[805] L. Hermann (Lehrbuch der experimentellen Toxicologie) remarks that the vomiting must be considered as a reflex action from the inflammatory excitement of the digestive apparatus, especially of the stomach. It is witnessed if the poison is administered subcutaneously or injected into the brain. Indeed, it is established that (at least, so far as the muscles are concerned) the co-ordinated movements producing vomiting are caused by excitement of the medulla oblongata. Giannussi and others found that after section between the first and third vertebræ of dogs, and subsequent administration of tartar emetic, no vomiting took place; and Grimm’s researches seem to show that the suspected vomit-centre is identical with the respiratory centre, so that the vomiting movement is only an abnormal respiratory movement. L. Hermann, however, considers the theory that when tartar emetic is introduced into the vessels the vomit-centre is directly excited, erroneous, for (1) in introducing it by the veins much larger doses are required to excite vomiting than by the stomach; and (2), after subcutaneous injection of the salt, antimony is found in the first vomit. His explanation, therefore, is that antimony is excreted by the intestinal tract, and in its passage excites this action. Majendie’s well-known experiment—demonstrating that, after extirpation of the stomach, vomiting movements were noticed—is not considered opposed to this view.
The effect of small doses given repeatedly to animals has been several times investigated. Dr. Nevin[806] experimented upon eleven rabbits, giving them tartar emetic four times a day in doses of 32·4 mgrms. (1⁄2 grain), 64·8 mgrms. (1 grain), and 129·6 mgrms. (2 grains). Five died, the first after four, the last after seventeen days; three were killed after one, three, and four days respectively, two after an interval of fourteen days, and one thirty-one days after taking the last dose. There was no vomiting; diarrhœa was present in about half the number; one of the rabbits, being with young, aborted. The chief symptoms were general dulness, loss of appetite, and in a few days great emaciation. Four of the five that died were convulsed before death, and several of the animals exhibited ulcers of the mucous membrane of the mouth, in places with which the powder had come in contact. Caillol and Livon have also studied the action of small doses of the white oxide of antimony given in milk to cats. A cat took in this way in 109 days ·628 grm. The animal passed gradually into a cachectic state, diarrhœa supervened, and it died miserably thin and exhausted.
[806] Lever, Med. Chir. Journ., No. 1.
§ 757. Effects of Tartar Emetic on Man.[807]—The analogy between the symptoms produced by arsenic and antimony is striking, and in some acute cases of poisoning by tartar emetic, there is but little (if any) clinical difference. If the dose of tartar emetic is very large, there may be complete absence of vomiting, or only a single evacuation of the stomach. Thus, in a case mentioned by Taylor, in which a veterinary surgeon swallowed by mistake 13 grms. (200 grains) of tartar emetic, vomiting after fifteen minutes could only be induced by tickling the throat. So, again, in the case reported by Mr. Freer, a man, aged 28, took 7·77 grms. (120 grains) of tartar emetic by mistake for Epsom salts; he vomited only once; half an hour after taking the poison he had violent pain in the stomach and abdomen, and spasmodic contraction of the abdomen and arms; the fingers were firmly contracted, the muscles quite rigid, and there was involuntary aqueous purging. After six hours, during which he was treated with green tea, brandy, and decoction of oak-bark, he began to recover, but suffered for many nights from profuse perspirations.
[807] Antimony occasionally finds its way into articles of food through obscure channels. Dr. Page has recorded the fact of antimonial lozenges having been sold openly by an itinerant vendor of confectionery. Each lozenge contained nearly a quarter of a grain (·16 mgrms.), and they caused well-marked symptoms of poisoning in the case of a servant and two children. How the antimony got in was unknown. In this case it appears to have existed not as tartar emetic, but as an insoluble oxide, for it would not dialyse in aqueous solution.—“On a remarkable instance of Poisoning by means of Lozenges containing Antimony,” by David Page, M.D., Medical Officer of Health, Lancet, vol. i., 1879, p. 699.