Action.—The action of monkshood is a subject of great interest, but has hitherto been much misunderstood. Sir B. Brodie, who was the first to examine it in recent times, found that the leading phenomena in animals, were staggering, excessive weakness, slow laborious respiration, and slight convulsive twitches before death.[[2249]] Had these observations been followed up by his successors with a discriminating eye, toxicologists would not have been so much misled as they have been. Orfila, who was the next to examine the subject experimentally, failed to appreciate the phenomena with exactness.[[2250]] He thinks monkshood acts peculiarly upon the brain, causing delirium, and that it is a local irritant, capable of developing more or less intense inflammation. A single experiment made in 1836 convinced me that the former statement is incorrect, and led me to consider that the symptoms depend in a great measure on gradually-increasing paralysis of the muscles, which terminates in immobility of the chest and diaphragm, and consequent asphyxia. Dr. Pereira, in some experiments with an alcoholic extract, published in 1842, took notice of two remarkable phenomena,—an extraordinary diminution of common sensation, evidenced by the animal being insensible to pinching and pricking,—and the total absence of stupor, as shown by the animal following its owner, and recognizing him when called.[[2251]] Similar observations have been made in poisoning with monkshood in man. The ablest investigation yet undertaken into the actions of this substance is contained in the unpublished Inaugural Dissertation of Dr. Fleming.
He found that the most remarkable symptoms are weakness and staggering, gradually increasing paralysis of the voluntary muscles, slowly increasing insensibility of the surface, more or less blindness, great languor of the pulse, and convulsive twitches before death. He farther observed that the pupil becomes much contracted; that the irritability of the voluntary muscles is impaired; that the veins are congested after death, the blood unaltered, and the heart capable of contracting for some time after respiration has ceased. Lastly, he maintains that this poison has not, as is generally thought, any irritant properties, that neither the plant, nor its extract, nor its alkaloid occasions vascularity in any membrane to which it is applied, even, for example, in the lips or tongue while burning and tingling from its topical action; that this peculiar effect is therefore merely a nervous phenomenon; and that he never could observe either the diffuse cellular inflammation described by Orfila to arise from the application of monkshood to a wound, or the inflammatory redness of the alimentary canal noticed by others as one of its effects when swallowed.
Orfila ascertained that monkshood exerts its action through the medium of the blood; for its effects are greater when it is introduced into a wound, than when it is swallowed, and they are still greater when it is injected directly into a vein. It is a poison of very great activity. I have found that thirty grains of an alcoholic extract, the produce of three-quarters of an ounce of fresh leaves, will kill a rabbit in two hours and a quarter, if introduced between the skin and muscles of the back. Five drachms of the root in one of Orfila’s experiments with the dog, occasioned death in twenty-one minutes, when swallowed.
The alkaloid, aconitina, seems to produce in animals precisely the same effects as the plant or its extract. Orfila and Dr. Pereira agree in this; and my own observation, limited to a single experiment, is to the same effect. It is probably the most subtile of all known poisons. Dr. Pereira mentions that the fiftieth part of a grain has endangered life when used medicinally.[[2252]] In my experiment the tenth of a grain, introduced in the form of hydrochlorate into the cellular tissue of a rabbit, killed it in twelve minutes.
Symptoms in Man.—A perplexing discrepance exists in the accounts that have been published of the effects of monkshood on man; which seems to have arisen, less from any actual contrariety in the phenomena, than from loose observation, or a misunderstanding of the facts; for most of the recent statements of competent observers are consistent with one another.
Dr. Fleming says that in medicinal doses it occasions warmth in the stomach, nausea, numbness and tingling in the lips and cheeks, extending more or less over the rest of the body, diminution in the force and frequency of the pulse, which sometimes sinks to 40 in the minute, great muscular weakness, confusion of sight or absolute blindness; and if the dose be unduly large, there is a sense of impending death, sometimes slight delirium, and a want of power to execute what the will directs, but without any loss of consciousness. The warmth which is excited is unattended with any elevation of temperature, vascularity of the skin, or acceleration of the pulse. No true hypnotic effect is produced; but by inducing serenity, or deadening pain, it may predispose to sleep. The highest degree of these effects is not unattended with danger.
