first results of Nysten, that air injected into the veins causes death by arrestment of the action of the heart.[^[2007]]

Proceeding with these data, Nysten found that oxygen and azote had the same effect when apart, as when united in the form of atmospheric air; that carburetted hydrogen, hydrogen, carbonic oxide, and phosphuretted hydrogen likewise seemed to act in the same way; and that the nitrous oxide, or intoxicating gas, although it does not cause so much mechanical injury as the others, on account of its superior solubility in the blood, has the same effect when injected in sufficient quantity, and produces little or none of the symptoms of intoxication excited by it in man.[^[2008]] As to carbonic acid gas, he found that, on account of its great solubility in the blood, it is difficult to produce mechanical injury with it; that sixty-four cubic inches are absorbed, and do not excite any particular symptoms; but that when injected into the carotid artery, it occasions death by apoplexy, although it is rapidly absorbed by the blood.[^[2009]]

The other gases he tried were hydrosulphuric acid, nitric oxide, ammonia and chlorine; and all of these proved to be positively and highly deleterious.

Two or three cubic inches of hydrosulphuric acid gas caused tetanus and immediate death, when injected into the veins, although the gas was at once absorbed by the blood. The same quantity acted with almost equal rapidity when injected into the cavity of the chest. Similar results were obtained when it was injected into the cellular tissue, or even when it was left for some time in contact with the sound skin.[^[2010]] The last important fact has been since confirmed by Lebküchner in his Thesis on the permeability of the tissues;[^[2011]] and it had previously been observed also by the late Professor Chaussier, whose experiments will be mentioned presently (p. [617]). In none of Nysten’s experiments with this gas was the blood changed in appearance.

Nitric oxide gas, according to Nysten, is the most energetic of all the poisonous gases. A very small quantity causes death by tetanus, when introduced into a vein, the cavity of the chest, or the cellular tissue; and it always changes the state of the blood, giving it a chocolate-brown colour, and preventing its coagulation. In one of Nysten’s experiments a cubic inch and three-quarters injected into the chest killed a little dog in 45 minutes.[^[2012]] Dr. John Davy appears to have found this gas not so active.[^[2013]]

Nysten found the two other gases, ammonia and chlorine, to be acrid in their action. When injected into the veins they kill by over-stimulating the heart; and when injected into the cavity of the chest, they excite inflammation in the lining membrane.[^[2014]] Hébréart farther remarked in his experiments relative to the action of irritants on the windpipe, that chlorine when inspired, produces violent inflammation in the windpipe and its great branches, ending in the secretion of a pseudo-membrane like that of croup;[^[2015]] and that a very small quantity of ammonia has the same effect.

From this abstract of Nysten’s researches, it appears to follow, that ammonia and chlorine are irritants; hydrosulphuric acid and nitric oxide, narcotics; oxygen, azote, hydrogen, carburetted hydrogen, phosphuretted hydrogen, carbonic oxide, and nitrous oxide, negative poisons; and carbonic acid, doubtful in its nature. Some of these conclusions do not correspond with the effects observed in man; which will presently be found to lead to the inference, that not only carbonic acid, but likewise carbonic oxide, nitrous oxide, and carburetted hydrogen are narcotics. The reason Nysten did not find these gases injurious was probably, that, before they could pass from the vein into which they were injected, to the brain on which they act, they were in a great measure exhaled from the lungs. The experiments of physiologists since Nysten’s time likewise tend to show that oxygen gas is a positive poison when pure, and that even hydrogen possesses active properties. The inquiries of Mr. Broughton led him to consider hydrogen a positive poison, because animals die in it in half a minute, and the heart immediately after death is found to have lost its contractility. Previous experimentalists had also remarked hypnotic effects from the inhalation of it diluted with oxygen.[^[2016]] As to oxygen, the same physiologist ascertained that when pure, it is a narcotic poison, though a feeble one, as at least five hours of continuous respiration in the pure gas are required to prove fatal.[^[2017]]

Of the Effects of the Poisonous Gases on Man.

According to the effects of the poisonous gases on man, they may be arranged in two groups, the first including the irritants, the second the narcotics. It might have been therefore a more philosophical mode of arrangement, if the former had been considered under the irritant class of poisons; but it is more convenient to examine the whole deleterious gases together.

The irritant gases are nitric oxide gas and nitrous acid vapour, hydrochloric acid gas, chlorine, ammonia, sulphurous acid, and some others of little consequence.

Of Nitric oxide gas and Nitrous acid vapour.—Before nitric oxide gas can be breathed in ordinary circumstances, it is transformed by the oxygen of the air into nitrous acid vapour, of a ruddy colour and irritating odour. Hébréart found that in animals killed by inhaling it the windpipe was much inflamed.[^[2018]] Sir H. Davy tried to inhale it, and with this view took the precaution of previously breathing the nitrous oxide or intoxicating gas, in order to expel the atmospheric air as much as possible from his lungs. But he found that the small quantity of nitrous acid fumes formed with the remaining air was sufficient to cause a sense of burning in the throat, and at once stimulated the glottis to contract, so that none of the nitric oxide gas could pass into the larynx. The subsequent entrance of the external air into the mouth, which Sir Humphrey unluckily had not provided for, was of course attended by the immediate formation of more acid fumes, by which his tongue, cheeks, and gums, were irritated and inflamed; and there is no doubt, as Sir Humphrey himself remarks, that if he had succeeded in inhaling the nitric oxide gas, the same chemical change would have happened in the lungs and excited pneumonia.[^[2019]]

The following cases will prove that nitrous acid vapour, disengaged from the fuming nitrous acid, is a very violent and dangerous poison when inhaled. A chemical manufacturer, in endeavouring to remove from his store-room a hamper in which some bottles of nitrous acid had burst, breathed the fumes for some time, and was seized in four hours with symptoms of inflammation in the throat and stomach. At night the urine was suppressed; the skin then became blue; at last he was seized with hiccup, acute pain in the diaphragm, convulsions, and delirium; and he died twenty-seven hours after the accident.[^[2020]] Another case has been described in the Bulletins of the Medical Society of Emulation. It proved fatal in two days, and the symptoms were those of violent pneumonia. In this instance there was pneumonia of one side, and pleurisy of the other; the uvula and throat were gangrenous, and the windpipe and air-tubes dark-red; the veins throughout the whole body were much congested, the skin very livid in many places, and the blood fluid in the heart, but coagulated in the vessels.[^[2021]] Dr. Reitz, a writer in Henke’s Journal, met with two cases of death from the same cause in hatters. They had incautiously exposed themselves too much to the fumes, which are disengaged during the preparation of nitrate of mercury for the operation of felting, and which are well known to be nitric oxide gas converted into nitrous acid vapour by contact with the air. Two men died of inflammation of the lungs excited in that manner; and a third, a boy of fourteen, after sleeping all night in an apartment where the mixture was effervescing, was attacked in the morning with yellowness of the skin, giddiness, and colic, which ended fatally in six days.[^[2022]]

Of Poisoning with Chlorine.—The experiments of Nysten and Hébréart with chlorine, and its well-known irritating effects when inhaled in the minutest quantities, show that it will produce inflammation of the lungs and air-passages. The following is the only instance of poisoning with it in man which has come under my notice. A young man, after breathing diluted chlorine as an experiment, was instantly seized with violent irritation in the epiglottis, windpipe, and bronchial branches, cough, tightness, and sense of pressure in the chest, inability to swallow, great difficulty in breathing or articulating, discharge of mucus from the mouth and nostrils, severe sneezing, swelling of the face, and protrusion of the eyes. Ammonia was of no use; but singular relief was obtained from the inhalation of a little sulphuretted hydrogen, so that in an hour and a half he was tolerably well.[^[2023]]

Although this gas is very irritating to an unaccustomed person, yet by the force of habit one may breathe with impunity an atmosphere much loaded with it. I have been told by a chemical manufacturer at Belfast, that his men can work in an atmosphere of chlorine, where he himself could not remain above a few minutes. The chief consequences of habitual exposure are acidity and other stomach complaints, which the men generally correct by taking chalk. He has likewise observed that they never become corpulent, and that corpulent men who become workmen are soon reduced to an ordinary size. It is not probable, however, that the trade is an unhealthy one; for several of this gentleman’s workmen have lived to an advanced age; one man, who died not long ago at the age of eighty, had been forty years in the manufactory; and I have seen in Mr. Tenant’s manufactory at Glasgow a healthy-looking man who had been also about forty years a workman there. It is an interesting fact, that during the epidemic fever which raged over Ireland from 1816 to 1819, the people at the manufactory at Belfast were exempt from it.

Of Poisoning with Ammonia.—For an account of the effects of ammonia, which, when in the state of gas, acts violently as an irritant on the mouth, windpipe, and lungs, the reader is referred to the chapter on ammonia and its salts in page [193]. It appears to form one of the gases disengaged from the soil of necessaries, as will be noticed presently, and excites inflammation in the eyes of workmen who are incautiously exposed to it.[^[2024]]

Of Poisoning with Hydrochloric Acid Gas.—I have not met with any account of the effects of hydrochloric acid gas on man. But no doubt can be entertained that it will likewise act as a violent and pure irritant.

It is exceedingly hurtful to vegetable life. In the course of some experiments performed in 1827 by Dr. Turner and myself on the effects of various gases on plants, we found that a tenth of a cubic inch diluted with 20,000 times its volume of air, so as to be quite imperceptible to the nostrils, shrivelled and killed all the leaves of various plants, which were exposed to it for twenty-four hours.[^[2025]] These experiments were repeated in 1832 by Messrs. Rogerson, apparently in ignorance of them. Their results are on the whole the same; and the slighter effect obtained by them from minute proportions of the gas was evidently owing to the small size of their glass-jars not allowing them to use a sufficient quantity of it.[^[2026]] They farther found that proportions of hydrochloric acid gas, amounting to a twentieth of the air, kill small animals in half an hour with symptoms of obstructed respiration. Their experiments with less proportions are not precise, yet warrant the inference that even a thousandth part of the gas will probably prove fatal in no long time.[^[2027]]

Of Poisoning with Hydrosulphuric Acid Gas.—The narcotic gases are of much greater importance than the irritants, on account of the singularity of their effects, and the greater frequency of accidents with them. This group includes hydrosulphuric acid, carburetted-hydrogen, carbonic acid, carbonic oxide, nitrous oxide, cyanogen, and oxygen.

Hydrosulphuric acid gas is probably the most deleterious of all the gases. According to Thenard and Dupuytren, air containing only an 800th of it will kill small birds in a few seconds; and a 290th is sufficient to kill a dog; which, however, will sustain so much as a 400th.[^[2028]] Chaussier previously found, that a horse was killed by breathing atmospheric air which contained a 250th of hydrosulphuric acid gas; and that it acts with energy on animals, whether it be inhaled, or injected into the stomach, anus, or cellular tissue, or even simply applied to the skin. Nine quarts of the gas injected into the anus of a horse killed it in one minute; and a rabbit, whose skin alone was exposed to it, died in ten minutes.[^[2029]] Ulterior inquiries by MM. Parent-Duchâtelet and Gaultier de Claubry,—scarcely so precise however as those of their predecessors,—appear to lead to the conclusion, that its energy is in some circumstances not so great. While superintending the clearing out of some of the choked drains of Paris, they found that the workmen suffered no harm, though they habitually breathed an atmosphere containing from 25 to 80 ten-thousandths of hydrosulphuric acid gas, and on some occasions even so much as one per cent.; nay, on one occasion Gaultier remained several minutes without injury, collecting air for chemical analysis in an atmosphere, which proved to be loaded with three per cent. of the gas.[^[2030]] None of these researches point out the precise manner of death. Dr. Percy of Nottingham informs me he found in 1839, that dogs, which breathed air, containing this gas, quickly died in convulsions like those caused by hydrocyanic acid; that in some instances the heart’s action was observed to have ceased, when the body was opened immediately after death; but that in general it either continued to beat for some time, or could be made to do so when its state of congestion was relieved by withdrawing a little blood.

Dr. Turner and I found that hydrosulphuric acid gas is very injurious to vegetables, and that it acts differently from muriatic acid gas, as it appeared to exhaust the vitality of plants and to cause in them a state analogous to narcotic poisoning in animals. Four cubic inches and a half, diluted with eighty volumes of air, caused drooping of the leaves of a mignonette plant in twenty-four hours; and the plant, though then removed into the open air, continued to droop till it bent over altogether and died.[^[2031]]

The best description of the effects of this gas on man has been given by M. Hallé,[^[2032]] in his account of the nature and effects of the exhalations from the pits of the Parisian necessaries; which exhalations appear, from the experiments of Thenard and Dupuytren, to be mixtures chiefly of ammonia and sulphuretted-hydrogen. The symptoms, in cases where the vapours are breathed in a state of concentration, are sudden weakness and all the signs of ordinary asphyxia. The individual becomes suddenly weak and insensible; falls down; and either expires immediately, or, if he is fortunate enough to be quickly extricated, he may revive in no long time, the belly remaining tense and full for an hour or upwards, and recovery being preceded by vomiting and hawking of bloody froth.[^[2033]] When the noxious emanations are less concentrated, several affections have been noticed, which may be reduced to two varieties, the one consisting of pure coma, the other of coma and tetanic convulsions. In the comatose form, the workman seems to fall gently asleep while at work, is roused with difficulty, and has no recollection afterwards of what passed before the accident. The convulsive form is sometimes preceded by noisy and restless delirium, sometimes by sudden faintness, heaving or pain in the stomach, and pains in the arms, and almost always by difficult breathing, from weakness in the muscles of the chest. Insensibility, and a state resembling asphyxia rapidly succeed, during which the pupil is fixed and dilated, the mouth filled with white or bloody froth, the skin cold, and the pulse feeble and irregular. At last convulsive efforts to breathe ensue; these are followed by general tetanic spasms of the trunk and extremities; and if the case is to prove fatal, which it may not do for two hours, a state of calm and total insensibility precedes death for a short interval.[^[2034]] When the exposure has been too slight to cause serious mischief, the individual is affected with sickness, colic, imperfectly defined pains in the chest, and lethargy.[^[2035]]

The appearances in the bodies of persons killed by these emanations are fluidity and blackness of the blood, a dark tint of all the internal vascular organs, annihilation of the contractility of the muscles, more or less redness of the bronchial tubes, and secretion of brown mucus there as well as in the nostrils, gorging of the lungs, an odour throughout the whole viscera like that of decayed fish, and a tendency to early putrefaction.[^[2036]] Chaussier in his experiments also remarked in animals, that when a plate of silver or bit of white lead was thrust under the skin it was blackened.[^[2037]] Dr. Percy could not detect the gas in the brain of animals killed by inhaling it.

These extraordinary accidents may be occasioned not only by exposure to the vapours from the fosses, but likewise by the incautious inhalation of the vapours proceeding from the bodies of persons who have been asphyxiated there. Sickness, colic, and pains in the chest, are often caused in the latter mode; and Hallé has even given an instance of the most violent form of the convulsive affection having originated in the same manner.[^[2038]]

In order that the reader may comprehend the exact cause of these accidents,—as it is not easy for an Englishman to comprehend how suffocation may arise from the fumes of a privy,—it may be necessary to explain, that in Paris the pipe of the privy terminates under ground in a pit, which is usually contained in a small covered vault, or is at the bottom of a small square tower open at the roof of the house; and that the pit is often several feet long, wide and deep. Here the filth is sometimes allowed to accumulate for a great length of time, till the pit is full; and it is in the process of clearing it out that the workmen are liable to suffer. Hallé has given an interesting narrative of an attempt made to empty one of these pits in presence of the Duc. de Rochefoucault, the Abbé Tessier, himself, and other members of the Academy of Sciences, who were appointed by the French government to examine into the merits of a pretended discovery for destroying the noxious vapours. The pit chosen was ten feet and a half long, six wide, and at least seven deep; and repeated attempts had been previously made without success to empty it. For some time the process went on prosperously; when at last one of the workmen dropped his bucket into the pit. A ladder being procured, he immediately proceeded to descend, and would not wait to be tied with ropes. “But hardly,” says Hallé, “had he descended a few steps of the ladder, when he tumbled down without a cry, and was overwhelmed in the ordure below, without making the slightest effort to save himself. It was at first thought he had slipped his foot, and another workman promptly offered to descend for him. This man was secured with ropes in case of accident. But scarcely had he descended far enough to have his whole person in the pit except his head, when he uttered a suppressed cry, made a violent effort with his chest, slipped from the ladder, and ceased to move or breathe. His head hung down on his breast, the pulse was gone; and his complete state of asphyxia was the affair of a moment. Another workman, descending with the same precautions, fainted away in like manner, but was so promptly withdrawn that the asphyxia was not complete, and he soon revived. At last a stout young man, secured in the same way as the rest, also went down a few steps. Finding himself seized like his companions, he re-ascended to recover himself for a moment; and still not discouraged, he resolved to go down again, and descended backwards, keeping his face uppermost, so that he was able to search for his companion with a hook and withdraw the body.” It was impossible to go on with the operation of clearing out; and the pit was shut up again. The first workman never showed any sign of life; the second recovered after discharging much bloody froth; all the persons in the vault were more or less affected; and a gentleman who, in trying to resuscitate the dead workman, incautiously breathed the exhalations from his mouth, was immediately and violently seized with the convulsive form of the affection.[^[2039]]

The same kind of accident has been observed at Paris in the vaults of cemeteries, owing to the same cause,—the disengagement of hydrosulphuric acid and hydrosulphate of ammonia during putrefaction. A remarkable instance is related by Guérard.[^[2040]] Analogous accidents have happened in this country in clearing out drains.

In none of the French investigations on this singular subject has any allusion been made to the question, whether the health sustains any injury from long-continued exposure to the gas in very minute proportion. It is probably injurious however. At one time, while in the practice of not using any precautions against inhaling the gas in chemical researches, I used to remark that daily exposure to it in minute quantity caused in a few weeks an extraordinary lassitude, languor of the pulse, and defective appetite. Strohmeyer in the like circumstances was liable to severe headache. Mr. Taylor says that the workmen in the Thames Tunnel suffered severely for some time from a similar exposure. Many of them became affected with giddiness, sickness, general debility and emaciation, then with a low fever attended with delirium, and in the course of a few months several died. No cause could be discovered for their illness except the frequent escape of sulphuretted-hydrogen from the roof. The affection only disappeared, when the communication from bank to bank was completed, so that the tunnel could be thoroughly ventilated.[^[2041]]

The presence of hydrosulphuric acid in all such emanations is best proved by exposing to them a bit of filtering paper moistened with a solution of lead. The smell alone must not be relied on, as putrescent animal matter exhales an odour like that of hydrosulphuric acid, though none be present. Workmen ought to be aware that hydrosulphuric acid may be quickly fatal where lights burn with undiminished brilliancy; and that in places where it is apt to accumulate, the degree of purity of the air may vary so much in the course of working, as to be wholesome only a few minutes before, as well as a few minutes after a fatal accident.[^[2042]]

In the present place, some notice may be taken of an extraordinary accident, which happened in 1831 near London. Great doubts may be entertained whether hydrosulphuric acid was the cause of it; and while these exist, it is not possible to arrange it under a proper head. It is too important, however, in relation to Medical Jurisprudence, to be omitted in this work; and I take the opportunity of mentioning it here, as the accident was ascribed to hydrosulphuric acid by those who witnessed it.

In August, 1831, twenty-two boys living at a boarding-school at Clapham were seized in the course of three or four hours with alarming symptoms of violent irritation in the stomach and bowels, subsultus of the muscles of the arms, and excessive prostration of strength. Another had been similarly attacked three days before. This child died in twenty-five, and one of the others in twenty-three hours. On examination after death, the Peyerian glands of the intestines were found in the former case enlarged, and as it were tuberculated; in the other there were also ulcers of the mucous coat of the small intestines, and softening of that coat in the colon. A suspicion of accidental poisoning having naturally arisen, the various utensils and articles of food used by the family were examined but without success. And the only circumstance which appeared to explain the accident was, that two days before the first child took ill, a foul cess-pool had been opened, and the materials diffused over a garden adjoining to the children’s play-ground. This was considered a sufficient cause of the disease by Dr. Spurgin and Messrs. Angus and Saunders of Clapham, as well as by Drs. Latham and Chambers, and Mr. Pearson of London, who personally examined the whole particulars.[^[2043]] Their explanation may be the only rational account that can be given of the matter. But as no detail of their chemical inquiries was ever published, their opinion cannot be received with confidence by the medical jurist and the physician; since it is not supported, so far as I am aware by any previous account of the effects of hydrosulphuric acid gas.

Of Poisoning with Carburetted Hydrogen.—Of the several species of carburetted hydrogen gas it is probable that all are more or less narcotic; but they are much inferior in energy to sulphuretted hydrogen.

Sir H. Davy found that when he breathed a mixture of two parts of air and three of carburetted hydrogen, procured from the decomposition of water by red-hot charcoal, he was attacked with giddiness, headache, and transient weakness of the limbs. When he breathed it pure, the first inspiration caused a sense of numbness in the muscles of the chest; the second caused an overpowering sense of oppression in the breast, and insensibility to external objects; during the third he seemed sinking into annihilation, and the mouthpiece dropped out of his hand. On becoming again sensible, which happened in less than a minute, he continued for some time to suffer from a feeling of impending suffocation, extreme exhaustion, and great feebleness of the pulse. Throughout the rest of the day he was affected with weakness, giddiness and rending headache.[^[2044]] These experiments show that the gas is deleterious. Yet Nysten found it inert when injected into the veins, and what is more to the point, colliers breathe the air of coal mines without apparent injury when strongly impregnated with it.

The mixed gases of coal-gas or oil-gas appear likewise to be inert when considerably diluted; for gas-men breathe with impunity an atmosphere considerably loaded with them; and in the course of some researches on the illuminating power and best mode of burning these gases, Dr. Turner and myself daily, for two months, breathed air strongly impregnated with them, but never remarked any unpleasant effect whatever.

It would seem, however, from several accidents in France and England, that when the impregnation is carried a certain length, poisonous effects may ensue; and that the symptoms then induced are purely narcotic. The first case, which occurred at Paris in 1830, has been related by M. Devergie. In consequence of a leak in the service-pipe which supplied a warehouse, five individuals who slept in the house were attacked during the night with stupor; and if one of them had not been awakened by the smell and alarmed the rest, it is probable that all would have perished. As it was, one man was found completely comatose and occasionally convulsed, with froth issuing from the mouth, occasional vomiting, stertorous respiration, and dilated pupils. Some temporary amendment was procured by blood-letting, but the breathing continued laborious, and he expired about nine hours after the party went to bed, and six hours after the alarm was given. On dissection the vessels of the brain were found much gorged, the blood in the heart and great vessels firmly coagulated, one of the lungs congested, and its bronchial tube blocked up by a kidney bean. The immediate cause of death in this case is therefore doubtful.[^[2045]] A similar set of cases happened at Leeds in 1838. An old woman and her grand-daughter were found dead in bed one morning at nine o’clock, ten hours and a half after they had been seen alive and well. The air of the apartment was loaded with coal-gas from a leak in a street-pipe ten feet from the bedroom. One body was cold and stiff when found, and the other became rigid very soon. The attitude and expression were calm, the integuments pale, the cerebral membranes natural, the brain itself turgid, and its ventricles distended, in the case of the girl, with an ounce and a half of serosity, the lungs congested, the alimentary mucous membrane red, and the blood every where fluid, and unusually florid, even in the right side of the heart.[^[2046]] Another accident of the same kind, which proved fatal to five individuals, occurred at Strasbourg in 1841. Four were found dead, another survived twenty-four hours after the accident was discovered, and a sixth recovered. It appears from the statement of this person, that the first symptoms were headache and giddiness, then nausea and vomiting, afterwards confusion of ideas, and at length insensibility. General prostration, partial palsy, coma, and convulsions were the leading symptoms after the accident was observed. In the four people found dead the most remarkable appearances were cerebral congestion, redness of the bronchial membrane, accumulation of bloody, frothy mucus in the air tubes, scarlet redness of the lungs, coagulation and darkness of the blood. In the person who was found alive, but did not recover, there was no cerebral congestion, gorging of the air tubes, or redness of the lungs. Professor Tourdes, who reports these cases, ascertained that air containing a fiftieth of coal-gas kills rabbits in twelve or fourteen minutes, and that even a thirtieth proves fatal, though slowly. The gas which caused the accident, and which was prepared from a mixture of water and slate coal, consisted of 22·5 per cent. light carburetted hydrogen, 6·0 bicarburetted hydrogen, 21·9 carbonic oxide, 31 hydrogen, 14 azote, and 4·6 carbonic acid; and by experiment the author found that the most energetic of these gases as a poison is the carbonic oxide, and that the action of the two carburetted-hydrogens is quite feeble.[^[2047]] It is somewhat remarkable that no such accident has ever happened in Edinburgh, where nevertheless coal-gas is more used for purposes of illumination in private houses than in any other city. The fine quality of the gas,—for it contains a mere trace of carbonic acid, and probably less than four per cent. of carbonic oxide,—may be the reason why accidents are not occasioned by it. It is a singular fact, however, that the powerful odour of the gas, when it accidentally escapes in the night-time, generally awakes very soon those who are exposed to inhale it.

Of Poisoning with Carbonic Acid Gas.—Carbonic acid gas is the most important of the deleterious gases; for it is the daily source of fatal accidents. It is extricated in great quantity from burning fuel; it is given out abundantly in the calcining of lime; it is disengaged in a state of considerable purity in brew-houses by the fermentation of beer; it is often met with in mines and caverns, particularly in coal-pits and draw-wells; it may collect in apartments where fuel is burnt without a proper outlet for the vitiated air, or where persons are crowded too much for the capacity of the room. Hence many have been killed by descending incautiously into draw-wells, by falling into beer-vats, and by sleeping before the traps of lime-kilns, or in apartments without vents and heated by choffers. Instances have even occurred of the same accident from sleeping in greenhouses during the night, when plants exhale much carbonic acid; and some dreadful cases have occurred of suffocation from confinement in small crowded rooms.

Physiologists, as already remarked, are not quite agreed as to the action of carbonic acid gas,—whether it is a positive poison, or simply an asphyxiating gas. But in my opinion reasons enough exist for believing that it is positively and energetically poisonous. This is perhaps shown by its effects being much more rapidly produced, and much more slowly and imperfectly removed, than asphyxia from immersion in hydrogen or azote.[^[2048]] Thus immersion for twenty-five seconds in an atmosphere of carbonic acid gas has been found sufficient to kill an animal outright; and fifteen seconds will kill a small bird.[^[2049]] But it is more unequivocally established by the three following facts:

In the first place, if, instead of the nitrogen contained in atmospheric air, carbonic acid gas be mixed with oxygen in the same proportion, animals cannot breathe this atmosphere for two minutes without being seized with symptoms of poisoning.[^[2050]] Even a much less proportion has the same effect. Five per cent. in the air will affect small birds in two minutes, and kill them in half an hour.[^[2051]] Persons have become apoplectic in an atmosphere of carbonic acid gas, which to those who entered it appeared at first quite respirable.[^[2052]]

Secondly, Professor Rolando of Turin having found that the land tortoise sustained little injury when the great air-tube of one lung was tied,—he contrived to make it breathe carbonic acid gas with one lung, while atmospheric air was inhaled by the other; and he remarked that death took place in a few hours.[^[2053]]

Thirdly, the symptoms caused by inhaling the gas may be also produced by applying it to the inner membrane of the stomach or to the skin. On the one hand aërated water has been known to cause giddiness or even intoxication when drunk too freely at first;[^[2054]] and the sparkling wines probably owe their rapid intoxicating power to the carbonic acid they contain. And, on the other hand, M. Collard de Martigny has found that, if the human body be enclosed in an atmosphere of the gas, due precautions being taken to preserve the free access of common air to the lungs, the usual symptoms of poisoning with carbonic acid are produced, such as weight in the head, obscurity of sight, pain in the temples, ringing in the ears, giddiness, and an undefinable feeling of terror; and that if the same experiment be made on animals and continued long enough, death will be the consequence.[^[2055]]

When a man attempts to inhale pure carbonic acid gas, for example by putting the face over the edge of a beer-vat, or the nose into a jar containing chalk and weak muriatic acid, the nostrils and throat are irritated so strongly, that the glottis closes and inspiration becomes impossible. Sir H. Davy in making this experiment, farther remarked, that the gas causes an acid taste in the mouth and throat, and a sense of burning in the uvula.[^[2056]] I have remarked the same effects from very pure gas disengaged by tartaric acid from carbonate of soda. Hence, when a person is immersed in the gas nearly or perfectly pure, as in a beer-vat, or old well, he dies at once of suffocation.

The effects are very different when the gas is considerably diluted; for the symptoms then resemble apoplexy. As they differ somewhat according to the source from which the gas is derived, and the admixtures consequently breathed along with it, it will be necessary to notice separately the effects of the pure gas diluted with air,—of the emanations from burning charcoal, tallow, and coal,—and finally of air vitiated by the breath.

1. M. Chomel of Paris has related a case of poisoning with the gas diluted with air, in the person of a labourer, who was suddenly immersed in it at the bottom of a well, and remained there three-quarters of an hour. He was first affected with violent and irregular convulsions of the whole body and perfect insensibility, afterwards with fits of spasm like tetanus; and during the second day, when these symptoms had gone off, he continued to be affected with dumbness.[^[2057]]—It is worthy of particular remark that, contrary to general belief, these effects may be produced in situations where the air is not sufficiently impure to extinguish lights. Thus M. Collard de Martigny relates the case of a servant, who, on entering a cellar where grape-juice was fermenting, became suddenly giddy, and, under a vague impression of terror, fled from the place, dropping her candle on the floor and shutting the door behind her. She fell down insensible outside the door, and those who went to her assistance found on opening the door that the light continued to burn.[^[2058]]—Mr. Taylor indeed has since ascertained that a candle will burn in air, which contains ten, or even twelve per cent. of carbonic acid,[^[2059]]—a proportion more than sufficient to cause poisoning in no long time. It is also important to observe, that, contrary to what would be expected from the statements of Sir H. Davy and other experimentalists on the effects of the pure gas, it will often happen that no odour or taste is perceived. M. Bonami, in an account of an accident which happened at Nantes to two workmen who descended an old well, says that the first while descending uttered a piercing cry and fell down; and that as soon as his comrade, who tried to rescue him, was lowered ten or twelve feet, he felt as if he was about to be suffocated for want of breath, but perceived no strong or disagreeable smell.[^[2060]] It should be remembered therefore by workmen, that there may be danger in descending pits where none is indicated by the sense of smell, or by the extinguishing of a light.

2. The fumes of burning charcoal have been long known to be deleterious. The early symptoms caused by them have been little noticed; for, as this variety of poisoning generally occurs during sleep, the patient is seldom seen till the symptoms are fully formed. In an attempt at self-destruction described in a French journal, the first effects were slight oppression, then violent palpitation, next confusion of ideas, and at last insensibility.[^[2061]] Tightness in the temples, and an undefinable sense of alarm have also been remarked;[^[2062]] and others have, on the contrary, experienced a pleasing sensation that seduced them to remain on the fatal spot.[^[2063]] The best account of the incipient symptoms has been given by Mr. Coathupe of Wraxhall, in an account of an experiment he made with Joyce’s stove,—a preposterous invention, the fuel of which was supposed by the inventor to burn without contaminating the air, although it was neither more nor less than prepared charcoal. Having closed every aperture in a room of the capacity of eighty cubic yards, Mr. Coathupe kindled the stove and watched the results. In four hours he had slight giddiness, in five hours and a half intense giddiness, the desire to vomit without the power, excessive prostration and incapability of muscular effort, a frequent full throbbing pulse, a sense of distention of the cerebral arteries, agonizing headache, chiefly in the hindhead, but no sense of suffocation. At this time he experienced great difficulty in opening the window and removing the stove; and in seven hours, when his wife entered the room, he was unable to tell what was the matter, although quite conscious of all that was passing. He then slowly recovered.[^[2064]] A similar account has also been given by Mr. Chapman of Tooting of the effects of this notorious stove. A young gentleman, after being only one hour in a chamber heated by it, felt first slight giddiness and headache, and afterwards violent pain in the head and tightness round the forehead and temples; the pupils became excessively dilated and nearly insensible; there was constant ringing in the ears, a feeble frequent pulse, paleness of the features and lividity of the lips and hands, coldness of the extremities, laborious irregular breathing, and extreme prostration. A temporary relief, obtained by stimulants, was succeeded by violence; which, however, was subdued by blood-letting; and he recovered.[^[2065]] A set of cases, 70 in number, similar to the last two, but milder, occurred in January, 1836, in the church of Downham in Norfolk, which was heated by two of these stoves.[^[2066]]

The following abstract of a case by Dr. Babington will convey an accurate idea of the advanced symptoms. The waiter of a tavern and a little boy, on going to bed, left a choffer of charcoal burning beside it; and next morning were found insensible. The boy died immediately after they were discovered. The waiter had stertorous breathing, livid lips, flushing of the face, and a full, strong pulse; for which affections he was bled to ten ounces. When Dr. Babington first saw him, however, the pulse had become feeble, the breathing imperfect, and the limbs cold; the muscles were powerless but twitched with slight convulsions, the sensibility gone, the face pale, the eyelids closed, the eyes prominent and rolling, the tongue swollen and the jaw locked upon it, and there was a great flow of saliva from the mouth. The employment of galvanism at this time caused an evident amendment in every symptom. But it was soon abandoned; because each time it was applied, the excitement was rapidly followed by corresponding depression. Cold water was then dashed upon him, ammonia rubbed on his chest, and oxygen thrown into the lungs; through which means a warm perspiration was brought out, and his state rapidly improved. He was nearly lost, however, during the subsequent night by hemorrhage from the divided vein; but next day he was so well that he could even speak a little. For two days afterwards the left side of the face was paralyzed, and his mental faculties were somewhat disordered.[^[2067]]—In such cases as this the stupor is generally very deep. There is a case in a French Journal of a girl, who, after remaining some time in a small close chamber heated by a charcoal choffer, fell down insensible, remained in that state for three hours, and found, on recovering from her lethargy, that the choffer had fallen, and burnt the skin and subjacent fat of the thighs to a cinder.[^[2068]]

Occasionally the stage of stupor is followed, as in some other varieties of narcotic poisoning, by a stage of delirium, at times of the furious kind, or by a state resembling somnambulism.[^[2069]] It does not follow that recovery is certain because coma has thus given place to delirium,—an alteration, which in most varieties of narcotic poisoning is considered a sure sign of recovery. Collard de Martigny has related a case which eventually proved fatal, notwithstanding this sign of improvement.[^[2070]]

The narcotism induced by breathing charcoal fumes often lasts a considerable length of time,—much longer indeed than the effects of other narcotic poisons. This will appear sufficiently from the case described by Dr. Babington. One of the people, mentioned at the commencement of this chapter as having been suffocated at Gerolzhofen, lingered five days in a state of coma before he expired.

Commonly in cases of recovery, there is found to have been no consciousness of any thing going on around, or recollection of what passed subsequently to the first impressions of poisoning. The reverse, however, occurred in Mr. Coathupe’s experiment; and a similar instance has been published, where the individual, though apparently insensible, knew when the room was first entered by strangers, and heard them call him by name and bid him put out his tongue, and stretch forth his arm,—without, however, his having the power to answer, or in any way to express the consciousness of understanding them.[^[2071]]

Poisoning with charcoal vapour has become a subject of great importance in French medical jurisprudence, partly on account of the frequency with which it is resorted to for the purpose of committing suicide, and partly because repeated attempts have been made to conceal murder by arranging matters so as to present the appearances of suicide. M. Devergie says, that in the years 1834 and 1835 no fewer than 360 cases of poisoning with charcoal-vapour occurred in Paris, of which nearly four-fifths proved fatal; and he has given the particulars of two attempts to conceal murder under the appearance of death from this cause.[^[2072]]

The subject has therefore been carefully examined by various authors, but by none so successfully as by M. Devergie; of whose important researches the following is a brief analysis.

In stating the various sources whence charcoal-vapour may become incidentally the cause of death, he dwells particularly on the risk of its admission from adjoining vents, even in other houses from that where the accidents happen,—because there may be currents in the apartment which occasion back-draught. Three remarkable cases of this kind, very obscure in their origin, have been related by M. d’Arcet.[^[2073]]

The very discrepant effects of the poison on different individuals, simultaneously and to appearance alike exposed to it, have usually been explained by reference to the great density of the gas, which consequently accumulates near the floor. Some, however, have doubted the fact that the gas is unequally diffused. Mr. Taylor in particular says he ascertained by analysis, that air collected above and below a choffer of burning charcoal was equally contaminated, that what was collected a foot above its level contained 4·65 per cent., and that another portion taken the same distance below it contained 4·5 of carbonic acid.[^[2074]] M. Devergie has discovered the source of these discrepant opinions. He has found,[^[2075]] that, notwithstanding the high density of carbonic acid gas, the currents caused by the heat, disengaged when charcoal is burnt in a room, without an issue for the products of combustion, produce an equable mixture of gases at all elevations in the apartment, provided the air be examined while still warm, and not long after the charcoal has burnt out; but that, at a later period, such as twelve hours, the carbonic acid partly separates and sinks, so that, while the air at the top contains only a 78th, that near the floor contains four times as much, or a 19th of carbonic acid gas.

