5. Poisons Affecting the Heart.—These kill by sudden shock, syncope, or collapse. They comprise prussic acid, dilute solution of oxalic acid and oxalates, aconite, digitalis, strophanthus, convallaria, and tobacco.
6. Poisons Acting on the Lungs.—These have for their type carbonic acid gas and coal gas. The fumes of ammonia are intensely irritating, and may give rise to laryngitis, bronchitis, and even pneumonia. Nitric acid fumes sometimes produce no serious symptoms for an hour or more, but there may then be coughing, difficulty of breathing, and tightness in the lower part of the throat, followed by capillary bronchitis (see p. 120).
VI.—DUTY OF PRACTITIONER IN SUPPOSED CASE OF POISONING
If called to a case supposed or suspected to be one of poisoning, the medical man has two duties to perform: To save the patient's life, and to place himself in a position to give evidence if called on to do so. If life is extinct, his duty is a simple one. He should make inquiries as to symptoms, and time at which food or medicine was last taken. He should take possession of any food, medicine, vomited matter, urine, or fæces, in the room, and should seal them up in clean vessels for examination. He should notice the position and temperature of the body, the condition of rigor mortis, marks of violence, appearance of lips and mouth. He should not make a post-mortem examination without an order in writing from the coroner. In making a post-mortem examination, the alimentary canal should be removed and preserved for further investigation. A double ligature should be passed round the œsophagus, and also round the duodenum a few inches below the pylorus. The gut and the gullet being cut across between these ligatures, the stomach may be removed entire without spilling its contents. The intestines may be removed in a similar way, and the whole or a portion of the liver should be preserved. These should all be put in separate jars without any preservative fluid, tied up, sealed, labelled, and initialled. All observations should be at once committed to writing, or they will not be admitted by the court for the purpose of refreshing the memory whilst giving evidence. If the medical practitioner is in doubt on any point, he should obtain technical assistance from someone who has paid attention to the subject.
In a case of attempted suicide by poisoning, is it the duty of the doctor to inform the police? He would be unwise to do so. He had much better stick to his own business, and not act as an amateur detective.
VII.—TREATMENT OF POISONING
The modes of treatment may be ranged under three heads: (1) To eliminate the poison; (2) to antagonize its action; (3) to avert the tendency to death.
1. The first indication is met by the administration of emetics, to produce vomiting, or by the application of the stomach-tube. The best emetic is that which is at hand. If there is a choice, give apomorphine hypodermically. The dose for an adult is 10 minims. It may be given in the form of the injection of the Pharmacopœia, or preferably as a tablet dissolved in water. Apomorphine is not allied in physiological action to morphine, and may be given in cases of narcotic poisoning. Sulphate of zinc, salt-and-water, ipecacuanha, and mustard, are all useful as emetics. Tickling the fauces with a feather may excite vomiting.