A question has arisen whether this salt can be considered as a poison, capable of occasioning death? In general where a large dose has been administered, it is all rejected by the vomiting which it excites; we accordingly find in the works of Morgagni and other pathologists, the history of various cases in proof of the innocence of this salt. Hoffman, however, relates the case of a woman who experienced very severe symptoms shortly after having taken tartar emetic, and that she ultimately died,[[301]] and there are other similar instances recorded in the works of Foderé and Orfila. It also deserves notice, that tartarized antimony is very liable to produce deleterious effects, where, from the insensibility of the nervous system, the operation of vomiting cannot be excited, as in apoplexy, drunkenness, and in that state of coma, which follows the ingestion of narcotic vegetables. M. Cloquet communicated to Orfila a case highly illustrative of this fact, in which a person, labouring under apoplexy, received into his stomach more than forty grains of tartar emetic, without exciting either nausea or vomiting. On opening the body, independent of the morbid state of the brain, which must be regarded as the immediate cause of death, extensive organic lesions were discovered in the alimentary canal, which could alone be attributed to the action of the tartar emetic. This fact will suggest a very important precaution to the practitioner, who may be called upon to treat a person labouring under a state of the system which will prevent the act of vomiting.[[302]].
The symptoms produced by this salt will resemble those of a corrosive poison; and where vomiting is produced, it frequently happens that although the patient may be eventually saved, an irritability of stomach, so great as to cause the rejection of all aliments, will remain for a considerable period; and Dr. Male states that in the only case of poisoning by this salt which he had ever seen, the person was affected with violent convulsions, which returned at intervals for several weeks after recovery from the immediate effects of the poison.[[303]] M. Orfila, after detailing several cases of poisoning by emetic tartar, concludes by saying that the general symptoms, upon such occasions, may be reduced to the following: a rough metallic taste; nausea; copious vomitings; frequent hiccup; cardialgia; burning heat in the epigastric region; pains of the stomach; abdominal colics; inflation; copious stools; syncope; small, contracted and accelerated pulse; skin cold, sometimes intensely hot; breathing difficult; vertigo, loss of sense, convulsive movements; very painful cramps in the legs; prostration of strength,—death.
Sometimes to the above symptoms is joined a great difficulty of swallowing; deglutition may be suspended for some time. The vomiting and alvine evacuations do not always take place, the necessary consequence of which is an increase in the violence of the other symptoms.
Antidotes.
The great indication to be fulfilled in a case of this description, is the ejection of the salt by vomiting. MM. Orfila and Berthollet rely very confidently upon the effects of bark, strong tea, infusion of galls, and other vegetable astringents, which have undoubtedly the power of decomposing the salt. They ought, therefore, to be employed as diluents to assist vomiting, but they are not to be considered as antidotes which can render this latter operation less indispensable.
Physiological action of emetic tartar.
M. Majendie has shewn by experiment, that if tartarized antimony be injected into the veins of a dog, the animal vomits, and has frequent stools; his breathing becomes difficult; his pulse frequent and intermitting; a great degree of disquietude, and tremblings are the precursory signs of death, which generally takes place within the first hour from the injection of the emetic tartar. On opening the body great alterations are perceived in the lungs; they are found of an orange or violet colour, have no crackling, are distended with blood, and of a tight texture. The mucous membrane of the intestinal canal, from the cardia to the extremity of the rectum is red, and strongly injected.
If, instead of thus injecting the emetic tartar into the veins, it be injected into the stomach, and the œsophagus is tied to prevent vomiting, M. Orfila informs us that the same alterations will be found after death. The very same effects will also arise from the application of the emetic tartar to the different absorbing surfaces, such as the cellular substances, &c.
Mr. Brodie[[304]] has also thrown considerable light upon the action of this salt. He observes that the effects of emetic tartar so much resemble those of arsenic, which we have already described, and those of muriate of baryta, which will form a future subject of inquiry, that it would be needless to enter into a detail of the individual experiments which he made with it. When applied to a wound in animals which are capable of vomiting, it usually, but not constantly, operated very speedily as an emetic; in other respects he found no material difference in the symptoms produced in the different species of animals, which he had been in the habit of employing as subjects of experiment. The symptoms were paralysis, drowsiness, and, at last, complete insensibility; the pulse became feeble, but the heart continued to act after apparent death, and was maintained in action by means of artificial respiration; but never for a longer period than for a few minutes. Whence it would appear, that this poison acts by being absorbed, and that it directs a sedative influence upon the heart, as well as the brain, but that its principal action is on the latter. The length of time which elapses, from the application of the poison to the death of the animal, varies; in some instances Mr. Brodie found that it did not exceed three quarters of an hour, but in others, it was two or three hours, or even longer, before death took place. When a solution of emetic tartar was injected into the stomach of a rabbit, Mr. Brodie observed the same symptoms to take place, as when it was applied to a wound.