When it is administered in doses adequate to occasion death, it seems in general to operate by inducing extreme depression of the circulation. Dr. Fleming recognizes two other modes of death in animals,—first, by an overwhelming depression of the nervous system, proving fatal in a few seconds, without arresting the action of the heart,—and secondly, by asphyxia, or arrestment of the respiration, the result of paralysis gradually pervading the whole muscular system, respiratory, as well as voluntary. But these effects, he thinks, cannot be recognized in the cases which have been published of poisoning in man, because the dose required to produce either of them is very large. The least variable symptoms in the human subject are, first, numbness, burning, and tingling in the mouth, throat, and stomach,—then sickness, vomiting, and pain in the epigastrium,—next, general numbness, prickling, and impaired sensibility of the skin, impaired or annihilated vision, deafness, and vertigo,—also frothing at the mouth, constriction at the throat, false sensations of weight or enlargement in various parts of the body,—great muscular feebleness and tremor, loss of voice, and laborious breathing,—distressing sense of sinking and impending death,—a small, feeble, irregular, gradually-vanishing pulse,—cold, clammy sweat and pale bloodless features,—together with perfect possession of the mental faculties, and no tendency to stupor or drowsiness,—finally, sudden death at last, as from hemorrhage, and generally in a period varying from an hour and a half to eight hours. The symptoms may begin in a few minutes, as in a case observed by Dr. Fleming, which was occasioned by the tincture of the root; or they may be postponed for three-quarters of an hour, as in an instance recorded by Dr. Pereira,[[2253]] which arose from the root being used by mistake for horse-radish. Two or three drachms of the root are sufficient to kill a man; and Dr. Fleming mentions one instance where two grains of the alcoholic extract occasioned alarming effects, and another where four grains proved fatal. I may observe, however, that I have given six grains of a carefully prepared alcoholic extract (the same of which thirty grains killed a rabbit in little more than two hours), to a female suffering from rheumatism, without being able to observe any effect whatsoever.
If all the reports of cases now on record are to be trusted, the following anomalies have occurred. Some persons are said to have presented convulsions. Slight spasmodic twitches of the muscles are not uncommon, and probably depend, as Dr. Fleming suggests, on venous congestion, the result of incomplete asphyxia. Stupor and even apoplectic insensibility are also sometimes represented to have been observed. If really ever present, they must depend on the same cause; but there is reason to apprehend, that extreme nervous depression and faintness have been mistaken for stupor and coma. Delirium of the frantic kind, mentioned by some of the older authors, is justly considered by Dr. Fleming to be of doubtful occurrence, as it has never been observed in recent times. Irritation in the alimentary canal is distinctly mentioned as indicated by prominent symptoms, even in some cases observed but a few years ago, and apparently with care. Dr. Fleming properly objects to nausea, vomiting, or pain in the epigastrium as evidence of irritation in the stomach; for these symptoms may all depend on the same local nervous impression which is produced on the organs of taste. And he denies that purging is ever produced in any genuine case of poisoning with monkshood. The following, however, seem unequivocal examples of irritation in the alimentary canal. M. Pallas[[2254]] mentions, that three out of five persons, who took a spirituous infusion of the root by mistake for lovage [Ligusticum levisticum], died in two hours with burning in the throat, vomiting, colic, swelling of the belly and purging. A similar set of cases is described by M. Degland.[[2255]] Four persons took the tincture of the root by mistake for tincture of lovage; and three of them were seized with burning pain from the throat to the stomach, a sense of enlargement of the tongue and face, colic, tenderness of the belly, vomiting, and purging. One of these, who ultimately recovered, had frantic delirium for some time after the other symptoms went off. The two others died, one in two hours, the other half an hour later. Dr. Pereira[[2256]] and Dr. Fleming doubt the authenticity of these cases; and it may be, that such unusual symptoms may have arisen either from some other root mistaken by the narrators for monkshood, or from irritant substances given along with or after it. At the same time I may mention, that in the first trials I made with monkshood as a medicine, using a carefully prepared extract of the root, I was deterred from proceeding by two patients being attacked with severe vomiting, griping, and diarrhœa.
