Effects on Man.—When tartar-emetic is swallowed by man, it generally causes vomiting very soon and is all discharged; and then no other effect follows. But if it remains long in the stomach before it excites vomiting, or if the dose be large, more permanent symptoms are sometimes induced. The vomiting recurs frequently, and is attended with burning pain in the pit of the stomach, and followed by purging and colic pains. There is sometimes a sense of tightness in the throat, which may be so great as to prevent swallowing. The patient is likewise tormented with violent cramps. Among the cases hitherto recorded no notice is taken of pulmonary symptoms; which might be expected to occur if Magendie’s experiments are free of fallacy.
The late introduction of large doses of tartar-emetic into medical practice having excited some doubt as to its poisonous properties, it becomes a matter of some moment to possess positive facts on the subject. The following cases may therefore be quoted, which will satisfy every one that this substance is sometimes an active irritant.
The first is particularly interesting from its close resemblance to cholera. It occurred in consequence of an apothecary having sold tartar-emetic by mistake for cream of tartar. The quantity taken was about a scruple. A few moments afterwards the patient complained of pain in the stomach, then of a tendency to faint, and at last he was seized with violent bilious vomiting. Soon after that he felt colic pains extending throughout the whole bowels, and accompanied ere long with profuse and unceasing diarrhœa. The pulse at the same time was small and contracted, and his strength failed completely; but the symptom which distressed him most was frequent rending cramp in the legs. He remained in this state for about six hours, and then recovered gradually under the use of cinchona and opium; but for some time afterwards he was liable to weakness of digestion.[[1141]]
The next case to be mentioned, where the dose was forty grains, proved fatal, although the person vomited soon after taking it. The symptoms illustrate well the compound narcotico-acrid action often observed in animals. The poison was taken voluntarily. Before the person was seen by M. Récamier, who relates the case, he had been nearly two days ill with vomiting, excessive purging, and convulsions. On the third day he had great pain and tension in the region of the stomach, and appeared like a man in a state of intoxication. In the course of the day the whole belly became swelled, and at night delirium supervened. Next day all the symptoms were aggravated; towards evening the delirium became furious; convulsions followed; and he died during the night, not quite five days after taking the poison.[[1142]]
Severe effects have also been caused by so small a dose as six grains. A woman, who swallowed this quantity, wrapped in paper, was seized in half an hour with violent vomiting, which soon became bloody. In two hours the decoction of cinchona was administered with much relief. But she had severe colic, diarrhœa, pain in the stomach, and some fever; of which symptoms she was not completely cured for five days.[[1143]] A case has been published, where a dose of only four grains caused pain in the belly, vomiting, and purging, followed by convulsions, failure of the pulse, and loss of speech; and recovery took place very slowly.[[1144]] Under the head of the treatment another case will be noticed where half a drachm excited severe symptoms, and was probably prevented from proving fatal only by the timely use of antidotes.
While these examples prove that tartar-emetic is occasionally an active irritant in the dose of a scruple or less, it must at the same time be admitted to be uncertain in its action as a poison. This appears from the late employment of it in large doses as a remedy for inflammation of the lungs. The administration of tartar-emetic in large doses was a common enough practice so early as the seventeenth century, and was also occasionally resorted to by physicians between that and the present time. But it is only in late years that, by the recommendations of Professor Rasori of Milan,[[1145]] and M. Laennec of Paris, it has again become a general method of treatment. According to this method, tartar-emetic is given to the extent of twelve, twenty, or even thirty grains a day in divided doses; and not only without producing any dangerous irritation of the alimentary canal, but even also not unfrequently without any physiological effect whatever. Doubts were at one time entertained of the accuracy of the statements to this effect published by foreign physicians; but these doubts are now dissipated, as the same practice has been tried, with the same results, by many in Britain. Rasori ascribes the power the body possesses of enduring large doses of tartar-emetic without injury, to a peculiar diathesis which accompanies the disease and ceases along with it. And it is said, that the same patients, who, while the disorder continues, may take large doses with impunity, are affected in the usual manner, if the doses are not rapidly lessened after the disease has begun to give way. The testimony of Laennec on the subject is impartial and decisive. He observes he has given as much as two grains and a half every two hours till twenty grains were taken daily, and once gave forty grains in twenty-four hours by mistake; that he never saw any harm result; and that vomiting or diarrhœa was seldom produced, and never after the first day. The power of endurance he found to diminish, but not, as Rasori alleges, to cease altogether, when the fever ceases; for some of his patients took six, twelve, or eighteen grains daily when in full convalescence.[[1146]] My own observations correspond with Laennec’s, except as to the effects of large doses during convalescence, of which effects I have had no experience. I have seen from six to twenty grains, given daily in several doses of one or two grains, check bad cases of pneumonia and bronchitis, without causing vomiting or diarrhœa after the first day, and also without increasing the perspiration. At the same time I have twice seen the first two or three doses excite so violent a purging and pain in the stomach and whole bowels, that I was deterred from persevering with the remedy. In continued fever too I have repeatedly found that the doses mentioned above did not cause any symptoms of irritation in the stomach or intestines.
The large quantities now mentioned have even been sometimes given in a single dose with nearly the same results. Dr. Christie mentions in his Treatise on Cholera that he sometimes gave a scruple in one dose with the effect of exciting merely some vomiting and several watery stools. But he admits that in one instance symptoms were induced like those of a case of violent cholera.[[1147]]
The same large doses have been given by some in delirium tremens without any poisonous effect being produced. A correspondent of the Lancet has even mentioned that on one occasion, after gradually increasing the dose, he at last wound up the treatment, successfully as regarded the disease, and without any injury to the patient, by giving four doses of twenty grains each, in the course of twenty minutes.[[1148]]
These facts are sufficiently perplexing, when viewed along with what were previously quoted in support of the poisonous effects of tartar-emetic. On a full consideration of the whole circumstances, however, I conceive the conclusion which will be drawn is, that this substance is not so active a poison as was till lately supposed;—that in the dose of four, six, or ten grains, it may cause severe symptoms, but is uncertain in its action,—and that although there appears to be some uncertainty in the effects of even much larger doses, such as a scruple, yet in general violent irritation will then be induced, and sometimes death itself.
An instance is related in the Journal Universel of a man who, while in a state of health, swallowed seventeen grains, and then tried to suffocate himself with the fumes of burning charcoal. He recovered, though not without suffering severely from the charcoal fumes; but he could hardly be said to have been affected at all by the tartar-emetic.[[1149]] Here the inactivity of the poison was probably owing to the narcotic effects of the fumes.