Disputes have also arisen as to the precise nature of the emanations from burning charcoal,—some believing that carbonic acid is alone discharged in such quantity as to prove injurious, and is singly sufficient to account for the effects which have been observed,—while others maintain that carbonic oxide, carburetted-hydrogen, or some peculiar pyrogenous vapour, may be also formed, and prove the real cause of the active properties of the vapour. According to the researches of Orfila, charcoal in a state of vivid ignition emits carbonic acid only, a hundred parts of the consumed air having been ascertained by him to be composed of 42 azote, 46 common air, and 12 carbonic acid. But when the combustion is low, a hundred parts consist of 52 azote, 20 common air, 14 carbonic acid, and 14 carburetted-hydrogen; so that not only is the air more thoroughly consumed; but likewise an additional poisonous gas is brought into action.[^[2076]] The difference thus indicated has been supposed to account for what is often observed in countries where charcoal choffers are much in use for warming close apartments,—namely, that the practice is attended with most danger when the combustion is low, and that it is unsafe to close the doors of an apartment till the fuel is in a state of vivid ignition. M. Guérard again maintains, that when the supply of air is incomplete and combustion low, carbonic oxide gas is formed in considerable quantity; and that this gas, confessedly a much more powerful narcotic than carbonic acid, is probably the cause of many cases of poisoning with charcoal fumes.[^[2077]] M. Devergie doubts the exactness of Orfila’s experiments on this head, but gives no new analysis. He observes that charcoal-vapour gives the air of a room a peculiar odour and bluish misty appearance, the latter of which slowly diminishes, and in twelve hours disappears; and that possibly there may be both a little carbonic oxide and carburetted-hydrogen in the air. But nevertheless he is of opinion that the carbonic acid alone is adequate to occasion all the effects observed in man or animals.[^[2078]] Professor Hünefeld is of a different opinion, and has supplied the most satisfactory explanation of the important fact, that charcoal fumes are most noxious when the fuel has been just kindled and burns low; for he ascertained that at first it gives out a pyrogenous acid, which occasions headache and tendency to sickness, and which is not a product of combustion at the moment, but exists ready formed; and that when charcoal is at a full red heat, this noxious substance is no longer given off.[^[2079]] Mr. Coathupe also thinks the cause of poisoning by charcoal fumes is an unknown pyrogenous body, and not carbonic acid gas.[^[2080]]—This department of inquiry is obviously susceptible of more precise information. But meanwhile, whatever may be the probability that, besides carbonic acid, some other gases, or some peculiar pyrogenous body, may occasionally exist in charcoal fumes, and increase their poisonous property, little doubt can exist that the carbonic acid is singly sufficient to account for all the leading phenomena.

M. Devergie has been led to the opinion that air, in which a fourth part of its oxygen has been converted into carbonic acid, and which therefore contains five per cent. of that gas, is amply enough impregnated to occasion death.[^[2081]] This corresponds with the observations of M. Ollivier, who found that three per cent. was as much as could be breathed with impunity even for a moderate length of time.[^[2082]] Less, however, will suffice to prove injurious or even fatal, if the air be breathed long. Mr. Coathupe inferred from a rough estimate, that in the dangerous experiment he made upon himself, the carbonic acid, if uniformly diffused in the apartment, which was probably the case, amounted to only two per cent.; but his data were inadequate.[^[2083]]

Proceeding from the fact that five per cent. of carbonic acid is sufficient to cause death, Devergie points out what quantity of charcoal is required to form that proportion,—a question of no small moment in respect to charges of murder, concealed under the semblance of suicide by suffocation with charcoal fumes. And he shows, that a French bushel, or decalitre, weighing 3000 grammes, is sufficient for a close apartment of 1275 cubic mètres, that is 6·6 pounds avoirdupois for a space of 1666 English cubic yards, provided the gas be uniformly diffused.[^[2084]] The quantity of charcoal burnt in a given case may be arrived at pretty nearly from the weight of ashes left, which is estimated in round numbers at a twenty-fifth by himself,[^[2085]] and at a twentieth by Ollivier.[^[2086]]

It is important to remark that complete closure of an apartment is by no means essential for the action of carbonic acid, whether disengaged within it or introduced from without. For poisoning has occurred, even where a window was partially open.[^[2087]]

3. It is probable that in some circumstances a very small quantity of the mixed gases proceeding from the slow combustion of tallow and other oily substances will produce dangerous symptoms. Dr. Blackadder remarked in the course of his experiments on flame, that the vapour into which oil is resolved, previous to its forming flame round the wick, excites in minute quantities intense headache.[^[2088]] The emanations from the burning snuff of a candle, which are probably of the same nature, seem to be very poisonous. An instance indeed has been recorded in which they proved fatal. A party of iron-smiths, who were carousing on a festival day at Leipzig, amused themselves with plaguing a boy, who was asleep in a corner of the room, by holding under his nose the smoke of a candle just extinguished. At first he was roused a little each time. But when the amusement had been continued for half an hour he began to breathe laboriously, was then attacked with incessant epileptic convulsions, and died on the third day.[^[2089]]—The effects of such emanations are probably owing to empyreumatic volatile oil, which will be presently seen to be an active poison.

4. The vapours from burning coal are the most noxious of all kinds of emanations from fuel, and cause peculiar symptoms. But they are less apt to lead to accidents than the vapour of charcoal, as they are much more irritating to the lungs. This effect depends on the sulphurous acid gas which is mingled with the carbonic acid.

Sulphurous acid gas is exceedingly deleterious to vegetable life, being hardly inferior in that respect to hydrochloric acid. Dr. Turner and I found that a fifth of a cubic inch diluted with ten thousand times its volume of air destroyed all the leaves of various plants in forty-eight hours.[^[2090]] I am not acquainted with any experiments on animals or observations on man regarding the effects of the pure gas. But it will without a doubt prove a powerful irritant.

Some of the peculiarities in the cases now to be mentioned were possibly owing to the admixture of sulphuric acid gas with the carbonic, both being inhaled in a diluted state. The cases are described by Mr. Braid, at the time surgeon at Leadhills. In March, 1817, several of the miners there were violently affected, and some killed, in consequence, it was supposed, of the smoke of one of the steam-engines having escaped into the way-gates, and contaminated the air in the workings. Four men who attempted to force their way through this air into the workings below were unable to advance beyond, and seem to have died immediately. The rest attempted to descend two hours after, but were suddenly stopped by the contaminated air. As soon as they reached it, although their lights burnt tolerably well, they felt difficulty in breathing, and were then seized with violent pain and beating in the head, giddiness and ringing in the ears, followed by vomiting, palpitation and anxiety, weakness of the limbs and pains above the knees, and finally with loss of recollection. Some of them made their escape, but others remained till the air was so far purified that their companions could descend to their aid. When Mr. Braid first saw them, some were running about frantic and furious, striking all who came in their way,—some ran off terrified whenever any one approached them,—some were singing,—some praying,—others lying listless and insensible. Many of them retched and vomited. In some the pulse was quick, in others slow, in many irregular, and in all feeble. All who could describe their complaints had violent headache, some of them tenesmus, and a few diarrhœa. In a few days all recovered except the first four and three others who had descended to the deeper parts of the mine.[^[2091]]—Another accident of the same nature, and followed by the same phenomena, happened more lately at Leadhills.[^[2092]] Similar accidents have been also witnessed by Mr. Bald, civil engineer, among the coal-miners who work in the neighbourhood of a burning mine belonging to the Devon Company. It is worthy of remark, that the men sometimes worked for a considerable length of time before they were taken ill. Such being the case, it will be readily conceived that the burning of the lights was not a test of the wholesomeness of the air. Here, as at Leadhills and in other instances already mentioned, the lights continued to burn where the men were poisoned.[^[2093]]

5. Somewhat analogous to the symptoms now described are the effects of the gradual contamination of air in a confined apartment. Every one must have read of the horrible death of the Englishmen who were locked up all night in a close dungeon in Fort William at Calcutta. One hundred and forty-six individuals were imprisoned in a room twenty feet square, with only one small window; and before next morning all but 23 died under the most dreadful of tortures,—that of slowly increasing suffocation. They seem to have been affected nearly in the same way as the workmen at Leadhills.[^[2094]] A similar accident happened in London in 1742. The keeper of the round-house of St. Martin’s, crammed 28 people into an apartment six feet square and not quite six feet high; and four were suffocated.[^[2095]]

The morbid appearances left on the body after poisoning with carbonic acid gas have been chiefly observed in persons killed by charcoal vapour. According to Portal the vessels of the brain are congested, and the ventricles contain serum; the lungs are distended, as if emphysematous; the heart and great veins are gorged with black fluid blood; the eyes are generally glistening and prominent, the face red, and the tongue protruded and black.[^[2096]]—Gorging of the cerebral vessels seems to be very common. Yet sometimes it is inconsiderable, as in two cases related by Dr. Bright, where, except in the sinuses and in the greater veins of the ventricles and substance of the brain, no particular gorging or vascularity seems to have been met with,—the external membranes in particular having been very little injected.[^[2097]] This, however, is certainly a rare occurrence. Serous effusion in the ventricles and under the arachnoid membrane is very general, yet not invariable.—Dr. Schenck, medical inspector of Siegen, in reporting two cases of death caused by the vapours of burning wood, notices paleness of the countenance as a singular accompaniment of cerebral congestion; and calls the attention of medical jurists to the extreme calmness of the features as a general character of this variety of poisoning.[^[2098]] Although the same appearance has also been noticed by others,[^[2099]] the countenance nevertheless is often livid. But whether livid or pale, it is always composed.—It appears from an account in Pyl’s Essays of several cases of suffocation from the fumes of burning wood, that besides the appearances mentioned by Portal, there is usually great livor of the back, frothiness as well as fluidity of the blood, and more or less gorging of the lungs with blood.[^[2100]]—A common appearance where the poisonous emanation has been charcoal vapour, is a lining of dark, or sometimes actually black dust on the mucous membranes of the air passages, thickest near the external opening of the nostrils, and disappearing towards the glottis. There are obvious reasons why this appearance cannot always be expected to occur; but when present, it may be in doubtful circumstances a very important article of evidence.[^[2101]] In Wildberg’s collection of cases there is a report on two people who were suffocated in bed, in consequence of the servant having neglected to open the flue-trap when she kindled the stove in the bed-chamber; and in each of them Wildberg found all the appearances now quoted from Portal and Pyl. The tongue was black and swelled.[^[2102]]—Mertzdorff has related a case of death from the same cause, in which, together with the preceding appearances, an effusion of blood was found between the arachnoid and pia mater over the whole surface of both hemispheres.[^[2103]] In one of Dr. Bright’s cases there was a small ecchymosis in the cortical substance on the outer side of the anterior lobe, and not extending into the medullary matter. Fallot mentions an instance of suffocation from charcoal vapour, where a little coagulated blood was found between the layers of the arachnoid membrane of the cerebellum in the region of the left occipital hollow.[^[2104]] Three instances of extravasation are enumerated in a list of German cases analysed by Dr. Bird.[^[2105]] Such appearances might be expected more frequently, considering the manifest tendency of this kind of poisoning to cause congestion in the head.—The blood is generally described as being liquid and very dark. But M. Ollivier has lately called attention to the fact, that the blood both before and after death is not unusually more florid in the veins than natural.[^[2106]] In a case mentioned by M. Rayer globules of an oily-looking matter were found swimming on the surface of the blood and urine.[^[2107]] This is a solitary observation.—The body usually remains flaccid, and the customary stage of rigidity is imperfect. In some instances, however, as in those related by Dr. Schenck, the stage of rigidity is passed through in the usual manner. It is not uncommon to find vomited matter lying beside the body, a circumstance which may naturally mislead the unpractised. This is represented by Professor Wagner of Berlin to have occurred uniformly in his experience;[^[2108]] and it is also mentioned in many of the cases reported by others;[^[2109]] but it is not invariable.—A red appearance in the stomach and intestines has been noticed in many cases,[^[2110]] and often ascribed to inflammation; but it is probably nothing more than the result of the venous congestion, which pervades most of the membranous surfaces of the body.

The least variable appearances according to Dr. Bird are general lividity, protrusion of the tongue, a calm expression and attitude, cerebral congestion, and serous effusion. This author’s paper in the Medical Gazette, 1838–39, i., or in Guy’s Hospital Reports, iv., enters very fully into the appearances after death, and may be consulted with advantage for further details.

The treatment of poisoning with carbonic acid consists chiefly in the occasional employment of the cold affusion, and in moderate blood-letting either from the arm or from the head. In a case which happened at Paris, where a lady tried to make away with herself by breathing charcoal fumes, and was found in a state of almost hopeless insensibility, various remedies were tried unsuccessfully, till cupping from the nape of the neck was resorted to; and she then rapidly recovered.[^[2111]] Another instance where blood-letting was also singularly successful deserves particular mention; because for three hours the patient remained without pulsation in any artery, and without the slightest perceptible respiration. At first neither by cupping nor by venesection could any blood be obtained; and it was only after the long interval just mentioned, and constant artificial inflation of the lungs, that the blood at length trickled slowly from the arm. The pulse and breathing were after this soon re-established; but it was not till eight hours later that sensibility returned.[^[2112]]

Of Poisoning with Carbonic Oxide Gas.—Carbonic oxide gas, according to Nysten, has not any effect on man when injected into the pleura; but when thrown slowly into the veins, it gives the arterial blood a brownish tint, and induces for a short time a state resembling intoxication.[^[2113]] The quantity injected into the veins was probably too small to produce the full effect, or it was discharged in passing through the lungs; for this gas certainly appears to be very deleterious when breathed by man, or the lower animals. M. Leblanc found by experiment that a sparrow was killed almost immediately in air containing only a twentieth of it, and that so little even as a hundredth part proved fatal in two minutes.[^[2114]]

A set of interesting but hazardous experiments were made with it in 1814 by the assistants of Mr. Higgins of Dublin. One gentleman, after inhaling it two or three times, was seized with giddiness, tremors, and an approach to insensibility, succeeded by languor, weakness, and headache of some hours’ duration. The other had almost paid dearly for his curiosity. Having previously exhausted his lungs, he inhaled the pure gas three or four times, upon which he was suddenly deprived of sense and motion, fell down supine, and continued for half an hour insensible, apparently lifeless, and with the pulse nearly extinct. Various means were tried for rousing him, without success; till at last oxygen gas was blown into the lungs. Animation then returned rapidly: but he was affected for the rest of the day with convulsive agitation of the body, stupor, violent headache, and quick irregular pulse; and after his senses were quite restored, he suffered from giddiness, blindness, nausea, alternate heats and chills, and then feverish, broken, but irresistible sleep.[^[2115]] A French aëronaut, who used for his balloon a mixture of carbonic oxide and hydrogen, obtained by decomposing water with red-hot charcoal, lately suffered from similar symptoms in a milder degree, in consequence of the gas being disengaged upon him from the safety-valve of his balloon.[^[2116]]

Of Poisoning with Nitrous Oxide Gas.—The nitrous oxide or intoxicating gas is the last of the narcotic gases to be noticed. Nysten found, that, when slowly injected in large quantity into the veins of animals, it only caused slight staggering.[^[2117]] Frequent observation, however, has shown that it is by no means so inert when breathed by man. Sir H. Davy, who first had the courage to inhale it, observed that it excited giddiness, a delightful sense of thrilling in the chest and limbs, acuteness of hearing, brilliancy of all surrounding objects, and an unconquerable propensity to brisk muscular exertion. These feelings were of short duration, but were generally succeeded by alertness of body and mind, never by the exhaustion, depression, and nausea, which follow the stage of excitement brought on by spirits or opium.[^[2118]] Although many have since experienced the same enticing effects, yet they are by no means uniform. For others have been suddenly seized with great weakness, tendency to faint, loss of voice, and sometimes convulsions; and two of Thenard’s assistants, on making the experiment, fainted away, and remained some seconds motionless and insensible.[^[2119]] It is a remarkable circumstance in the operation of this gas, that, unlike other stimulants, it does not lose its virtues under the influence of habit. Neither does the habitual use of it lead to any ill consequence. Sir H. Davy, in the course of his researches, which were continued above two months, breathed it occasionally three or four times a day for a week together, at other periods four or five times a week only; yet at the end his health was good, his mind clear, his digestion perfect, and his strength only a little impaired.[^[2120]]

Nitrous oxide gas is one of the few gases that are not injurious to vegetables. Dr. Turner and I found that seventy-two cubic inches, diluted with six times their volume of air, had no effect on a mignionette plant in forty-eight hours.[^[2121]]

Of Poisoning with Cyanogen Gas.—Cyanogen gas has been proved by the experiments of M. Coullon to be an active poison to all animals,—the guinea-pig, sparrow, leech, frog, wood-louse, fly, crab; and the symptoms induced were coma, and more rarely convulsions.[^[2122]] These results are confirmed by the later experiments of Hünefeld, who found that it produces in the rabbit anxious breathing, slight convulsions, staring of the eyes, dilated pupils, coma, and death in five or six minutes.[^[2123]] Buchner likewise found that small birds, held for a few seconds over the mouth of a jar containing cyanogen, died very speedily; and on one occasion remarked, while preparing the gas, that the fore-finger, which was exposed to the bubbles as they escaped, became suddenly benumbed, and that this effect was attended with a singular feeling of pressure and contraction in the joints of the thumb and elbow.[^[2124]] It would undoubtedly be most dangerous to breathe this gas, except much diluted, and in very small quantity.

Of all narcotic gases it is the most noxious to vegetables. Dr. Turner and I found that a third of a cubic inch, diluted with 1700 times its volume of air, caused the leaves of a mignionette plant to droop in twenty-four hours. As usual with the effects of narcotic gases on vegetables, the drooping went on after the plant was removed into the open air; and in a short time it was completely killed.[^[2125]]

Of Poisoning with Oxygen Gas.—Of all the narcotic gases, none is more singular in its effects than oxygen. When breathed in a state of purity by animals, they live much longer than in the same volume of atmospheric air. But if the experiment be kept up for a sufficient length of time, symptoms of narcotic poisoning begin to manifest themselves. For an hour no inconvenience seems to be felt; but the breathing and pulse then become accelerated; a state of debility next ensues; at length insensibility gradually comes on, with glazing of the eyes, slow respiration and gasping; coma is in the end completely formed; and death ensues in the course of six, ten, or twelve hours. If the animals are removed into the air before the insensibility is considerable, they quickly recover. When the body is examined immediately after death, the heart is seen beating strongly, but the diaphragm motionless; the whole blood in the veins as well as the arteries is of a bright scarlet colour; some of the membranous surfaces, such as the pulmonary pleura, have the same tint, and the blood coagulates with remarkable rapidity. The gas in which an animal has died rekindles a blown out taper. These experiments, which physiology owes to the researches of Mr. Broughton,[^[2126]] furnish a solitary example of death from stoppage of the respiration, although the heart continues to pulsate, and the lungs to transmit florid blood. Death is probably owing to hyper-arterialization of the blood.

CHAPTER XXXII.
CLASS THIRD.
OF NARCOTICO-ACRID POISONS GENERALLY.

The third class of poisons, the narcotico-acrids, includes those which possess a double action, the one local and irritating like that of the irritants, the other remote, and consisting of an impression on the nervous system.

Sometimes they cause narcotism; which is generally of a comatose nature, often attended with delirium; but in one very singular group there is neither insensibility nor delirium, but merely violent tetanic spasms.

At other times they excite inflammation where they are applied. This effect, however, is by no means constant. For Orfila justly observes, that under the name of narcotico-acrids several poisons are usually described which seldom excite inflammation. Those which inflame the tissues where they are applied rarely occasion death in this manner. Some of them may produce very violent local symptoms; but they generally prove fatal through their operation on the nervous system.

For the most part, their narcotic and irritant effects appear incompatible. That is, when they act narcotically, the body is insensible to the local irritation; and when they irritate, the dose is not large enough to act narcotically. In large doses, therefore, they act chiefly as narcotics, in small doses as irritants. Sometimes, however, the narcotic symptoms are preceded or followed by symptoms of irritation; and more rarely both exist simultaneously.

Most, if not all, of them, to whatever part of the body they are applied, act remotely by entering the blood-vessels; but it has not been settled whether they operate by being carried with the blood to the part on which they act, or by producing on the inner membrane of the vessels a peculiar impression, which is conveyed along the nerves. Some of them produce direct and obvious effects where they are applied. Thus monkshood induces a peculiar numbness and tingling of the part with which it is placed in contact. The organs on which they act remotely are the brain and spine, and sometimes the heart also.

The appearances in the dead body are, for the most part, inconsiderable; more or less inflammation in the stomach or intestines, and congestion in the brain; but even these are not constant.

As a distinct class, they differ little from some poisons of the previous classes. Several of the metallic irritants, and a few vegetable acrids are, properly speaking, narcotico-acrids: they excite either narcotism or irritation, according to circumstances. But still, the poisons about to be considered form a good natural order when contrasted with these irritants. For the irritants which possess a double action are nevertheless characterized by the symptoms of inflammation being at least their most prominent effects; while the most prominent feature in the effects of the poisons now to be considered is injury of the nervous system. It is more difficult to draw the line of separation between the present class and the pure narcotics; for many narcotico-acrids rarely cause any symptom but those of narcotism.

The narcotico-acrids are all derived from the vegetable kingdom. Many of them owe their power to an alkaloid, consisting of oxygen, hydrogen, carbon, and azote.

The characters which distinguish the symptoms and morbid appearances of the narcotico-acrids from those of natural disease, do not require special mention; for almost all the remarks made in the introduction to the class of narcotics are applicable to the present class also. A few of the characters, however, which have been laid down, do not apply so well to the narcotico-acrids as to the narcotics. In particular, it appears that what was said on the short duration of the effects of the narcotics does not apply so well to the present class of poisons; some of which, in a single dose, continue to cause symptoms even of narcotism for two or three days. But the rule, that they seldom prove fatal if the case lasts above twelve hours, is still applicable,—at all events they rarely prove fatal after that interval by their narcotic action. The poisonous fungi, however, have proved fatal as narcotics so late as thirty-six hours, or even three days, after they were taken; and perhaps digitalis has proved fatal narcotically at the remote period of three weeks. But such cases are extremely rare.

Some narcotico-acids, such as the different species of strychnos, are quite peculiar in their effects; so that their symptoms may be distinguished at once from natural disease.

Orfila divides the narcotico-acrids into six groups, and this arrangement will be followed in the present work; but they are not all very well distinguished from one another.

CHAPTER XXXIII.
OF POISONING WITH NIGHTSHADE, THORN-APPLE, AND TOBACCO.

The first group of the narcotico-acrids comprehends these whose principal symptom in the early stage of their effects is delirium. All the plants of the group belong to the natural order Solanaceæ, and Linnæus’s class Pentandria Monogynia. Those which have been particularly examined are deadly nightshade, thorn-apple, and tobacco.

Of Poisoning with Deadly Nightshade.

The deadly nightshade, or Atropa belladonna, is allied in physiological and botanical characters to the hyoscyamus and solanum formerly mentioned; and by the older writers, indeed, was confounded with the latter. It is a native of Britain, growing in shady places, particularly on the edge of woods. The berries, which ripen in September, have a jet-black colour. Their beauty has frequently tempted both children and adults to eat them, although they have a mawkish taste; and many have suffered severely. It is not the berry alone which is poisonous; the whole plant is so; and the root is probably the most active part.[^[2127]] From one to four grains of the dried powder of the root will occasion dryness in the throat, giddiness, staggering, flushed face, dilated pupils, and sometimes even delirium.[^[2128]] The juice of the leaves is very energetic, two grains of its extract being, when well prepared, a large enough dose to cause disagreeable symptoms in man. It is a very uncertain preparation, unless when procured by evaporation in vacuo; for some samples from the Parisian shops have been found by Orfila to be quite inert.

It contains a peculiar alkaloid, named atropia. In the belladonna Brandes obtained a volatile, oily-like, alkaloidal fluid, of a penetrating narcotic smell, and bitterish, acrid taste, which he supposed to be the active principle of the plant.[^[2129]] The ulterior researches of Geiger and Hesse, however, as well as the simultaneous analysis of Mein, have proved that this fluid is not the pure alkaloid of belladonna, and that the real atropia is a solid substance, forming colourless, silky crystals, soluble in ether and alcohol, sparingly so in water, slightly bitter, liable to decomposition under contact with air and moisture, volatilizable, but with some decomposition, a little above 212°, and capable of forming definite crystallizable salts with acids.[^[2130]] The aqueous solutions of its salts exhale during evaporation a narcotic vapour, which dilates the pupil, and causes sickness, giddiness, and headache.[^[2131]]

The ordinary extract of belladonna in the dose of half an ounce will kill a dog in thirty hours when introduced into the stomach. Half that quantity applied to a wound will kill it in twenty-four hours. And forty grains injected into the jugular vein prove even more quickly fatal. Convulsions are rarely produced, but only a state like intoxication.[^[2132]]

The oleaginous atropia of Brandes in a dose of two or three drops kill small birds instantaneously like concentrated hydrocyanic acid; in less doses it occasions staggering, gasping, and in a few minutes death amidst convulsions; and the dead body presents throughout the internal organs great venous turgescence and even extravasation of blood, but more especially excessive congestion within the head.[^[2133]] The pure crystalline atropia of Mein, when dissolved in water and greatly diluted, causes extreme and protracted dilatation of the pupils.

Symptoms in Man.—On man the effects of belladonna are much more remarkable. In small doses, whatever be the kind or surface to which it is applied,—such as the skin round the eye, or the surface of a wound, or the inner membrane of the stomach,—it causes dilatation of the pupil. This effect may be excited without any constitutional derangement. When the extract is rubbed on the skin round the eye, or a solution of it dropped upon the eyeball, vision is not impaired; but when it is taken internally so as to affect the pupils, the sight is commonly much obscured. The effects of large or poisonous doses have been frequently witnessed in consequence of children and adults being tempted to eat the berries by their fine colour and bright lustre. From the cases that have been published the leading symptoms appear in the first instance to be dryness in the throat, then delirium with dilated pupils, and afterwards coma. Convulsions are rare, and, when present, slight.

The dryness of the throat is not a constant symptom. It is often, however, very distinct. It occurred, for example, in 150 soldiers who were poisoned near Dresden, as related by M. Gaultier de Claubry,[^[2134]] and in six soldiers whose cases have been described by Mr. Brumwell.[^[2135]] The former had not only dryness of the throat, but likewise difficulty in swallowing.

The delirium is generally extravagant, and also most commonly of the pleasing kind, sometimes accompanied with immoderate uncontrollable laughter, sometimes with constant talking, but occasionally with complete loss of voice, as in the cases of the 150 soldiers. At other times the state of mind resembles somnambulism, as in the instance of a tailor who was poisoned with a belladonna injection, and who for fifteen hours, though speechless and insensible to external objects, went through all the customary operations of his trade with great vivacity, and moved his lips as if in conversation.[^[2136]] Sometimes frantic delirium is almost the only symptom of consequence throughout the whole duration of the poisoning. Thus a gentleman at Perigueux in France, who took by mistake a mixture containing a drachm and a half of extract, was attacked in half an hour with delirium, which soon became furious, and continued till next day, when it gradually left him.[^[2137]] In others the delirium is attended with a singular and total loss of consciousness, but without coma, as in the following case which occurred not long ago at St. Omer. A young man having taken by mistake an infusion of two drachms of dried leaves, was seized in an hour with great dryness of the mouth and throat, afterwards slight delirium, loss of consciousness, and dilatation of the pupil, next with retention of urine, convulsive twitches of the face and extremities, and incessant tendency to walk up and down. In three hours, after the action of an emetic and a clyster, he lay down, but still in a state of total unconsciousness and muttering delirium. Blood-letting being at last resorted to as a remedy, he speedily recovered his senses, and eventually got well, after suffering for some time from headache, fatigue, and much debility.[^[2138]]

The pupil is not only dilated in all cases, but likewise for the most part insensible;[^[2139]] and, as in the soldiers at Dresden, the eyeball is sometimes red and prominent. The vision also, as in these soldiers, is generally obscure; sometimes it is lost for a time;[^[2140]] and so completely that even the brightest light cannot be distinguished.[^[2141]]

The sopor or lethargy, which follows the delirium, occasionally does not supervene for a considerable interval. In a case related by Munnik it did not begin till twelve hours after the poison was taken.[^[2142]] Sometimes, as in the same case, the delirium returns when the stupor goes off. A patient of my colleague Dr. Simpson, after using a belladonna suppository consisting of two grains of extract, was attacked with dryness of the throat and delirium, followed soon by drowsiness and stupor; and in five or six hours more, as the stupor wore off, the delirium returned, prompting to constant movements as if she was busy with her toilette and various other ordinary occupations. Sometimes the relation of the delirium to the coma is reversed, as in a case related by Mr. Clayton, where sopor came on first, and delirium ensued in six hours. The dose in this instance was forty grains of the extract.[^[2143]] Frequently the stupor is not distinct at any stage.—Even the delirium is not always formed rapidly. A man whose case is described by Sir John Hill did not become giddy for two hours after eating the berries, and the delirium did not appear till five hours later.[^[2144]] In Mr. Brumwell’s cases, the delirium was not particularly noticed till the morning after the berries were taken.

Convulsions, it has been already stated, are rare. In the case from the 24th volume of Sedillot’s Journal, the muscles of the face were somewhat convulsed: there is also at times more or less locked-jaw,[^[2145]] or subsultus tendinum;[^[2146]] and occasionally much abrupt agitation of the extremities.[^[2147]] But well-marked convulsions do not appear to be ever present.

The effects now detailed are by no means so quickly dissipated as those of opium. Almost every person who has taken a considerable dose has been ill for a day at least. The case from Sedillot’s Journal lasted three days, delirium having continued twelve hours, the succeeding stupor for nearly two days, and the departure of the stupor being attended with a return of delirium for some hours longer. One of Mr. Brumwell’s patients, too, was delirious for three days; and Plenck has noticed several instances where the delirium was equally tedious.[^[2148]] Sage has related a case in which the individual was comatose for thirty hours.[^[2149]] Blindness is also a very obstinate symptom, which sometimes remains after the affection of the mind has disappeared. This happened in Plenck’s cases. In two children whose cases have been described in a late French journal, the eyes were insensible to the brightest light for three days.[^[2150]] In general, the dilated state of the pupils continues long after the other symptoms have departed. It further appears from an official narrative in Rust’s Journal, that dilated pupil is not the only symptom which may thus continue, but that various nervous affections, such as giddiness, disordered vision, and tremors, may prevail even for three or four weeks.[^[2151]]

Hitherto little or no mention has been made of symptoms of irritation from this poison. They are in fact uncommon, and seldom violent. In the cases related by Gaultier de Claubry and by Mr. Brumwell, dryness and soreness of the throat and difficult deglutition were remarked, and appear not unusual. These symptoms were especially noticed by Buchner, who by way of curiosity took half a drachm of seeds digested in beer. The sense of dryness and constriction of the throat were such as to prevent him swallowing even the saliva.[^[2152]] Sage’s patient passed blood by stool; and after the symptoms of narcotic poisoning ceased, he had aphthous inflammation in the throat, and swallowing was so difficult as for some time to excite convulsive struggles. Aphthæ in the throat and swelling of the belly also succeeded the delirium in Munnik’s case. Mr. Wibmer alludes to the case of a man who, besides difficult deglutition at the beginning, had violent strangury towards the close.[^[2153]] An instance of violent strangury with suppression of urine and bloody micturition is also related by M. Jolly. In the early stage, the patient had redness of the throat and burning along the whole alimentary canal, combined with the customary delirium and loss of consciousness. The symptoms were caused by forty-six grains of the extract given by mistake instead of jalap.[^[2154]] Nausea and efforts to vomit are not infrequent at the commencement.

If the accident be taken in time, poisoning with belladonna is rarely fatal; for, as the state first induced is delirium, not sopor, suspicion is soon excited, and emetics may be made to act before a sufficient quantity of the poison has been absorbed to prove fatal. Hence few fatal instances have occurred in recent times. Mr. Wilmer, however, has mentioned two fatal cases occurring in children, and terminating within twenty-four hours.[^[2155]] M. Boucher, a writer in the old French Journal of Medicine, has referred to several cases of the same nature;[^[2156]] Gmelin has described the particulars of a good example;[^[2157]] and many others have been succinctly quoted by Wibmer, chiefly from the older authors.[^[2158]]

Cases of poisoning with this plant have occurred in man through other channels besides the stomach. Allusion has already been made to the instance of a tailor who was poisoned by an injection. A small quantity will sometimes suffice when administered in that way. A woman, whose case is mentioned in Rust’s Journal, was attacked with wild delirium, flushed face and glistening eyes, in consequence of receiving, during labour, a clyster, that contained six grains of the common extract;[^[2159]] and Dr. Simpson’s patient, who was severely affected, had only two grains.

Perhaps the berry is in some circumstances not very active. A French physician, M. Gigault of Pontcroix, says he has frequently had occasion to treat cases of poisoning with it, as accidents of the kind are extremely common in his neighbourhood; that he never knew it prove fatal; and that in one instance a young man took a pound of the berries before going to bed, and was not subjected to treatment till next morning, when he was found in a state of delirium, but speedily recovered after the free operation of emetics.[^[2160]]

Morbid Appearances.—I have hitherto seen but one good account of the appearances after death from poisoning with belladonna. It is described by Gmelin. The subject was a shepherd who died comatose twelve hours after eating the berries. When the body was examined twelve hours after death, putrefaction had begun, so that the belly was swelled, the scrotum and penis distended with fetid serum, the skin covered with dark vesicles, and the brain soft. The blood-vessels of the head were gorged, and the blood every where fluid, and flowing profusely from the mouth, nose, and eyes.[^[2161]] In the only other fatal case I have read, where the body was inspected, there appears to have been no unusual appearance at all.[^[2162]]

As the husks and seeds of the berries are very indigestible, some of them will almost certainly be found in the stomach, as happened in the instance last quoted. It should likewise be remembered that the best possible evidence of the cause of the symptoms may be derived during life from the presence of the seeds, husks, or even entire berries, in the discharges. If vomiting has not been brought on at an early period, we may expect to find these remains both in the vomited matter and in the alvine evacuations. Mr. Wilmer mentions an instance in which the black husks appeared in the stools brought away by laxatives at least thirty hours after the poison was swallowed.[^[2163]] One of Mr. Brumwell’s patients vomited the seeds towards the close of the third day.[^[2164]] Several patients of M. Boucher vomited fragments of the fruit on the second day, and passed more by stool and injections on the third, although they had been treated with activity from the commencement.[^[2165]]

While most of the cases of poisoning with belladonna have originated in accident, at the same time they have not been all of this description. Gmelin has quoted an instance of intentional and fatal poisoning by the juice of the berries being mixed with wine; and another singular case of poisoning with the decoction of the buds, given by an old woman for the purpose of committing theft during the stupor of the individual.[^[2166]]

Other species of atropa are probably similar to belladonna in properties. Wibmer quotes a single instance of frantic delirium occurring among several shepherds, as well as their cattle, from eating the herb of the A. mandragora.[^[2167]] This is well known to have been used anciently as a medicinal narcotic.

Of Poisoning with Thorn-Apple.

The thorn-apple, or Datura stramonium, is another plant of the same natural order, which it is proper to notice, because people have often been poisoned with it, and it has become a common ornament of our gardens. The cases of poisoning which have occurred in recent times in this country have been all accidental. But not long ago the thorn-apple appears to have been extensively used in Germany to cause loss of consciousness and lethargy, preparatory to the commission of various crimes.[^[2168]] It was also proved to have been used lately in France for this purpose. Some thieves made a man insensible with wine in which stramonium seeds had been steeped, and robbed him of five hundred francs while in this state. For twenty-four hours the victim knew nothing of what became of him; he was met wandering in a wood, affected with delirium, unconsciousness, staring of the eyes, and oppression of the breathing; and for some time he was taken for a madman.[^[2169]] In the Eastern Archipelago, according to Mr. Crawford, this is a common mode of committing theft and robbery.[^[2170]]

It is chiefly the fruit and seeds that have hitherto been examined; but the whole plant is probably poisonous. Brandes discovered in it a volatile, oleaginous, alkaline substance, which he supposed to be its active principle.[^[2171]] But, though his observations were confirmed by Bley,[^[2172]] it now appears that the real principle is a colourless, crystalline alkaloidal substance, of an acrid taste like tobacco, which was discovered more lately by Geiger and Hesse; this is named daturine, or daturia.[^[2173]]

The physiological effects of the extract have been determined by Orfila. He found that half an ounce killed a dog within twenty-four hours after being swallowed, that a quarter of an ounce applied to a wound killed another in six hours, and that thirty grains killed another when injected into the jugular vein. The symptoms were purely nervous, and not very prominent. Hence this poison, like the former, acts through the blood-vessels, and probably on the brain.[^[2174]] Bley’s daturia proves quickly fatal to small animals in the dose of a few drops. The crystalline daturia of Geiger and Hesse kills a sparrow in the dose of an eighth of a grain, and occasions great and persistent dilatation of the pupil when applied to the eye.

Symptoms in Man.—The symptoms produced by a poisonous dose in man are variable. The leading features are great delirium, dilatation of the pupils, and stupor; but sometimes spasms occur, and occasionally palsy.

