Several cases of poisoning with ammonia or its carbonate have occurred in the human subject. Plenck has noticed shortly a case which proved fatal in four minutes, and which was caused by a little bottleful of ammonia having been poured into the mouth of a man who had been bitten by a mad-dog.[[471]] The symptoms are not mentioned, but it is probable, from the rapidity of the poisoning, that a nervous affection must have been induced. More generally, however, the effects are simply irritant; and the seat of the irritation will vary with the mode in which the poison is given. If it is swallowed, the stomach and intestines will suffer; if it is imprudently inhaled in too great quantity, inflammation of the lining membrane of the nostrils and air-passages will ensue. Huxham has related a very interesting example of the former affection, as it occurred in a young man, who had acquired a strange habit of chewing the solid carbonate of the shops. He was seized with great hemorrhage from the nose, gums, and intestines; his teeth dropt out; wasting and hectic fever ensued; and, although he was at length prevailed on to abandon his pernicious habit, he died of extreme exhaustion, after lingering several months.[[472]] But the most frequent cases of poisoning with ammonia have arisen from its being inhaled, and thus exciting bronchial inflammation. An instructive instance of the kind has been related by M. Nysten. A medical man, liable to epilepsy, was found in a fit by his servant, who ignorantly tried to rouse him by holding assiduously to his nostrils a handkerchief dipped in ammonia. In this way about two drachms appear to have been consumed. On recovering his senses, the gentleman complained of burning pain from the mouth downwards to the stomach, great difficulty in swallowing, difficult breathing, hard cough, and copious expectoration, profuse mucous discharge from the nostrils, and excoriation of the tongue. The bronchitis increased steadily, and carried him off in the course of the third day, without convulsions or any mental disorder having supervened.[[473]] A case precisely similar is related in the Edinburgh Medical and Surgical Journal. A lad, while convalescent from an attack of fever, was seized with epilepsy, for which his attendant applied ammonia under his nose “with such unwearied, but destructive benevolence, that suffocation had almost resulted. As it was, dyspnœa with severe pain of the throat and breast, immediately succeeded; and death took place forty-eight hours afterwards.”[[474]] A third instance has been recorded of analogous effects produced by the incautious use of ammonia as an antidote for prussic acid. The patient had all the symptoms of a violent bronchitis, accompanied with redness and scattered ulceration of the mouth and throat; but he recovered in thirteen days.[[475]] A fourth case, similar to the preceding, has been related by M. Souchard of Batignolles. A druggist, who inhaled while asleep the fumes of ammonia from a broken carboy, awoke in three-quarters of an hour, with the mucous membrane of the mouth and nostrils corroded, and a bloody discharge from the nose. A severe attack of bronchitis followed, during which he could not speak for six days; but being actively treated with antiphlogistic remedies, he recovered.[[476]]—An extraordinary case has been published by Mr. Paget of death from injecting ammonia into the blood-vessels. A solution weak enough to allow of the nose being held over it was injected into a nævis in a child two years old. An attack of convulsions immediately followed, and in a minute the child expired.[[477]]
Nysten’s case is the only one in the human subject in which the morbid appearances were ascertained. The nostrils were blocked up with an albuminous membrane. The whole mucous coat of the larynx, trachea, bronchi, and even of some of the bronchial ramifications, was mottled with patches of lymph. The gullet and stomach showed red streaks here and there; and there was a black eschar on the tongue, and another on the lower lip.
Of Poisoning with Hydrochlorate of Ammonia.—The effects of the hydrochlorate of ammonia on animals have been examined by Professor Orfila and Dr. Arnold; but I have not yet met with any instance of its operation as a poison on man. When given to dogs it irritates and inflames the parts it touches, and causes the ordinary symptoms of local irritation. But it also acts remotely. For, first, like arsenic, and other poisons of the third order of irritants, it produces inflammation of the stomach, in whatever way it is applied to the body,—Orfila having found that organ affected when the salt was applied to the subcutaneous cellular tissue;[[478]] and, secondly, according to the experiments of Arnold, it causes, when swallowed, excessive muscular weakness, slow breathing, violent action of the heart, and tetanic spasms,—effects which cannot arise from mere injury of the stomach. Half a drachm will thus kill a rabbit in eight or ten minutes;[[479]] and two drachms a small dog in an hour.[[480]]
CHAPTER XII.
OF POISONING WITH THE ALKALINE SULPHURETS.
The liver of sulphur, or sulphuret of potass of the pharmacopœias, the last poison of this order to be mentioned, is allied to the ammoniacal salts in action. It is of no great consequence in a toxicological point of view in this country, being put to little use; but several accidents have been caused by it in France, where it is employed for manufacturing artificial sulphureous waters; and farther, its properties should be accurately ascertained, because till lately it was erroneously resorted to as an antidote for some metallic poisons.
Chemical Tests.—It has a grayish, greenish, or yellowish colour when solid; its dust smells of sulphuretted hydrogen, which is also copiously disengaged from it by the mineral acids: and it forms with water a yellow solution of the same odour.—In composite fluids it may be detected by heating it with acetic acid, and passing the disengaged gases through solution of acetate of lead, in which a black precipitate of sulphuret of lead is produced, from the action of sulphuretted-hydrogen.[[481]]
Action and Symptoms.—Orfila found that a solution of six drachms and a half, secured in the stomach of a dog by a ligature on the gullet, caused death by tetanus in seven minutes, without leaving any morbid appearance in the body; that inferior doses caused death in the same manner, but at a later period, and with symptoms of irritation in the alimentary canal, which also was seen red, black, or even ulcerated after death; that a solution of twenty-two grains injected into the jugular vein killed a dog in two minutes, convulsions having preceded death, and the heart being found paralysed immediately after it; and that a drachm and a half thrust in small fragments under the skin occasioned death in thirteen hours with coma and extensive inflammation of the cellular tissue.[[482]] There can be no doubt, therefore, that liver of sulphur is a true narcotic acrid poison.—It is absorbed, and may be detected in the blood, liver, kidneys, and urine by Orfila’s process.[[483]]
Orfila has collected three cases of poisoning in the human subject with this substance;[[484]] and a fourth has been related by M. Cayol.[[485]] Of these cases two proved fatal in less than fifteen minutes; and the symptoms were acrid taste, slight vomiting, mortal faintness, and convulsions, with an important chemical sign, the tainting of the air with the odour of sulphuretted-hydrogen. The dose in one case was about three drachms. The two other patients, who recovered, were for some days dangerously ill. The symptoms were burning pain and constriction in the throat, gullet, and stomach; frequent vomiting, at first sulphureous, afterwards sanguinolent; purging, at first sulphureous; sulphureous exhalations from the mouth; pulse at first quick and strong, afterwards feeble, fluttering, and almost imperceptible; in one case sopor; finally severe inflammation of the gullet, stomach and intestines, which abated in three days. One of these patients took four drachms of sulphuret of soda, the other two ounces of sulphuret of potass; but it is probable, that the latter dose was partly decomposed by long keeping.
Morbid Appearances.—The morbid appearances in the two fatal cases were great lividity of the face and extremities, and exhaustion of muscular contractility immediately after death; the stomach was red internally, and lined with sulphur; the duodenum also red; the lungs soft, gorged with black fluid blood, and not crepitant.
Treatment.—The most appropriate treatment consists in the instant administration of any diluent, then of frequent doses of the chloride of soda, and lastly the antiphlogistic mode of subduing inflammation. The chloride of soda or lime decomposes sulphuretted hydrogen, the disengagement of which is the probable cause of death in the quickly fatal cases.[[486]]