POISONING.
An examination of the Registrar-general’s annual Report for 1882 gives some interesting and suggestive statistics as to cases of poisoning, which we think it may not be out of place to call attention to. Probably few of our readers will be aware how frequently cases of poisoning occur in the ordinary course of events. In the year 1881, for example, there were five hundred and sixty-nine deaths recorded in England alone from poisoning; while the year 1882 shows a record considerably in excess of this, namely, five hundred and ninety-nine, or one in every eight hundred and sixty-three of the total deaths registered. Fully two-fifths of these cases are classified under the heading ‘Accident and Negligence’—the remainder are suicides, of which we will have a word to say by-and-by—and as it is not too much to assume that in nearly every instance such cases are preventable, we purpose calling attention to some of the more common causes of these fatalities, in the hope that the suggestions and warnings thrown out may not be without their influence in producing more care in the handling and use of these dangerous substances.
Glancing over the various poisons, we find that the well-known preparations of opium, laudanum, and morphia—opium itself being included—head the list, having caused eighty-five deaths through accident or negligence. This might have been expected from preparations so largely used in domestic remedies; but the seventy-eight deaths from lead-poisoning which follow do surprise us, in view of the fact that the conditions which produce as well as the conditions which mitigate or counteract the effects of this subtle poison, are now so well known. Lead is followed by the four stronger acids—hydrochloric, nitric, sulphuric, and carbolic, which amongst them have caused thirty-four deaths under the same category. Arsenic, again, caused nine; phosphorus, eleven; chlorodyne, six; chloral, fourteen; chloroform, four; soothing syrup, four; with a host of casualties from substances of minor importance.
Reading between the lines of the Registrar-general’s Report, which it is not difficult to do, with the help of the medical journals, we will find that there are two prolific causes of these accidents—first, the giving or taking of overdoses of certain remedies containing poisons; and second, the substitution of one bottle or substance for another, as, for example, where a number of substances are congregated together, as in the case of the domestic cupboard. In the first class may be instanced the giving of overdoses of opiates or soothing preparations to children; the taking of overdoses of narcotics or soothing compounds, such as chloral, by habitual drinkers; and the general familiarity which the handling or using of these powerful agents frequently begets in those habitually using them. In the second class may be instanced such mistakes as the substituting of one bottle containing, say, a poisonous liniment, for a mixture intended for internal administration; the hasty and foolish practice of quaffing off a draught from any jug, bottle, or dish without examining the contents; and lastly, mistakes caused from accumulating within easy access powerful medicines, in the hope that they may come of future use.
Now, every good housewife may not be a trained nurse, but she is almost certain to be called upon at one time or another to act as nurse, and she may save herself many a bitter reflection if she would only attend to the following simple and easy to be remembered rules:
(1) Never give an infant an opiate or other powerful soothing remedy without first obtaining the sanction of the doctor. No practice is more common when mothers meet than to talk over their children’s complaints, suggest remedies, and magnify their several experiences, with the result that domestic recipes are lauded, approved, and tried too often in total ignorance either of their suitability or safety. Few mothers are aware of the important fact, that a medicine containing a narcotic or soothing ingredient may cure one infant and kill another of equal strength, age, &c. This varied action of soothing remedies on infants cannot be too well known or too strongly impressed upon mothers.
(2) Where powerful remedies, particularly such as contain opiates or chloral, are being administered, the patients should not be allowed to measure them or repeat the dose for themselves. In the midst of racking pain or tossing about with sleeplessness, the chances are that the patient will take a larger dose than that prescribed, to obtain speedier relief; although it is not even in this that the principal risk of accident lies. The great risk is that the patient will repeat the dose before the influence of the previous dose has exhausted itself; repeating the dose in a state of semi-consciousness or of complete recklessness, to the total disregard of either quantity or consequence. It would be well if persons in the habit of taking laudanum, morphia, chloral, and chlorodyne would keep this danger in mind.