Dr. Fowler has related the case of a little girl who took a drachm and a half of the seeds. In less than two hours she was attacked with maniacal delirium, accompanied with spectral illusions; and she remained in this state most of the following night, but had some intervals of lethargic sleep. Next morning, after the operation of a laxative, she fell fast asleep, and after some hours she awoke quite well.[^[2175]] In a case somewhat like this, related in Henke’s Journal, the child had general redness of the skin, swelling of the belly, locked jaw, tremors of the extremities, and an attitude and expression as if about to tumble into a pit. Recovery took place after the action of an emetic.[^[2176]]

In two instances, one related by Vicat in his treatise on the poisonous plants of Switzerland,[^[2177]] the other by Dr. Swaine[^[2178]] in the Edin. Phys. and Lit. Essays, the leading symptoms were furious delirium and palsy of the whole extremities. In the instances of three children related by Alibert there were delirium, restlessness, constant incoherent talking, dancing and singing, with fever and flushed face.[^[2179]] In another recorded by Dr. Young, there were some convulsions, and livid suffusion of the countenance.[^[2180]] In an instance communicated to me by my colleague Dr. Traill, where eighteen or twenty grains of extract of stramonium were taken by mistake for sarsaparilla, the symptoms were dryness of the throat immediately afterwards, then giddiness, dilated pupils, flushed face, glancing of the eyes, and incoherence, so that he seemed to his friends to be intoxicated: and subsequently there was incessant unconnected talking, like that of demency. Emetics were given without effect, and little amendment was obtained from blood-letting, leeches on the temples, cold to the head, or purgatives. But after a glass of strong lemonade vomiting took place, the symptoms began to recede, in ten hours he recognized those around him, and next day he was pretty well. Kaauw Boerhaave has related with great minuteness the case of a girl who very nearly lost her life in consequence of a man having given her the powder in coffee with the view of seducing her. The symptoms were redness of the features, delirium, nymphomania, loss of speech; then fixing of the eyes, tremors, convulsions, and coma; afterwards tetanic spasm and slow respiration with the coma. She was with much difficulty roused for a time by the operation of emetics, and eventually got well after her lethargy had lasted nearly a day.[^[2181]] In another related in Rust’s Magazin, and caused by a decoction of the fruit, which was mistaken for thistle-heads, the leading symptoms were spasmodic closing of the eyelids and jaws, spasms also of the back, complete coma, and excessive dilatation and insensibility of the pupil.[^[2182]] This case, which seems to have been a very dangerous one, was rapidly cured by free blood-letting. Blood-letting, indeed, seems peculiarly called for in poisoning with thorn-apple, on account of the strong signs of determination of blood to the head.—Gmelin has quoted several fatal cases, one of which endured for six hours only;[^[2183]] and Dr. Young says, that a child has been killed by a single apple.[^[2184]] The most complete account yet published of the phenomena of poisoning with stramonium when fatal is given by Mr. Duffin of London. A child of his own, two years old, swallowed about 100 seeds without chewing them. Soon after she became fretful and like a person intoxicated; in the course of an hour efforts to vomit ensued, together with flushed face, dilated pupils, incoherent talking, and afterwards wild spectral illusions and furious delirium. In two hours and a half she lost her voice and the power of swallowing, evidently owing to spasms of the throat. Then croupy breathing and complete coma set in, with violent spasmodic agitation of the limbs, occasional tetanic convulsions, warm perspiration, and yet an imperceptible pulse. Subsequently the pulse became extremely rapid, the belly tympanitic, and the bladder paralyzed, but with frequent involuntary stools, probably owing to the administration of cathartics; and death took place in twenty-four hours. At an early period twenty seeds were discharged by an emetic: the stools contained eighty; and none were found in the alimentary canal after death. There was never any marked sign of congestion of blood in the head, except flushed face at the beginning.[^[2185]] Dr. Droste of Osnaburg has related a fatal case occasioned by a decoction of 125 seeds given to remove colic. In fifteen minutes the patient became delirious, but soon fell apparently fast asleep, and died in seven hours without again awaking.[^[2186]]

Dangerous effects may result from the application of the thorn-apple to the skin when deprived of the cuticle. An instance has been lately published of alarming narcotism from the application of the leaves to an extensive burn.[^[2187]]

Morbid Appearances.—As to the morbid appearances, Droste found in his case redness of the cardiac end of the stomach, which contained two table-spoonfuls of a pulpy matter mixed with black and white grains, the remains of the teguments of the seeds; and there was also lividity of the back, lividity of the lungs, emptiness of the cavities of the heart, and gorging of the vessels of the brain. Haller says he once found general congestion of the brain and sinuses,[^[2188]]—an appearance which may naturally be expected, considering the signs of strong determination of blood towards the head, which often prevail during life. In Mr. Duffin’s case, however, the brain was healthy, not congested; the stomach and intestines presented no morbid appearance; and the only unusual appearances observed were a slight blush over the pharynx, larynx, and upper third of the gullet, thickening and swelling of the rima glottidis, and a semi-coagulated state of the blood.

Of Poisoning with Tobacco.

A plant of the same natural order with the two former, tobacco, the Nicotiana tabacum of botanists, is familiarly known to be in certain circumstances a virulent poison. Every part of the plant possesses active properties. It has been used as a poison in this country for criminal purposes.

Vauquelin analyzed it some time ago, and procured an acrid volatile principle which he called nicotine.[^[2189]] This substance, which was afterwards obtained in a purer state as a crystalline body by Hermbstädt, has been more recently ascertained by MM. Posselt and Reimarus to be nothing else than essential oil of tobacco, which is sold at ordinary temperatures; and they succeeded in procuring another principle which they consider the true nicotina. This is fluid at 29° F., volatile, extremely acrid, alkaline, and capable of forming crystallizable salts with some of the acids.[^[2190]] Tobacco then appears to contain an acrid alkaline principle, and an essential oil to which the alkaloid adheres with great obstinacy. The relation of the empyreumatic oil of tobacco to these principles has not been accurately ascertained, though it probably contains one or other of them. It is well known to be an active poison, which produces convulsions, coma and death. Mr. Morries-Stirling found that its active part is removed from the oil by washing with weak acetic acid, as he also observed in the instance of similar oils obtained from various narcotic vegetables.[^[2191]]

Process for detecting Tobacco in Organic mixtures.—In a medico-legal case which happened at Aberdeen in 1834, and of which some notice is taken at page [651], Dr. Ogston of that city successfully employed the following process for detecting tobacco in the contents of the stomach. The contents, consisting of a pulpy fluid, were acidulated with acetic acid, digested, and filtered; the liquid was treated with diacetate of lead, filtered again, freed of lead by hydrosulphuric acid, filtered a third time, treated with caustic potash, and then allowed to settle. The supernatant liquid, which had the taste of tobacco-juice, was separated and distilled to half its volume. The distilled liquor had a strong tobacco odour and taste, and some acridity, and gave a precipitate with infusion of galls. The residuum in the retort presented oily particles on its surface, and when heated in an open basin filled the apartment with a vapour which had a strong odour of tobacco smoke, and caused in several persons present a sense of acridity of the throat, watering of the eyes, and tendency to sneeze. Various additional experiments confirmatory of these results were also performed; and a simultaneous examination of tobacco-powder gave precisely the same indications. I am indebted to Dr. Ogston for these particulars and a detailed narrative of his investigation; which appears to supply a convenient and conclusive process for the detection of tobacco.—Perhaps the ordinary process for obtaining nicotina may also be employed with advantage. This consists in distilling the suspected substance with caustic potash, neutralizing the distilled liquor with sulphuric acid, concentrating the product to a thin syrup, exhausting this with etherized alcohol, evaporating off the solvent, and distilling the extract with strong solution of potash. Nicotina passes over, and may be recognized by its sensible and chemical qualities.

The effects of tobacco are somewhat different from those of belladonna and thorn-apple; but it is here arranged with them, as it belongs to the same natural family. Orfila remarked that 5½ drachms of common rappee, introduced into the stomach of a dog and secured by a ligature, caused nausea, giddiness, stupor, twitches in the muscles of the neck, and death in nine hours; and that two drachms and a quarter applied to a wound proved fatal in a single hour. Mr. Blake thinks tobacco has no direct action on the heart, even when admitted directly into the blood by the jugular vein;—that it acts primarily on the capillary circulation of the lungs, by obstructing which it prevents the blood from reaching the left cavities of the heart, and thus acts on that organ indirectly. For he observed, that laboured respiration always preceded any sign of depressed action of the heart, that forcible action of the heart often returned after its first cessation, and that its contractility continued after death.[^[2192]] An infusion of ten grains caused laborious breathing in ten seconds, and in twenty seconds temporary arrestment of the heart’s action, which then returned, and was attended for a time with increased arterial pressure. Soon afterwards the animal recovered, without any convulsions or loss of sensibility. Two scruples had the same effect. But when three drachms were used, convulsions succeeded similar phenomena, and death ensued in two minutes, the heart continuing to act for some time after respiration had ceased, until at length it was stopped by the usual consequences of asphyxia.[^[2193]] On the other hand, Sir B. Brodie found that the effects are very different, according to the form in which the poison is used. Thus four ounces of a strong infusion, when injected into the anus of a dog, killed it in ten minutes by paralyzing the heart; for after death the blood in the aortal cavities was arterial. But the empyreumatic essential oil does not act in that manner: it excites convulsions and coma, without affecting the heart. It may prove fatal in two minutes.[^[2194]] Like other violent poisons, tobacco has no effect when applied directly to the brain or nerves.[^[2195]] Two drops of the alkaloid, nicotina, injected into the jugular vein of a dog, begin to act in ten seconds, and will prove fatal in a minute and a half.[^[2196]]

Symptoms in Man.—The effects observed in man are allied to those produced in dogs by the infusion. In a slight degree they are frequently witnessed in young men, while making their first efforts to acquire the absurd practice of smoking. The first symptoms are acceleration and strengthening of the pulse, with very transient excitement, then sudden giddiness, fainting and great sickness, accompanied with a weak, quivering pulse. These effects are for the most part transient and trifling, but not always. Some degree of somnolency is not uncommon. Dr. Marshall Hall has given an interesting account of a young man who smoked two pipes for his first debauch, and in consequence was seized with nausea, vomiting, and syncope, then stupor, stertorous breathing, general spasms and insensible pupils. Next day the tendency to faint continued, and in the evening the stupor, stertor and spasms returned; but from that time he recovered steadily.[^[2197]] Gmelin has quoted two cases of death from excessive smoking,—caused in one by seventeen, in the other by eighteen pipes, smoked at a sitting.[^[2198]] It is likewise mentioned by Lanzoni that an individual fell into a state of somnolency and died lethargic on the twelfth day in consequence of taking too much snuff;[^[2199]] Dr. Cheyne says, “he is convinced apoplexy is one of the evils in the train of that disgusting practice;”[^[2200]] and I have met with an instance where the excessive use of snuff, occasioned twice, at distant intervals, an attack resembling imperfect apoplexy, united with delirium. Such cases, however, must be admitted to be rare; and the practice of taking snuff is in general unattended with injury.

Serious consequences have resulted from the application of tobacco to the abraded skin. In the Ephemerides an account is given of three children who were seized with giddiness, vomiting, and fainting from the application of tobacco-leaves to the head for the cure of ring-worm.[^[2201]] Dr. Merriman has also alluded to an instance of death in a child from the incautious employment of a strong decoction of tobacco as a lotion for ring-worm of the scalp.[^[2202]] And in Leroux’s Journal there is an account of a man, who, after using a tobacco decoction for the cure of an eruptive disease, was seized with symptoms of poisoning, and died in three hours.[^[2203]]

In recent times poisoning with tobacco has been often produced by the employment of too large doses in the way of injection. Richard has mentioned a case, not fatal, which arose from an infusion of five leaves in a choppin of water, used as an injection by a lady for costiveness. She was immediately seized with colic, giddiness, buzzing in the ears, headache, nausea, and then syncope of seven hours’ duration. During this period the breathing was difficult, the pulse very slow, the pupils dilated, the skin cold and moist, the urine suppressed, the efforts to vomit constant, and the belly depressed, contracted, and affected with constant borborygmus. She recovered under the use of emollient injections and fomentations.[^[2204]] Dr. Grahl of Hamburg has related minutely a fatal case, which arose from an ounce of rather more, boiled for fifteen minutes in water, and administered by advice of a female quack. The individual, who laboured merely under dyspepsia and obstinate costiveness, was seized in two minutes with vomiting, violent convulsions, and stertorous breathing, and died in three-quarters of an hour.[^[2205]] Another accident of the same kind is noticed in the Journal de Chimie Médicale, where the person became as it were intoxicated, and died immediately. Instead of an infusion of two drachms she had used a decoction of two ounces.[^[2206]]—M. Tavignot describes the following remarkable case occasioned by a similar dose. An infusion prepared by mistake with two ounces and one drachm, instead of a drachm and a half, was used as an injection for a stout man affected with ascarides. In seven minutes he was seized with stupor, headache, paleness of the skin, pain in the belly, indistinct articulation, and slight convulsive tremors, at first confined to the arms, but afterwards general. Extreme prostration and slow laborious breathing soon ensued, and then coma, which ended fatally in eighteen minutes.[^[2207]]—Even two drachms, however, or a drachm and a half, are by no means a safe dose. An anonymous writer in the Medical and Surgical Journal says a patient of his died in convulsions an hour or two after receiving a clyster composed of two drachms infused in eight ounces.[^[2208]] Nay, in the Acta Helvetica there is an account by an anonymous writer of the case of a woman, who, after an injection made with one drachm only, was seized with pain in the belly, anxiety and faintings, proving fatal in a few hours.[^[2209]] And a case, fatal in thirty-five minutes, which was occasioned by the same dose, occurred not long ago in Guy’s Hospital, London.[^[2210]]

Tobacco is an equally deadly poison when swallowed in large quantity. M. Caillard has related the particulars of the case of a lunatic, who, having swallowed half an ounce of snuff during a lucid interval, was seized with vomiting, and afterwards with oppression, incoherence, cold sweats, a slow full pulse, and dilated pupils; but he slowly recovered.[^[2211]] The French poet Santeuil was killed in this way by a practical joker at the Prince of Condé’s table. When the bottle had circulated rather freely, a boxful of Spanish snuff was emptied into a large glass of wine, and thus administered to the unlucky victim, who was in consequence “attacked with vomiting and fever, and expired in two days amidst the tortures of the damned.”[^[2212]] The following important case has been communicated to me by Dr. Ogston of Aberdeen, who was employed in the judicial investigations connected with it. An elderly man, a pensioner, was seen to enter a brothel, while in perfect health; and in an hour he was carried out insensible and put down in a passage, where he was found by the police unable to speak or move. While carrying him to the watch-house hard by, the officers observed him attempt to vomit; but he was scarcely laid down before the fire, when he expired. It was ascertained, that he had drunk both rum and whisky in the brothel, and that something had been given him “to stupefy him or set him asleep.” On dissection the blood was found every where very fluid, and four ounces of serosity were collected from the lateral ventricles and base of the skull. But there was no other unusual appearance, except that the stomach contained about four ounces of a thick brownish pulp, in which were seen several pellets of a powder resembling snuff. In these contents Dr. Ogston could not detect any opium; but he detected tobacco by the process mentioned above. No doubt could exist that the man died of poisoning with tobacco; but as no evidence could be obtained to inculpate any one in particular of many individuals who were in the brothel with him, the case was not made the subject of trial.

Evidence is not wanting, therefore, to prove that this plant is a very active poison; yet every one knows that under the influence of habit it is used in immense quantities over the whole world as an article of luxury, without any bad effect having ever been clearly traced to it. Its poisonous qualities were known in Europe as soon as it was brought from America; and the belief that such properties could not fail to be attended, as in the case of spirits and opium, with evil consequences from its habitual use, led to much opposition on the part of various governments to its introduction. Soon after it was brought to England by Sir W. Raleigh, King James wrote a philippic against it, entitled “The Counter-blaste to Tobacco.” Some countries even prohibited it by severe edicts. Amurath the 4th in particular made the smoking of tobacco capital; several of the Popes excommunicated those who smoked in the church of St. Peter’s; in Russia it was punished with amputation of the nose; and in the Canton of Bern it ranked in the tables next to adultery, and even so lately as the middle of last century a particular court was held there for trying delinquents.[^[2213]] Like every other persecuted novelty, however, smoking and snuff-taking passed from place to place with rapidity; and now there appear to be only two luxuries which yield to it in prevalence, spirituous liquors and tea.

The only accounts I have seen of the morbid appearances after poisoning with tobacco are contained in the cases of Dr. Grahl and Dr. Ogston. In the former there was great lividity of the back, paleness of the lips, flexibility of the joints (two days after death), diffuse redness of the omentum without gorging of vessels, similar redness with gorging of vessels both on the outer and inner coats of the intestines, in some parts of the mucous coat patches of extravasation, unusual emptiness of the vessels of the abdomen; while the stomach was natural, the lungs pale, the heart empty in all its cavities, and the brain natural. The appearances in Dr. Ogston’s case have been already stated.

Writers on the diseases of artisans have made many vague statements on the supposed baneful effects of the manufacture of snuff on the workmen.[^[2214]] It is said they are liable to bronchitis, dysentery, ophthalmia, carbuncles and furuncles. At a meeting of the Royal Medical Society of Paris, however, before which a memoir to this purport was read, the facts were contradicted by reference to the state of the workmen at the Royal Snuff Manufactory of Gros-Caillou, where 1000 people are constantly employed without detriment to their health.[^[2215]] This subject was afterwards investigated with care by MM. Parent-Duchatelet and D’Arcet, who inquired minutely into the state of the workmen employed at all the great tobacco-manufactories of France, comprising a population of above 4000 persons; and the results at which they arrived are,—that the workmen very easily become habituated to the atmosphere of the manufactory,—that they are not particularly subject either to special diseases, or to disease generally,—and that they live on an average quite as long as other tradesmen.[^[2216]] These facts are derived from accurate statistical returns, showing the number of days each person was annually off work from sickness, the ages at which superannuated allowances were granted, the period of death, and the prevalent diseases.

CHAPTER XXXIV.
OF POISONS OF THE UMBELLIFEROUS ORDER OF PLANTS.

The Natural Order Umbelliferæ contains a variety of plants, to which narcotico-acrid properties have been at different times ascribed. But these properties have been satisfactorily traced in the instance of four species only, the Conium maculatum, Œnanthe crocata, Cicuta virosa, and Æthusa cynapium. It is supposed that others may be poisonous. But the facts on the subject are equivocal; for the several species of the family are very apt to be confounded with one another, and there is reason to think that other species have repeatedly been mistaken for one of the four already mentioned.

The symptoms caused by the umbelliferous narcotics comprehend chiefly coma, convulsions, paralysis, and delirium. But the knowledge possessed on this head is rather vague, and the phenomena are not unfrequently complex and difficult to observe with accuracy; so that their nature has been sometimes misunderstood. The irritant properties of the poisons of this tribe of narcotico-acrids are seldom well defined.

Of Poisoning with Hemlock.

The first to be mentioned is the common hemlock, or Conium maculatum, one of the most abundantly diffused of umbelliferous vegetables. It is distinguished from all those which it resembles by its tall, smooth, spotted stem,—its smooth leaves,—the rugged edge of the five ribs of its fruit,—its singular mousy odour,—and the very peculiar odour of conia, emitted when the pulp or juice of the leaves is mixed with caustic potash. The only other umbelliferous native which has a spotted stem, the Myrrhis temulenta, is easily distinguished from hemlock by the whole plant being very hairy.

Cases of poisoning with hemlock are not infrequent on the continent, the root having been mistaken for fennel, asparagus, parsley, but particularly parsnep.[^[2217]] It is generally believed to have furnished the poison which was used in ancient times, and especially among the Greeks, for despatching criminals; but we have not any precise information on the subject.

A peculiar alkaloid was indicated in hemlock not long ago by Brandes, half a grain of which killed a rabbit with symptoms like those of tetanus.[^[2218]] Other chemists were unable to obtain his results. But the subject was afterwards taken up with success by Geiger, who obtained from the plant a volatile, oleaginous alkaloid, which possesses great energy as a poison.[^[2219]] Mr. Morries-Stirling procured from hemlock by destructive distillation an empyreumatic oil similar in properties to those of hyoscyamus, stramonium and tobacco, but producing in animals a state of pure coma.[^[2220]]

The effects of hemlock on the animal system have been variously described by different observers. Sometimes they have appeared to be purely soporific like those of opium; at other times they have resembled the effects of belladonna and thorn-apple; and in the lower animals they are quite different, as I have witnessed them, from what they have been described to be in man,—the phenomena being simply those of asphyxia from paralysis of the muscles, without material convulsions and without insensibility. Its irritant action is not well established.

Orfila observed that an ounce of the extract of the leaves killed a dog in forty-five minutes when swallowed, ninety grains killed another through a wound in an hour and a half, and twenty-eight grains another through a vein in two minutes. It therefore acts by entering the blood-vessels. The extract is a very uncertain preparation; the reason of which is, that the alkaloid conia is very easily decomposed in its natural state of mixture by heat or age, being converted into an inert resinoid matter,—that the dried leaves of hemlock contain scarcely any of it,—and that even an extract of the fresh leaves contains little, unless prepared with a gentle heat, yet speedily.[^[2221]] The symptoms remarked by Orfila were convulsions and insensibility; and in the dead body the blood of the left cavities of the heart was sometimes found arterial.—The result of my observations is quite at variance with this statement. In various experiments with a strong extract prepared from the green seeds with absolute alcohol, the only effect I could remark were palsy, first of the voluntary muscles, next of the chest, lastly of the diaphragm,—asphyxia in short from paralysis, without insensibility, and with slight occasional twitches only of the limbs, and the heart was always found contracting vigorously for a long time after death. Thirty grains of a soft extract introduced between the skin and muscles of the back killed a rabbit in five minutes, and a five months’ puppy in twenty minutes.[^[2222]]

The root is much less energetic than is represented by some authors, and probably varies in this respect at different seasons. I have found that four ounces and a half of juice, the produce of twelve ounces of roots collected in November, had no effect on a dog when secured in its stomach by a ligature on the gullet; and that four ounces obtained from ten ounces of roots in the middle of June, when the plant was coming into flower, merely caused diarrhœa and languor. Orfila had previously observed that three pounds of roots had no effect in the month of April; but that two pounds in the end of May, when the plant was in full vegetation, killed a dog in six hours.[^[2223]] The alcoholic extract of the juice obtained from six ounces of roots on the last day of May, I have found to kill a rabbit in thirty-seven minutes, when introduced in a state of emulsion between the skin and muscles of the back; and the effects were analogous to those obtained with the extract of the leaves. The differences depending on season will probably account for various persons having found the juice of the root harmless. Gmelin quotes an instance where four ounces of the juice were taken without injury. He adds another where three ounces of the juice of the herb were swallowed daily for eight days with as little effect. But, as he judiciously observes, other less active plants have probably been sometimes mistaken for hemlock.[^[2224]]

The alkaloid, conia, seems to be the active principle of hemlock, and is a poison of extraordinary virulence. On investigating this subject in 1835,[^[2225]] I found that it is a local irritant, possessing an acrid taste, and capable of exciting redness or vascularity in any membrane to which it is applied; but that these topical effects are readily overwhelmed by its swift and intense narcotic action. This action consists of swiftly spreading palsy of the muscles, which affects first those of voluntary motion, then the respiratory muscles of the chest and abdomen, and lastly the diaphragm, so as to terminate by causing asphyxia. The paralytic state is usually interrupted from time to time by slight convulsive twitches of the limbs and trunk at the beginning. The muscular contractility is impaired or annihilated by the topical action of the poison, but not by its indirect action through absorption. The heart is not appreciably affected; for it contracts vigorously long after all motion, respiration, and other signs of life are extinct; and it contains after death, not florid but dark blood in its left cavities. The blood undergoes no alteration. The external senses are little, if at all impaired, until the breathing is almost arrested; and volition too is retained. But a contrary inference may be drawn by a careless observer, in consequence of the paralytic state taking away the means, by which in animals sensation is expressed and volition exercised. The action of conia, in short, is confined to the spinal cord; and it acts as a sedative, by exhausting the nervous energy.

Conia is probably a deadly poison to all orders of animals: at least I found it to be so to the dog, cat, rabbit, mouse, frog, fly, and flea; and Geiger killed the kite, pigeon, sparrow, slow-worm, and earth-worm with it. It acts through every texture where absorption is carried on readily, through the stomach, eye, lungs, cellular tissue, peritonæum, or veins; and its activity is in proportion to the speed with which absorption is carried on in the part. It acts therefore through absorption. Its activity is increased by neutralization with an acid, by which it is rendered much more soluble in water. Few poisons equal it in subtility and swiftness. A single drop, applied to the eye of a rabbit, will kill it in nine minutes; and three drops in the same way will kill a strong cat in a minute and a half. Five drops, introduced into the throat of a little dog, began to act in thirty seconds, and proved fatal in one minute. And when two grains, neutralized with thirty drops of weak hydrochloric acid, were injected into the femoral vein of a young dog, it died before there was time to note the interval, so that only two or three seconds at most had elapsed, before all internal signs of life were extinct. This extraordinary rapidity of action seems incompatible with its operation taking place by conveyance of the poison with the blood to the spinal cord. Mr. Blake, as formerly mentioned (p. [15]), denies that its action in this way was ever so swift in his hands, and alleges that he could never observe the interval to be shorter than fifteen seconds. If the reader, however, will consult the original account of my experiment,[^[2226]] which was made along with Dr. Sharpey, he will see that we could scarcely be mistaken as to the interval in that instance.

Symptoms in Man.—M. Haaf, a French army-surgeon, has described a fatal case of poisoning with hemlock, which closely resembled poisoning with opium. The subject of it, a soldier, had partaken along with several comrades of a soup containing hemlock leaves, and appeared to them to drop asleep not long after, while they were conversing. In the course of an hour and a half they became alarmed on being all taken ill with giddiness and headache; and the surgeon of the regiment was sent for. He found the soldier, who had fallen asleep, in a state of insensibility, from which, however, he could be roused for a few moments. His countenance was bloated, the pulse only 30, and the extremities cold. The insensibility became rapidly deeper and deeper, till he died, three hours after taking the soup.[^[2227]] His companions recovered.

Dr. Watson has briefly described two cases which were fatal in the same short space of time. The subjects were two Dutch soldiers, who, in common with several of their comrades, took broth made with hemlock leaves and various other herbs. Giddiness, coma, and convulsions were the principal symptoms. The men who recovered were affected exactly as if they had taken opium.[^[2228]]

When the dose is not sufficient to prove fatal, there is sometimes paralysis, attended with slight convulsions, as in a case noticed by Orfila.[^[2229]] More commonly there is frantic delirium. Matthiol has related an instance of this last description, occurring in the cases of a vine-dresser and his wife, who mistook the roots for parsneps Both of them became in the course of the night so delirious that they ran about the house, knocking themselves against every object which came in their way.[^[2230]] Kircher, as quoted by Wibmer, tells a parallel story of two monks who became so raving mad after eating the roots, that they plunged into water, imagining that they were turned into geese, and they were affected for three years with incomplete palsy and neuralgic pains.[^[2231]] These and some other cases of the like kind, recorded by the older medical authors, must be received with reserve. Independently of other considerations, there is often no certainty that the poison was really the hemlock of modern botanists, and not some other umbelliferous vegetable.

Morbid Appearances.—In Haaf’s case the vessels of the head were much congested; and the blood must have been very fluid, for on the head being opened a quantity flowed out, which twice filled an ordinary chamber-pot. This state of the blood likewise occurred in a case which I examined here some years ago along with Dr. C. Coindet of Geneva. A hypochondriacal old woman took by advice of a neighbour two ounces of a strong infusion of hemlock leaves with the same quantity of whisky, which she swallowed in the morning fasting. She died in an hour, comatose and slightly convulsed. The vessels within the head were not particularly turgid; but the blood was everywhere remarkably fluid. Dr. Coindet subsequently found that a small portion of the infusion prevents fresh drawn blood from coagulating; but I suspect there must have been some mistake here, for a carefully prepared alcoholic extract of very great power, which was used in my experiments alluded to above, had no such effect on blood fresh drawn from rabbits and dogs. On account of this extreme fluidity of the blood, it often flows from the nose, but the skin is much marked with lividity.[^[2232]] The fluidity of the blood is nothing more than the result of the proximate cause of death,—slowly formed asphyxia.

Of Poisoning with Water-Hemlock.

Another plant of the order Umbelliferæ, the water-hemlock or Cicuta virosa, possesses also great energy as a poison; and in its effects it appears to resemble considerably the hydrocyanic acid. The plant is indigenous. It is easily known from other umbelliferous species inhabiting watery places by the peculiar structure of its root-stock, which is not fleshy, but hollow, and composed of a number of large cells with transverse plates.

From a numerous set of experiments with the root of the cicuta performed by Wepfer, it appears to cause true tetanic convulsions in frequent paroxysms, and death on the third day.[^[2233]] Simeon ascertained that the alcoholic extract of the root is very poisonous.[^[2234]] Schubarth found that an ounce of the juice of the stems and leaves, collected after the flowers had begun to blow, produced no effect on the dog.[^[2235]] It is probably inert, or at all events feebly poisonous in this climate, although it grows luxuriantly in many localities. I have found that twelve ounces of juice, expressed from sixteen ounces of roots in the beginning of August, merely caused some efforts to vomit, when secured in the stomach of a dog by a ligature on the gullet; that the alcoholic extract of twelve ounces of leaves gathered at the same time had no effect when introduced in the form of emulsion between the skin and muscles of the back of a rabbit; and that the alcoholic extract of two ounces of unripe seeds proved equally inert when imployed in the same way.

Symptoms in Man.—Wepfer has likewise related several instances which occurred in the human subject. Among the rest he has described the cases of eight children who ate the roots instead of parsneps. Of those who were seriously affected, one, a girl six years old, who ultimately recovered, had tetanic fits, followed by deep coma, from which it was impossible to rouse her for twenty-four hours. Two of them died. The first symptoms in these two were swelling in the pit of the stomach, vomiting or efforts to vomit, then total insensibility, with involuntary discharge of urine, and finally severe convulsions, during which the jaws were locked, the eyes rolled, and the head and spine were bent backwards, so that a child might have crept between the body and the bed-clothes. One of them died half an hour after being taken ill, and the other not long after.[^[2236]] Mayer of Creutsburg mentions four cases, which were occasioned by the roots. One of the individuals, a child three years old, was attacked with colic, vomiting, and convulsions, and died in a few hours. The three others, the eldest of whom was six years of age, had coldness, paleness of the features, dilated immoveable pupils, violent colic, general spasms, and insensibility. The action of the heart was intermitting and the breathing oppressed. After the remains of the roots were brought up by emetics, and infusion of gall was administered, they gradually recovered. They had eaten between them no more than a single root weighing about two ounces, as they had in their possession another of that weight, which they said was not so large. This accident happened in the middle of March.[^[2237]]

According to Guersent, poisoning with the cicuta commences with dimness of sight, giddiness, acute headache, anxiety, pain in the stomach, dryness in the throat, and vomiting.[^[2238]]

Mertzdorff has related the particulars of the inspection of three cases which proved quickly fatal with convulsions and vomiting. Nothing remarkable seems to have been found except great gorging of the cerebral vessels.[^[2239]]

Of Poisoning with Hemlock Dropwort.

The Œnanthe crocata of botanists, the hemlock dropwort, five-finger-root, or dead-tongue of vernacular speech in England, a species of the same family with the last two, and an abundant plant in some localities throughout this country, has usually been held one of the most virulent of European vegetables. It seems well entitled to this character in general; but climate, or some other more obscure cause, renders it inert in some situations.

It is said to be liable to be confounded with common hemlock, or Conium maculatum,—a mistake which can happen only in very ignorant hands. It has smooth, dark-green leaves, more fleshy, and much less minutely divided, than those of hemlock; it presents a purplish appearance at the joints only of the stem, and no diffused purple spots; its fruit is oblong and black, not round, rough, and light brown; and its root, instead of being single, long, tapering, and little branched, consists of from two to ten tubers, like fingers, which are white, and terminate in a few rootlets. These tubers are formed annually in summer from the flowering stem of the season, and send out flowering stems the subsequent year. During the first autumn, winter, and spring they are firm, white, and amylaceous; but in their second summer they become more pulpy, less amylaceous, and grayer. At all times they emit, when broken across, an oleo-resinous juice, which quickly becomes yellow; this juice abounds most when the plant, which is growing at their expense, is about to flower; and it abounds much more at this period in localities in the south of England, than in Scotland, especially in the neighbourhood of Edinburgh.

Brotero and some others have attempted to subdivide the species into two, the Œnanthe crocata proper, and the Œ. apiifolia. But the best authorities deny that these can be distinguished; and from what I have now seen in sundry localities, it appears to me that the distinctions pointed out by Brotero, confessedly obscure enough in themselves, are the result of differences in climate, soil, and situation.

The only analysis of this plant with which I am acquainted is one executed in 1830 by MM. Cormerais and Pihan-Dufeillay, who found in the root a resinoid matter, which adheres obstinately to the solid portion of it, and which seems to be the active ingredient.[^[2240]] I have subjected the roots to various processes, and among the rest to that by which Geiger detected conia in hemlock, but without discovering any indication of the existence of an alkaloid. My materials, however, were not well fitted for a chemical analysis; because the œnanthe root of this neighbourhood is inert or nearly so. The whole plant contains a heavy-smelling volatile oil, which may be obtained by distillation in the usual way, and most abundantly from the ripe seeds. This oil is yellowish, viscid, and inert.

It is strange that a plant, so universally considered a potent poison, and so frequently the cause of fatal accidents, has not yet been made the subject of physiological investigation. A few imperfect experiments by M. Cormerais and his companion, made with the resinoid matter of the roots, show that this substance produces in animals dulness, convulsions of the voluntary muscles, a semi-paralytic state of the hind legs, and sometimes shortness of breath, vomiting, and fluid evacuations by stool. All the animals experimented on recovered. On repeating these experiments with larger quantities I found the resin of the root, grown near Woolwich, and kindly sent to me by Dr. Pereira, to be a poison of great energy and singular properties. Twenty-four grains obtained from eight ounces of roots in the middle of December, when introduced in the form of emulsion between the skin and muscles of the rabbit, caused in half an hour depression, uneasiness, and hurried breathing,—then twitches of the ears, neck, and fore-legs,—next combined spasm and convulsive starting of the head and limbs,—then, after a quiet interval, a more violent fit of the same kind, affecting the whole body with a singular combination of tetanus and convulsive starting,—finally, after several such fits, a paroxysm more violent than before, ending in immoveable tetanic rigidity, which speedily proved fatal, 78 minutes after the application of the poison. No morbid appearance could be detected in the body. The heart contracted vigorously for some time after death. These phenomena correspond in the main with what has been recorded of the symptoms caused by the roots in man.—Dr. Pereira informs me he had found the juice both of the root and leaves to act as a poison, either when introduced into the peritonæum, or when injected into the veins; and in the latter way it was so energetic as to prove fatal in one minute.

Symptoms in Man.—Since Lobel first took notice of the poisonous properties of the œnanthe root in 1570, an uninterrupted series of observations has been published, down to the present day, showing that in France, Germany, Holland, Spain, and various parts of England as far north as Liverpool, it is at all seasons of the year, even in October and in the beginning of January, a poison of great activity. In several of the cases death has been occasioned by a single handful of the roots, in one instance by a piece no bigger than the finger, or even in consequence of the individuals merely tasting them. A girl seems to have had a narrow escape after eating, with an interval of three hours, two pieces of the size of a walnut. Very seldom has death been delayed beyond four hours, and on some occasions a single hour has been sufficient. Sometimes the symptoms have been slow in making their appearance, an hour and a half having occasionally elapsed before the effects were evident; but in every instance their progress was rapid, once the symptoms had fairly set in; and some died in convulsions almost immediately after being taken ill.

The particular effects have been variable. Most generally the first symptoms have been giddiness and staggering, as if from ordinary intoxication, occasionally headache, and often extreme feebleness of the limbs. Stupor has then generally succeeded, sometimes with the intervention of efforts to vomit, sometimes too with an interval of delirium. Convulsions have also commonly made their appearance in the next place; and ere long a state of insensibility has ensued attended in every instance with occasional violent convulsive fits like epilepsy, and with permanent locked-jaw; which symptoms have continued till near death. In one or two cases the individual has suddenly, without any premonitory symptoms, fallen down convulsed, and died almost immediately. In one or two instances again, the effects have rather been those of irritant poisoning, namely, inflammation of the mouth and throat, spasms of the muscles of the throat, vomiting, and excessive weakness and faintness, without any convulsions or insensibility.—It appears then that this plant is a true narcotico-acrid poison. The emanations from the plant are said on some occasions to have proved injurious; but the effect here was probably the work of the imagination.

Aware of these singular properties being generally ascribed to the Œnanthe crocata, I was anxious to make a methodical examination of the subject, physiologically as well as chemically,—especially as the plant grows in great abundance and very luxuriantly in a locality not far from Edinburgh. But I have found it in that situation, to all appearance, quite inert. The juice of fourteen ounces of the root in the end of October had no effect on a little dog when secured in the stomach by a ligature on the gullet. The juice of sixteen ounces in the middle of June was also without effect. An alcoholic extract of four ounces of the full grown leaves in the end of June, introduced into the cellular tissue in the form of emulsion, had no effect on a rabbit. An alcoholic extract of three ounces of the ripe seeds was administered in the same way with the same result. Finally, the resinoid extract of eight ounces of the root, analogous to that which had proved so deadly in my hands when obtained from Woolwich plants, had also no effect whatever, when prepared from those growing in the neighbourhood of Edinburgh. Relying upon these results, I ate a whole tuber weighing an ounce, without observing any effect, except its disagreeable taste; which was the only circumstance that prevented me from trying a larger quantity.—It may be well to add, that, amidst the numerous cases of poisoning with œnanthe now on record, there is not one that has occurred in Scotland. At the same time, the common people in Scotland are not at all given to rash experiments in cookery, or to make use of vegetables not produced by the care of the gardener or farmer.[^[2241]]

The only other locality from which I have been hitherto able to obtain plants for examination is the neighbourhood of Liverpool, where a fatal case of poisoning with it occurred near the close of last century. When the juice of sixteen ounces of this root in the beginning of September was secured in the stomach of a dog, efforts to vomit were produced, followed by several fits of violent convulsions and spasm of the voluntary muscles, a paralytic state of the fore-legs, and a constant tendency to fall backwards; but the animal recovered.

