§ 636. The foregoing is a fair picture of what may be expected in cantharides poisoning. It is remarkable that the popular idea as to the influence of cantharidin in exciting the sexual passion, holds good only as to the entire cantharides, and not with cantharidin. It is very possible that cantharidin is not the only poisonous principle in the insect. The symptoms in other cases, fatal or not, have been as follows:—Immediate burning in the mouth and throat, extending to the stomach and alimentary canal, and increasing in intensity until there is considerable pain. Then follow salivation, difficulty in swallowing, and vomiting, and generally diarrhœa, pain in the kidneys, irritation of the bladder, priapism, and strangury, are all present. The pulse is accelerated, the breathing disturbed, there are pains in the head, and often mydriasis, giddiness, insensibility, delirium, and convulsions; trismus has been noticed. The desire to micturate frequently is urgent, the urine is generally bloody, and contains pus. Pregnant women have been known to abort. In a few of the cases in which a different course has been run, the nervous symptoms have predominated over those of gastro-intestinal irritation, and the patient has sunk in a kind of collapse. In a case of chronic poisoning by cantharides, extending over three months, and recorded by Tarchioni Bonfanti,[642] after the first dose appeared tetanic convulsions, which subsided in twenty-four hours, there was later cystitis, and from time to time the tetanic convulsions returned; gastro-enteritis followed with frequent vomiting, when, cantharides being found in the matters ejected, the otherwise obscure nature of the illness was shown.
[642] Gaz. Med. Ital. Lomb., 1863.
In a case recorded by Sedgwick,[643] following the gastro-enteric symptoms, there were epileptic convulsions; in this instance also was noticed an unpleasant smell, recalling the notion formerly held that cantharides imparted a peculiar odour to the breath and urine. In a case of chronic poisoning related by Tardieu, six students, during several months, used what they thought was pepper with their food, but the substance proved to be really powdered cantharides. The quantity taken each day was probably small, but they suffered from pain about the loins, and also irritation of the bladder. There was no sexual excitement.
[643] Med. Times, 1864.
§ 637. Post-mortem Appearances.—In a French criminal case, in which a man poisoned his step-brother by giving cantharides in soup, the pathological signs of inflammation of the gastro-intestinal tract were specially evident, the mouth was swollen, the tonsils ulcerated, the gullet, stomach, and intestines were inflamed, and the mucous membrane of the intestines covered with purulent matter. In another case there was an actual perforation 3 inches from the pylorus. The inflammatory appearances, however, are not always so severe, being confined to swelling and inflammation without ulceration. In all cases there has been noted inflammation of the kidneys and urinary passages, and this is seen even when cantharidin is administered to animals by subcutaneous injection. In the urine will be found blood and fatty epithelial casts, as well as pus. The contents of the stomach or the intestines will probably contain some remnants of powdered cantharides, if the powder itself has been taken.