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.