No morbid appearances of any note have been observed after death in any of the fatal cases which are recorded.—The most appropriate treatment consists in the prompt employment of emetics, and diffusible stimulants.

Of Poisoning with Fool’s Parsley.

Another umbelliferous plant of great activity is fool’s parsley, or Æthusa cynapium. It has occasioned several accidents by reason of its resemblance to parsley,—from which, however, it is at once distinguished by the leaves being dark and glistening on their lower surface, and by the nauseous smell they emit when rubbed. It contains an alkaloid, which crystallizes in rhombic prisms, and is soluble in water and alcohol, but not in ether. It was discovered by Professor Ficinus of Dresden.[^[2242]]

Orfila found that six ounces of the juice, when retained in the stomach of a dog, by a ligature, caused convulsions and stupor, and death in an hour.[^[2243]]

Symptoms in Man.—Some interesting information on the characters and properties of this plant is contained in the Medical and Physical Journal. Among other cases the writer relates those of two ladies who ate a little of it in a sallad instead of parsley, and who were soon seized with nausea, vomiting, headache, giddiness, somnolency, pungent heat in the mouth, throat, and stomach, difficulty in swallowing and numbness of the limbs.[^[2244]] Gmelin has related the case of a child, who died in eight hours in consequence of having eaten the æthusa. The symptoms were spasmodic pain in the stomach, swelling of the belly, lividity of the skin, and difficult breathing.[^[2245]] In two children who recovered, the chief symptoms at the height of the poisoning were complete insensibility, dilated, insensible pupil, and staring of the eyes. In one of them there was also frequent vomiting, in the other convulsions. The treatment consisted in the administration of milk, sinapisms to the legs, and cold spunging with vinegar.[^[2246]]

CHAPTER XXXV.
OF THE NARCOTIC RANUNCULACEÆ.

The greater part of the poisons belonging to the Natural Family Ranunculaceæ are acrid only in their action, and have been already taken notice of among the irritants. Two only are yet known to possess narcotic properties, namely, monkshood, and black hellebore. The latter is a true narcotico-acrid. The former has till lately been always considered so; but its acrid properties seem doubtful or feeble, while its action on the nervous system is most intense.

Of Poisoning with Monkshood.

Monkshood, the Aconitum napellus of botanists, is an active poison, and has commonly been considered a true narcotico-acrid. But its effects have been hitherto much misunderstood. It has been used for criminal purposes in Ireland; and in 1841, a woman, M’Conkey, who was executed there for poisoning her husband, was proved to have administered this substance [see p. [61]]. The root of another species, the A. ferox, is well known to be in common use as a poison, under the name of Bikh, in Bengal, and Nabee, in the Madras Presidency.

The toxicological history of the genus, and of this species in particular, has been rendered complex and obscure, by the extreme difficulty of distinguishing accurately the several species from one another. The whole genus, now a numerous one, is generally conceived to be eminently poisonous. But from some observations of my own, as well as an elaborate inquiry, not yet made public, by Dr. Alexander Fleming,[^[2247]] a recent graduate of this university, I am inclined to think that this is a mistake, that the poisonous species are not numerous, and that many aconites are inert, at least in this climate.

The A. napellus, a doubtful native of Britain, and the most common species in our gardens, shoots up annually a leafy stem from a black, tapering, spindle-shaped root. The stem, which is from two to five feet high, ends in a long dense spike of fine blue flowers; and when the seeds ripen in autumn, it dies down, and the root also shrivels and perishes. But in the spring, while the stem is rising, one or more tubers form near the crown of the root; each tuber quickly assumes the spindle-shaped form of its parent, but has a light brown, instead of a brownish-black tegument; and when the plant is in flower, the new tuber, destined for the root of next year’s plant, is as large as the parent one, firmer, more amylaceous, and not so apt to shrivel in drying. This mode of propagation has led some to describe the root erroneously as sometimes palmated. Dr. Fleming considers the young, full-grown tuber to be the most active part of the plant; but the root of the existing plant, the leaves, and also the seeds, are highly energetic; and every part is more or less so.

Every part of the A. napellus, but especially the root, affects remarkably the organs of taste, producing a very singular sense of heat, numbness, and tingling of those parts of the mouth to which it is applied. Dr. Fleming has ascertained, that this peculiar taste, or rather sensation, is a property belonging to the narcotic principle of monkshood, and that in all probability it is a measure of the activity of the plant as a poison. It is most intense in the root, next in the seeds, and next in the leaves before the flowers blow. Geiger first ascertained, and I have since observed, that the sensation thus occasioned by the leaves diminishes in intensity as the flowers expand, and almost disappears when the seeds ripen. Contrary to what has been often stated, it is not diminished by drying the leaves, even with the heat of the vapour-bath. Nor is it materially lessened by time, if the dried leaves be preserved with care; for I have found it intense after six years. Geiger observed some years ago, that several species or varieties do not possess it. I have ascertained that A. napellus, sinense, tauricum, uncinatum, and ferox, possess it intensely, A. schleicheri and nasutum feebly, A. neomontanum very feebly; all of which are therefore probably poisonous, in proportion to the intensity of their taste. A. ferox, well known as a deadly poison in the East, and undoubtedly the most virulent of all the species, produces by far the most intense and persistent effect on the mouth of all the species I have had an opportunity of examining. Those which do not produce it at all, at least in this climate, are A. paniculatum, lasiostomum, vulparia, variegatum, nitidum, pyrenaïcum, and ochroleucum. It would be premature to say that all these species are inert; but I suspect they are: and, at all events, I have ascertained that the leaves of A. paniculatum, although the officinal species recognised in the London Pharmacopœia, are quite inactive in this climate; and Dr. Fleming has found the root inert in medicinal doses of considerable magnitude.

The properties of monkshood have been traced by Geiger and Hesse to a peculiar alkaloid, named aconitina: which is white, pulverulent, fusible, not volatile, soluble in ether and alcohol, sparingly so in water, and capable of forming crystallizable salts with acids. It produces most intensely the peculiar impression caused by the plant on the mouth, tongue, and lips; and it is a poison of tremendous activity, probably indeed the most subtle of all known poisons. Although not a volatile principle, it has been supposed peculiarly liable to decomposition by heat, at least in its natural state of combination in the plant or its pharmaceutic preparations. This opinion is founded on the uncertainty of the medicinal action of the common extract of the shops, and on the results of experiments on animals by Orfila.[^[2248]] In one experiment he found that half an ounce of the extract of the Parisian shops had no effect at all on a dog, while a quarter of an ounce killed another within two hours. Careless preparation may account for such differences; but at the same time an error in choosing the species of plant is an equally probable explanation. The properties of monkshood appear to me to resist a heat of 212°, either in drying the plant or in preparing an extract from it.

The medico-legal chemistry of monkshood has not been studied. If any of the suspected matter be obtained in a pure state, its best character is its remarkable taste; to which I have found nothing exactly similar in the numerous trials I have made with other narcotic and acrid plants. A complex substance, such as the contents of the stomach, or vomited matter, should be evaporated over the vapour-bath to the consistence of thin syrup, and agitated with absolute alcohol. The filtered alcoholic solution being then evaporated, the extract may be subjected to the sense of taste.

Action.—The action of monkshood is a subject of great interest, but has hitherto been much misunderstood. Sir B. Brodie, who was the first to examine it in recent times, found that the leading phenomena in animals, were staggering, excessive weakness, slow laborious respiration, and slight convulsive twitches before death.[^[2249]] Had these observations been followed up by his successors with a discriminating eye, toxicologists would not have been so much misled as they have been. Orfila, who was the next to examine the subject experimentally, failed to appreciate the phenomena with exactness.[^[2250]] He thinks monkshood acts peculiarly upon the brain, causing delirium, and that it is a local irritant, capable of developing more or less intense inflammation. A single experiment made in 1836 convinced me that the former statement is incorrect, and led me to consider that the symptoms depend in a great measure on gradually-increasing paralysis of the muscles, which terminates in immobility of the chest and diaphragm, and consequent asphyxia. Dr. Pereira, in some experiments with an alcoholic extract, published in 1842, took notice of two remarkable phenomena,—an extraordinary diminution of common sensation, evidenced by the animal being insensible to pinching and pricking,—and the total absence of stupor, as shown by the animal following its owner, and recognizing him when called.[^[2251]] Similar observations have been made in poisoning with monkshood in man. The ablest investigation yet undertaken into the actions of this substance is contained in the unpublished Inaugural Dissertation of Dr. Fleming.

He found that the most remarkable symptoms are weakness and staggering, gradually increasing paralysis of the voluntary muscles, slowly increasing insensibility of the surface, more or less blindness, great languor of the pulse, and convulsive twitches before death. He farther observed that the pupil becomes much contracted; that the irritability of the voluntary muscles is impaired; that the veins are congested after death, the blood unaltered, and the heart capable of contracting for some time after respiration has ceased. Lastly, he maintains that this poison has not, as is generally thought, any irritant properties, that neither the plant, nor its extract, nor its alkaloid occasions vascularity in any membrane to which it is applied, even, for example, in the lips or tongue while burning and tingling from its topical action; that this peculiar effect is therefore merely a nervous phenomenon; and that he never could observe either the diffuse cellular inflammation described by Orfila to arise from the application of monkshood to a wound, or the inflammatory redness of the alimentary canal noticed by others as one of its effects when swallowed.

Orfila ascertained that monkshood exerts its action through the medium of the blood; for its effects are greater when it is introduced into a wound, than when it is swallowed, and they are still greater when it is injected directly into a vein. It is a poison of very great activity. I have found that thirty grains of an alcoholic extract, the produce of three-quarters of an ounce of fresh leaves, will kill a rabbit in two hours and a quarter, if introduced between the skin and muscles of the back. Five drachms of the root in one of Orfila’s experiments with the dog, occasioned death in twenty-one minutes, when swallowed.

The alkaloid, aconitina, seems to produce in animals precisely the same effects as the plant or its extract. Orfila and Dr. Pereira agree in this; and my own observation, limited to a single experiment, is to the same effect. It is probably the most subtile of all known poisons. Dr. Pereira mentions that the fiftieth part of a grain has endangered life when used medicinally.[^[2252]] In my experiment the tenth of a grain, introduced in the form of hydrochlorate into the cellular tissue of a rabbit, killed it in twelve minutes.

Symptoms in Man.—A perplexing discrepance exists in the accounts that have been published of the effects of monkshood on man; which seems to have arisen, less from any actual contrariety in the phenomena, than from loose observation, or a misunderstanding of the facts; for most of the recent statements of competent observers are consistent with one another.

Dr. Fleming says that in medicinal doses it occasions warmth in the stomach, nausea, numbness and tingling in the lips and cheeks, extending more or less over the rest of the body, diminution in the force and frequency of the pulse, which sometimes sinks to 40 in the minute, great muscular weakness, confusion of sight or absolute blindness; and if the dose be unduly large, there is a sense of impending death, sometimes slight delirium, and a want of power to execute what the will directs, but without any loss of consciousness. The warmth which is excited is unattended with any elevation of temperature, vascularity of the skin, or acceleration of the pulse. No true hypnotic effect is produced; but by inducing serenity, or deadening pain, it may predispose to sleep. The highest degree of these effects is not unattended with danger.

When it is administered in doses adequate to occasion death, it seems in general to operate by inducing extreme depression of the circulation. Dr. Fleming recognizes two other modes of death in animals,—first, by an overwhelming depression of the nervous system, proving fatal in a few seconds, without arresting the action of the heart,—and secondly, by asphyxia, or arrestment of the respiration, the result of paralysis gradually pervading the whole muscular system, respiratory, as well as voluntary. But these effects, he thinks, cannot be recognized in the cases which have been published of poisoning in man, because the dose required to produce either of them is very large. The least variable symptoms in the human subject are, first, numbness, burning, and tingling in the mouth, throat, and stomach,—then sickness, vomiting, and pain in the epigastrium,—next, general numbness, prickling, and impaired sensibility of the skin, impaired or annihilated vision, deafness, and vertigo,—also frothing at the mouth, constriction at the throat, false sensations of weight or enlargement in various parts of the body,—great muscular feebleness and tremor, loss of voice, and laborious breathing,—distressing sense of sinking and impending death,—a small, feeble, irregular, gradually-vanishing pulse,—cold, clammy sweat and pale bloodless features,—together with perfect possession of the mental faculties, and no tendency to stupor or drowsiness,—finally, sudden death at last, as from hemorrhage, and generally in a period varying from an hour and a half to eight hours. The symptoms may begin in a few minutes, as in a case observed by Dr. Fleming, which was occasioned by the tincture of the root; or they may be postponed for three-quarters of an hour, as in an instance recorded by Dr. Pereira,[^[2253]] which arose from the root being used by mistake for horse-radish. Two or three drachms of the root are sufficient to kill a man; and Dr. Fleming mentions one instance where two grains of the alcoholic extract occasioned alarming effects, and another where four grains proved fatal. I may observe, however, that I have given six grains of a carefully prepared alcoholic extract (the same of which thirty grains killed a rabbit in little more than two hours), to a female suffering from rheumatism, without being able to observe any effect whatsoever.

If all the reports of cases now on record are to be trusted, the following anomalies have occurred. Some persons are said to have presented convulsions. Slight spasmodic twitches of the muscles are not uncommon, and probably depend, as Dr. Fleming suggests, on venous congestion, the result of incomplete asphyxia. Stupor and even apoplectic insensibility are also sometimes represented to have been observed. If really ever present, they must depend on the same cause; but there is reason to apprehend, that extreme nervous depression and faintness have been mistaken for stupor and coma. Delirium of the frantic kind, mentioned by some of the older authors, is justly considered by Dr. Fleming to be of doubtful occurrence, as it has never been observed in recent times. Irritation in the alimentary canal is distinctly mentioned as indicated by prominent symptoms, even in some cases observed but a few years ago, and apparently with care. Dr. Fleming properly objects to nausea, vomiting, or pain in the epigastrium as evidence of irritation in the stomach; for these symptoms may all depend on the same local nervous impression which is produced on the organs of taste. And he denies that purging is ever produced in any genuine case of poisoning with monkshood. The following, however, seem unequivocal examples of irritation in the alimentary canal. M. Pallas[^[2254]] mentions, that three out of five persons, who took a spirituous infusion of the root by mistake for lovage [Ligusticum levisticum], died in two hours with burning in the throat, vomiting, colic, swelling of the belly and purging. A similar set of cases is described by M. Degland.[^[2255]] Four persons took the tincture of the root by mistake for tincture of lovage; and three of them were seized with burning pain from the throat to the stomach, a sense of enlargement of the tongue and face, colic, tenderness of the belly, vomiting, and purging. One of these, who ultimately recovered, had frantic delirium for some time after the other symptoms went off. The two others died, one in two hours, the other half an hour later. Dr. Pereira[^[2256]] and Dr. Fleming doubt the authenticity of these cases; and it may be, that such unusual symptoms may have arisen either from some other root mistaken by the narrators for monkshood, or from irritant substances given along with or after it. At the same time I may mention, that in the first trials I made with monkshood as a medicine, using a carefully prepared extract of the root, I was deterred from proceeding by two patients being attacked with severe vomiting, griping, and diarrhœa.

It may be well to conclude these general statements by the particulars of a few well authenticated cases. Dr. Pereira describes two that were occasioned by the root having been dug up in February by mistake for horse-radish.[^[2257]] The parties, a gentleman and his wife, ate, the former about a root and a half, the latter not much more than half a root. Both of them in three-quarters of an hour had burning, and numbness in the lips, mouth, and throat, extending to the stomach and followed by vomiting. The husband had subsequently violent and frequent vomiting, partly owing to an emetic. His extremities became cold, the lips blue, the eyes glaring, and the head covered with cold sweat. There was no spasm or convulsion, but some tremor. He had no delirium, or stupor, or loss of consciousness, but complained of violent headache. The respiration was not affected; and although he felt very weak, he was able to walk with a little assistance only a few minutes before death; which took place, as if from fainting, about four hours after the poison was swallowed.—His wife, in addition to the early symptoms already mentioned, had such weakness and stiffness of the limbs that she was unable to stand; and she could utter only unintelligible sounds; but she had no spasms or convulsions. She experienced a strange sensation of numbness in the hands, arms, and legs, diminution of sensibility over the whole integuments, especially of the face and throat, where the sense of touch was almost extinguished. She had also some dimness of vision, giddiness, and at times an approach to loss of consciousness, but no delirium, sleepiness, or deafness. She recovered, under the use of emetics, laxatives, and stimulants. In neither of these cases was there any diarrhœa.—A patient of Mr. Sherwen,[^[2258]] five minutes after taking a tincture of the root, suffered from the same incipient symptoms as above, but without actual vomiting. The face seemed to her to swell, and the throat to contract; she became nearly blind, and excessively feeble, but did not lose her consciousness. The eyes were fixed and protruded, and the pupils contracted, the jaws stiff, the face livid, the whole body cold, the pulse imperceptible, the heart’s action feeble and fluttering, and the breathing short and laborious. An emetic was followed first by violent convulsions, and then by vomiting; after which she slowly recovered. At all times she was so sensible as to be able to tell how the accident happened.—Dr. Ballardini of Brescia met with twelve simultaneous cases of poisoning with the juice of the leaves, used by mistake for scurvy-grass [Cochlearia officinalis]. Each person had three ounces of juice. Three of them died in two hours; but the rest were saved. The chief symptoms were extreme weakness and anxiety, paleness and distortion of the features, dilatation of the pupils, dulness of the eyes, giddiness, headache, chiefly occipital, some distension and pain of the belly, vomiting of a green matter, and in some diarrhœa. The whole body was cold, the nails livid, the limbs cramped, the pulse small and scarcely perceptible. In the fatal cases there were convulsions.[^[2259]]—MM. Pereyra and Perrin mention, that, while using the alcoholic extract in the Hospital of St. André at Bordeaux, the sample of the drug happened to be changed when the dose had been raised so high as ten grains; and that the patients who were taking it were then all seized with burning in the mouth and throat, vomiting, pungent pains in the extremities, cold sweating, anxiety, extreme general prostration, great slowness and irregularity of the pulse, convulsions, and congestion in the venous system. One patient died; the others recovered under no other treatment than stimulant friction along the spine.[^[2260]] An infant at Suippe, in the French Department of the Marne, ate a few leaves and flowers of monkshood, while walking in a garden. Soon afterwards he began to stagger as if tipsy, and to complain of pain in the belly. In two hours an emetic was given; but a few minutes afterwards, the eyes became convulsed, the jaws locked, the trunk bent rigidly backward, and the limbs convulsed; and death ensued in five minutes more.[^[2261]]

Morbid Appearances.—In Ballardini’s fatal cases the pia mater and arachnoid were much injected; there was much serosity under the arachnoid and in the base of the cranium; the lungs were considerably gorged with blood; the heart and great vessels contained but a little black fluid blood: the villous coat of the stomach was spotted with red points; and the small intestines presented inwardly red patches and much mucus. In the Bordeaux case there was venous congestion in the head and chest, the lungs particularly being much gorged with blood. The right side of the heart was full of blood, of gelatinous consistence. In Pallas’s cases the gullet, stomach, small intestines and rectum were very red, the lungs dense, dark, and gorged, and the cerebral vessels turgid.

Few trustworthy observations have been made on the effects of the other species of aconite. Dr. Pereira found the A. ferox of the East Indies to be a much more deadly poison to animals than common monkshood; but its effects were otherwise identical.[^[2262]] Three grains of the root put into the throat of a rabbit, killed it in nineteen minutes; one grain of the alcoholic extract, introduced into the peritonæum, proved equally deadly. Nine grains will kill a cat in four hours.[^[2263]]——Of the other aconites the A. cammarum, and A. lycoctonum are said to have proved fatal frequently in Germany; but no accurate facts on the subject are on record.—It was stated above that the A. paniculatum, supposed by De Candolle to have been the true aconite of Baron Störck, is inert in this country. I introduced the alcoholic extract of three ounces of the fresh leaves collected near the end of June, into the cellular tissue between the skin and muscles of a young rabbit, having previously converted the extract into an emulsion with mucilage and water. This was four times the dose of A. napellus, which I had found sufficient to kill a strong adult rabbit in two hours and a quarter; but no effect whatever was produced.—Mr. Ramsay of Broughty Ferry has described a case of fatal poisoning with a handful of aconite leaves which were mistaken for parsley, and which he supposes to have been those of A. neomontanum. The subject, a boy of fourteen, was attacked with a sense of burning in the mouth, throat, and stomach, afterwards with vomiting and convulsions, and died considerably within five hours.[^[2264]] The very feeble taste of this species—which besides is little cultivated in Scotland,—inclines me to doubt whether it was the species that produced such violent effects.

Of Poisoning with Black Hellebore.

Black hellebore, or Christmas-rose, the Helleborus niger of botanists, is a true narcotico-acrid poison. It is a doubtful native of this country. It produces a large white ranunculus-like flower about midwinter. The root, the only part used in medicine, or to be found in the shops, consists of a short root-stock and numerous, long, black undivided rootlets. The fresh root in January is not acrid to the taste. Its active principle appears from the researches of MM. Feneulle and Capron, to be an oily matter containing an acid.[^[2265]]

Its action has not yet been examined with particular care. Two or three drachms of the root killed a dog in eighteen hours, when swallowed; two drachms killed another in two hours, when applied to a wound; and six grains in a wound caused death in twenty-three hours. In all cases the leading symptoms are efforts to vomit, giddiness, palsy of the hind-legs, and insensibility.[^[2266]] Ten grains of the extract introduced into the windpipe killed a rabbit in six minutes.[^[2267]] Orfila found redness of the rectum, when the animals survived a few hours. But none of these experiments show the powerful irritant action exerted by the root upon man.

The Bulletins of the Medical Society of Emulation mention two cases of poisoning with hellebore, which arose from the ignorance of a quack doctor. Both persons, after taking a decoction of the root, were seized in forty-five minutes with vomiting, then with delirium, and afterwards with violent convulsions. One died in two hours and a half, the other in less than two hours.[^[2268]] Morgagni has related a case which proved fatal in about sixteen hours, the leading symptoms of which were pain in the stomach, and vomiting. The dose in this instance was only half a drachm of the extract.[^[2269]] In a case not fatal, related by Dr. Fahrenhorst, the symptoms were those of irritant poisoning generally, that is, burning pain in the stomach and throat, violent vomiting, to the extent of sixty times in the first two hours, cramps of the limbs, and cold sweating. The most material symptoms were at this time quickly subdued by sinapisms to the belly and anodyne demulcents given internally; and in four days the patient was well. The dose here was a table-spoonful of the root in fine powder.[^[2270]] In small doses of ten or twenty grains, it is well known to be a powerful purgative to man. I have known severe griping produced by merely tasting the fresh root in January.

The morbid appearances in Morgagni’s case were the signs of inflammation in the digestive canal, particularly in the great intestines. In the case described in the French Bulletins, there was gorging of the lungs, and the stomach had a brownish-black colour as if gangrenous.

The other species of hellebore have not been carefully examined; but it is probable that they all possess similar properties. The H. hyemalis and viridis are said by Buchner to be weaker than the H. niger; and the H. fœtidus is the most poisonous of all.[^[2271]]

CHAPTER XXXVI.
OF POISONING WITH SQUILL, MEADOW-SAFFRON, WHITE HELLEBORE, AND FOXGLOVE.

The natural family Liliaceæ, and the allied family, Melanthaceæ, contain many species which possess narcotico-acrid properties. Those which are best known in Europe are squill, meadow-saffron, cevadilla, and white hellebore. To these may be added foxglove, as possessing properties in some measure analogous, and also rue and ipecacuan.

Of Poisoning with Squill.

The root of the squill, or Squilla maritima, possesses the properties of the narcotico-acrids. Orfila’s experiments on animals, indeed, assign to it only an action on the nervous system. He found that two ounces and a half of the fresh root, when secured in the stomach of a dog by a ligature on the gullet, excited efforts to vomit, dilated pupil, and lethargy; and in two hours the animal suddenly fell down in a violent fit of tetanus, and expired. From thirty-six grains injected into the jugular vein no effect followed for sixteen hours; when at last, as in the former case, the animal dropped down convulsed and died immediately.[^[2272]]

The effects, however, caused by squill on man leave no doubt that it is also an active irritant; for it causes sickness, vomiting, diarrhœa, gripes, and bloody urine, when given in over-doses. It has likewise produced narcotic symptoms in man. Lange mentions an instance of a woman, who died from taking a spoonful of the root in powder to cure tympanitis. She was immediately seized with violent pain in the stomach; and in a short time expired in convulsions. The stomach was found every where inflamed, and in some parts eroded.[^[2273]]—A woman, whose case is mentioned in a French journal, after taking from a female quack a vinous tincture made with seventy-five grains of extract of squill, was seized with nausea and severe colic, to which were added in twenty-four hours a small contracted pulse, extreme tenderness of the belly, and cold extremities; and she died in the course of the second day.[^[2274]] Twenty-four grains of the powder have proved fatal.[^[2275]] I have seen a quarter of an ounce of the syrup of squills, which is a common medicinal dose, cause severe vomiting, purging, and pain.

An acrid principle, named scillitin, has been discovered in the squill. A difference of opinion prevails as to its nature. Some chemists consider it to be a resin; but Landerer has obtained it in the crystalline form, with alkaline properties. A grain of it will kill a dog.

Of Poisoning with White Hellebore and Cevadilla.

White hellebore, the root-stock of Veratrum album, and cevadilla, the seed and capsules of Asagræa officinalis, and possibly of Veratrum sabadilla, seem to be characteristic examples of the narcotico-acrid poisons. They both possess a strong bitter taste, followed by acridity. The cevadilla-seed in particular has an intensely disagreeable and persistent bitter taste, and produces at the same time a combination of acridity and numbness of the lips, tongue, and cheeks. They owe their active properties chiefly to an alkaloid of great energy, termed veratria.

White hellebore root is familiarly known to be a virulent poison. The best account of its effects is contained in a Thesis by Dr. Schabel, published at Tübingen in 1817. Collecting together the experiments previously made by Wepfer, Courten, Viborg, and Orfila, and adding a number of excellent experiments of his own, he infers that it is poisonous to animals of all classes,—horses, dogs, cats, rabbits, jackdaws, starlings, frogs, snails, and flies;—that it acts in whatever way it is introduced into the system,—by the stomach, rectum, windpipe, nostrils, pleural membrane of the chest, an external wound, or the veins;—that it produces in every instance symptoms of irritation in the alimentary canal, and injury of the nervous system;—and that it is very active, three grains of the extract applied to the nostrils of a cat having killed it in sixteen hours.[^[2276]]

Symptoms in Man.—Its effects on man are similar. A singular account of several cases of poisoning with the root is contained in Rust’s Journal. A family of eight people, in consequence of eating bread for a whole week, in which the powder of the root had been introduced by mistake instead of cumin seeds, were attacked with pains in the belly, a sensation as if the whole intestines were wound up into a clue, swelling of the tongue, soreness of the mouth, and giddiness; but they all recovered by changing the bread and taking gentle laxatives.[^[2277]]

Another set of cases of a more aggravated nature, though still not fatal, is given in Horn’s Archives.[^[2278]] Three people took the root by mistake for galanga. The symptoms that ensued were characteristic of its double action. In an hour they all had burning in the throat, gullet, and stomach, followed by nausea, dysuria, and vomiting; weakness and stiffness of the limbs; giddiness, blindness, and dilated pupil; great faintness, convulsive breathing, and small pulse. One of them, an elderly woman, who took the largest share, had an imperceptible pulse, stertorous breathing, and total insensibility even to ammonia held under the nose. Next day she continued lethargic, complained of headache, and had an eruption like flea-bites. A fatal case is quoted by Bernt from Schuster’s Medical Journal. A man took twice as much as could be held on the point of a knife, was attacked with violent and incessant vomiting, and lived only from morning till night. The gullet, stomach, and colon were here and there inflamed.[^[2279]]

No detailed inquiry has yet been made respecting the properties of cevadilla; but there can be no doubt that it will prove an energetic poison, similar in its effects to white hellebore, and probably more active. Wibmer quotes Villemet for the fact, that half a drachm of the seeds excites vomiting and convulsions in the cat and dog, and Lentin for the case of a child, who died in convulsions in consequence of the powder having been used inwardly and outwardly.[^[2280]]

The alkaloid, veratria, has been made the subject of experiment by various physiologists. The most complete investigation yet undertaken is that of Dr. Esche;[^[2281]] who found that it causes in a few minutes restlessness, anxiety, salivation, slowness and irregularity of the pulse, slow respiration, nausea, violent vomiting, borborygmus, spasms of the abdominal muscles and brisk purging of watery mucus, often tinged with blood;—that by and by the muscles become extremely feeble, so that the animal cannot support itself;—that coldness of the surface succeeds, together with spasmodic contractions of the throat, face, and extremities, but without any stupor;—and that finally the respiration and pulse gradually become extinguished, extreme prostration ensues, and death takes place in a fit of tetanic spasm. No particular morbid appearance was found in the dead body, and especially no sign of inflammation. Magendie found, that one grain in the form of acetate killed a dog in a few seconds when injected into the jugular vein, and in nine minutes when injected into the peritonæum; and that the principal symptom in such rapid cases was tetanic spasm.

Of Poisoning with Meadow-Saffron.

The Colchicum autumnale, meadow-saffron, or autumn-crocus, is a more familiar poison in this country than white hellebore, and seems to possess very similar properties. Two parts of the plant are met with in the shops, the cormus or bulb, and the seeds; both of which are poisonous. Both have a strong, disagreeable, persistent, bitter taste. The seeds, and probably the bulb also, contain a bitter crystalline principle, called colchicina, which is soluble in water, neutralizes acids, and possesses intense activity as a poison.

A good physiological investigation into the action of colchicum as a poison is still wanting. Baron Störck found that two drachms of the dried bulb caused in dogs violent diarrhœa and diuresis, ending fatally.[^[2282]] Sir Everard Home observed that the active part of about two drachms dissolved in sherry, caused in a dog, when injected into the jugular vein, slow respiration, languor of the pulse, vomiting, diarrhœa, extreme prostration, and death in five hours.[^[2283]]—Geiger and Hesse, the discoverers of colchicina, gave a cat a tenth of a grain, which occasioned salivation, vomiting, purging, staggering, extreme languor, colic, and death in twelve hours.[^[2284]]

The effects of colchicum on man, like those observed in animals, rather associate it with the acrid than with the narcotic poisons.

In the Edinburgh Journal a case is briefly noticed of a man who took by mistake an ounce and a half of the wine of the bulb, and died in forty-eight hours, after suffering much from vomiting, acute pain in the stomach, colic, purging, and delirium.[^[2285]]—Chevallier has described a similar case arising from the wine of the bulb having been given intentionally as a poison. In a few minutes burning pain, urgent thirst, and frequent vomiting of mucus ensued; and death took place in three days.[^[2286]]—Three American soldiers, who drank by mistake a large quantity of colchicum wine prepared from the bulb, died with similar symptoms. One of them, who took eighteen ounces, and died in two days, presented the leading symptoms of malignant cholera, namely, frequent vomiting, copious rice-water stools, cramps of the abdominal muscles and flexion of the extremities, coldness of the skin, tongue, and breath, blueness of the nails, dull, sunken eyes, contracted pupils, and collapse of the features. The two others had at first similar symptoms, which passed into those of chronic dysentery, and proved fatal in a few weeks.[^[2287]]—M. Caffe has related the case of a young lady who destroyed herself by taking five ounces of the wine containing the active matter of rather more than the fourth part of one bulb. She was soon seized with acute pain in the stomach, then with frequent vomiting, general coldness and paleness, a sense of tightness in the chest and oppression of the breathing, a slow thready pulse, and extreme prostration,—and subsequently with severe and constant cramps in the soles of the feet. In eleven hours she had less frequent efforts to vomit, but was excessively exhausted; in twenty hours the pulse was imperceptible; and in two hours more she died. There was no suppression of urine, no purging, no diminution of sensibility, delirium, convulsions, or change in the state of the pupils.[^[2288]] About a twelvemonth afterwards the sister of this patient put an end to herself with the same preparation, of which she took the same quantity; and she died, with precisely the same symptoms, in twenty-eight hours.[^[2289]] M. Ollivier met with two cases of death within twenty-four hours, in consequence of a tincture being taken which contained the active part of forty-eight grains of the dry bulb; and a third case of death in three days caused by three doses of a watery decoction made each time with 46 grains of the bruised bulb collected in July. Severe purging and prostration followed each dose. There was no symptom of any affection of the brain.[^[2290]]—Mr. Henderson describes a case occasioned by an ounce of the tincture. No injury accrued for three hours. The patient then had gnawing pain in the stomach followed by vomiting, and then by purging, at first bilious, afterwards watery, and attended with numbness in the feet, and subsequently a sense of prickling. In the course of the second day there was intense gnawing pain in all the joints of the extremities, profuse acid sweating, tightness in the head, and pain in the hindhead and nape of the neck. Blood-letting, laxatives, and hyoscyamus were employed with success; but the case seems very nearly to have proved fatal.[^[2291]]

The seeds produce similar effects. Bernt has noticed the cases of two children who were poisoned by a handful of colchicum seeds, and who died in a day, affected with violent vomiting and purging.[^[2292]] Mr. Fereday of Dudley relates a carefully detailed case of a man who died in forty-seven hours after swallowing by mistake two ounces of the wine of the seeds, and in whom the symptoms were acute pain, coming on in an hour and a half, then retching, vomiting, and tenesmus, feeble pulse, anxious expression, afterwards incessant coffee-coloured vomiting, suppression of urine, excessive weakness of the limbs and feeble respiration, and, for a short period before death, profuse, dark, watery purging. There was neither insensibility nor convulsions.[^[2293]]—Blumhardt relates a similar case caused by an infusion of a large table-spoonful of the seeds. In three-quarters of an hour the man was seized with griping, and then profuse diarrhœa and vomiting. Next morning, twelve hours after the poison was taken, his physician found him still affected with vomiting and purging, but not with pain. He seemed, indeed, to suffer so little, and to improve so much under the use of emollients, that he was thought to be fairly recovering. But next day the pulse was almost imperceptible, the countenance and extremities were cold, the voice hoarse, the breathing hurried, the eyes sunk, the pupils dilated, the epigastrium tender, and the forehead affected with pain; and he died at twelve the same day.[^[2294]]

The leaves, too, are poisonous. Dr. Bleifus has related a case in proof of this. A man gathered the leaves in the middle of May, and, after cooking them, ate about two ounces for supper. In six hours he was seized with violent colic, vomiting, and purging. In fifteen hours, when his physician first saw him, the countenance was ghastly as in malignant cholera, the pupils dilated and scarcely contractile, but the mind entire. He complained of rheumatic pains in the neck, and burning pain in the pit of the stomach. He had frequent vomiting and purging, spasms of the muscles of the belly, coldness of the skin, a slow, small, wiry pulse, and cramps of the fingers and the calves of the legs. Coffee and lemon-juice allayed the vomiting, and a temporary amendment ensued. But early on the third morning he became worse, and soon afterwards the narrator of the case found him dying.[^[2295]]

The flowers are not less poisonous than the bulbs, leaves, and seeds. A case is noticed in Geiger’s Journal of poisoning with a decoction of some handfuls of the flowers, where death occurred within twenty-four hours, under incessant colic, vomiting and purging.[^[2296]]

Doubts exist as to the degree of activity of colchicum. Some practitioners direct half an ounce of the tincture of the seeds to be given as a medicinal dose,[^[2297]] even four times a day.[^[2298]] Others administer from one to two drachms night and morning. According to more general experience, these are dangerous doses. Dr. Lewins, junior, has seen dangerous symptoms from a drachm given thrice a day for a week;[^[2299]] a fatal case occurred a few years ago in the Edinburgh Infirmary, from this amount having been given for a few days only; I have known very violent effects produced by half an ounce taken by mistake, although most of it was brought away by emetics in an hour; and, in medical practice, I have seldom seen the dose of a sound preparation gradually raised to a drachm thrice a day, without such severe purging and sickness ensuing as rendered it prudent to diminish or discontinue the remedy. There is no doubt, however, that larger doses have occasionally been taken without any ill effect. Constitutional peculiarity can alone account for such differences in the instance of the tincture of the seeds. As to the preparations of the bulb, an additional source of diversity of effect is a difference in the activity of the bulb according to season. On this point no accurate facts have yet been brought forward. The bulb is usually directed to be gathered in July, when it is most plump and firm, and most charged with starch. Orfila, however, says that three bulbs, collected at this time, had no effect whatever on a dog;[^[2300]] and Buchner maintains that it is most energetic in the autumn, when the flowering stem is rising.[^[2301]] I suspect, on the other hand, that it is very energetic in the spring, when it is watery, more membranous, and shrivels much in drying; for it is then very bitter.

The morbid appearances are chiefly those of inflammation of the alimentary canal.

In the bodies of the children mentioned by Bernt there was considerable redness of the stomach and small intestines; in Geiger’s case inflammation of the stomach and duodenum only; in the case mentioned in the Edinburgh Journal, and in that related by Chevallier, there was no morbid appearance at all to be found. In Mr. Fereday’s case the omentum was curled and folded up between the stomach on the one hand, and the liver and diaphragm on the other; the stomach and intestines were coated with much mucus; there was no appearances of inflammation there but on two points, one in the stomach, the other in the jejunum, where a red patch appeared, owing to blood effused between the muscular and peritoneal coats; the bladder was empty, the pleura red, the lungs much gorged, their surface, as well as that of the diaphragm and heart, covered with ecchymosed spots; and the skin over most of the body presented patches of a purple efflorescence.—In Blumhardt’s case the muscles were rigid twenty-three hours after death; the heart and great vessels contained coagulated blood; the cardiac end of the gullet was internally dark-violet; the stomach externally of a clear violet hue, and its veins turgid; the gall-bladder turgid with greenish-yellow bile; and the inner membrane of the whole small intestines chequered here and there with red, inflamed-like spots.[^[2302]]—In one of M. Caffe’s cases there was congestion of the cerebral vessels, coagulated blood in the heart, uniform grayness, softness, and brittleness of the mucous coat of the stomach, and enlargement of the muciparous follicles of the small intestines, as well as unusual distinctness and lividity of the Peyerian glands. In the other case putrefaction was so far advanced in forty-eight hours as to make the appearances equivocal.