(3) Never place bottles or packets containing poison alongside of those intended for internal use. This is one of the most prolific causes of accidents; and experience has shown that neither the distinctive blue corrugated bottles, which are now frequently used to hold poisons, nor labels, are sufficient to insure immunity from accident, even among trained nurses, where medicines are allowed to be collected indiscriminately together. (In the act of writing this, a case in point has come under our observation which well illustrates the fearful risk that is run in failing to attend to this simple rule. A daughter was requested by her mother to give her a dose of her medicine. Only two bottles were on the dressing-room table, the one containing the medicine required, and the other containing a poisonous liniment. The daughter saw the liniment bottle, read the label poison, took up the other bottle containing the mixture correctly, but put it down again to pick something up, and the second time took up the bottle, but this time without reading the label, with the result that the liniment was given instead of the mixture, with fatal results. Similar cases might be multiplied indefinitely.)
(4) Never put any poison, such as carbolic acid, oxalic acid, or any other of the stronger acids into beer-bottles, jugs, cups, or other vessels which both children and adults are apt to associate in their minds with substances not in themselves dangerous. One can hardly take up a medical journal without finding some death recorded in this manner. A bottle or cup is standing on a table or in a cupboard, and under the impression that it contains beer or spirits, tea or coffee, or even pure water, some one quaffs the contents, and only finds when it is probably too late that he has drunk some virulent poison. One is very apt to say, ‘How stupid!’ on reading such cases, and yet one of the earliest experiences of the writer was in connection with a mistake in every respect resembling this, and it well illustrates how such mistakes may be made by intelligent if not even educated men—men trained to exercise eyes, nose, and mouth—without their being detected until too late. A student in the dispensary, one hot dusty day, feeling thirsty, thought he would slake his thirst not at the tap, but from the ‘Aqua fontana’ bottle on the shelf. Next this bottle stood another containing turpentine, both bottles being correctly and plainly labelled. Feeling confident in his bottle, he carelessly lifted it from the shelf, took a long draught, and never discovered that he was quaffing the turpentine until the bottle was withdrawn from his mouth. Fortunately, nature dealt kindly by the lad, in quickly rejecting the nauseous liquid.
Lastly, never accumulate powerful remedies, in the belief that they may be required on some future occasion. It is highly probable that many of our readers will have a family medicine chest in which there is a place for every bottle, and in which every bottle must be in its place, and the whole in beautiful order. This is the very idea for a medicine cupboard—not only a place for everything, and everything in its place, but all plainly and correctly marked. As a rule, however, nothing can be further from the reality than such a picture. The ordinary domestic medicine cupboard is too frequently a shelf of some press or dark closet, where all medicines and remedies not in use—poisonous liniments, poisonous mixtures, simples, and so on—are all literally huddled together, with nothing to mark their contents save the stereotyped directions: ‘The liniment for external use,’ or, ‘A teaspoonful three times a day.’ It is not difficult under such circumstances to picture a typical case of what is almost certain sooner or later to occur. Johnny, one of the children, is frequently troubled with a cough, but the east winds having for a time been propitious, Johnny’s cough mixture is put away in the cupboard. By-and-by, however, Johnny overheats himself, is again caught by the east wind, and so his mamma goes to the cupboard for his mixture. Johnny escapes it may be all the poisonous liniments, for the bottle is distinctly marked, ‘A teaspoonful three times a day;’ but Johnny does not by any means escape all risk, for it is more than probable that his mamma has quite forgotten about his papa’s tonic mixture containing strychnine, or her own fever mixture containing aconite, or his older brother’s mixture containing arsenic, and probably many others, all labelled, ‘A teaspoonful three times a day,’ and all resembling Johnny’s as much as two peas do each other. This is no fanciful picture, but one which we have experienced again and again—sometimes with serious consequences, but more frequently with more fright than hurt. Still, such a risk should never be run. The agony which a mother feels when she realises either that she has given, or that her child has taken an overdose of poison or of some powerful medicine by mistake, requires to be witnessed to be understood in all its terrible reality; but once witnessed, we think it might be sufficient to act as a warning as to getting too familiar or careless in the handling or storing of such potent agents.