It may be well to conclude these general statements by the particulars of a few well authenticated cases. Dr. Pereira describes two that were occasioned by the root having been dug up in February by mistake for horse-radish.[[2257]] The parties, a gentleman and his wife, ate, the former about a root and a half, the latter not much more than half a root. Both of them in three-quarters of an hour had burning, and numbness in the lips, mouth, and throat, extending to the stomach and followed by vomiting. The husband had subsequently violent and frequent vomiting, partly owing to an emetic. His extremities became cold, the lips blue, the eyes glaring, and the head covered with cold sweat. There was no spasm or convulsion, but some tremor. He had no delirium, or stupor, or loss of consciousness, but complained of violent headache. The respiration was not affected; and although he felt very weak, he was able to walk with a little assistance only a few minutes before death; which took place, as if from fainting, about four hours after the poison was swallowed.—His wife, in addition to the early symptoms already mentioned, had such weakness and stiffness of the limbs that she was unable to stand; and she could utter only unintelligible sounds; but she had no spasms or convulsions. She experienced a strange sensation of numbness in the hands, arms, and legs, diminution of sensibility over the whole integuments, especially of the face and throat, where the sense of touch was almost extinguished. She had also some dimness of vision, giddiness, and at times an approach to loss of consciousness, but no delirium, sleepiness, or deafness. She recovered, under the use of emetics, laxatives, and stimulants. In neither of these cases was there any diarrhœa.—A patient of Mr. Sherwen,[[2258]] five minutes after taking a tincture of the root, suffered from the same incipient symptoms as above, but without actual vomiting. The face seemed to her to swell, and the throat to contract; she became nearly blind, and excessively feeble, but did not lose her consciousness. The eyes were fixed and protruded, and the pupils contracted, the jaws stiff, the face livid, the whole body cold, the pulse imperceptible, the heart’s action feeble and fluttering, and the breathing short and laborious. An emetic was followed first by violent convulsions, and then by vomiting; after which she slowly recovered. At all times she was so sensible as to be able to tell how the accident happened.—Dr. Ballardini of Brescia met with twelve simultaneous cases of poisoning with the juice of the leaves, used by mistake for scurvy-grass [Cochlearia officinalis]. Each person had three ounces of juice. Three of them died in two hours; but the rest were saved. The chief symptoms were extreme weakness and anxiety, paleness and distortion of the features, dilatation of the pupils, dulness of the eyes, giddiness, headache, chiefly occipital, some distension and pain of the belly, vomiting of a green matter, and in some diarrhœa. The whole body was cold, the nails livid, the limbs cramped, the pulse small and scarcely perceptible. In the fatal cases there were convulsions.[[2259]]—MM. Pereyra and Perrin mention, that, while using the alcoholic extract in the Hospital of St. André at Bordeaux, the sample of the drug happened to be changed when the dose had been raised so high as ten grains; and that the patients who were taking it were then all seized with burning in the mouth and throat, vomiting, pungent pains in the extremities, cold sweating, anxiety, extreme general prostration, great slowness and irregularity of the pulse, convulsions, and congestion in the venous system. One patient died; the others recovered under no other treatment than stimulant friction along the spine.[[2260]] An infant at Suippe, in the French Department of the Marne, ate a few leaves and flowers of monkshood, while walking in a garden. Soon afterwards he began to stagger as if tipsy, and to complain of pain in the belly. In two hours an emetic was given; but a few minutes afterwards, the eyes became convulsed, the jaws locked, the trunk bent rigidly backward, and the limbs convulsed; and death ensued in five minutes more.[[2261]]
Morbid Appearances.—In Ballardini’s fatal cases the pia mater and arachnoid were much injected; there was much serosity under the arachnoid and in the base of the cranium; the lungs were considerably gorged with blood; the heart and great vessels contained but a little black fluid blood: the villous coat of the stomach was spotted with red points; and the small intestines presented inwardly red patches and much mucus. In the Bordeaux case there was venous congestion in the head and chest, the lungs particularly being much gorged with blood. The right side of the heart was full of blood, of gelatinous consistence. In Pallas’s cases the gullet, stomach, small intestines and rectum were very red, the lungs dense, dark, and gorged, and the cerebral vessels turgid.