The treatment consists in evacuation of the stomach and bowels by emetics and oleaginous laxatives in the early stage, and afterwards in the employment of opium, stimulants, the warm bath, and occasionally blood-letting.

Of Poisoning with Foxglove.

Foxglove, or Digitalis purpura, a plant which is common in this country both as a native and in gardens, possesses powerful and peculiar properties. The leaves are considered its most active part. They contain an alkaloid; but chemists have not fixed its nature with precision. M. Le Royer of Geneva procured a pitchy, deliquescent, uncrystallizable substance;[^[2303]] but more lately M. Pauguy obtained a principle in fine acicular crystals, soluble in alcohol and ether, but insoluble in water, alkaline in its reaction, and of a very acrid taste. This principle is called digitalin.[^[2304]] It seems to be the same substance, which has also been detected by Radig, as quoted by Dr. Pereira.[^[2305]] The leaves, like those of other narcotic vegetables, yield by destructive distillation an empyreumatic oil similar in chemical qualities and physiological effects to the empyreumatic oil of hyoscyamus.[^[2306]]

From an extensive series of experiments on animals by Orfila with the powder, extract and tincture of the leaves, foxglove appears to cause in moderate doses vomiting, giddiness, languor, and death in twenty-four hours, without any other symptoms of note; but in larger doses, it likewise produces tremors, convulsions, stupor and coma. It acts energetically both when applied to a wound, and when injected into a vein.[^[2307]] Mr. Blake has inferred from his researches, that when injected into the jugular vein, it occasions both obstruction of the pulmonary capillaries, and direct depression of the heart’s action. In the dog an infusion of three drachms of leaves arrested in five seconds the action of the heart; which was motionless after death, turgid, inirritable, and full of florid blood in its left cavities. An infusion of an ounce, injected back into the aorta from the axillary artery, caused in ten seconds great obstruction of the systemic capillaries, indicated by sudden increase of arterial pressure in the hæmadynamometer; the heart was unaffected for forty-five seconds, when it became slow in its pulsations, and the arterial pressure diminished; and in four minutes the heart ceased to beat, although for a little longer it continued excitable by stimulation. As no affection of the brain or spine was apparent before the heart became affected, the author infers that the action depends on the poisoned blood being circulated through the substance of the heart, and not on any intermediate influence upon the nervous centre.[^[2308]]

Symptoms in Man.—Upon man its effects as a poison have been frequently noticed, partly in consequence of its being given by mistake in too large a dose as a medicine, partly on account of the singular property it possesses, in common with mercury, of accumulating silently in the system, when given long in moderate doses, and at length producing constitutional effects even after it has been discontinued. The effects of a dose somewhat larger than is usually given, are great nausea, frontal headache, sense of disagreeable dryness in the gums and pharynx, some salivation, giddiness, weakness of the limbs, feebleness and increased frequency of the pulse, in a few hours an appearance of sparks before the eyes, and subsequently dimness of vision, and a feeling of pressure on the eyeballs. These effects may be occasioned by so small a dose as two or three grains of good foxglove.[^[2309]] The symptoms arising from its gradual accumulation are in the slighter cases nausea, vomiting, giddiness, want of sleep, sense of heat throughout the body, and of pulsation in the head, general depression, great languor and commonly retardation of the pulse, sometimes diarrhœa, sometimes salivation, and for the most part profuse sweating. A good instance of this form of the effects of foxglove is mentioned in the Medical Gazette. A man took it at his own hand for dropsy during twenty days, when the pulse sank to half its previous frequency, he was seized with restless, want of sleep, incoherent talking with imaginary persons, dilated pupils, nausea, thirst, and increase of urine; and these complaints did not materially subside for six days.[^[2310]] The depressed action of the heart may be the occasion of death in particular circumstances. Mr. Brande mentions from the experience of Dr. Pemberton the case of an elderly woman, who, while under the full influence of foxglove, fell in a fainting fit on walking across the floor; after which, although she at first got better, there were frequent attacks of fainting and vomiting till she died.[^[2311]] In other instances convulsions also occur; and it appears from a case mentioned by Dr. Blackall, that the disorder thus induced may prove fatal. One of his patients, while taking two drachms of the infusion of the leaves daily, was attacked with pain over the eyes and confusion, followed in twenty-four hours by profuse watery diarrhœa, delirium, general convulsions, insensibility, and an almost complete stoppage of the pulse. Although some relief was derived from an opiate clyster, the convulsions continued to recur in frequent paroxysms for three weeks; in the intervals he was forgetful and delirious; and at length he died in one of the convulsive fits.[^[2312]]

A case which exemplifies the effects of a single large dose is related in the Edinburgh Journal. An old woman drank ten ounces of a decoction made from a handful of the leaves in a quart of water. She grew sick in the course of an hour, and for two days she had incessant retching and vomiting, with great faintness and cold sweats in the intervals, some salivation and swelling of the lips, and a pulse feeble, irregular, intermitting, and not above 40. She had also suppression of urine for three days.[^[2313]]

A somewhat similar instance may be found in the Journal de Médecine. A man, fifty-five years old took by mistake a drachm instead of a grain for asthma, and was attacked in an hour with vomiting, giddiness, excessive debility, so that he could not stand, loss of sight, colic, and slow pulse. These effects continued more or less for four days, when the vomiting ceased; and the other symptoms then successively disappeared, the vision, however, remaining depraved for nearly a fortnight.[^[2314]]

A very interesting fatal case, which arose from an over-dose administered by a quack doctor, and which became the ground of a criminal trial at London in 1826, is shortly noticed in the same Journal. Six ounces of a strong decoction when taken as a laxative early in the morning. Vomiting, colic, and purging, were the first symptoms; towards the afternoon lethargy supervened; about midnight the colic and purging returned; afterwards general convulsions made their appearance; and a surgeon, who saw the patient at an early hour of the succeeding morning, found him violently convulsed, with the pupils dilated and insensible, and the pulse, slow, feeble, and irregular. Coma gradually succeeded, and death took place in twenty-two hours after the poison was swallowed.[^[2315]]

This is the only case in which I have seen an account of the appearances in the dead body, and they are related imperfectly. It is merely said that the external membranes of the brain were much injected with blood, and the inner coat of the stomach red in some parts.

The affections induced by poisoning with digitalis are often much more lasting than the effects of most other vegetable narcotics. Dr. Blackall’s case is one instance in point, and another no less remarkable in its details is described in Corvisart’s Journal. The usual local and constitutional symptoms were produced by a drachm of the powder being taken by mistake; and the slowness of the pulse did not begin to go off for seven days, the affection of the sight not for five days more.[^[2316]]

The preparations of foxglove are very uncertain in strength. From what I have observed in the course of their medicinal employment, I conceive few powders retain the active properties of the leaves, and even not many tinctures. Two ounces of the tincture of the London College have been taken in two doses with a short interval between them, yet without causing any inconvenience.[^[2317]] This assuredly could not happen with a sound preparation.

Of Poisoning with Rue.

The Ruta graveolens, or rue, although its wild variety is expressly declared by Dioscorides to be mortal when taken too largely, has attracted little attention as a poison in recent times, and is indeed scarcely considered deleterious. Orfila seems to have found it by no means active; for the juice of two pounds of leaves, secured in the stomach of a dog by tying the gullet, did not prove fatal till the second day, the symptoms were not well marked, and the only appearances in the dead body were the signs of slight inflammation in the stomach. Even when the distilled water was injected into a vein, the only effects were a temporary nervous disorder similar to intoxication.[^[2318]]

According to the late experimental inquiry, however, by M. Hélie,[^[2319]] rue is possessed of peculiar and energetic properties. All parts of its organization, especially the roots and leaves, produce the effects of the narcotico-acrid poisons; and although he never met with any instance of a fatal result, its activity is such as to render this event not improbable, even when the dose is by no means very large. His attention was drawn to the subject in consequence of finding, that it was often employed in his neighbourhood for producing abortion,—a property ascribed to it immemorially by the country people of France; and all the instances he has seen of its poisonous action were cases in which it had been given with this object. Sometimes the juice of the leaves is given, sometimes an infusion of them, sometimes a decoction of the root; and in one instance a woman took a decoction of two roots, each about as thick as the finger. The effects were, severe pain in the stomach, followed by violent and obstinate vomiting, drowsiness, giddiness, confusion, dimness of sight, difficult articulation, staggering, contracted pupils, convulsive movements of the head and arms, like those of chorea, retention of urine, slowness of the pulse, and great prostration. There was never any purging. In the course of two days or a little more miscarriage took place, preceded by the usual precursors, and followed by abatement of the symptoms of poisoning. At the period of the milk-fever, however, these symptoms again increased, and the patient was also attacked with swelling and pain in the tongue and copious salivation. In about ten days the pulse began to increase in frequency; and a mild typhoid fever commonly succeeded, from which recovery took place slowly. In another case the symptoms throughout their whole course were so mild, that, although miscarriage occurred, the subject of it was not confined to bed, and in fifteen days recovered her health completely. M. Hélie adds, that with full knowledge of the doubts entertained by eminent authorities, whether any substance whatever possesses a peculiar property of inducing miscarriage, he is strongly persuaded that rue is really a substance of the kind, and that it will take effect even when there is no natural tendency to miscarriage, or any particular weakness of constitution.

Notwithstanding these statements, it may be suspected that M. Hélie has overrated both its poisonous properties and its virtues as a drug capable of inducing miscarriage.

Of Poisoning with Ipecacuan.

Ipecacuan is well known as an emetic. It is procured from a plant of the natural family Rubiaceæ, the Cephaëlis ipecacuanha. It contains a peculiar principle, not yet crystallized, which is white, permanent in the air, sparingly soluble in water, easily soluble in alcohol and ether, fusible about 122° F., capable of forming crystallizable salts with acids, and possessing an alkaline reaction on litmus. It was discovered by M. Pelletier.[^[2320]]

Ipecacuan itself is not known to be a poison; because in consequence of its emetic properties it is quickly discharged from the stomach. But in doses of considerable magnitude it would probably be dangerous. In some constitutions the odoriferous effluvia from the powder induce difficult breathing, anxiety, and imperfect convulsions. I have met with several instances of this singular idiosyncrasy, and one in particular where the subject of it, a surgeon’s apprentice, suffered so often and so severely as to be induced to abandon the medical profession. A German physician, Dr. Prieger, has published a remarkable case of a druggist’s servant, who, in consequence of incautiously inhaling the dust of ipecacuan powder, was attacked with a sense of tightness in the chest, vomiting, and soon after an alarming sense of suffocation from tightness of the throat. When these symptoms had continued several hours the uneasiness in the throat was removed after the use of a decoction of uva-ursi and rhatany-root; but the dyspnœa remained several days.[^[2321]]

Its active principle, emeta, is a powerful poison. Two grains of the pure alkaloid will kill a dog; and the symptoms are frequent vomiting, followed by sopor and coma, and death in fifteen or twenty-four hours. In the dead body the lungs and stomach are found inflamed. The same effects result from injecting it into a vein, or applying it to a wound.[^[2322]] It appears, then, to be a narcotico-acrid. But its irritant properties are so prominent that it might be properly arranged with the vegetable acrids.

CHAPTER XXXVII.
OF POISONING WITH STRYCHNIA, NUX VOMICA, AND FALSE ANGUSTURA.

The next group of the narcotico-acrids includes a few vegetable poisons that act in a very peculiar manner. They induce violent spasms, exactly like tetanus, and cause death during a fit, probably by suspending the respiration. But they do not impair the sensibility. During the intervals of the fits the sensibility is on the contrary heightened, and the faculties are acute.

Death, however, does not always take place by tetanus. In some cases the departure of the convulsions has been followed by a fatal state of general and indescribable exhaustion.

Besides thus acting violently on the nervous system, they also possess local irritant properties; but these are seldom observed on account of the deadliness and quickness of their remote operation on the spine and nerves.

They exert their action by entering the blood-vessels. The dose required to prove fatal is exceedingly small. The organ acted on is chiefly the spinal cord; but sometimes they seem also to act on the heart.

They seldom leave any morbid appearances in the dead body. Like the other causes of death by obstructed respiration, such as drowning and strangling, they produce venous congestion; but this is frequently inconsiderable. Sometimes, however, they leave signs of inflammation in the alimentary canal.

Their energy resides in peculiar alkaloids. The only poisons included in this group, are derived from the genus Strychnos. The bark of Brucea antidysenterica was long supposed also to possess similar properties; but it is now known that the bark of Strychnos nux-vomica was mistaken for the bark of that tree.

Several species of Strychnos have been examined, namely, the S. Nux-vomica, the S. Sancti Ignatii or St. Ignatius bean, the S. colubrina, or snake-wood, the S. tieuté, which yields an Indian poison the Upas tieuté, the S. Guianensis, and likewise the S. potatorum and Pseudo-kina; and all have been found to possess the same remarkable properties, except the last two, which are inert.

All of them, except the S. pseudo-kina, and probably the S. potatorum,[^[2323]] contain an alkaloid to which their poisonous properties are owing. This is strychnia or strychnin, a substance which has lately been made the subject of many experiments by chemists and physiologists.

Of Poisoning with Strychnia.

Strychnia was discovered by Pelletier and Caventou soon after the discovery of morphia.[^[2324]] For an account of the best process for preparing it, the reader may consult a paper by M. Henry in the journal quoted below.[^[2325]]

Its leading properties are the following. Its crystals when pure are elongated octaedres. It has a most intensely bitter taste, perceptible, it is said, when a grain is dissolved in 80 pounds of water.[^[2326]] It is very sparingly soluble in water, but easily soluble in alcohol and the volatile oils. Its alcoholic solution has an alkaline reaction. It forms neutral and crystallizable salts with the acids. In its ordinary form it is turned orange-red by the action of nitric acid; which tint becomes violet-blue on the gradual addition of hydrosulphate of ammonia. The action of nitric acid is owing to the presence of a yellow colouring matter, or of another alkaloid, brucia, which is also contained in nux vomica, but exists in larger quantity in the false angustura bark. Pure strychnia is not turned orange-red by nitric acid.[^[2327]]

No poison is endowed with more destructive energy than strychnia. I have killed a dog in two minutes with a sixth part of a grain injected in the form of alcoholic solution into the chest; I have seen a wild-boar killed in the same manner with the third of a grain in ten minutes; and there is little doubt that half a grain thrust into a wound might kill a man in less than a quarter of an hour. It acts in whatever way it is introduced into the system, but most energetically when injected into a vein. The symptoms produced are very uniform and striking. The animal becomes agitated and trembles, and is then seized with stiffness and starting of the limbs. These symptoms increase till at length it is attacked with a fit of violent general spasm, in which the head is bent back, the spine stiffened, the limbs extended and rigid, and the respiration checked by the fixing of the chest. The fit is then succeeded by an interval of calm, during which the senses are quite entire or unnaturally acute. But another paroxysm soon sets in, and then another and another, till at length a fit takes place more violent than any before it; and the animal perishes suffocated. The first symptoms appear in 60 or 90 seconds, when the poison is applied to a wound. When it is injected into the pleura, I have known them begin in 45 seconds, and Pelletier and Caventou have seen them begin in 15 seconds.[^[2328]] M. Bouillaud has recently found that it has no effect when directly applied to the nerves.[^[2329]] The experiments of Mr. Blake tend to show, that its action is exerted solely on the nervous system, and that it has no direct action on the heart, even when directly admitted into the blood by the jugular vein.[^[2330]] It appears to act peculiarly by irritating the spinal cord.

Dangerous effects have often been occasioned by an accidental over-dose in ordinary medical practice. These are well exemplified by a case communicated to Dr. Bardsley by Dr. Booth of Birmingham. A man of 46, affected with hemiplegia for nearly four weeks, began to use strychnia, and had been affected by it for eleven days without particular inconvenience. During this period he took twice a day gradually increasing doses, till the amount of one grain was attained; when the usual physiological effect having ceased to occur, the quantity was increased to a grain and a half. But the first dose caused anxiety and excitability, in three hours stupor and loss of speech, and at length violent tetanic convulsions, which proved fatal in three hours and three-quarters.[^[2331]] A fatal case, occasioned by the large dose of two scruples, has been recorded by a German physician, Dr. Blumhardt. In fifteen minutes, imperfect vomiting was brought on by emetics. At this time, the patient, a lad of seventeen, lay on his back, quite stiff, and with incipient fits of locked-jaw. The spasms gradually extended to the rest of the body, till at last violent fits of general tetanus were established, under which the whole body became as stiff as a board, the arms spasmodically crossed over the chest, the legs extended, the feet bent, so that the soles were concave, the breathing arrested, the eyeballs prominent, the pupils dilated and not contractile, and the pulse hurried and irregular. In the second severe fit he died, one hour and a half after taking the poison.[^[2332]] I have known very dangerous tetanic spasm induced by so small a dose as two-thirds of a grain of the ordinary impure strychnia of the shops; and Dr. Pereira describes a case, communicated by a friend, where death was occasioned by a dose of half a grain administered three times a day.[^[2333]] As each fit of spasm went off, respiration, which was found to have ceased, was maintained artificially; but no sooner did natural breathing return, than the paroxysm of tetanus returned also; and at length artificial inflation of the lungs failed to restore life.

The only accounts I have seen of the morbid appearances after death from strychnia are in the cases of Dr. Booth and Dr. Blumhardt. In the former, the muscles were in a rigid state, the fingers contracted, the vessels of the brain gorged, the membranes of the spinal cord highly injected; and four patches of extravasated blood were found between the spinal arachnoid and the external membrane. In the latter, twenty-four hours after death, there was general lividity of the skin, and extraordinary rigidity of the muscles. Fluid blood flowed in abundance from the spinal cavity, where the veins were gorged, the pia mater injected, the spinal column softened at its upper part, and here and there almost pulpy. There was also congestion and softening of the brain. The head and great vessels were flaccid, and contained scarcely any blood. The inner membrane of the stomach and intestines presented some redness, but not more than is often seen independently of irritation there.

Strychnia has been found by Pelletier and Caventou in four species of Strychnos, the S. nux vomica, Sancti Ignatii, Colubrina, and Tieuté; and from the researches of MM. Martius and Herberger on the composition and properties of the American poison Wourali, it is also probably contained in the S. guianensis.[^[2334]] Vauquelin could not find it in the S. pseudo-kina, which is destitute of bitterness.

Of Poisoning with Nux Vomica.

Tests of Nux Vomica.—Nux vomica, the most common of these poisons, is a flat, roundish seed, hardly an inch in diameter, of a yellowish or greenish-brown colour, covered with short silky hair, and presenting a little prominence on the middle of one of its surfaces. In powder it has a dirty greenish-gray colour, an intensely bitter taste, and an odour like powder of liquorice. It inflames on burning charcoal, and when treated with nitric acid acquires an orange-red colour, which is destroyed by the addition of protochloride of tin. Its infusion also is turned orange-red by nitric acid, and precipitated grayish-white with tincture of galls.

Orfila and Barruel have made some experiments on the mode of detecting it in the stomach, and the following is the plan recommended by them. The contents of the stomach, or the powder, if it can be separated, must be boiled in water acidulated with sulphuric acid. The liquid after filtration is neutralized with carbonate of lime, and then evaporated to dryness. The dry mass is then acted on with successive portions of alcohol, and evaporated to the consistence of a thin syrup. The product has an intensely bitter taste, yields a precipitate with ammonia, becomes deep orange-red with nitric acid, and will sometimes deposit crystals of strychnia on standing two or three days.[^[2335]] By this process Dr. R. D. Thomson, in a case which proved fatal in three hours, detected nux-vomica, although vomiting had been induced by emetics.[^[2336]]

These experiments it is important to remember, because, contrary to what takes place in regard to vegetable poisons generally, nux vomica is often found in the stomachs of those poisoned with it.

Its Mode of Action and Symptoms in Man.—The poisonous properties of nux vomica are now well known to the vulgar; and in consequence it is occasionally made the instrument of voluntary death, although no poison causes such torture. It is difficult to conceive, considering its intensely bitter taste, how any one could make it the instrument of murder. But a fact is stated in Rust’s Journal, which shows that it may be used for that purpose. At a drinking party one man wagered with another, that if he took a little Cocculus indicus in beer, he would be compelled to walk home on his head. The wager was taken and the potion drunk; but nux vomica was substituted for the Cocculus indicus, itself too a virulent poison; and the man went home and died in convulsions fifteen minutes afterwards.[^[2337]]

Many experiments have been made on animals with nux vomica; but the first accurate inquiry was that of Magendie and Delille read before the French Institute in 1809. The symptoms they remarked were precisely the same with those produced by strychnia. Half a drachm of the powder killed a dog in forty-five minutes, and a grain and a half of the alcoholic extract thrust into a wound killed another in seven minutes. The animals uniformly experienced dreadful fits of tetanic spasm, with intervals of relaxation and sensibility, and were carried off during a paroxysm.

The cause of death appears to be prolonged spasm of the thoracic muscles of respiration. The spasm of these muscles is apparent in the unavailing efforts which the animals make to inspire. The external muscles of the chest may be felt during the fits as hard almost as bone; and, according to an experiment of Wepfer, the diaphragm partakes in the spasm of the external muscles.[^[2338]]

On account of the singular symptoms of irritation of the spinal cord, uncombined with any injury of the brain, this poison is believed to act on the spinal marrow alone. This is farther shown by the experiments of Mr. Blake with strychnia alluded to above. But from some experiments by Segalas it appears also to exhaust the irritability of the heart: for in animals he found that organ could not be stimulated to contract after death, and life could not be prolonged by artificial breathing.[^[2339]] A similar observation was made long ago by Wepfer, who found the heart motionless and distended with arterial blood in its left cavities;[^[2340]] and a case of poisoning in the human subject to the same effect will be presently related. The pulse is always very weak, often wholly suppressed during a paroxysm; and in the case alluded to it was found on dissection pale, flaccid and empty, having been apparently affected with spasm. The action exerted through the medium of the spinal cord on the muscles is wholly independent of the brain; for Stannius found that in frogs the removal of the brain does not interfere with the effects.[^[2341]]

Of late poisoning with nux vomica has been common. The most characteristic example yet published is a case related by Mr. Ollier, of a young woman, who in a fit of melancholy, took between two and three drachms of the powder in water. When the surgeon first saw her, half an hour afterwards, she was quite well. But going away in search of an emetic, and returning in ten minutes, he found her in a state of great alarm, with the limbs extended and separated, and the pulse faint and quick. She then had a slight and transient convulsion succeeded by much agitation and anxiety. In a few minutes she had another, and not long afterwards a third, each about two minutes in duration. During these fits, “the whole body was stiffened and straightened, the legs pushed out and forced wide apart; no pulse or breathing could be perceived; the face and hands were livid, and the muscles of the former violently convulsed.” In the short intervals between the fits she was quite sensible, had a feeble rapid pulse, complained of sickness with great thirst, and perspired freely. “A fourth and most violent fit soon succeeded, in which the whole body was extended to the utmost from head to foot. From this she never recovered: she seemed to fall into a state of asphyxia, relaxed her grasp, and dropped her hands on her knees. Her brows, however, remained contracted, her lips drawn apart, salivary foam issued from the corners of the mouth, and the expression of the countenance was altogether most horrific.” She died an hour after swallowing the poison.[^[2342]]—A case precisely similar, produced by three pence worth of the powder, and fatal in little more than an hour, is related by Mr. Watt of Glasgow.[^[2343]]—Another apparently also similar but fatal in three hours, is related by Dr. R. D. Thomson.[^[2344]] There is in fact very little variety of symptoms in different cases, where death occurs in the primary stage.—Occasionally even in such rapid cases there is a little vomiting in the first instance. This was remarked in Mr. Watt’s case, and also in another described by MM. Orfila and Ollivier.[^[2345]]

When death does not take place thus suddenly in a fit of spasm, the person continues to be affected for twelve or sixteen hours with similar, but milder paroxysms; and afterwards he may either recover without farther symptoms, or expire in a short time apparently from exhaustion, or suffer an attack of inflammation of the stomach and intestines, which may or may not prove fatal.

M. Jules Cloquet has described a case, where the patient seemed to die of the excessive exhaustion produced by the violent, long continued spasms. The tetanic fits lasted about twenty-four hours, the sensibility in the intervals being acute. Slight signs of irritation in the stomach succeeded; and death ensued on the fourth morning.[^[2346]]

In the Bulletins of the Medical Society of Emulation another case is related, which arose from an over-dose of the alcoholic extract being taken by an old woman who was using it for palsy. She took three grains at once. Violent tetanus was soon produced; and afterwards she had a regular attack of inflammation of the stomach and intestines, which proved fatal in three days.

The last instance to be noticed exemplifies very well the effects of the poison when the quantity is insufficient to cause death. A young woman swallowed purposely a drachm mixed in a glass of wine. In fifteen minutes she was seized with pain and heat in the stomach, burning in the gullet, a sense of rending and weariness in the limbs succeeded by stiffness of the joints, convulsive tremors, tottering in her gait, and at length violent and frequent fits of tetanus. Milk given after the tetanus began excited vomiting. She was farther affected with redness of the gums, inflammation of the tongue, burning thirst, and pain in the stomach. The pulse also became quick, and the skin hot. Next day, though the fits had ceased, the muscles were very sore, especially on motion. The tongue and palate were inflamed, and there was thirst, pain in the stomach, vomiting, colic and diarrhœa. These symptoms, however, abated, and on the fourth day disappeared, leaving her exceedingly weak.[^[2347]]

This and the previous case show clearly the double narcotico-acrid properties of the poison.

With regard to the dose requisite to prove fatal, the smallest fatal dose of the alcoholic extract yet recorded is three grains, which was the quantity taken in the case from the Parisian bulletins: Hoffmann mentions a fatal case caused by two fifteen grain doses of the powder;[^[2348]] and in Hufeland’s Journal there is another caused by two drachms, which was fatal in two hours.[^[2349]]—A dog has been killed by eight grains of the powder, and a cat by five.[^[2350]] It is even said that a dog has been killed by two grains.[^[2351]]

It has been thought, from some observations by Mr. Baker on the medicinal use of nux vomica in Hindostan that, by the force of habit, the constitution may become to a certain extent accustomed to large doses of this poison, in the same manner as it acquires the power of enduring large doses of opium. The natives of Hindostan, often take it morning and evening for many months continuously, beginning with an eighth part of a nut, and gradually increasing the dose to an entire nut, or about twenty grains. If it is taken either immediately before or after meals, it never occasions any unpleasant effects; but if this precaution be neglected, spasms are apt to ensue.[^[2352]] As it is found unsafe, however, to increase the dose beyond one nut, and the poison is taken in the form of coarse powder, in which state it must be slowly acted on by the fluid in the stomach, it is probable that the modifying influence of habit is inconsiderable. Habit certainly does not familiarize the system to strychnia used medicinally. The same dose, which has once excited its peculiar physiological action, will for the most part suffice to excite it again, however frequently the dose may be repeated.—The facts mentioned by Mr. Baker show that nux vomica is not a cumulative poison; and European experience, in the instance of strychnia, is to the same effect.

Morbid Appearances.—The morbid appearances differ according to the period at which death occurs. In Mr. Ollier’s case, where death took place in an hour, the appearances were insignificant. The stomach was almost natural, the vessels of the brain somewhat congested, the heart flaccid, empty, and pale. In the case in Hufeland’s Journal there was general inflammation of the stomach, duodenum and part of the jejunum. In Cloquet’s case, a slower one, there was very little appearance of inflammation. In that from the Parisian bulletins, on the contrary, the stomach was highly inflamed, the intestines violet-coloured, in many places easily lacerated and apparently gangrenous. In an interesting dissection of a case, which was quickly fatal,—that related by Orfila and Ollivier, there was found much serous effusion on the surface of the cerebellum, and softening of the whole cortical substance of the brain, but especially of the cerebellum. Blumhardt too, found softening of the cerebellum and congestion of the cerebral vessels, together with softening of the spinal cord and general gorging of the spinal veins. This is some confirmation of an opinion advanced not long ago in France by Flourence and others, that nux vomica acts particularly on the cerebellum.[^[2353]] In Dr. R. D. Thomson’s case, which was examined by Mr. Taylor, there was found much congestion of the whole membranes and substance of the brain and cerebellum, and even some extravasation of blood within the cavity of the arachnoid over the upper surface of the former. Mr. Watt remarked in his case (sixty hours, however, after death in summer) softening of the substance of the brain and the lumbar part of the spinal cord.—In Orfila and Ollivier’s case the lungs were found much gorged with black fluid blood.—In Blumhardt’s case the heart and great vessels were entirely destitute of blood.—There is sometimes seen, as in Dr. R. D. Thomson’s case, a brown powder lining the stomach, even although vomiting may have occurred.

The body appears sometimes to retain for a certain period after death the attitude and expression impressed on it by the convulsions during life. In the instance mentioned by Orfila and Ollivier the muscles immediately after death remained contracted, the head bent back, the arms bent, and the jaws locked. This state may even continue for some hours, so that the body appears to pass into the state of rigidity which precedes decay, without also passing through the preliminary stage of flaccidity immediately after death. In the case related by Mr. Ollier, the body five hours after death “was still as stiff and straight as a statue, so that if one of the hands was moved the whole body moved along with it;” and in Blumhardt’s case the rigidity twenty hours after death was unusually great. This state of rigidity, however, does not invariably occur. On the contrary, in animals the limbs become very flaccid immediately after death; but the usual rigidity supervenes at an early period.[^[2354]] In Dr. R. D. Thomson’s case flaccidity immediately followed death.

Treatment.—Little is known of the treatment in this kind of poisoning. But it is of the greatest moment to evacuate the stomach thoroughly, and without loss of time. Hence emetics are useful; but if the stomach-pump is at hand it ought to be resorted to without waiting for the operation of emetics. Torosiewicz describes the case of a young woman who, after the usual symptoms had begun to appear in consequence of the administration of a tea-spoonful of powder, recovered under the action of an emetic followed by rhatany-root.[^[2355]] When nux vomica is taken in powder,—the most frequent form in which it has been used,—it adheres with great obstinacy to the inside of the stomach. Consequently whatever means are employed for evacuating the stomach, they must be continued assiduously for a considerable time. If the patient is not attacked with spasms in two hours, he will generally be safe.

M. Donné of Paris has stated that he has found iodine, bromine, and chlorine to be antidotes for poisoning with the alkaloid of nux vomica, as well as for the other vegetable alkaloids. Iodine, chlorine, and bromine, he says, form with the alkaloid compounds which are not deleterious,—two grains and a half of the iodide, bromide, and chloride of strychnia, having produced no effect on a dog. Animals which had taken one grain of strychnia or two grains of veratria, did not sustain any harm, when tincture of iodine was administered immediately afterwards. But the delay of ten minutes in the administration of the antidote rendered it useless. In the compounds formed by these antidotes with the alkaloids, the latter are in a state of chemical union, and not decomposed. Sulphuric acid separates strychnia, for example, from its state of combination with chlorine, iodine, or bromine, and forms sulphate of strychnia, with its usual poisonous qualities.[^[2356]] It remains to be proved that the same advantages will be derived from the administration of these antidotes in the instance of poisoning with the crude drug, nux vomica, as in poisoning with its alkaloid.

In general little difficulty will be encountered in recognizing a case of poisoning with nux vomica. Tetanus or locked-jaw is the only disease which produces similar effects. But that disease never proves so quickly fatal as the rapid cases of poisoning with nux vomica; and it never produces the symptoms of irritation observed in the slower cases. Besides, the fits of natural tetanus are almost always slow in being formed; while nux vomica brings on perfect fits in an hour or less. It is right to remember, however, that nux vomica may be given in small doses, frequently repeated, and gradually increased, so as to imitate exactly the phenomena of tetanus from natural causes. Medical men will be at no loss to discover, on reflection, how the preparations of this drug may be rendered formidable secret poisons.

Of Poisoning with the St. Ignatius Bean and Upas Tieuté.

The Strychnos Sancti Ignatii, or St. Ignatius bean, contains about three times as much strychnia as nux vomica, namely, from twelve to eighteen parts in the 1000. It is very energetic. Dr. Hopf has mentioned an instance of a man, who was attacked with tetanus of several hours’ duration after taking the powder of half a bean in brandy, and who seems to have made a narrow escape.[^[2357]]

The Strychnos tieuté is the plant which yields the Upas tieuté, one of the Javanese poisons. This substance has been analyzed by Pelletier and Caventou, and found to contain strychnia.[^[2358]] From the experiments of Magendie and Delille, the Upas tieuté appears to be almost as energetic as strychnia itself.[^[2359]] Mayer found that the bark of the plant which yields it, when applied in the dose of fifty grains to a wound, killed a rabbit in two hours and a half.[^[2360]] Dr. Darwin has given an account of its effects on the Javanese criminals, who used formerly to be executed by darts poisoned with the tieuté. The account quoted by him is not very authentic; yet it accords precisely with what would be expected from the known properties of the poison. He says, that a few minutes after the criminals are wounded with the instrument of the executioner, they tremble violently, utter piercing cries, and perish amidst frightful convulsions in ten or fifteen minutes.[^[2361]]

Of Poisoning with False Angustura Bark.

Besides these poisons of the genus Strychnos, the present group comprehends another, of the same properties, which was once supposed to be derived from a plant of a different family, the Brucea antidysenterica.

A species of bark, commonly called the false angustura bark, was introduced by mistake into Europe instead of the true angustura, cusparia, or bark of the Galipea officinalis. It was long supposed to be the bark of the Brucea antidysenterica; but it is now known to be the bark of S. nux vomica.[^[2362]] It is a poison of great energy. It gave rise to so many fatal accidents soon after its introduction, that in some countries on the continent all the stores of angustura were ordered to be burnt. It contains a less proportion of strychnia, but more of the alkaloid brucia than nux vomica, the seed of the plant.

According to Andral, brucia is twenty-four times less powerful than strychnia;[^[2363]] but the bark itself is as strong nearly as nux-vomica, for Orfila found that eight grains killed a dog in less than two hours.[^[2364]]

The symptoms it induces are the same as those caused by nux vomica. They are minutely detailed in a paper by Professor Emmert of Bern.[^[2365]] It appears that during the intervals of the fits the sensibility is remarkably acute: a boy who fell a victim to it implored his physician not to touch him, as he was immediately thrown into a fit. Professor Marc of Paris was once violently affected by this poison, which he took by mistake for the true angustura to cure ague. He took it in the form of infusion, and the dose was only three-quarters of a liqueur-glassful; yet he was seized with nausea, pain in the stomach, a sense of fulness in the head, giddiness, ringing in the ears, and obscurity of vision, followed by stiffness of the limbs, great pain on every attempt at motion, locked-jaw, and impossibility of articulating. These symptoms continued two hours; and abated under the use of ether and laudanum.[^[2366]]

Some interesting experiments were made by Emmert with this poison to show that it acts on the spine directly, and not on that organ through the medium of the brain. If an animal be poisoned by inserting the extract of false angustura bark into its hind-legs after the spinal cord has been severed at the loins, the hind-legs as well as the fore-legs are thrown into a state of spasm; or if the medulla oblongata be cut across and respiration maintained artificially, the usual symptoms are produced over the whole body by the administration of it internally or externally,—the only material difference being that they commence more slowly, and that a larger dose is required to produce them, than when the medulla is not injured. On the other hand, when the spinal cord is suddenly destroyed after the symptoms have begun, they cease instantaneously, although the circulation goes on for some minutes.[^[2367]]

The true angustura bark has a finer texture than the other, and is darker coloured, aromatic, pungent, and less bitter. The ferro-cyanate of potass causes in a muriatic infusion of the false bark a precipitate, which is first green and then becomes blue; and the same reagent converts into blue the reddish powder which lines the bark. No such effects are produced on the true angustura bark. Nitric acid renders the rusty efflorescence of the spurious bark deep dirty blue, but has no such effect on the true bark; which, besides, never exhibits a yellow efflorescence.

With the preceding poisons Orfila has arranged also some poisons used by the American Indians; but, as in Europe they are mere objects of curiosity, it is scarcely necessary to treat of them particularly here.

The most interesting and best known of them is the wourali poison of Guiana, variously called woorara, urari, or curare, by different authors. It is believed to have been traced by Martius to a new species of strychnos, the S. guianensis, and more recently by Dr. Schomburg to a different species, the S. toxicaria of that traveller. But the action it exerts does not correspond exactly with what would be expected of a plant belonging to that genus.

The effects of wourali have been investigated by Sir B. Brodie in the Philosophical Transactions for 1811–12, in Orfila’s Toxicology, in Magendie’s Memoir on Absorption, and in Fontana’s Traité des Poisons. But the most detailed inquiry is that by Emmert, published in 1818. It produces, not convulsions or spasm of the muscles, but on the contrary paralysis, and probably occasions death in this way by suspending the respiration, in the same way as hemlock and conia. According to Emmert’s experiments the spine only is acted on, and not the brain also.[^[2368]] Some remarkable experiments were made in 1839 by Mr. Waterton, to show the power of artificial respiration in accomplishing recovery from its effects. After the animals had fallen down motionless from the action of the poison introduced through a wound, and when the action of the heart had become so feeble as not to affect the pulse, artificial respiration, continued in one instance for seven hours and a half, and in another for two hours, had the effect of restoring the animals to health.[^[2369]]

CHAPTER XXXVIII.
OF POISONING WITH CAMPHOR, COCCULUS INDICUS, ETC.

