The following fatal cases deserve particular mention. Orfila quotes one from the Gazette de Santé for May, 1819, which was caused by two doses of twenty-four grains taken with the interval of a day between them, for the purpose of suicide. The ordinary symptoms of irritation in the bowels and urinary organs ensued, miscarriage then took place, and the patient died on the fourth day, with dilated pupils and convulsive motions, but with unimpaired sensibility.[[1498]] Another instance related by Dr. Ives of the United States, presented two stages, like that related by Orfila, but with the remarkable difference that an interval of several days intervened between the irritant and narcotic effects. A man swallowed an ounce of the tincture and was seized in a short time with hurried breathing, flushed face, redness of the eyes and lacrymation, convulsive twitches, pain in the stomach and bladder, suppression of urine and priapism; in the evening delirium set in, and next morning there was loss of consciousness; but from this time under the use of blood-letting, emetics, blisters, sinapisms, and castor-oil, he got well and continued so for fourteen days. But after that interval he was suddenly attacked with headache and shivering, then with convulsions, and subsequently with coma; which, however, was removed for a time by outward counter-irritants. Next day the coma returned at intervals, and on the subsequent day the convulsions also, which gradually increased in severity for three days more, and then proved fatal.[[1499]] In this case it admits of question whether the affection which proved the immediate cause of death really arose from the cantharides, or was an independent disease.—A third case, fatal on the fourth day, occurred in April, 1830, near Uxbridge in the south of England. I have not been able to learn the particulars exactly; but it appears to have been produced by cantharides powder, which was mixed with beer by two scoundrels at a dancing party for the purpose of exciting the venereal appetite of the females. A large party of young men and women were in consequence taken severely ill; and one girl died, who had been prevailed on to take the powder at the bottom of the vessel, on being assured that it was ginger.
The quantity of the powder or tincture requisite to prove fatal or dangerous has not been accurately settled. Indeed practitioners differ much even as to the proper medicinal doses. The smallest dose of the powder yet known was twenty-four grains (Orfila); and the smallest fatal dose of the tincture was one ounce, which is equivalent to six grains of powder.[[1500]] It is probable that this is one of the poisons whose operation is liable to be materially affected by idiosyncrasy. The medicinal dose is from half a grain to two grains of the powder, and from ten drops to two drachms of the tincture. But Dr. Beck has quoted an instance where six ounces of the tincture were taken without injury.[[1501]] On the other hand Werlhoff has mentioned the case of a lad who used to be attacked with erection and involuntary emission on merely smelling the powder.[[1502]] This statement, though extraordinary, is not without support from the parallel effects of other substances.
The familiar effects of cantharides on the external surface of the body are not unattended with danger, if extensive, or induced in particular states of the constitution. An ordinary blistered surface often ulcerates in febrile diseases; and in the typhoid state which characterizes certain fevers, this ulceration has been known to pass on to fatal sloughing, especially when the blister has been applied to parts on which the body rests. I have met with two such cases. On the other hand if the blistered surface be very extensive, death may take place in the primary stage of the local affection, in consequence of the great constitutional disturbance excited. Thus in 1841 a girl, affected with scabies, received cantharides ointment by mistake instead of sulphur ointment from an hospital-serjeant at Windsor Barracks; and having anointed nearly her whole body with it, was seized with violent burning pain of the integuments, followed by vesication, general fever, and the usual symptoms of the action of this poison on the urinary organs. These effects were so severe that she died in five days.[[1503]]
Section II.—Of the Morbid Appearances caused by Cantharides.
The only precise account I have hitherto seen of the morbid appearances caused by cantharides is contained in the history of the case from the Gazette de Santé. The brain was gorged with blood. The omentum, peritonæum, gullet, stomach, intestines, kidneys, ureters, and internal parts of generation were inflamed; and the mouth and tongue were stripped of their lining membrane.—In dogs Schubarth observed, besides the usual signs of inflammation in the alimentary canal, great redness of the tubular part of the kidneys, redness and extravasated patches on the inside of the bladder, and redness of the ureters as well as of the urethra.[[1504]] M. Poumet denies that any morbid appearance is ever found in any part of the genito-urinary organs of animals; but he sometimes found blood effused into the stomach and intestines.[[1505]] In Dr. Ives’s case the blood-vessels of the brain and cerebellum were gorged, the cerebellum spread over with lymph, the villous coat of the stomach softened and brittle, and the kidneys inflamed and presenting blood in their pelvis.
When the case has been rapid, the remains of the powder may be found in the stomach or intestines by Poumet’s process. From the researches of Orfila and Lesueur, confirmed by those of Poumet, it appears not to undergo decomposition for a long time when mixed with decaying animal matters. After nine months’ interment the resplendent green points continue brilliant.[[1506]]
Section III.—Of the Treatment of Poisoning with Cantharides.
The treatment of poisoning with cantharides is not well established. No antidote has yet been discovered. At one time fixed oil was believed to be an excellent remedy. But the experiments of Robiquet on the active principle of the poison, and those of Orfila on the effects of its oleaginous solution, rather prove that oil is the reverse of an antidote. The case mentioned in the Genoa Memoirs was evidently exacerbated by the use of oil. When the accident is discovered early enough, and vomiting has not already begun, emetics may be given; and if vomiting has begun, it is to be encouraged. Oleaginous and demulcent injections into the bladder generally relieve the strangury. The warm bath is a useful auxiliary. Leeches and blood-letting are required, according as the degree and stage of the inflammation may seem to indicate.
Many other insects besides the Cantharis vesicatoria possess similar acrid properties. Two of them, however, may be briefly alluded to, because they have caused fatal poisoning. The one is the Meloë proscarabæus, the Maiwurm of the Germans, a native of most European countries. In Rust’s Magazin there is an account of four persons who took the powder of this insect from a quack for spasms in the stomach. The principal symptoms were stifling and vomiting; and two of the people died within twenty-four hours.[[1507]] The other is the Bombyx, of which at least two species are believed to possess powerful irritant properties, the B. pityocarpa and B. processionea. The following is an instance of their effects. A child ten years old had a common blister applied to the neck and spine as a remedy for deafness; and four days afterwards her mother dressed the abraded skin with the leaves of beet-root, from which she had previously shaken a great number of caterpillars. The child soon complained of insupportable itching and burning in the part, and endeavoured to tear off the dressings. The mother persevered, however; and her child died in two days of gangrene of the whole integuments of the back. The surgeon who saw the child on the last day of her life, ascribed the gangrene to the insects mentioned above, and states that they possess the power of exciting erysipelas when applied even to the sound skin.[[1508]] It is probable that many other insects in Europe have similar properties. The Mylabris cichorii, which is partially used in Italy,[[1509]] and is in common use in India and China for blistering, possesses active irritant properties. The Cantharis ruficollis, another species used in the Nizam’s Territories in India, is also energetic. Other species known to possess activity are Mylabris fusselini, Meloe majalis, M. trianthemum, Coccinella bipunctata, C. septem-punctata, and Cantharis vittata.