The third group of the narcotico-acrids resemble strychnia in their action so far, that they occasion in large doses convulsions of the tetanic kind. But they differ considerably by producing at the same time impaired sensibility or sopor. They are camphor, Cocculus indicus, its active principle picrotoxin, the Coriara myrtifolia, the Upas antiar, a Java poison, and perhaps also the yew-tree.

Of Poisoning with Camphor.

Camphor dissolved in oil soon causes in dogs paroxysms of tetanic spasm. At first the senses are entire in the intervals; but by degrees they become duller, till at length a state of deep sopor is established, with noisy laborious breathing, and expiration of camphorous fumes; and in this state the animal soon perishes. A solution of twenty grains in olive oil will kill a dog in less than ten minutes when injected into the jugular vein. When camphor is given to dogs in fragments, it does not excite convulsions, but kills them more slowly by inducing inflammation of the alimentary canal. These are the results of numerous experiments by Orfila.[^[2370]]

They are confirmed by others performed more lately by Scudery of Messina; but this experimentalist likewise remarked, that the convulsions were attended with a singular kind of delirium, which made the animals run up and down without apparent cause, as if they were maniacal. He also found the urinary organs generally affected, and for the most part with strangury.[^[2371]] Lebküchner discovered camphor in the blood of animals poisoned with it.[^[2372]]

Symptoms in Man.—The symptoms caused by camphor in man may not have been observed; but so far as they have been witnessed, they establish its claim to be considered a narcotic and acrid poison. Its effects appear to be singularly uncertain: at least they are very discrepant; and the reason for this is not apparent.

Its narcotic effects are well exemplified in an account given by Mr. Alexander from personal experience, and by Dr. Edwards of Paris, as they occurred in a patient of his who received a camphor clyster.

Mr. Alexander, in the course of his experiments on his own person with various drugs, was nearly killed by this poison, and has left the best account yet published of its effects in dangerous doses on man. After having found, by a previous experiment, that a scruple did not cause any particular symptom, he swallowed in one dose two scruples mixed with syrup of roses. In the course of twenty minutes he became languid and listless, and in an hour giddy, confused, and forgetful. All objects quivered before his eyes, and a tumult of undigested ideas floated through his mind. At length he lost all consciousness, during which he was attacked with strong convulsive fits and maniacal frenzy. These alarming symptoms were dispelled, on Dr. Monro, who had been sent for, accidentally discovering the subject of his patient’s experimental researches, and administering an emetic. But a variety of singular mental affections continued for some time after. The emetic brought away almost the whole camphor which had been swallowed three hours before.[^[2373]]

In Dr. Edwards’s patient, the symptoms were excited by an injection containing half a drachm of camphor. In a few minutes he felt a camphrous taste, which was followed by indescribable uneasiness. On then going down stairs for assistance, he was astonished to feel his body so light, that he seemed to himself to skim along the floor almost without touching it. He afterwards began to stagger, his face became pale, he felt chilly, and was attacked with a sense of numbness in the scalp. On then taking a glass of wine, which he asked for, he became gradually better; but for some time his mind was singularly affected. He felt anxious, without thinking himself in danger; he shed tears, but could not tell why; they flowed in fact involuntarily. For twenty-four hours his breath exhaled a camphrous odour.[^[2374]]

Hoffmann has related a case analogous to those of Alexander and Edwards. The dose was two scruples taken in oil; the symptoms vertigo, chilliness, anxiety, delirium, and somnolency.[^[2375]]

These cases would seem to indicate very considerable activity; yet there can be little doubt that even larger doses have been at times taken with much less effect. Thus, from an account given by Dr. Eickhorn of New Orleans, of its operation on himself, when incautiously swallowed to the amount of two drachms in frequent small doses within three hours, it would appear that the only result was great heat, palpitation, hurried pulse, and pleasant intoxication, then moisture of the skin, next profound sleep for some hours, attended with excessive sweating, and finally no ultimate ill consequence except great debility.[^[2376]] I am assured by a correspondent, Dr. Jennison of Cambridge, U. S., that a medical friend of his has given 90 grains of camphor four times a day in phrenitis, with safety and advantage.

Professor Wendt of Breslau has related an instance, which proves the irritant action of camphor on man, and likewise the uncertainty of the dose required to act deleteriously. In the case of Mr. Alexander, two scruples would in all probability have proved fatal, had they not been discharged in time by vomiting. In the case now to be noticed, 160 grains were taken in a state of solution in alcohol, and were not vomited; yet the individual recovered. He was a drunkard, who took four ounces of camphorated spirit, prescribed for him as an embrocation. Soon afterwards he was attacked with fever, burning heat of the skin, anxiety, burning pain in the stomach, giddiness, flushed face, dimness of sight, sparks before the eyes, and some delirium. He soon got well under the use of almond oil and vinegar, but did not vomit.[^[2377]]

Morbid Appearances.—The morbid appearances caused by camphor have not, so far as I know, been witnessed in man. In dogs examined immediately after death, the heart is no longer contractile, and its left cavities contain arterial blood of a reddish-brown colour. When the poison has been given in fragments, it leaves marks of inflammation in the stomach and intestines. Orfila found these organs much inflamed in such circumstances.[^[2378]] Scudery found the membranes of the brain much injected, and the brain itself sometimes softened; the inner membrane of the stomach either very red, or checkered with black, gangrenous-like spots of the size of millet-seeds; the duodenum in the same state; the ureters, urethra, and spermatic cords inflamed; and every organ in the body, even the brain, impregnated with the odour of camphor.[^[2379]]

Of Poisoning with Cocculus Indicus.

The Menispermum cocculus, Cocculus suberosus, or Anamirta cocculus of botanists, is a creeping plant which grows in the island of Ceylon, on the Malabar coast, and in other parts of the East Indies. Its fruit, which is the only part of the plant hitherto particularly examined, is like a large, rough, grayish-black pea, and is known in the shops by the name of Cocculus indicus. It has a rough, ligneous pericarp, enclosing a pale grayish-yellow, brittle kernel, of a very strong lasting bitter taste. The medical jurist should make himself well acquainted with its external characters, because, besides being occasionally used in medicine, it is a familiar poison for destroying fish, and has also been extensively used by brewers as a substitute for hops,—an adulteration which is prohibited in Britain by severe statutes. It has been analyzed by M. Boullay of Paris,[^[2380]] who found in it besides other matters, a peculiar principle termed picrotoxin. This principle constitutes, according to Boullay, about a fifth part of the kernel; according to Nees von Esenbeck, only a hundreth part:[^[2381]] and my own experiments agree with the results of the latter. It is moderately soluble in water, and crystallizes readily from a hot acidulous watery solution. It is more soluble in hot alcohol, from which it crystallizes in granular masses. Ten grains of it killed a dog in twenty-five minutes in the second paroxysm of tetanus.

The seeds themselves occasion vomiting soon after they are swallowed; so that animals may often swallow them, if not without injury, at all events without danger. But if the gullet be tied, the animal soon begins to stagger; the eye acquires a peculiar haggard expression, which is the sure forerunner of a tetanic paroxysm; and the second, third, or fourth fit commonly proves fatal. Three or four drachms will kill a dog when introduced into the stomach; less will suffice when it is applied to a wound; and still less when it is injected into a vein.[^[2382]] Wepfer has related a good experiment, from which he infers that Cocculus indicus acts by exhausting the irritability of the heart. In the intervals of the fits the pulse could not be felt; and on opening the chest immediately after death, he found the heart motionless and all its cavities distended.[^[2383]] Orfila also sometimes found the heart motionless, and its left cavities filled with reddish-brown blood.[^[2384]]

This poison does not seem to possess distinct acrid properties in regard to animals. M. Goupil indeed found that it produced vomiting and purging,[^[2385]] but Orfila could not observe any such effect. According to Goupil it possesses the singular property of communicating to the flesh of animals, more particularly of fish, that have been killed with it, some of the poisonous qualities with which it is itself endowed. The accuracy of this statement may be doubted, the alleged fact being contrary to analogy. Besides, this poison has been used immemorially in the East for taking fish; and it is familiarly used for the same purpose in some parts of France, though prohibited by statute. Chevallier mentions that in a particular parish the inhabitants live half the year on fish caught with this poison; and that a friend of his made trial of fish so caught, without the slightest injury.[^[2386]]

Symptoms in Man.—Although it is well known that malt liquors have often been adulterated with Cocculus indicus for the purpose of economizing hops, cases of poisoning in the human subject are rare, because the quantity required to communicate the due degree of bitterness is small. Professor Bernt has shortly noticed a set of cases, which arose in consequence of an idiot having seasoned soup with it by mistake. Nine people were taken ill with sickness, vomiting, pain in the stomach and bowels; and one died in twelve days.[^[2387]] The symptoms under which this person died are not stated; but the account of the accident sent to Bernt imputed death to the poison,—which is improbable, considering the length of the interval before death.

In the same group with camphor and Cocculus indicus Orfila has arranged Upas antiar, a Javanese poison. This poison is a very bitter milky juice or extract, which is known in Europe only as an article of curiosity. It has been sometimes confounded with the Upas tieuté. It owes its properties to a neutral principle called antiarin.[^[2388]] From the experiments of MM. Magendie and Delille,[^[2389]] as well as from those of Sir B. Brodie[^[2390]] and of Emmert[^[2391]] it appears to act in the same manner, and to produce the same effects, as camphor and Cocculus indicus. In small doses it acts as an irritant; in large doses it causes convulsions and coma.

It is here noticed principally because it is one of the poisons which act violently on the heart. If the body of an animal be examined immediately after death from the Upas antiar, the heart is found to have lost its irritability, and the left ventricle to contain florid blood: Schnell found, that, like many other active poisons, it has no effect when applied to the divided end of a nerve.[^[2392]]

The Coriaria myrtifolia is also supposed by some to possess the properties of the present group, and is sufficiently important from its energy, and its occasional injurious effects on man, to claim some notice here.

Its toxicological action has been investigated by Professor Mayer of Bonn, who found that it excites in most animals violent fits of tetanus, giving place to apoplectic coma; and that in the dead body the brain is seen gorged with blood, the blood in the heart and great vessels fluid, the heart not irritable immediately after death, and the inner membrane of the stomach yellowish and shrivelled. A drachm of the extract of the juice killed a cat in two hours when swallowed; half a drachm applied to a wound killed another in eighty-five minutes; and six grains in the same way killed a kitten in three hours and a half. A drachm swallowed by a young dog killed it in two hours and a half. Ten grains of the extract of the infusion applied to a wound killed a kitten in six hours; and three grains another in three hours. A buzzard was killed in three-quarters of an hour by half a drachm of the extract of the juice. Frogs are also soon killed by it. Rabbits, it is remarkable, are scarcely affected by this poison, either administered internally, or applied to a wound,—a drachm in the former way, and half as much in the latter, having produced no effect at all. A grain, however, injected into the jugular vein occasioned in about five hours a single convulsive paroxysm, which proved immediately fatal.[^[2393]]

Instances of poisoning with this substance have occurred in the human subject,—generally in consequence of its having been taken in various parts of the continent with senna, which it is employed to adulterate. Sauvages has recorded two cases of death occasioned by the berries. In one, a child, death took place within a day under symptoms like epileptic convulsions; and in the other, an adult, who swallowed only fifteen berries, convulsions, coma, and lividity of the face were produced, ending fatally the same evening, though the greater part of the berries were discharged by emetics.[^[2394]] In recent French journals various similar cases are recorded. M. Fée describes five cases, one of them fatal. In this instance, a male adult, death occurred within four hours after he took an infusion of senna adulterated with the coriaria; and the symptoms were violent convulsions, locked-jaw and colic.[^[2395]] M. Roux has noticed a great number of cases in the fullest paper yet published on its effects on man, and gives the details of three which came under his own notice, and of which one proved fatal. In the fatal case, that of a child three years and a half old, who took between eighty and a hundred berries, the symptoms were heat and pricking of the tongue, sparking and rolling of the eyes, loss of voice, locked-jaw, and convulsions recurring in occasional fits of eight or ten minutes in duration. Death ensued in sixteen hours and a half.[^[2396]] Roux refers also among other instances to those of no fewer than ten soldiers, who were attacked at the same time in consequence of eating the berries, and of whom two died. In Roux’s fatal case there was injection of the membranes of the brain, and no other particular appearance; in that mentioned by Fée, there was inflammation of the stomach and bowels; and in one of Sauvages’s cases no morbid appearance at all was discovered.

Considering these very pointed proofs of the poisonous qualities of the coriaria, it is not a little singular that doubts have lately arisen whether it is a poison at all. Peschier of Geneva says he has ascertained that tanners, who use it in their trade on account of the powerful astringency of the leaves, also take it internally for gleet, and that he gave a decoction of an ounce to chickens, dogs, and men, without witnessing any ill effect.[^[2397]]

Of Poisoning with Yew.

The leaves and berries of the Taxus baccata, or yew, are known to be poisonous; but their effects have not been investigated with care. I have arranged it in the meantime with the present group.

M. Grognier, as quoted by Orfila, ascertained that a decoction of eight ounces of berries without seeds had no effect on a dog; that a pound and a half of seeds had no effect on a horse; that three ounces of the juice of the leaves given to a large dog merely caused vomiting; and that a decoction of twelve ounces of leaves, confined in the stomach of a dog by a ligature on the gullet, had also no effect. But two ounces of the juice of the leaves killed a small dog; and Orfila himself ascertained, that thirty-six grains of extract of the leaves, injected into the jugular vein, caused giddiness, stupor, and death.[^[2398]]

Accidents have repeatedly happened to children in this country from yew-berries. Mr. Hurt of Mansfield has given the particulars of an interesting case. A child, three years and a half old, two hours after eating the berries, was observed to look ill at dinner, and became affected with lividity and heaviness of the eyes, as if he was about to fall asleep. Vomiting followed, without any pain; and he died before a medical man, who was sent for, could arrive. Four other children, somewhat older, who had eaten the seeds, were made to vomit by emetics, and got well. The dead body of the first child presented many livid spots, redness of the villous coat of the stomach, and gorging of the brain and membranes with blood. A mass of berries, seeds, and potatoes was found in the stomach.[^[2399]]—Dr. Hartmann of Frankfort mentions that a girl, who took a decoction of the leaves to produce abortion, died in consequence, but without having miscarried.[^[2400]]—Dr. Percival has related other cases in his essays.[^[2401]]

CHAPTER XXXIX.
OF THE POISONOUS FUNGI.

A fourth group of poisons possessing narcotico-acrid proper ties, includes the poisonous fungi or mushrooms.

Accidents arising from the deadly fungi being mistaken for eatable mushrooms are common on the continent, and especially in France. They are not uncommon, too, in Britain; but they are less frequent than abroad, because the epicure’s catalogue of mushrooms in this country contains only three species, whose characters are too distinct to be mistaken by a person of ordinary skill; while abroad a great variety of them have found their way to the table, many of which are not only liable to be confounded with poisonous species, but are even also themselves of doubtful quality.

The present subject cannot be thoroughly studied without a knowledge of the appearance and characters of all the fungi which have been ascertained to be esculent, as well as of those which are known to be deleterious. This information, however, I cannot pretend to communicate, as it would lead to great details. In what follows, therefore, a simple list will be given of the two classes, with references to the proper source for minute descriptions of them, and some general observations on the effects of the poisonous species.

List of the wholesome and poisonous Fungi.—The only good account yet published of the innocent or eatable fungi of Great Britain is contained in an elaborate essay on the subject by Dr. Greville of this place. He enumerates no fewer than twenty-six different species, which grow abundantly in our woods and fields, and which, although most of them utterly neglected in this country, are all considered abroad to be eatable, and many of them delicate. They are the following: Tuber cibarium, or common truffle; T. moschatum and T. album, two species of analogous qualities; Amanita cæsarea or aurantiaca, the Oronge of the French, a species which is often confounded by the ignorant with a very poisonous one, the A. muscaria, or pseudo-aurantiaca; Agaricus procerus; A. campestris, the common mushroom of meadows; A. edulis, or white caps; A. oreades, or Scotch bonnets; A. odorus; A. uburneus; A. ulmarius; A. ostreatus; A. violaceus; A. deliciosus; A. piperatus; and A. acris; Boletus edulis; and B. scaber; Fistulina hepatica; Hydnum repandum; Morchella esculenta, the common morelle; Helvella mitra, and H. leucophæa. Of these the Agaricus acris, procerus, and piperatus are probably unwholesome; and the Amanita cæsarea is very rare in this country, if indeed it is indigenous at all. The A. muscaria, with which it is apt to be confounded, is common enough. The species to which our cooks confine their attention are the Tuber cibarium or truffle, the Agaricus campestris, or common mushroom, and the Morchella esculenta, or morelle. The Agaricus edulis is also to be met with in some markets, but is not in general use.[^[2402]]

The best description of the poisonous species is to be found in Orfila’s Toxicology. He enumerates the Amanita muscaria, alba, citrina, and viridis; the Hypophyllum maculatum, albocitrinum, tricuspidatum, sanguineum, crux-melitense, pudibundum and pellitum; the Agaricus necator, acris, piperatus, pyrogalus, stypticus, annularis, and urens.[^[2403]] To these may be added the Agaricus semiglobatus, on the authority of Messrs. Brande and Sowerby,[^[2404]] the A. campanulatus,[^[2405]] the A. procerus, on the authority of a case by Dr. Peddie of this city,[^[2406]] the A. myomica, on the authority of Ghiglini,[^[2407]] the A. panterinus on that of Dr. Paolini of Bologna,[^[2408]] the A. bulbosus of Bulliard, or Amanita venenata, on that of Pouchet,[^[2409]] the Agaricus vernus, insidiosus, globocephalus, sanguineus, torminosus and rimosus, on that of Letellier,[^[2410]] and the Hypophyllum niveum on the authority of Paulet.

Circumstances which modify their qualities.—The qualities of the fungi as articles of food are liable to considerable variety. Some, which are in general eaten in safety, occasionally become hurtful; and some of the poisonous kinds may under certain circumstances become inert, or even esculent. But the causes which regulate these variations are not well ascertained.

It has been thought by some that most fungi become safe when they have been dried;[^[2411]] and there may be some truth in this remark, as their poisonous qualities appear to depend in part on a volatile principle. But it is by no means universally true. Foderé mentions that the Agaricus piperatus continues acrid after having been dried.[^[2412]]

Climate certainly alters their properties. The Agaricus piperatus is eaten in Prussia and Russia;[^[2413]] but is poisonous in France. The Agaricus acris and A. necator, also enumerated above as meriting their names, are used freely in Russia.[^[2414]] The Amanita muscaria in France and Britain is a violent poison, and is considered so even in Russia;[^[2415]] but in Kamschatka it yields a beverage which is used as a substitute for intoxicating liquors.[^[2416]]

There is some reason to believe also that the weather or period of the season influences some of the esculent species. Thus Foderé has mentioned instances of the common morelle having appeared injurious after long-continued rain.[^[2417]]

Even the Agaricus campestris or common mushroom is generally believed to become somewhat unsafe towards the close of the season, or as it turns old. Its external characters at that time are sensibly altered; the margin of the cap is more acute, its white colour less lively, and the fleshy hue of its lamellæ is changed to brown or black. In this state, however, I have often eaten it freely and with impunity.

Cooking produces some difference on their effects. The very best of them are indigestible when raw; and some of the poisonous species may lose in part their deleterious qualities when cooked, because heat expels the volatile principle; but, on the whole, I believe the effect of cooking has not been satisfactorily shown to be considerable. Dr. Pouchet of Rouen seems to have clearly proved, that the poisonous properties of two of the most deadly fungi, the Amanita muscaria and A. venenata, may be entirely removed by boiling them in water. A quart of water, in which five plants had been boiled for fifteen minutes, killed a dog in eight hours, and again another in a day; but the boiled fungi themselves had no effect at all on two other dogs; and a third, which had been fed for two months on little else than boiled amanitas, not only sustained no harm, but actually got fat on this fare.[^[2418]] Pouchet is inclined to think that the whole poisonous plants of the family are similarly circumstanced.—On the other hand some cryptogamous botanists have maintained that the qualities of the esculent mushrooms are injured by cooking, and that when used in the raw state they may be taken for a long time as a principal article of food without injury. This statement, as to the effect of mushrooms when used for a length of time as food, will be more fully considered presently. It is easy to understand how boiling may remove their active properties, although other modes of cookery may not do so. Roasting had no effect in impairing the activity of Agaricus procerus in the case observed by Dr. Peddie.

On certain persons all mushrooms, even the very best of the eatable kinds, act more or less injuriously. They cause vomiting, diarrhœa, and colic. In this respect they are on the same footing with the richer sorts of fish, which by idiosyncrasy act as poisons on particular constitutions. It is probably under this head that we must arrange an extraordinary case mentioned by Sage of a man who died soon after eating a pound of truffles. He was seized with headache, a sense of weight in the stomach, and faintness; and he lived only a few hours.[^[2419]]

Lastly, it is not improbable from a singular set of cases to be related presently, that, contrary to what some botanists have alleged, the best mushrooms when taken in large quantity, and for a considerable length of time, are deleterious to every one.

Foderé,[^[2420]] Orfila,[^[2421]] Decandolle,[^[2422]] and Greville,[^[2423]] have laid down general directions for distinguishing the esculent from the poisonous varieties; but it is extremely questionable whether their rules are always safe; and certainly they are not always accurate, as they would exclude many species in common use on the continent. It appears that most fungi which have a warty cap, more especially fragments of membrane adhering to their upper surface, are poisonous. Heavy fungi, which have an unpleasant odour, especially if they emerge from a vulva or bag, are also generally hurtful. Of those which grow in woods and shady places a few are esculent, but most are unwholesome; and if moist on the surface they should be avoided. All those which grow in tufts or clusters from the trunks or stumps of trees ought likewise to be shunned. A sure test of a poisonous fungus is an astringent, styptic taste, and perhaps also a disagreeable, but certainly a pungent, odour. Some fungi possessing these properties have indeed found their way to the epicure’s table; but they are of very questionable quality. Those whose substance becomes blue soon after being cut are invariably poisonous. Agarics of an orange or rose-red colour, and boleti which are coriaceous or corky, or which have a membranous collar round the stem, are also unsafe; but these rules are not universally applicable in other genera. Even the esculent mushrooms, if partially devoured and abandoned by insects, are avoided by some as having in all probability acquired injurious qualities which they do not usually possess; but this test I have often disregarded.—These rules for knowing deleterious fungi seem to rest on fact and experience; but they will not enable the collector to recognise every poisonous species. The general rules laid down for distinguishing wholesome fungi are not so well founded, and therefore it appears necessary to specify them.

On the Poisonous Principle of the Fungi.—Few attempts have been hitherto made to discover by chemical analysis the principles on which the effects of the poisonous mushrooms depend. M. Braconnot analyzed a considerable number both of the esculent and poisonous species, and found in some a saccharine matter, in others an acrid resin, in others an acrid volatile principle, and in all a spongy substance, which forms the basis of them, and which he has denominated fungin.[^[2424]] The last ingredient is innocuous, and it does not appear that M. Braconnot could trace the peculiar powers of the fungi to any of the acrid principles. The subject was afterwards resumed by M. Letellier, who says he found in some of them one, in others two poisonous principles. One of these is an acrid matter so fugacious, that it disappears when the plant is either dried, or boiled, or macerated in weak acids, alkalis, or alcohol. To this principle he says are owing the irritant properties of some fungi. The other principle is more fixed, as it resists drying, boiling, and the action of weak alkalis and acids. It is soluble in water, has neither smell nor taste, and forms crystallizable salts with acids; but he did not succeed in separating it in a state of purity. To this principle he attributes the narcotic properties of the fungi. He found it in the Amanita bulbosa, muscaria, and verna; and he therefore proposed to call it amanitine. Its effects on animals appear to resemble considerably those of opium.[^[2425]]—Chansarel found that the poisonous principle resides in the juice, and not in the fleshy part after it is well washed.[^[2426]]

Of the Symptoms produced in Man by the Poisonous Fungi.—The mode of action of the poisonous fungi has not been particularly examined; but the experiments of Paulet long ago established that they are poisonous to animals as well as to man.[^[2427]]

The symptoms produced by them in man are endless in variety, and fully substantiate the propriety of arranging them in the class of narcotico-acrid poisons. Sometimes they produce narcotic symptoms alone, sometimes only symptoms of irritation, but much more commonly both together. It is likewise not improbable, that fungi, even though not belonging to the varieties commonly acknowledged as poisons, induce, when taken for a considerable length of time, a peculiar depraved state of the constitution, leading to external suppuration and gangrene. Each of these statements will now be illustrated by a few examples.

The following is a good instance of pure narcotism. A man gathered in Hyde Park a considerable number of the Agaricus campanulatus by mistake for the A. campestris, stewed them, and proceeded to eat them; but before ending his repast, and not above ten minutes after he began it, he was suddenly attacked with dimness of vision, giddiness, debility, trembling, and loss of recollection. In a short time he recovered so far as to be able to go in search of assistance. But he had hardly walked 250 yards when his memory again failed him, and he lost his way. His countenance expressed anxiety, he reeled about, and could hardly articulate. The pulse was slow and feeble. He soon became so drowsy that he could be kept awake only by constant dragging. Vomiting was then produced by means of sulphate of zinc; the drowsiness gradually went off; and next day he complained merely of languor and weakness.[^[2428]]—An equally remarkable set of cases of pure narcotism, which occurred a few years ago in this city, has been related by Dr. Peddie. Half an hour after eating the Agaricus procerus, an elderly man and a boy of thirteen were attacked with giddiness and staggering, as if they were intoxicated; and in an hour they became insensible, the man indeed so much so that for some time he could not be roused by any means. Emetics having little effect, the stomach was cleared out by the pump, and powerful stimulants were employed both inwardly and outwardly, by means of which sensibility was in some degree restored. Occasional convulsive spasms ensued, and afterwards furious delirium, attended with frantic cries and vehement resistance to remedies, and followed by a state like delirium tremens. The pupils were at first much contracted, afterwards considerably dilated as sensibility returned, and in the boy contracted while he lay torpid, but dilated when he was roused. In neither instance was there any pain felt at any time; nor were the bowels affected. Another boy who took a small quantity only had no other symptom but giddiness, drowsiness, and debility.[^[2429]]—A singular form of the narcotic effects of the fungi occurred in the case of a boy of fourteen, who had eaten the Agaricus panterinus near Bologna. In the course of two hours he was seized with delirium, a maniacal disposition to rove, and some convulsive movements. Ere long these symptoms were succeeded by a state resembling coma in every way, except that he looked as if he understood what was going on: and in point of fact really did so. He recovered speedily under the use of emetics.[^[2430]]

In the next set of cases the symptoms were those of almost pure irritation. Several French soldiers in Russia ate a large quantity of the Amanita muscaria, which they had mistaken for the Amanita cæsarea. Some were not taken ill for six hours and upwards. Four of them, who were very powerful men, thought themselves safe, because while their companions were already suffering, they themselves felt perfectly well; and they refused to take emetics. In the evening, however, they began to complain of anxiety, a sense of suffocation, frequent fainting, burning thirst, and violent gripes. The pulse became small and irregular, and the body bedewed with cold sweat; the lineaments of the countenance were singularly changed, the nose and lips acquiring a violet tint; they trembled much; the belly swelled, and a profuse fetid diarrhœa supervened. The extremities soon became livid, and the pain of the abdomen intense; delirium ensued; and all four died.[^[2431]]

Such cases, however, do not appear to be very common; and much more generally the symptoms of poisoning with the fungi present a well-marked conjunction of deep narcotism and violent irritation, as the instances now to be mentioned will show.

Besides the four soldiers whose cases have just been described, several of their comrades were severely affected, but recovered. Two of these had weak pulse, tense and painful belly, partial cold sweats, fetid breath and stools. In the afternoon they became delirious, then comatose, and the coma lasted twenty-four hours.

A man, his wife, and three children, ate to dinner carp stewed by mistake with the Amanita citrina. The wife, the servant, and one of the children had vomiting, followed by deep sopor; but they recovered. The husband had true and violent cholera, but recovered also. The two other children became profoundly lethargic and comatose, emetics had no effect, and death soon ensued without any other remarkable symptom. The individuals who recovered were not completely well till three weeks after the fatal repast.[^[2432]] This set of cases shows the tendency of the poisonous fungi to cause in one person pure irritation, and in another pure narcotism.

The last set of cases to be mentioned were produced by the Hypophyllum sanguineum, a small conical fungus of a mouse colour, well known to children in Scotland by the name of puddock-stool. This species seems to cause convulsions as well as sopor. A family of six persons, four of whom were children, ate about two pounds of it dressed with butter. The incipient symptoms were pain in the pit of the stomach, a sense of impending suffocation, and violent efforts to vomit; which symptoms did not commence in any of them till about twelve hours after the poisonous meal, in one not till twenty hours, and in another not till nearly thirty hours. One of the children, seven years of age, had acute pain of the belly, which soon swelled enormously; afterwards he fell into a state of lethargic sleep, but continued to cry; about twenty-four hours after eating the fungi the limbs became affected with permanent spasms and convulsive fits; and in no long time he expired in a tetanic paroxysm. Another of the children, ten years old, perished nearly in the same manner, but with convulsions of greater violence. The mother had frequent bloody stools and vomiting; the skin became yellow; the muscles of the abdomen were contracted spasmodically, so that the navel was drawn towards the spine; profound lethargy and general coldness supervened; and she too died about thirty-six hours after eating the fungus. A third child, after slight symptoms of amendment had shown themselves, became worse again, and died on the third day with trembling, delirium, and convulsions. This patient, who had taken very little of the poison, was not attacked till about thirty hours after the meal. The fourth child, after precursory symptoms like those of the rest, became delirious, and had an attack of colic and inflammation of the bowels, without diarrhœa; but he eventually recovered. The father had a severe attack of dysentery for three days, and remained five days speechless. For a long time afterwards he had occasional bloody diarrhœa; and, although he eventually recovered, his health continued to suffer for an entire year.[^[2433]] The cases now mentioned illustrate clearly the simultaneous occurrence of narcotic and irritant symptoms in the same individuals.

A striking circumstance in respect to the symptoms of poisoning with the fungi, is the great difference in the interval which elapses before they begin. In the first case the symptoms appear to have commenced in a few minutes; but, on the contrary, an interval of twelve hours is common; and Gmelin has quoted a set of cases, seventeen in number, in which, as in one of those related by Picco, the interval is said to have been a day and a half.[^[2434]] The tardiness of the approach of the symptoms is owing to the indigestibility of most of the fungi. Their indigestibility is in fact so great, that portions of them have been discharged by vomiting so late as fifty-two hours after they were swallowed.[^[2435]]

Another circumstance, worthy of particular notice, is the great durability of the symptoms. Even the purely narcotic effects of some fungi have been known to last above two days. In the instance just alluded to, the vomiting of the poison was the first thing that interrupted a state of deep lethargy, which had prevailed for fifty-two hours. The symptoms of irritation, after their violence has been mitigated, might continue, as in the instance quoted from Orfila, for about three weeks.

It was stated above, that some people are apt to suffer unpleasant effects from eating even the best and safest of the esculent mushrooms. These effects, which depend on idiosyncrasy, are confined chiefly to an attack of vomiting and purging, followed by more or less indigestion. Some persons have been similarly affected, even by the small portion of mushroom-juice which is contained in an ordinary ketchup seasoning. This accident, however, may very well be often unconnected with idiosyncrasy; as I have seen those who gather mushrooms near Edinburgh, for the purpose of making ketchup, picking up every fungus that came in their way.

There is some reason for suspecting that even the best mushrooms, when taken as a principal article of food for a considerable length of time, will prove injurious, and that they then induce a peculiar depraved habit, which leads to external suppuration and gangrene. The only cases which have hitherto appeared in support of this statement, were lately published in Rust’s Journal. A family, consisting of the mother and four children, were seized with a kind of tertian fever, and the formation of abscesses, which discharged a thin, ill-conditioned pus, passed rapidly into spreading gangrene, and proved fatal to the mother and one of the children. No other cause could be discovered to account for so extraordinary a conjunction of symptoms in so many individuals, except that for two months they had lived almost entirely on mushrooms; and the probability of this being really the cause, was strengthened by the fact, that the father who slept always with his family, and who alone escaped, lived on ordinary food at a place where he worked not far off.[^[2436]] In opposition, however, to the natural inference from this narrative, some have believed, that mushrooms may be safely eaten to a large amount and for a long time, provided they be used raw. A botanist of Persoon’s acquaintance, while studying the cryptogamous plants in the vicinity of Nuremberg, says he found that the peasants ate them in large quantities as their daily food; and, in imitation of their custom, he ate for several weeks nothing but bread and raw mushrooms; yet at the end he experienced an increase rather than a diminution of strength, and enjoyed perfect health. He adds that they lose their good qualities by cooking; but he has supplied no facts in support of that statement.[^[2437]] It is said that eatable fungi, used for a considerable time as a principal article of food, as in Russia, cause greenness of the skin.[^[2438]] There is no reason for supposing, as some have done,[^[2439]] that wholesome mushrooms may produce the effects of the poisonous kinds, if eaten in large quantity.

Of the Morbid Appearances.—The morbid appearances left in the bodies of persons poisoned by this deleterious fungi have been but imperfectly collected.

The body is in general very livid, and the blood fluid; so much so sometimes, that it flows from the natural openings in the dead body.[^[2440]] In general, the abdomen is distended with fetid air, which, indeed, is usually present during life. The stomach and small intestines of the four French soldiers (p. [705]), presented the appearance of inflammation passing in some places to gangrene. In two of them especially, the stomach was gangrenous in many places, and far advanced in putrefaction. The same appearances were found in Picco’s cases. In these there was also an excessive enlargement of the liver. The lungs have sometimes been found gorged or even inflamed. The vessels of the brain are also sometimes very turgid. They were particularly so in a case related by Dr. Beck, where death was occasioned in seven hours by an infusion of the Amanita muscaria in milk. The whole sinuses of the dura mater, as well as the arteries were enormously distended with blood; the arachnoid and pia mater were of a scarlet colour; the vessels of the membrane between the convolutions, together with the plexus choroides, were also excessively gorged; and the substance of the brain was red. Lastly, a clot of blood, as big as a bean, was found in the cerebellum.[^[2441]]—The stomach, unless there had been vomiting or diarrhœa, will usually contain fragments of the poison, if it has not been taken in a state of minute division; and this evidence of the cause of death may be obtained, even although the individual survived two days or upwards. Sometimes fragments are found in the intestines. In one of Picco’s patients who lived twenty-four hours, there was found in the neighbourhood of the ileo-cæcal valve, which was much inflamed.[^[2442]]

Of the Treatment.—The treatment of poisoning with the fungi does not call for any special observations. Emetics are of primary importance; and after the poison has been by their means dislodged, the sopor and inflammation of the bowels are to be treated in the usual way. No antidote is known. Several have at different times been a good deal confided in; but none are of any material service. Chansarel found acids useless, but thought infusion of galls advantageous.[^[2443]]

In concluding the present chapter it is necessary to take notice of a variety of poisoning, not altogether unimportant in a medico-legal point of view. A person may seem to die of poisoning with the deleterious fungi, from eating esculent mushrooms intentionally drugged with some other vegetable or mineral poison. It must be confessed, that if the murderer is dexterous in the choice and mode of administering the poison, such cases might readily escape suspicion, and even when suspected might not be cleared up without difficulty. The ascertaining the species of mushroom, by finding others where it has been gathered, will not supply more than presumptive proof of the wholesomeness of that which has been eaten; because the esculent and poisonous species sometimes grow near one another, and have a mutual resemblance, so that a mistake may easily occur. The presumption may be somewhat strengthened by evidence derived from the interval which elapses before the symptoms begin, from the nature and progress of the symptoms themselves, and from the morbid appearances. Some one or other of these circumstances may establish the fact of poisoning with a deleterious fungi. It is impossible, however, that they shall ever establish satisfactorily that the fungus was naturally wholesome; and, on the whole, the only decided evidence of poisoning by some other means will be the actual discovery of another poison.

The case now under consideration is not a mere hypothetical one. Ernest Platner has related a very interesting example, which proves how easily poisoning of the kind supposed may be accomplished without suspicion. A servant-girl poisoned her mistress by mixing oxide of arsenic with a dish of mushrooms. She died in twenty hours, after suffering severely from vomiting and colic pains. On dissection there were found inflammation of the stomach, gangrenous spots in it, clots of blood in its contents, and redness of the intestines. Her death, however, was ascribed to the mushrooms having been unwholesome; and the real cause was not discovered till thirteen years after, when the girl was convicted of murdering a fellow-servant in a somewhat similar way by mixing arsenic with her chocolate, and then confessed both crimes.[^[2444]]

Poisonous Mosses.—It is not improbable that some of the mosses possess poisonous properties similar to those of the deleterious fungi. Dr. Winkler of Innsbruch mentions that the Lycopodium selago is used in the Tyrol in the way of infusion for killing vermin on animals; and that unpleasant accidents have been produced in man by its accidental use. Its effects appear to be sometimes irritant, but more generally narcotic in their nature.[^[2445]]

CHAPTER XL.
OF THE EFFECTS OF POISONOUS GRAIN AND PULSE.

The different sorts of grain are subject to certain diseases, in consequence of which meal or flour made from them is apt to be impregnated with substances more or less injurious to animal life. It is likewise believed, that unripe grain possesses properties which render it to a certain extent unfit for the food of man.

It is for the most part difficult to trace satisfactorily the operation of the poisons now alluded to, because they are seen acting only in times of famine and general distress, when it is not always easy to make due allowance for the effect of collateral circumstances. There is one poison of the kind, however, whose baneful influence has been so frequently and unequivocally witnessed, that no doubt now exists regarding its properties, I mean spurred rye, or ergot. It is a poison of no great consequence, perhaps, to the English toxicologist; for indeed I am not aware that a single instance of its operation has hitherto been observed in Britain.[^[2446]] But its effects are so singular, and the ravages it has often committed on the continent have been so dreadful, that a short account of it cannot fail to interest even the English reader. Besides, it has lately been introduced into the materia medica, as possessing very extraordinary medicinal qualities; and since its use is gaining ground, every medical jurist ought to be conversant with its properties as a poison. I have also met with an instance where it was administered for the purpose of procuring miscarriage.

Of Poisoning with Spurred Rye.

Spurred Rye, or Secale cornutum, the Seigle ergoté, or Ergot of the French, and Mutterkorn, or Roggenmutter, of the Germans, is a disease common to various grains, in consequence of which the place of the pickle is supplied by a long, black substance, like a little horn or spur. It has been known to attack many plants of the order Graminaceæ;[^[2447]] and among those used as food by man, it has been observed on barley, oats, spring-wheat, winter-wheat, and rye. But the rye seems peculiarly subject to it, almost all the poison which has caused epidemics, as well as what is now used in medicine, being produced by that grain.

Of the Cause and Nature of the Spur in Rye.—The spur attacks rye chiefly in damp seasons, and in moist clay soils, particularly those recently redeemed from waste lands in the neighbourhood of forests. Of all the places where the spur has been hitherto observed none combines these conditions so perfectly, and none has been so much infested with the disease, as the district of Sologne, situated between the rivers Loire and Cher, in France. According to the statistical researches of the Abbé Tessier, who in 1777 was deputed by the Parisian Society of Medicine to investigate the causes of the extraordinary prevalence of the ergot in that district, the country was then so much intersected by belts of wood around the fields, that the traveller in passing along might imagine he was constantly approaching an immense forest; the arable land was so poor, that, although it lay fallow every third season, it was exhausted in nine or twelve years at farthest, and then remained a long time in pasture before it could again bear white crops; the surface was so level, and consequently so wet, that crops were obtained only when the seed was sown on the tops of furrows a foot high; and the climate is so moist, that from the month of September till late in spring the whole country is overhung by dense fogs.[^[2448]] Here the rye, the common food of the peasantry, appears to have been in Tessier’s time more liable to be attacked by the spur than in any other part of the continent. Tessier found, that after being thrashed it contained on an average about a forty-eighth part of ergot, even in good seasons; but in bad seasons, and taking into account a considerable proportion which is shaken out of the ears and sheaves before they reach the barn, the proportion of ergot in the whole crop has been estimated so high as a fourth or even a third. In Sologne the disease was farther observed by Tessier to be always most prevalent in the dampest parts of a field, and to affect above all the first crop of fields redeemed from waste land, or from land which had previously been for some time in pasture.[^[2449]] The same connexion between moisture and the development of the ergot has been repeatedly traced in other parts of France, as well as in Germany.[^[2450]] And according to the experiments of Wildenow, it may be brought on at any time, by sowing the rye in a rich damp soil, and watering the plants exuberantly in warm weather.[^[2451]]

Opinions are much divided as to the cause and nature of the spur. It had been conceived by some that nothing else is required for its production but undue moisture combined with warmth; and that under these circumstances the spur is formed simply by a diseased process from the juices of the plant.[^[2452]] By others, such as Tillet, Fontana, and Réad, who also consider it to be simply a diseased formation, it has been held to arise from the germen being punctured when young by an insect;[^[2453]] and in support of this statement, General Field says he saw flies puncture the glumes in their milky state where spurs afterwards formed, and imitating the operation with a needle obtained the same result.[^[2454]] On the other hand, Decandolle, reviving a previous doctrine that the spur is a kind of fungus, conceived he had given strong grounds for believing this excrescence to be a species of sclerotium, which he terms S. clavus. Wiggers supports this doctrine by chemical analysis; for he endeavours to show that the basis of the structure of the spur is almost identical in chemical properties with the principle fungin.[^[2455]] Lastly, the most recent researches, those of Smith,[^[2456]] Queckett,[^[2457]] and Bauer,[^[2458]] founded chiefly on microscopical observations, tend to a union and modification of these two views,—namely, that the great mass of the spur is a peculiar morbid formation, and that the whitish bloom which covers fresh specimens consists of a multitude of microscopic fungi in the form of sporidia, which thickly envelope and impregnate the parts of fructification in the nascent state of the embryo, and are in all probability the exciting cause of the morbid degeneration of the pickle.[^[2459]]

Various opinions have been formed as to the mode of propagation of the spur. Fontana has alleged that one variety of it may spread from plant to plant over a field; and that he has expressly transmitted it by contact from one ear to another.[^[2460]] His opinion and statement of facts are at variance with experiments lately made by Hertwig, a German physician, who found that even when the ear while in flower was surrounded for twelve days with powder of spurred rye, the healthiness of the future grain was not in the slightest degree affected.[^[2461]] The same results have also been obtained by Wiggers, and more recently by Dr. Samuel Wright.[^[2462]] Wiggers, however, although he could not produce spurs in the way indicated by Fontana, observed that the white dust on the surface of the spurs will produce the disease in any plant, if sprinkled in the soil at its roots, appearing therefore to be analogous to the sporules or spawn of the admitted fungi. Mr. Queckett has made the most precise experiments on the mode of reproduction of the disease. He succeeded in infecting rye repeatedly with ergot by means of the sporidia developed on the spurs; but it is remarkable that he could not in the same way infect wheat or barley.[^[2463]]

Description and analysis of Spurred Rye.—The spur varies in length from a few lines to two inches, and is from two to four lines in thickness. If it is long, there is seldom more than one or two on a single ear, and the remaining pickles of the ear are healthy. But the ears which have small spurs have generally several, sometimes even twenty; and when there are many, few of the remaining pickles are altogether without blackness at the tips.[^[2464]] The substance of the spur is of a pale grayish-red tint; and externally it is bluish-black or violet, with two, sometimes three, streaks of dotted gray. It is specifically lighter than water, while sound rye is specifically heavier, so that they are easily separated from one another.[^[2465]] It is tough and flexible when fresh, brittle and easily pulverized when dry. The powder is disposed to attract moisture. It has a disagreeable heavy smell, a nauseous, slightly acrid taste, and imparts its taste and smell both to water and alcohol. Bread which contains it is defective in firmness, liable to become moist, and cracks and crumbles soon after being taken from the oven.[^[2466]]—It is easily known, when entire, by its external characters. Its powder, which is of an obscure grayish-red hue, is best known by the action of solution of potash, which immediately disengages a powerful odour of ergot, and forms a lake-red pulp; and this pulp yields by filtration a splendid lake-red solution, which gives a beautiful lake-red flaky precipitate, when either neutralized by nitric acid, or treated with an excess of solution of alum.

Spurred rye has been repeatedly subjected to analysis. The earlier researches of Vauquelin[^[2467]] and of Pettenkofer[^[2468]] do not lead to any pointed results. The presence of hydrocyanic acid indicated by Robert,[^[2469]] would not account for the very peculiar effects of ergot, and has besides been denied by Wiggers. Winkler obtained various principles from it, and among the rest a thick, rancid, slightly acrid oil, and a nauseous, sweetish, acrid fluid; but he did not determine, any more than his predecessors, in which of these principles the active properties of the spur reside.[^[2470]] Wiggers supplied more definite information on the subject. He denies the presence of hydrocyanic acid, and says he found ergot to consist chiefly of a heavy-smelling fixed oil, fungin, albumen, osmazome, waxy matter, and an extractive substance of a strong, peculiar taste and smell, in which, from experiments on animals, he was led to infer that its active properties reside. I have obtained all his chief results, except the most important of them; for the substance which ought to have been his ergotin was destitute of marked taste or smell of any kind.[^[2471]] Dr. Wright too could not obtain the ergotin of Wiggers, and concludes from his own experiments, that the spur consists of fungin, modified starch, mucilage, gluten, osmazome, colouring matter, various salts, and thirty-one per cent. of fixed oil, in which the active properties of the poison seemed to him to reside.[^[2472]] Buchner, however, thinks that the oil is not itself active, but owes its apparent energy to an acrid principle which alcohol removes from it, and which is not removed from the crude substance in separating the oil in the usual way by sulphuric ether, unless the ether be somewhat alcoholized.[^[2473]] However this may be, it seems ascertained by the experiments of Dr. Wright, that the fixed oil, obtained by means of common ether, concentrates in itself the peculiar properties possessed by ergot, either in small doses as a medicine, or in a single large dose as a poison.

Effects of Spurred Rye on Man and Animals.—Before proceeding to relate the effects of this poison on man, it should be mentioned, that at different times doubts have been entertained, whether the baneful effects ascribed to it might not really arise from some other cause. But independently of the connexion which has been frequently traced between the poison and the diseases imputed to it in the human subject, the question has been set at rest by the experiments which have been tried on animals, and which indeed were instituted with a view to settle the point in dispute.

The experiments hitherto made on animals are variable in their results, yet sufficient to show that spurred rye is an active poison of a very peculiar kind. According to the observations collected by Dr. Robert from a variety of authors, it follows that it is injurious and even fatal to all animals which are fed for a sufficient length of time with a moderate proportion of it, unless they escape its action by early vomiting; that dogs and cats, in consequence of discharging it by vomiting, suffer only slight symptoms of irritant poisoning;—but that swine, moles, geese, ducks, fowls, quails, sparrows, as well as leeches and flies, are sooner or later killed by it;—and that the symptoms it causes in beasts and birds are in the first instance giddiness, dilated pupil, and palsy, and afterwards diarrhœa, suppurating tumours, scattered gangrene throughout the body, and sometimes dropping off of the toes. Wiggers ascertained that nine grains of the substance he has considered its active principle occasioned in a fowl dulness, apparent suffering, gradually increasing feebleness, coldness and insensibility of the extremities, and in three days a fit of convulsions, ending in death.[^[2474]] Taddei lately found, that sparrows were killed by six grains of it in six or seven hours, with symptoms merely of great weakness, torpor, and indisposition to stir.[^[2475]]

Dr. Wright, whose experiments are the most extensive and precise yet made on this subject, found that a single dose, consisting of a strong infusion of between two drachms and a half and six drachms of ergot, if introduced into the jugular vein of a dog, occasions death, sometimes in a few minutes, sometimes not for more than two hours, with symptoms of alternating spasm and paralysis, occasionally a tendency to coma, and often depressed or irregular action of the heart, or even complete arrestment of its function;—that, when introduced into the cellular tissue, it produces inflammation and suppuration, sometimes circumscribed, sometimes diffuse, and always attended with an unhealthy discharge and great exhaustion;—and that, when admitted into the stomach, it excites irritation of the alimentary canal, excessive muscular prostration, at first excitability, but afterwards singular dulness or even complete obliteration of the senses, and occasional slight spasms; but that it is not a very active poison through this channel, as above three ounces are required to prove fatal to a dog. When it was administered in frequent small doses, he could not observe the effects remarked by Robert, but found that it induced a peculiar cachectic state, indicated by extreme muscular emaciation and weakness, loss of appetite, frequency of the pulse, repulsive fetor of the secretions and excretions, congestion of the alimentary mucous membrane, excessive contraction of the spleen, enlargement of the liver and absorbent glands, and non-formation of callus at the ends of fractured bones.[^[2476]]

With regard to its effects on man, it has been found by express experiment, that a single dose of two drachms excites giddiness, headache, flushed face, pain and spasms in the stomach, nausea, and vomiting, colic, purging, and a sense of weariness and weight in the limbs.[^[2477]] But it is not in this way that it has been usually introduced into the system; nor are these precisely the symptoms already hinted at as particular in its action. The effects now to be mentioned form a peculiar disease, which has often prevailed epidemically in different territories on the continent, and which arises from the spur being allowed to mix with the grain in the meal, and being taken as food for a continuance of time in rye-bread. The affection produced differs much in different epidemics and even in different cases of the same epidemic. Two distinct disorders have been noticed; the one a nervous disease, characterized by violent spasmodic convulsions; the other a depraved state of the constitution, which ends in that remarkable disorder, dry gangrene; and it does not appear that the two affections are apt to be blended together in the same case.

The first form of disease, the convulsive ergotism of the French writers, has been very well described by Taube, a German physician, as it occurred in the north of Germany in 1770–1. In its most acute form, it commenced suddenly with dimness of sight, giddiness and loss of sensibility, followed soon by dreadful cramps and convulsions of the whole body, risus sardonicus, yellowness of the countenance, excessive thirst, excruciating pains in the limbs and chest, and a small, often imperceptible pulse. Such cases usually proved fatal in twenty-four or forty-eight hours. In the milder cases the convulsions came on in paroxysms, were preceded for some days by weakness and weight of the limbs, and a strange feeling as of insects crawling over the legs, arms, and face; in the intervals between the fits the appetite was voracious, the pulse natural, the excretions regular; and the disease either terminated in recovery, with scattered suppurations, cutaneous eruptions, anasarca or diarrhœa, or it proved in the end fatal amidst prolonged sopor and convulsions.[^[2478]] Another more recent and very clear account of this form of the disease has been given by Dr. Wagner of Schlieben from his experience of an epidemic which prevailed in the neighbourhood of that place so lately as the years 1831 and 1832. In consequence of unusual moisture and late frosts in the summer of 1831, the rye was so much spurred in many fields that a fifth at least of the pickles was diseased. As soon as the country people proceeded to use the new rye, convulsive ergotism began to show itself, and it recurred more or less till next midsummer, when the diseased grain was all consumed. The usual symptoms were at first periodic weariness, afterwards an uneasy sense of contraction in the hands and feet, and at length violent and permanent contraction of the flexor muscles of the arms, legs, feet, hands, fingers and toes, with frequent attacks of a sense of burning or creeping on the skin. These were the essential symptoms; but a great variety of accessory nervous affections occasionally presented themselves. There was seldom any disturbance of the mind, except in some of the fatal cases, where epileptic convulsions and coma preceded death. Every case was cured by emetics, laxatives, and frequent small doses of opium, provided it was taken in reasonable time, and the unwholesome food was completely withdrawn.[^[2479]]

The other form of disease, which has been named gangrenous ergotism, by the French writers, and is known in Germany by the vulgar name of creeping-sickness (kriebelkrankheit), has been minutely described by various authors. In the most severe form, as it appeared in Switzerland in 1709 and 1716, it commenced, according to Lang, a physician of Lucerne, with general weakness, weariness, and a feeling as of insects creeping over the skin; when these symptoms had lasted some days or weeks, the extremities became cold, white, stiff, benumbed, and at length so insensible that deep incisions were not felt; then excruciating pains in the limbs supervened, along with fever, headache, and sometimes bleeding from the nose; finally the affected parts, and in the first instance the fingers and arms, afterwards the toes and legs, shrivelled, dried up, and dropped off by the joints. A healthy granulation succeeded; but the powers of life were frequently exhausted before that stage was reached. The appetite, as in the convulsive form of the disease, continued voracious throughout.[^[2480]] In milder cases, as it prevailed at different times in France, nausea and vomiting attended the precursory symptoms, and the gangrenous affection was accompanied with dark vesications.[^[2481]] In another variety, which has been witnessed in various parts of Germany, the chief symptoms were spasmodic contraction of the limbs at first, and afterwards weakness of mind, voracity and dyspepsia, which, if not followed by recovery, as generally happened, either terminated in fatuity or in fatal gangrene.[^[2482]]

These extraordinary and formidable distempers were first referred to the operation of spurred rye in 1597 by the Marburg Medical Faculty, who witnessed the ravages of the poison in Hessia during the preceding year. Since then repeated epidemics have broken out in Germany, Bohemia, Holstein, Denmark, Sweden, Lombardy, Switzerland, and France.[^[2483]] About the close of last century, partly in consequence of the attention of the respective governments being turned to the subject, partly by reason of the improved condition of the peasantry in these countries, and the greater rarity of seasons of famine, the epidemics became much less common or extensive. Nevertheless the creeping-sickness has been several times noticed in Germany since the present century began.[^[2484]]

Spurred rye is now generally believed to possess another singular quality, in consequence of which it has been lately introduced into the materia medica of this and other countries,—a power of promoting the contractions of the gravid uterus. This property seems to have been long familiar to the quacks and midwives of Germany; and towards the close of last century it rendered ergot so favourite a remedy with them, that several of the German states prohibited the use of it by severe statutes.[^[2485]] It was first fairly brought under the notice of regular accoucheurs by the physicians of the United States between the years 1807 and 1814.[^[2486]] There appears little reason for doubting that it possesses the power of increasing the contractions of the uterus when unnaturally languid; and consequently it has been employed, apparently with frequent good effect, to hasten languid natural labour, to promote the separation of the placenta, and to quicken the contraction of the womb after delivery. These facts, however, are mentioned chiefly as preparatory to the statement, that it has been also supposed to possess the power of producing abortion, and has been actually employed for that purpose in some foreign countries, and even in this city. Accurate information is still much wanted on this subject. No other poison seems so likely to possess a peculiar property of the kind. Nevertheless it is the opinion of the best authorities, that spurred rye has no such power, except in connexion with violent constitutional injury produced by dangerous doses; and that it is endowed with the property only of accelerating natural labour, not of inducing it, particularly in the early months of pregnancy.

It seems from the experiments of Dr. Wright to have no power whatever of inducing miscarriage in the lower animals.[^[2487]] Notwithstanding the improbability, however, of its possessing the property of bringing on abortion, it is one of the substances at present occasionally employed with the view of feloniously causing this accident. In a case of attempt to procure abortion, which occurred not long ago in this city, one of the articles repeatedly employed, but without success, was powder of spurred rye,—as I had occasion to ascertain by chemical analysis.

Of Spurred Maize.—It has been already observed, that many other plants of the Natural Family of Grasses are subject to the ergot besides rye. But the only other species in which the disease has been particularly examined is Indian corn or maize [Zea Mays]. It appears from the inquiries of M. Roullin that maize is very subject to the spur in the provinces of Neyba and Maraquita in Colombia; that the spur forms a black, pear-shaped body on the ear in place of the pickle; and that in this state the grain, which is known by the name of maïs peladero, possesses properties injurious to animal life. Its effects, however, are somewhat different from those of spurred rye. Men who eat the ergotted maize lose their hair and sometimes their teeth, but are never attacked with dry gangrene or convulsions. When swine eat it, which after a time they do with avidity, the bristles drop off, and the hind-legs become feeble and wasted. Mules likewise lose their hair, and the hoofs swell. Fowls lay their eggs without the shell. Apes and parrots, which frequent the fields of spurred maize, fall down as if drunk; and the native dogs and deer experience similar effects.[^[2488]]

Of the Rust of Wheat.

There are several other diseases to which grain is liable, and which are much more common in this country than the ergot. But very little is known of their effects on the animal body; which circumstance, since the wheat of this and other countries often suffers from them, is probably sufficient to show that their influence must be trifling, or at all events very seldom called forth. Wheat is liable to three diseases. One is a disease of the stalk and leaf rather than of the ear, and has the effect of preventing the development of the ear or its pickles, and of covering the plant with a brown powder. Of the two other diseases, which both attack the pickles of the ear, one consists in the substitution of a brown dry powder for the farina of the pickle, and the other of a deposition of black moist matter in the fissure of the pickle, the substance of which it also invades and partially destroys. One of these is called in Scotland brown rust, the other black rust.

Of the three diseases the only one which is apt to infect the flour is the black rust. The others, as they consist of a light dry powder, are almost entirely separated in thrashing and winnowing the grain. But the black rust being damp and adhesive, it is carried along with the pickles. Such pickles are almost invariably separated by the farmer if they are abundant; for otherwise, on account of the dark colour and disagreeable odour of the matter deposited on them, the flour possesses external qualities which would be at once recognized by a dealer of ordinary experience.

It is not improbable, that a moderate impregnation of bread with the powder formed by the diseases in question may take place, without leading to any unpleasant effect on the human body. Experiments to this effect were made by Parmentier with one of them, termed in France carie, or caries of wheat, which from his description appears to be the black rust of Scottish farmers. He gave two dogs each two drachms daily of the powder for fifteen days, without remarking any sign of ill health. Bread made with wheat flour containing a 64th of the powder, when eaten by various people, and Parmentier among the rest, to the amount of a pound daily for several days, caused slight headache and pain in the stomach the first day only; and in larger proportion it had as little effect.[^[2489]]

It appears, then, that the introduction of any deleterious ingredient into wheat bread is hardly to be dreaded from the common diseases to which wheat is liable in this country.

Of Unripe Grain.

Wheat and other grains have been supposed to acquire qualities detrimental to health, from being cut down while unripe, or used immediately after being cut down, although ripe. I am not aware that accidents have ever been traced or even imputed to such causes in this country; and, on the whole, I believe it is generally considered here, that imperfect ripening of the pickle rather lessens the quantity, than impairs the quality, of the flour. But several times epidemics have been ascribed in France to unripe wheat. In 1801 M. Bouvier read a memoir to the Society of Medicine at Paris, ascribing to new and unripe wheat an epidemic dysentery, which laid waste several districts of the department of the Oise in the autumn of 1793. These districts abound in small farms of a few acres, on the produce of which the cultivators depend in great measure for their subsistence. Hence in unfavourable seasons the corn was commonly cut down before it was ripe, and made into bread soon after being reaped. It was accordingly among the peasantry of these farms only, and not among the agriculturists in large farms, which were under better management, that the epidemic prevailed. Bouvier remarks, that at all times when the long continuance of wet weather has compelled the inhabitants of a district to cut down the wheat before it is ripe, or a previous dearth has forced them to use it when newly cut, epidemic disorders of the bowels have been observed to rage in the latter months of autumn. And as an instance of this he refers to the year 1783, when the crops around Paris were believed to have been injured by the extraordinary prevalence of fogs, and were cut down unripe and used immediately. Various epidemics broke out in the metropolis, and still more in the surrounding country.[^[2490]] This is an important subject for farther inquiry; but at present I cannot help thinking that M. Bouvier exaggerates the effects of the immaturity of the grain. At all events, the grain is often cut down in an unripe state in various districts of this country; and I have never heard that any epidemic diseases were produced. When M. Bouvier witnessed the epidemic of 1793 in the department of the Oise, he instructed the inhabitants of his own parish to dry the unripe corn before thrashing it, to repeat the process before the grain was converted into flour, and to mix with the flour a larger quantity than usual of yeast in making it into bread; and he states that in the succeeding year, which was even more unfavourable to the crops, they were enabled, by following these directions, to use unripe corn with safety.

Of Spoiled Bread.

This is the fittest opportunity for noticing certain injurious effects sometimes observed from the use of spoiled or mouldy bread. On the continent repeated instances have occurred of severe and even dangerous poisoning from spoiled rye-bread, barley-bread, and even wheat bread. Several instances have been observed of horses having been killed in a short space of time with symptoms of irritant poisoning after eating such bread with their ordinary food.[^[2491]] And Ur. Westerhoff has given an account of its effects on two children and several adults. In children the symptoms were redness of the features, dry tongue, frequent weak pulse, violent colic pains, urgent thirst and headache, and subsequently vomiting and diarrhœa, alternating with great exhaustion and sleepiness. The bread in these instances was made of rye.[^[2492]] It appears that in bread so spoiled a variety of mucedinous vegetables are developed, especially the Penicillium glaucum and P. roseum; and it is imagined by some, that this circumstance may account for the deleterious effect of the bread.[^[2493]]

Of the Effects of Darnel-Grass.

Grain is also rendered more or less injurious by the accidental or intentional admixture of a variety of foreign substances, by which, in common speech, it is said to be adulterated. The subject of the adulteration of grain is a very important topic in medical police. But as this practice seldom imparts to the grain qualities decidedly poisonous, the consideration of it would be misplaced here. One variety, however, the accidental adulteration of flour with the seeds of the Lolium temulentum or darnel-grass calls for some notice; for it may occasion not only symptoms of poisoning, but even also death itself.

This is the only poisonous species of the natural order of the grasses. The seeds appear to be powerfully narcotic, and at the same time to possess acrid properties. Seeger gave a dog three ounces of a decoction of the flour, and observed that it was seized in five hours with violent trembling and great feebleness, which were succeeded in four hours by sopor and insensibility; but it recovered next day.[^[2494]]

When mixed with bread and taken habitually by man, darnel-grass has been known to cause headache, giddiness, somnolency, delirium, convulsions, paralysis, and even death. M. Cordier found by experiment on himself, that very soon after eating bread containing darnel-grass flour, he felt confusion of sight and ideas, languor, heaviness, and alternate attacks of somnolency and vomiting. The bread was commonly vomited soon after he ate it.[^[2495]] Seeger has related some cases in which the somnolency was much more deep; and states that general tremors are almost always present.[^[2496]] A few years ago almost the whole inmates of the Poor’s House at Sheffield, to the amount of eighty, were attacked with analogous symptoms after breakfasting on oatmeal porridge; and it was supposed that the meal had been accidentally adulterated with the lolium. The chief symptoms were a piercing stare, violent agitation of the limbs, quivering of the lips, frontal headache, confusion of sight, dilated pupil, small tremulous pulse, twitches of the muscles, and palpitation. In twelve hours all of the persons attacked were well but two, who had strong convulsions in the subsequent night, but also eventually recovered.[^[2497]] A similar accident is mentioned by Perleb, as having happened at Freyburg in the House of Correction. The inmates, soon after eating bread made with new flour, were attacked to the number of forty, with loss of speech and somnolency; and for some days afterwards they complained of sickness.[^[2498]] The accident was ascribed to darnel-grass. In a recent instance which happened in the workhouse of Beninghausen, and which was traced to the lolium, seventy-four people were attacked with giddiness, tremor, convulsions, and vomiting. Those who had led a dissipated life suffered most, and children least of all.[^[2499]]

Sometimes this poison appears to excite symptoms of intestinal irritation, without acting as a narcotic. A small farmer near Poicters in France saved five bushels of the seed from a field of wheat,—had it ground with a single bushel of wheat, and afterwards made bread with the mixture for his own family. He himself, with his wife and a servant, began to eat the bread on a Thursday; but the two last were so violently affected with vomiting and purging, that they refused to continue taking it. He persevered himself, however, till on the Sunday evening he became so ill that his wife wished to send for medical aid. This he refused to allow, and next day he expired after suffering severely from fits of colic.[^[2500]]

Bley of Bemburg has examined chemically the grain of lolium. He obtained from it a bitter extractive matter, without any characteristic chemical properties, but which killed a pigeon. The seed has a very feeble bitterish taste. Bley maintains that its poisonous properties are essential to it, and not incidental, as some think.[^[2501]]

Of the Effects of certain Poisonous Leguminous Seeds.

Among the injurious substances with which various grains are apt to be accidentally mixed from their growing together, two leguminous plants may be here shortly mentioned, as they have often been the source of disagreeable accidents on the continent.

In the department of the Cher and Loire in France, severe effects have been traced to bread made partly with flour of the Lathyrus cicera. M. Desparanches, in a report to the Prefect of the Department, says this flour occasionally forms one-half of that of which bread is made in some parishes; that it produces sometimes sudden incapability of walking, sometimes imperfect paraplegia and pain, with a draggling gait and turning in of the toes, and sometimes also slight convulsive movements of the thighs and legs.[^[2502]] Similar effects have been traced to this substance formerly. Virey says it has been known to produce in particular a singular stiffness and state of semiflexion of the knee-joint, compelling the individual to move the limbs in one rigid mass.[^[2503]]

The Ervum ervilia, or Bitter-vetch, which is not a native of this country, has also been found in France to possess analogous properties. In 1815, according to Virey, a great variety of herbs grew up with the grain, in consequence of the wetness of the summer; and their seeds were thus subsequently mixed with the wheat and rye. Among these he particularizes the bitter-vetch as peculiarly noxious, because it produces so great weakness of the extremities, but especially of the limbs, that the individual trembles while standing, and totters when he walks, or even requires the help of stilts; and he adds, that horses are similarly affected, so as to become almost paralytic.[^[2504]]

The Cytisus laburnum, or laburnum tree, is another plant of the same family, which yields poisonous seeds. The whole plant is more or less deleterious. But it is chiefly the seed that has attracted attention hitherto.

I am not acquainted with any experiments relative to the action of the seeds on animals.—Its effects on man present considerable variety, and show that it is a true narcotico-acrid. In some instances they seem to have been purely narcotic. My colleague Dr. Traill has communicated to me two cases of this nature. In one of these, that of a child two years old, the first evident effects were sudden paleness and a fit of screaming, followed immediately by insensibility, and then by coldness of the whole body and lividity of the face; but vomiting having been induced by warm water and mustard, the seeds were discharged, the symptoms abated, and next day he was quite well. The other case was that of a boy who was left by his companions at Dr. Traill’s door in a state of complete insensibility, with froth at the mouth and a feeble pulse. An emetic, administered immediately, brought up a large quantity of laburnum seeds; after which the pulse became firmer, and sensibility quickly returned.—Mr. North has briefly noticed a similar case of a child, who after eating laburnum flowers, was seized with paleness and twitches of the face, coldness of the skin, laborious breathing, efforts to vomit, and great feebleness of the pulse. But recovery took place after the flowers were vomited.[^[2505]]—In other instances the effects have been chiefly limited to an irritant action on the stomach and bowels. Dr. Bigsby of Newark informs me that a few years ago a little girl in his neighbourhood, in consequence of eating the seeds, was attacked with violent vomiting and purging, and became in other respects very ill, but recovered in forty-eight hours.—Most generally, however, the effects are partly irritant, partly narcotic. In 1839 Dr. Annan of Kinross communicated to me the case of a little boy, who in an hour after swallowing a small quantity of unripe seeds, was attacked with violent vomiting and ghastly expression of countenance, and then fell into a very drowsy state, from which he was constantly roused by shaking him and dashing cold water on his body. But for a month afterwards he continued subject to vomiting and diarrhœa.—Mr. Bonney of Brentford has related the particulars of eleven cases, which presented all the varieties of poisoning with the seeds. The subjects were children from seven to nine years of age; and they took, some of them one seed, and none more than five. Three scarcely suffered at all. One vomited the poison and got well at once. Of the others, some had only nausea and feebleness of the pulse, another had also dilatation of the pupils, some had vomiting and purging, others great drowsiness, others again both sets of symptoms. In all the pulse was weak and generally rapid. Emetics, laxatives and ammonia were administered with success.[^[2506]]

The leaves of this plant are stated by Vicat, a good authority, to possess the property of acting violently as an emetic and purgative;[^[2507]] and Cadet says the unripe pods have been known to produce in small quantities severe vomiting, and profuse, protracted diarrhœa.[^[2508]]

My attention was lately turned by a criminal trial in this country to the effects of the bark, which is not alluded to as a poison by any author, although its properties seem well known to the peasantry in the north of Scotland. A lad Gordon was tried lately at Inverness for administering poison to a fellow-servant, and it was proved that he gave her laburnum-bark in broth. She immediately became very sick, and was soon attacked with incessant vomiting and purging, pain in the belly, rigor, and extreme feebleness; and several days elapsed before she could return to her work. The sickness, vomiting, purging and pain continued afterwards to recur more or less; great emaciation ensued; in six weeks she was so much reduced as to be compelled to quit service; and even six months afterwards, she continued so ill with a chronic dysenteric affection, that fears were entertained for her life, although eventually she did recover. Being consulted in the case, I was inclined to rely in the general properties of the plant and the peculiar, intense, nauseous bitterness of the bark, even more intense there than in the seeds, as adequate proof that the bark was capable of producing the effects observed in this case. I was scarcely prepared, however, to find it so deadly a narcotic poison, as it proved to be on careful experiment. Dr. Ross of Dornoch, who saw the woman and was also consulted on the part of the crown in the case, found that from twenty to seventy grains of dried laburnum-bark caused speedy and violent vomiting when administered to dogs, but no other marked effect. I found that when an infusion of a drachm of dried bark was injected into the stomach of a strong rabbit, the animal in two minutes began to look quickly from side to side, as if alarmed and uncertain in which direction to go, then twitched back its head two or three times, and instantly fell on its side in violent tetanic convulsions, with alternating opisthotonos and emprosthotonos so energetic that its body bounded with great force upon the side up and down the room. Suddenly in half a minute more all motion ceased, respiration was at an end, and, excepting that the heart continued for a little to contract with some force, life was extinct. No morbid appearance was visible anywhere. The heart was gorged, but irritable. Dr. Ross subsequently repeated this experiment, and obtained analogous results; but the animals he operated on did not die for half an hour or upwards.[^[2509]]

MM. Chevallier and Lassaigne have discovered in the seeds an active principle called cytisin, a nauseous, bitter, brownish-yellow, neutral, uncrystallizable substance, of which small doses killed various animals amidst vomiting and convulsions, and eight grains taken by man in four doses brought on giddiness, violent spasms, and frequency of the pulse, lasting for two hours, and followed by exhaustion.[^[2510]]

A great number of Brown’s division Papilionaceæ of the present natural family probably possess similar properties.

CHAPTER XLI.
OF POISONING WITH ALCOHOL, ETHER, AND EMPYREUMATIC OILS.

The last group of the narcotico-acrids comprehends alcohol, ether, and the oleaginous products of combustion.

Of Poisoning with Alcohol.

Of its Action on Animals, and Symptoms in Man.—Alcohol has been generally believed, since the experiments of Sir B. Brodie,[^[2511]] to act on the brain through the medium of the nerves, and to do so without entering the blood. This may be doubted. At least in some experiments performed several years ago by Dr. C. Coindet and myself it appeared not to act so swiftly, but that absorption might easily have taken place before its operation began. At all events, through whatever channel it may operate, there is no doubt that it enters the blood; for in man the breath has a strong smell of spirit for a considerable time after it is swallowed; and it has been found in the tissues and secretions after death from large doses. Professor Orfila found that alcohol is a violent poison when injected into the cellular tissue; and that it produces through that channel the same effects as when taken into the stomach.[^[2512]] In the course of our experiments Dr. C. Coindet and I found that it acted with great rapidity when injected into the cavity of the chest.

Authors who have treated of the action of alcohol and spirituous liquors on man, have distinguished three degrees in its immediate effects.

1. When the dose is small, much excitement and little subsequent depression are produced.

2. When the effect is sufficiently great to receive the designation of poisoning, the symptoms are more violent excitement, flushed face, giddiness, confusion of thought, delirium, and various mental affections, varying with individual character, and too familiar to require description here. These symptoms are soon followed by dozing and gradually increasing somnolency, which may at length become so deep as not to be always easily broken. After the state of somnolency has continued several hours, it ceases gradually, but is followed by giddiness, weakness stupidity, headache, sickness, and vomiting.

This degree of injury from alcohol may prove fatal, either in itself, by the coma becoming deeper and deeper,—or from the previous excited state of the circulation causing diseases of the brain in a predisposed habit,—or more frequently from the occurrence of some trifling accident, which in his torpid state the individual cannot avoid or remedy, such as exposure to cold, falling with the face in mud or water, suffocation from vomited matters getting into the windpipe, and the like.

Of simple poisoning by the gradual increase of coma the following judicial case in which I was consulted is a characteristic example. Two brothers drank in half an hour three bottles of porter, with which three half-mutchkins (24 ounces) of whisky had been secretly mixed by a companion, whose object was to fill them drunk by way of joke. In the course of drinking both became confused. In fifteen minutes after finishing the last bottle one of them fell down insensible, and had no recollection of what happened for twelve hours; but he recovered. The other staggered a considerable distance for an hour, and then became quite insensible and unable to stand. In four hours more consciousness and sensibility were quite extinct, the breathing stertorous and irregular, the pulse 80 and feeble, the pupils dilated and not contractile, and deglutition impossible. In this state he remained without any material change till his death, which took place in fifteen hours after he finished his debauch. A surgeon saw him when he had been five hours ill, but did little for his relief, as the case appeared hopeless.

There is a singular variety in the principal symptoms of this form of poisoning, even when completely formed. From a careful tabular analysis of no fewer than twenty-six cases, chiefly of the present denomination, collected by Dr. Ogston of Aberdeen from the experience of the police-office there, it appears that when the stage of stupor is fully formed, the person is sometimes capable of being roused, sometimes immovably comatose for a long time,—that the pulse is sometimes imperceptible or very feeble, sometimes distinct or even full, generally slow or natural, seldom frequent, very seldom firm,—that the pupils are occasionally contracted, much more generally dilated, and in a few instances alternating between one state and the other,—that the countenance is commonly pale, sometimes turgid and flushed,—and that the breathing is for the most part slow, and also soft, yet not unfrequently laborious, but very rarely stertorous. Convulsions are rare, having been observed twice only, and on both occasions in young people of the age of twelve or fourteen.[^[2513]] Dr. Ogston has tried to group these several symptoms together in classified cases; but the general conclusions at which he arrives are subject to important exceptions. Neither do any of the special symptoms seem to bear a marked relation to the ultimate event. It is peculiarly worthy of remark, that very many cases got well where the pupils were much dilated, the coma profound, and the pulse imperceptible.

In the present form of poisoning with alcoholic fluids, it usually happens that if the stage of stupor be completely overcome, recovery speedily ensues, without any particular symptom except headache, giddiness, sickness, and the customary consequences of a debauch. Hut on some occasions the comatose stage is succeeded by one which indicates much cerebral excitement,—by flushed face, injected eyes, restlessness, a febrile state of the pulse, and delirium, even of the violent kind. In other cases this affection puts on very much the characters of a slight attack of typhoid fever.

In the second variety of the second degree of intoxication, an apoplectic disposition is called into action by the excited state of the circulating system; and death ensues from apoplexy or some other disease of the brain, rather than from simple poisoning. Thus in some instances, as will be more fully mentioned under the head of the morbid appearances, extravasation of blood is found within the head after death, preceded by the usual phenomena of ordinary intoxication. Since this is a rare effect of intoxication, it must be considered as the result of poisoning with spirits, exciting sanguineous apoplexy in a predisposed constitution. In other cases the stupor of intoxication, after putting on all the characters of apoplexy for two days and upwards, terminates fatally without extravasation. Here the poison operates by developing a constitutional tendency to congestive apoplexy. Again, this mode of action is still more clearly shown in some cases, where an interval of returning health occurs between the immediate narcotic effects of the poison and the ultimate apoplectic coma which is the occasion of death. Such a course of events, which, however, is of rare occurrence, is well exemplified in the following cases. A man drank 32 ounces of rum one afternoon, and was comatose most of the ensuing night. Next morning, though very drowsy, he was sensible when roused; and in the evening he was considered convalescent. But two days afterwards he became delirious; in two days more he died comatose; and congestion was the only appearance found in the brain.[^[2514]] Another instance, most remarkable in its circumstances, is the following, which has been related by Dr. Golding Bird. A workman in a distillery, after drinking eight ounces of rectified spirit by mistake for water, suddenly fell down senseless and motionless, and remained so for eleven hours. He then began to recover, and came round so far that he returned to his work next morning. After this he continued to pass dark, pitch-like evacuations. In three weeks he became drowsy, mistook one thing for another, answered questions sluggishly, and had a frequent pulse, and dilated sluggish pupils; in which state he continued three weeks later when the account was published.[^[2515]] The following case, related by Dr. Chowne, also seems to belong to the same category, although it presents anomalies. A boy, eight years of age, soon after swallowing about eight ounces of gin, said he felt like a drunk man, and suddenly became motionless and insensible. In no long time he vomited a fluid of the odour of gin; and in seven hours from the commencement a fluid was withdrawn from the stomach, possessing no longer any such odour. He was now motionless, insensible, pale, and cold; the pupils were contracted, the pulse feeble and hurried, the breathing stertorous and slow; and he made ineffectual efforts to vomit. Stimulants of all kind had little effect on him for a day and a half, when the breathing became more natural, and his look quite intelligent. Yet he could not answer questions, exhibited no sign of volition, and had a pulse so frequent as 160. In twenty-four hours more the breathing became laborious and rattling, and the lips livid; and death took place near the close of the third day. The only appearances of any note in the dead body were general injection of the arachnoid membrane of the brain, and effusion of frothy mucus into the bronchial ramifications.[^[2516]] Similar to these is the following extraordinary case which has been communicated to me by Dr. Traill. A boy seven years of age, who was persuaded by two miscreants to take nearly five ounces of undiluted whisky, suffered for two days from the ordinary symptoms of excessive intoxication, which were then immediately followed by epileptic convulsions. These continued to recur with more or less violence, but always frequently, for two months down to the date of the judicial investigation to which the case gave rise. All these forms of the effects of drinking ardent spirits can scarcely be considered as simple poisoning, but as the result of poisoning developing a tendency to diseases of the head.

The third variety of poisoning with spirits in the second degree proves fatal, not in itself, but by some trivial accident happening, from which the individual cannot escape on account of his powerless insensibility. Thus, it is no uncommon thing for persons in a state of deep intoxication to fall down in an exposed place, where they perish from cold, or to tumble with the face in a puddle, and so be suffocated, or to be choked by inhaling the contents of the stomach imperfectly vomited, or by lying in such a posture that their neck-cloth produces strangulation. These statements are so familiar, that it is unnecessary to illustrate them by special facts. The reader’s attention was called to such accidents in the previous editions of this work. Two well-marked cases of the kind have been since published by Mr. Skae.[^[2517]]

In cases of simple poisoning in the second degree the progress of the symptoms is on the whole remarkably uniform, gradual and uninterrupted. But there are likewise some anomalies which it may be well to notice. Thus, occasionally after the phenomena of ordinary intoxication have gone on gradually increasing without having attained a very great height, sudden lethargy supervenes at once, and may prove fatal with singular rapidity. My colleague, Dr. Alison, has communicated to me the particulars of a case of the kind where death took place from simple intoxication, twenty minutes after the state of lethargy began. The individual reached his home in a state of reeling drunkenness, but able to speak and give an indistinct account of himself. He then became lethargic, and died in the course of twenty minutes. On examining the body, Dr. Alison could not discover any morbid appearance, except some watery effusion on the surface of the brain and in the ventricles; but the contents of the stomach had a strong smell of spirits. Instances of such excessive rapidity, however, are rare, unless from the third form of poisoning.—An anomaly of a different kind, of which a remarkable example was brought judicially under my notice, is sudden supervention of deep insurmountable stupor, without the usual precursory symptoms, yet not till after a considerable interval subsequently to drinking. In May, 1830, a lad of sixteen, in consequence of a bet with a spirit-dealer, swallowed sixteen ounces of whisky in the course of ten minutes, and, pursuant to the terms of the wager, walked up and down the room for half an hour. He then went into the open air, apparently not at all the worse for his feat; but in a very few minutes, while in the act of putting his hand into his pocket to take out some money, he became so suddenly senseless as to forget to withdraw his hand, and so insensible that his companions could not rouse him. A surgeon, who was immediately procured, contented himself with giving several clysters and a dose of tartar-emetic, which did not operate; and the young man died in the course of sixteen hours. The cause of the retardation of the symptoms was partly perhaps that he had taken supper only an hour before drinking the spirits, but chiefly, I presume, because the stupor was kept off for a time by the stimulus of determination to win his bet.—Several cases somewhat similar have been described by Dr. Ogston. In these sudden insensibility came on while the individuals had been drinking freely for some time, without showing any marked sign of approaching intoxication.[^[2518]] The cause of the postponement and sudden invasion of the stupor does not exactly appear; but a familiar cause of its abrupt invasion in ordinary cases of drunkenness is sudden exposure to cold.

It is impossible to fix the extremes of duration of the present form of poisoning in fatal cases. For, on the one hand, one or other of the accidents mentioned above may bring the case to a speedy close; and, on the other hand, the supervention of apoplexy may protract it to several days. The ordinary duration in fatal cases seems to be from twelve to eighteen hours.

3. The third degree of poisoning is not so often witnessed, because, in order to produce it, a greater quantity of spirits must be swallowed pure and at once, than is usually taken by those among whom poisoning in the second degree chiefly occurs. When swallowed in large quantity, as by persons who have taken foolish wagers on their prowess in drinking, there is seldom much preliminary excitement; coma approaches in a few minutes and soon becomes profound, as in apoplexy. The face is then sometimes livid, more generally ghastly pale; the breathing stertorous, and of a spirituous odour; the pupils sometimes much contracted, more commonly dilated and insensible; and if relief is not speedily procured, death takes place,—generally in a few hours, and sometimes immediately. According to Mr. Bedingfield, who witnessed many cases of poisoning with rum at Liverpool, which always follow the arrival of the West India vessels, the patient will recover if the iris remains contractile; but if it is dilated and motionless on the approach of a light, recovery is very improbable.[^[2519]]

A case is briefly alluded to by Orfila of a soldier, who drank eight pints of brandy for a wager, and died instantly.[^[2520]] A case of the same kind is quoted by Professor Marx.[^[2521]] Another, which happened in the person of a London cabman, is noticed in a French Journal. The man, for a bribe of five shillings, drank at a draught a whole bottle of gin; and in a few minutes he dropped down dead.[^[2522]] Similar accidents occur not infrequently in this country; but I have not met with any fully described by authors. A case of the less rapid variety of the present form occurred at the Infirmary here in 1820. A man stole a bottle of whiskey; and, being in danger of detection, took what he thought the surest way of concealing it, by drinking it all. He died in four hours with symptoms of pure coma.

Convulsions are not common in such cases. I have seen a remarkable example, however, in which the coma was accompanied with constant alternating opisthotonos and emprosthotonos. The subject was a boy who had been induced to drink raw whisky by an acquaintance, and had been two hours insensible before I saw him. The stomach-pump, which was immediately applied, brought away a large quantity of fluid with a strong spirituous odour; and he recovered his senses in fifteen minutes, but remained very drowsy for the rest of the day.

Such are the forms of poisoning with spirits usually admitted by authors. But it also appears to act sometimes as an irritant. After its ordinary narcotic action passes off, another set of symptoms occasionally appear, which indicate inflammation of the alimentary canal. Cases of this kind are exceedingly rare; yet they have been met with, as the following extract shows. “A young man at Paris had been drinking brandy immoderately for several successive days, when at length he was attacked with shivering, nausea, feverishness, pain in the stomach, vomiting of everything he swallowed except cold water, thirst, and at last hiccup, delirium, jaundice, and convulsions; and death took place on the ninth day. On examining the body the stomach was found gangrenous over the whole villous coat; the colon too was much inflamed; and all the small intestines were red.”[^[2523]]

A case of great complexity, but probably of the same nature, has been related by Opitz in Pyl’s Memoirs. The subject was a woman liable to epilepsy, and addicted to excessive drinking. After one of her drinking-bouts she was seized with vomiting and severe pain of the bowels, afterwards with delirium, then with convulsions, and she died in twenty-four hours after the first attack. The stomach and intestines were greatly inflamed, a table-spoonful of blood was effused into the ventricles of the brain, and the left lung was purulent.[^[2524]]

Besides the immediately fatal effects of spirituous liquors now described, there is still another variety of poisoning more common than any yet mentioned, and constituting a peculiar disease. People who fall into the unhappy vice of habitual intoxication, after remaining in a state of drunkenness for several days together, are often attacked with a singular maniacal affection, which is accompanied with tremors, particularly of the hands, and after enduring for several days, ends at last in coma. When the delirium is not so violent, the disease by proper treatment may be cured. But frequently, after the delirium and tremor have continued mildly for some time, they increase, and the delirium becomes furious, or coma rapidly supervenes; in either of which cases the disorder commonly proves fatal in two or three days more. This disease, which is now familiar to the physician, is called delirium tremens. It is supposed by some to depend on inflammation of the membranes of the brain, followed by effusion.

Other diseases, besides delirium tremens, are also slowly induced by the habitual and excessive use of spirituous liquors; but in general the habit of intoxication acts in inducing these diseases only as a predisposing cause. A particular variety of tuberculated liver probably arises from the habitual use of spirits without the co-operation of other causes. That variety of disease of the kidney, which was first brought under the notice of the profession by Dr. Bright,[^[2525]] is also obviously often connected with the habit of drinking spirits. The following have been enumerated among the diseases where the same habit acts powerfully as a predisposing cause—indurated pancreas,—indurated mesenteric glands,—scirrhous pylorus,—catarrh of the bladder,—inflammation, suppuration and induration of the kidneys,—incontinence of urine,—aneurism of the heart and great vessels,—apoplexy of the lungs,—varicose veins,—mania,—epilepsy,—tendency to gangrene of wounds,—spontaneous combustion.[^[2526]]

Of the Morbid Appearances.—Some doubts exist as to the morbid appearances in the bodies of those poisoned by spirituous liquors.

In animals killed by alcohol, Orfila says he found the villous coat of the stomach constantly of a cherry-red odour. I have several times remarked the same appearance. When the stomach was empty before the alcohol was introduced, I have always found the prominent part of its rugæ of a deep cherry-red tint, the margin of the patches being more florid, and evidently consisting of a minute network of vessels.

In man these signs of irritation have not been always observed. In the patient who died in the Infirmary here, the stomach was quite natural to appearance. Dr. Ogston notices injection of the small intestines and thickening of the mucous membrane of the stomach and intestines as common appearances in the cases he has examined; but he seems to consider these the effects not of the last fatal dose, but of the habit of frequent excessive drinking.[^[2527]]

The blood in the heart and great vessels is commonly fluid and very dark, and the lungs are sometimes more or less gorged with the same fluid.

The state of the brain differs much according to the mode of death. Sometimes great congestion and even actual extravasation of blood are found in the heads of persons who have died of excessive continuous drinking,—the excitement of such a debauch being apt, as already mentioned, to induce apoplexy in a predisposed habit. Accordingly extravasation was found by Professor Bernt of Vienna in no less than four cases of the kind, two of which happened in the persons of young men not above twenty-two years of age;[^[2528]] and Dr. Cooke quotes another in his work on nervous diseases.[^[2529]] I have myself met with another remarkable instance. A female out-pensioner of Trinity Hospital here, who was much addicted to drinking, and for fourteen days after the New-year of 1830 had been very little in her sober senses, soon after arriving at home one evening much intoxicated, fell down comatose, and died in ten or twelve hours. An enormous extravasation of clotted blood was found in the ventricles, producing extensive laceration of the right middle and anterior lobes of the brain.—In such cases it is natural to suppose that a predisposition to apoplexy must concur with the intoxication; otherwise it is not easy to see why death from extravasation is not more frequently produced by excessive drinking.

Extravasation is not apt to occur in the cases of rapid death brought on by a very large quantity swallowed at once. The circulation, indeed, is during life in a state quite the reverse of excitement; and accordingly the brain and its membranes are found quite healthy. They were particularly so in the man who died in the hospital here. It is right to mention, however, that one of Bernt’s cases, although the symptoms and other particulars are not mentioned, possibly belongs to the present variety, as the man swallowed for a wager a quart of brandy at a draught.[^[2530]] According to Dr. Ogston, who has given the best account of the appearances within the head in the ordinary cases of this kind, there is usually serous effusion under the arachnoid membrane, occasionally minute injection of vessels, commonly more or less general gorging of the larger veins, and especially effusion of serosity to the amount of two or even four ounces in the ventricles.[^[2531]]

When delirium tremens proves fatal, effusion is commonly found among the membranes of the brain; and occasionally to a great extent. In one instance, which proved fatal in two or three days, I have seen minute vascularity of the membranes, with effusion of fibrin, and without effusion of serosity; but such cases are rare. There is also, according to Andral, very extensive softening of the mucous coat of the stomach.[^[2532]] In an instance mentioned in Rust’s Journal, besides effusion into the cerebral membranes, there was found an enormous accumulation of fat in all the cavities, a conversion of the muscular substance into fat, and a nauseous sweet smell from the whole body.[^[2533]]

In all cases of rapid poisoning with spirituous liquors some of the poison will be found in the stomach. For when the case is one of pure narcotic poisoning, unaided by the effects of blows, exposure to cold, or the like, and the person dies in a few hours, the poison cannot be all absorbed before death.—Although the spirituous liquors used in Britain have all very powerful odours, the inspector in a case of importance ought not to confine himself to this test alone. He must subject the suspected matter to distillation; and then remove the water from what distils over by repeated agitation with dry carbonate of potass, till he procures the alcohol of the spirit in such a state of purity as to be inflammable.

Alcohol may also be in some circumstances detected in the tissues and secretions of the body. A spirituous odour has been remarked not infrequently in various parts, and especially in the brain. Dr. Cooke mentions a case in which the fluid in the ventricles of the brain had the smell and taste of gin, the liquor which had been taken;[^[2534]] Dr. Ogston adverts to an instance, in which after death by drowning during intoxication, he found in the ventricles nearly four ounces of fluid, having a strong odour of whisky;[^[2535]] in the case which occurred in the hospital here the odour of whisky was said to have been perceived in the pericardium; and in a man who died of long-continued intoxication from immoderate drinking Dr. Wolffe found that the surface, and still more the ventricles, of the brain had a strong smell of brandy, although the contents of the stomach had not.[^[2536]]

The presumption afforded by such facts as these, in favour of the absorption of alcohol and the possibility of detecting it throughout the animal system, has been turned to certainty by the late experimental researches of Dr. Percy; who found that in animals poisoned with alcoholic fluids, as well as in the case of a man who died during the night after drinking a bottle of rum, alcohol could be detected, generally in the urine, and also in the brain, by cautious distillation, and removing the water from the distilled fluid by means of dry carbonate of potass.[^[2537]] Dr. Percy gave me an opportunity of verifying his results with the brain of the man; and I had no difficulty in obtaining from a few ounces of brain a sufficiency of spirit to exhibit its combustion on asbestus repeatedly.

It is hardly necessary to add, that when the individual has survived the taking of the poison a considerable length of time, an odour of spirits will not be perceived either in the stomach or elsewhere. In the out-pensioner of Trinity Hospital, for example, who survived about twelve hours, no spirituous odour could any where be perceived. In such cases the poison disappears during life by absorption.—A question may even be entertained, whether the odour may not sometimes be imperceptible at the inspection of the body, although the poison was really present immediately after death. It is probable that, as in the instance of hydrocyanic acid, the alcohol, on account of its volatility or fluidity, will evaporate or percolate away in a few days. In this manner only can be explained the occasional absence of the odour in persons who have been killed in the early stage of drunkenness. I could not perceive any odour of whisky in the stomach of the woman Campbell, who was murdered by the notorious resurrectionist Burke, although she had drunk spirits to intoxication half an hour before her death. The body was not examined till thirty-eight hours after.[^[2538]] It must be observed, however, that alcohol may exist in the contents of the stomach and be detected by chemical analysis, although it is not indicated by its odour. I have twice had occasion to observe this, where the bodies were disinterred some time after death.

From all that has been said, there ought seldom to be much difficulty in recognizing a case of poisoning with spirituous liquors.

But, before quitting the subject, a form of it must be noticed which may be extremely difficult to distinguish. It was formerly remarked that the eatable mushrooms have been sometimes poisoned with substances possessing effects on the system analogous to those caused by the deleterious fungi. In the same manner spirituous liquors may be poisoned with narcotics allied to them in action. Thus, in former parts of this work, it has been stated that a young man was killed during a debauch in consequence of his companions having mingled opium with his wine; that many persons have been poisoned and some killed by fermented liquors drugged in the same manner; that murder has been accomplished by poisoning wine with nightshade; and that several fatal accidents have occurred in consequence of liqueurs having been too strongly impregnated with hydrocyanic acid, to give them a ratafia flavour. Cases of this nature may be embarrassing. In general, they may be made out by attending strictly to the symptoms, the quantity of liquor taken, and the contents of the stomach. But, it must be admitted, that if a murderer, who chooses such a method, should season his guest’s drink judiciously, and ply him well with it, a medical jurist might be puzzled to determine whether the liquor was to blame in point of quality or quantity.

Of the Treatment.—The treatment of poisoning with alcoholic fluids does not differ essentially from that of poisoning with opium. In the former, as in the latter, the chief objects must be to remove the poison from the stomach, and to rouse the patient from his state of stupor; but in poisoning with alcoholic fluids it is also frequently necessary to treat a secondary stage of reaction by local and even general antiphlogistic measures. As to the primary object, the removal of the poison from the stomach, it appears that in the present form of poisoning emetics are more seldom effectual than in the case of other narcotics, and that the stomach-pump should be promptly resorted to. It is remarkable that the operation of clearing out the stomach is likewise often a sufficient stimulus to dispel stupor immediately and even permanently. I have seen almost complete consciousness permanently restored with the discharge of the alcoholic fluid; and the same remark has been made by others. Where the senses are not thus restored, one of the most effectual stimulants, according to the practice of the police-office of this city, is the injection of water into the ears. Great advantage has been derived, as in poisoning with opium, from the cold affusion applied to the head. Dr. Ogston, who has appended to his paper formerly quoted a very useful summary of the treatment of poisoning with spirits, has found this a safe and effectual remedy where the heat of the head was unnaturally great and that of the body not too low.[^[2539]] Cases have been published where it proved successful although the pulse was gone at the wrist, the breathing scarcely perceptible, and the temperature of the whole body greatly reduced.[^[2540]] It is doubtless a powerful remedy: but where the general temperature of the surface is much lowered, I conceive it should be restricted to the head and neck, and conjoined with the application of warmth to the body. Dr. Ogston objects to the general use of blood-letting in cases of poisoning with spirits, as being often apt to be followed by sudden sinking. Where other remedies are judiciously used, it is probably seldom called for; and the purpose it is intended to serve, namely, the relief of cerebral congestion and determination, is better fulfilled by the local employment of cold, and local blood-letting. Ammonia and its acetate have been found useful as internal stimulants where the stupor is deep. The treatment of the secondary affections adverted to above does not require specific mention.

Of Poisoning with Sulphuric and Nitric Ether.

Sulphuric ether and nitric ether are poisons of the same nature with alcohol. But the effects produced by them when taken in considerable doses are not very well known.

Orfila found that half an ounce of sulphuric ether introduced into the stomach of a dog and secured there by a ligature on the gullet, excited efforts to vomit, in ten minutes inability to stand, and in six minutes more, insensibility. In fifteen minutes more the animal revived a little, but soon became again comatose; and it died in three hours after the commencement of the experiment. The villous coat of the stomach was reddish-black, the other coats of a lively red colour.[^[2541]]

The effects of the ethers on man have not been accurately ascertained. From some observations published in the Journal of Science, sulphuric ether appears to act energetically even in small doses. In moderate quantity it produces a strong sense of irritation in the throat, a feeling of fulness in the head, and other symptoms like those excited by nitrous-oxide gas. A gentleman, in consequence of inhaling it too long, was attacked with intermitting lethargy for thirty-six hours, depression of spirits and lowness of pulse.[^[2542]] When long and habitually used, as by persons afflicted with asthma, its dose must be gradually increased; and it appears that considerable quantities may then be taken for a great length of time without material injury. I have been informed of an instance of an asthmatic gentleman about sixty years of age who consumed sixteen ounces every eight or ten days, and had been in the habit of doing so for many years. Yet, with the exception of his asthma, he enjoyed tolerable health.

An interesting case has been published which proves that nitric ether in vapour is a dangerous poison when too freely and too long inhaled. A druggist’s maid-servant was found one morning dead in bed, and death had evidently arisen from the air of her apartment having been accidentally loaded with vapour of nitric ether, from the breaking of a three-gallon jar of the spiritus etheris nitrici. She was found lying on her side, with her arms folded across the chest, the countenance and posture composed, and the whole appearance like a person in deep sleep. The stomach was red internally, and the lungs were gorged.[^[2543]] The editor of the journal, where this case is related, says he is acquainted with a similar instance where a young man became completely insensible from breathing air loaded with sulphuric ether, remained apoplectic for some hours, and would undoubtedly have perished had he not been discovered and removed in time.

Of Poisoning with the Oleaginous products of Combustion.

The physiological effects of these substances have not yet been extensively investigated. It has been already mentioned, that the empyreumatic oils of tobacco and other narcotic vegetables are active poisons; and that the emanations from candle snuffings and imperfectly consumed tallow probably owe their injurious properties to a peculiar oil. Many empyreumatic oils are known, and some are used in medicine, which act powerfully on the animal system as stimulants and antispasmodics. Among these may be enumerated naphtha, oil of galbanum, oil of guiaiac, oil of amber, oil of wax, and Dippel’s oil. The last in particular, which is the rectified empyreumatic oil of hartshorn, but is prepared also from blood and various animal matters,[^[2544]] has been a good deal used of late on the continent for medical purposes, and has even been resorted to as a poison for the purpose of self-destruction.

The only one of these substances whose physiological properties have been examined with particular care, is the empyreumatic oil procured by the destructive distillation of lard. When freed of adhering acid by rectification from quicklime, this oil is limpid and very volatile, has an insupportable smell, and when diffused in the air, irritates the eyes and nostrils, and even excites giddiness. Buchner found it to possess simple narcotic properties. When a mouse was confined under a jar, into which a little of its vapour was introduced, it suddenly tried to escape, immediately fell down exhausted, and, although soon afterwards removed into the open air, expired in about fifteen minutes, without convulsions. It is much less powerful when introduced into the stomach, yet is still a dangerous poison through that channel; for five drops projected into the throat of a chaffinch very nearly proved fatal; and the only symptoms were excessive exhaustion, slow respiration, and insensibility.[^[2545]]

Similar effects have been occasionally observed in man. The late Professor Chaussier has related a case of poisoning in the human subject from the oil of Dippel, or rectified empyreumatic oil of hartshorn. It is merely mentioned, however, that the individual, on taking a spoonful by mistake, died immediately; and that no morbid appearance could be discovered in the dead body.[^[2546]] Another case has been more recently related, where the poison was the impure oil of commerce, from which the oil of Dippel is prepared by rectification. The subject was a woman, who took it intentionally in the dose of an ounce and a half. The symptoms induced could not be ascertained; but it appeared, that she had been attacked with vomiting, and, finding the action of the poison either less speedy, or less supportable than she expected, had thrown herself into a well and been drowned. The appearances in the body clearly showed that in this instance the poison had not acted as a pure narcotic. The whole body exhaled the peculiar fetid odour of the oil. The palate, tongue, throat, and gullet, were white and shrivelled. The stomach had outwardly a diffuse rose tint, crossed by gorged black veins, which here and there had burst and formed patches of extravasation. The contents of the stomach consisted of remains of food, a good deal of the oil, some water, and likewise some extravasated blood. Its villous coat was thick, covered with red points, corrugated into prominent rugæ, but not eroded. The intestines also presented signs of irritation, but in an inferior degree.[^[2547]] Dr. Kurtze, a German author, mentions that the impure oil [Oleum Animale Fœtidum] was given with malicious intention in repeated doses to an infant eighteen days old, whom he attended, and that it caused crying and vomiting; and he quotes Froriep’s Notizen, for the case of a woman of thirty, who swallowed nearly two ounces, and, after repeated attacks of vomiting, threw herself into a well and was drowned.[^[2548]]

These facts seem to establish sufficiently the propriety of arranging the empyreumatic oils among the narcotico-acrids.

Oil of turpentine possesses somewhat similar properties; but is much less active. It was found by Professor Schubarth, that two drachms of this oil administered to a dog produced immediate staggering, cries, tetanus, failure of the pulse and breathing, and death in three minutes; and in the dead body he remarked flaccidity of the heart, gorging of the lungs, and redness of the stomach.[^[2549]] It is likewise well known to be a powerful poison for vermin, such as lice, fleas, and worms.—On man its effects are capricious. It is frequently used along with other laxatives against obstinate constipation of the bowels, and either in the same manner or alone as a remedy for intestinal worms. For these purposes it has been at times administered in very large doses, for example in the quantity of two, three, or four ounces, without any other effect than brisk purging. But on the other hand it has sometimes, in much inferior doses, induced violent hypercatharsis, or acted severely on the urinary organs, producing strangury and bloody micturition, or affected the brain, producing a state like intoxication, followed by trance for many hours.[^[2550]] I am not aware that it has ever proved fatal.

Oil of tar, a composite substance obtained by the distillation of wood-tar, is another pyrogenous fluid of poisonous properties. Messrs. Slight of Portsmouth have related the case of a seaman, who, after taking nearly four ounces by mistake for spirits, was attacked with frequent vomiting of a matter having a strong odour of tar, attended with excessive pain in the bowels and loins. Nothing was done for his relief till about seven hours afterwards, when he was freely bled and purged, with immediate relief; and next morning he was so better as to be able to resume his work. The urine had a strong tarry odour, and for some time he suffered from heat in passing it.[^[2551]] A case occurred in the London Hospital, in which the symptoms were very different. A lad of eighteen, while intoxicated, took two or three draughts of oil of tar, although aware of its being poisonous. Not long afterwards he became insensible, and had laborious, rattling respiration, coldness of the extremities, suffusion of the conjunctiva, contraction of the pupils, and an exceedingly feeble pulse. The stomach-pump brought away a liquid with an overpowering smell of tar. Stimulants, external as well as internal, venesection, and turpentine clysters were of little avail; the insensibility continued, with only a short and imperfect interval; and he died about twenty-four hours after swallowing the poison. The pulmonary mucous membrane was highly injected, the lungs gorged with blood and of a tarry odour, the stomach and intestines natural, except that the whole valvulæ conniventes were yellow,—the brain and its membranes also natural.[^[2552]] It is mentioned in the paper of Messrs. Slight that a gentleman at Brighton died in consequence of a druggist using oil of tar by mistake for something else in making up a prescription.

Creasote is another pyrogenous substance possessing considerable activity as a poison. It is now extensively used in small doses as a medicine for a variety of purposes.

It has been made the subject of physiological experiment by various inquirers, and especially by Dr. Cormach; who found that doses of twenty-five or forty drops caused death in a few seconds when injected into the jugular vein of a dog, by arresting the heart’s action, and without visibly altering the condition of the blood; that a quantity somewhat larger caused only sopor and spasmodic twitches of the muscles, if injected into the carotid artery, and without proving fatal; that thirty drops introduced into the stomach of a rabbit excited convulsions, acute cries, and death in one minute, apparently from arrestment of the action of the heart; and that the same dose given to a dog brought on salivation, giddiness, tetanic spasm, a feeble, fluttering, almost imperceptible pulse, and general insensibility, with dilated immovable pupils; but recovery took place under the employment of blood-letting.[^[2553]]—The effects of too large a medicinal dose in man are pain in the stomach and vomiting, and also, according to Dr. Elliotson, giddiness, headache, and stupor.[^[2554]] Dr. Pereira alludes to a case, mentioned in the Times newspaper, of death caused in 36 hours by two drachms taken at once; and in this instance acute pain in the abdomen was a prominent symptom.[^[2555]] I presume this is the same case which is mentioned in the Edinburgh Medical and Surgical Journal as having occurred at Liverpool.[^[2556]]—The results of Dr. Cormack’s experiments on animals lead to the conclusion, that in poisoning with creasote, this substance may always be detected in the body, if it has not been removed by artificial means a considerable time before death.

CHAPTER XLII.
OF COMPOUND POISONING.

Having now investigated the three great classes of poisons in their relations to physiology, practice of physic, and medical jurisprudence, it will be necessary to offer a few observations on a subject of considerable medico-legal importance, which has been almost overlooked in systems of Toxicology,—Compound Poisoning.

When two poisons of different or opposite properties are administered about the same time in poisonous doses, the effects of the one may overpower and prevent the operation of the other, or they may merely modify the action of one another. In this manner the usual symptoms produced by one or by both may be entirely or in a great measure wanting; and even in the dead body the usual appearances occasioned by one or both may be modified or perhaps altogether absent.

Although in the course of reading I have met with a sufficient number of cases of the kind to show that compound poisoning is an object of some consequence to the medical jurist, the facts hitherto made public are not so numerous as to render a systematic arrangement of them practicable. The most advisable course, therefore, seems to be merely to describe for the present the cases which have been brought under my notice. These are as follows:

1. Poisoning with Arsenic and Alcohol.—A man, after taking twelve ounces of whisky at a debauch, swallowed, an hour afterwards, while in a state of excitement, but not particularly drunk, a quantity of arsenic, the dose of which could not be ascertained. Fifteen minutes after the arsenic was taken medical aid was procured, upon which repeated attempts were made to produce vomiting by means of ipecacuan and sulphate of zinc, but to no purpose. The stomach-pump was therefore resorted to; and, after at least an hour had been spent in previous attempts by emetics, the stomach was cleared of a fluid in which arsenic was unequivocally detected. No symptom of poisoning with arsenic followed. As the man took the arsenic seven hours after a meal, when of course the powder would at once be brought freely in contact with the villous coat of the stomach, it must, I think, be inferred, that the operation of the arsenic was impeded or prevented by the narcotism previously induced by the ardent spirits. For this case I am indebted to a former pupil, Mr. King.

Poisoning with Arsenic and Alcohol.—A case of the same description with the last, but which proved fatal in consequence of the large quantity of arsenic taken, has been related by Dr. Wood of Dumfries. A lad of seventeen, after a night’s debauch, swallowed half an ounce of arsenic early in the morning. In two hours and a half, when Dr. Wood first saw him, there was no symptom of poisoning with arsenic,—no symptom at all indeed but languor and drowsiness. A few minutes afterwards he had slight vomiting, which was repeatedly renewed by artificial means. For some hours the pulse was but little elevated. In eighteen hours he began to sink, and presented the usual constitutional symptoms of poisoning with arsenic; and in forty-one hours he expired. But from first to last he had scarcely any local symptom except vomiting, even although the stomach presented after death signs of violent irritation.[^[2557]]

3. Poisoning with Tartar-Emetic and Charcoal Fumes.—Under the head of poisoning with antimony, notice has already been taken of the case of a man who, after swallowing seventeen grains of tartar-emetic, attempted to commit suicide by suffocating himself with the fumes of burning charcoal. He recovered from both attempts, suffered severely from the usual narcotic effects of carbonic acid gas, but showed scarcely any symptom of the irritant action of tartar-emetic.[^[2558]]

4. Poisoning with Alcohol and with Laudanum.—Under the head of poisoning with opium, allusion has already been made to a remarkable case related by Mr. Shearman, where the usual effects of opium were much retarded in an individual who, at the time of swallowing the opium, was in a state of excitement from intoxication. For five hours there was no material stupor. But after that the usual narcotic symptoms supervened and eventually proved fatal.[^[2559]] The excitement of intoxication, however, has not always the effect of suspending the action of opium; for in a case which came under my notice in the Infirmary of this city,—that of a woman, who swallowed an ounce and a half of laudanum while much intoxicated,—the usual narcotic symptoms were fully formed in an hour: and although the stomach-pump was applied soon afterwards, she expired in less than five hours from the time the laudanum was swallowed,—those who had charge of her before she was brought into the hospital having neglected to use the proper means for keeping her roused.

5. Poisoning with Laudanum and Corrosive Sublimate.—Of all the cases of compound poisoning I have met with, the most remarkable is an instance which occurred in Edinburgh Castle, a few years ago, of poisoning with laudanum and corrosive sublimate. In this case, the individual, a young soldier, swallowed about the same time two drachms of the latter and half an ounce of the former. He had at first no violent symptoms whatever, indicating the operation of corrosive sublimate; which is an extremely rare occurrence. Afterwards he had frequent purging and tenesmus, with bloody stools and all the usual phenomena of violent dysentery, but no pain of belly, no tenderness even on firm pressure, no vomiting except under the use of emetics. On the fourth day a violent salivation set in; and under this and the dysenteric affection he became quickly exhausted, yet not so much, but that on the day of his death, the ninth after he took the poison, he was able to walk a little in his room without assistance. He died on the close-stool rather unexpectedly. I have unfortunately lost the original notes I had of this case, and have forgotten whether any narcotic symptoms were present at first; but my impression is that they were present, though in a slight degree only. Most of the previous particulars were communicated to me by the late Dr. Mackintosh. The stomach, duodenum, ileum, colon, and rectum were found after death enormously inflamed, ulcerated, and here and there almost gangrenous.—In this instance some of the corrosive sublimate must have been decomposed by the laudanum, and an insoluble meconate of mercury formed. But the quantity thus decomposed could have been but a small proportion of the whole,—as was indeed proved by the extensive ravages actually committed in the whole alimentary canal. I conceive, therefore, that there is no other way of accounting for the slight apparent effects of the corrosive sublimate, at the commencement particularly, than by supposing that the narcotic operation of the opium veiled or actually retarded the irritant action of the corrosive sublimate.

6. Poisoning with Opium and Belladonna.—A lady, who used a compound infusion of opium and belladonna as a wash for an eruption in the vulva, took it into her head one day to use the wash as an injection; and actually received three successive injections, containing each the active matter of a scruple of opium and half an ounce of belladonna leaves. Fortunately none of the three was retained above a few minutes, except the last, which was not discharged for ten minutes. In less than an hour, she was found in bed in a deep sleep, but the true cause was not suspected till three hours later. She was then completely insensible and motionless, with the face pale, the pupils excessively dilated and not contractile, the pulse frequent and small, and the breathing hurried. After the use of purgative injections, blood-letting, leeches to the head, and sinapisms to the legs, she began in five hours to show some sign of returning consciousness, which improved after a fit of vomiting. When thoroughly roused, her vision continued dim, the pupils excessively dilated, and the ideas somewhat confused. For three days the pulse continued frequent, and the pupils somewhat dilated.[^[2560]] Here the opium seems to have prevented the delirium usually induced by belladonna in the early stage, while on the other hand the belladonna prevented the usual effect of opium on the pupils, and actually produced the opposite action.

7. In the following cases, the active poisons to which the individuals were exposed were so numerous, that it is impossible to say which or how many of them occasioned the symptoms. A colour-maker was superintending a process in which cobalt, arsenic, mercury, sal-ammoniac, and nitric acid were subjected to heat in a mattrass, when the mattrass suddenly gave way, and a dense vapour was instantly discharged. The manufacturer, before he could escape, fell down insensible; and though speedily removed, he died in no long time, affected with enormous swelling of the abdomen. A workman who was also present, escaped by a window; but was nevertheless immediately attacked with swelling of the belly, which speedily became very great, and was attended with pain in the jaws, and dimness of sight. These symptoms were very slowly dissipated under the use of cold bathing and purgatives, which brought away an enormous quantity of fetid gas.[^[2561]]

These are not the only examples of compound poisoning which have come under my attention. But others I have noticed are not detailed with sufficient exactness to make it worth while to quote them. The instances given, however, are sufficient to show that poisons of opposite qualities given about the same time in large doses will disguise one another’s effects, or impede, or perhaps even prevent them, in a manner which renders such a combination of circumstances an important subject of inquiry for the medico-legal toxicologist.

It is probable that the modifying influence is established in one of two ways,—either by one poison producing a state of venous plethora or distension, which impedes, or for a time prevents, the absorption of the other,—or by one poison producing an insensibility of the membrane with which the other is in contact; so that not only the local injury actually done has not the usual remote effect on the constitution, or on distant organs, but likewise is at times substantially less extensive than in ordinary circumstances. These reflexions arise naturally from a review of the preceding cases; but of course further facts are necessary to give them weight.