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Fatal Dose.—One grain and a half.
Fatal Period.—Four hours; more commonly two to four days.
Detection of Phosphorus in Organic Mixtures.—Mitscherlich's method is the best. Introduce the suspected material into a retort. Acidulate with sulphuric acid to fix any ammonia present. Distil in the dark, through a glass tube kept cool by a stream of water. As the vapour passes over and condenses, a flash of light is perceived, which is the test.
XXI.—ARSENIC AND ITS PREPARATIONS
Arsenic is the most important of all the metallic poisons. It is much used in medicine and the arts. It occurs as metallic arsenic, which is of a steel-grey colour, brittle, and gives off a garlic-like odour when heated; as arsenious acid; in the form of two sulphides—the red sulphide, or realgar, and the yellow sulphide, or orpiment; and as arsenite of copper, or Scheele's green. It also exists as an impurity in the ores of several metals—iron, copper, silver, tin, zinc, nickel, and cobalt. Sulphuric acid is frequently impregnated with arsenic from the iron pyrites used in preparing the acid. It is a constituent of many rat pastes, vermin or weed killers, complexion powders, sheep dips, etc.
Arsenious Acid (White Arsenic, Trioxide of Arsenic).—Colourless, odourless, and almost tasteless. It occurs in commerce as a white powder or in a solid cake, which is at first translucent, but afterwards becomes opaque. Slightly soluble in cold water; 1 ounce of water dissolves about 1/2 grain of arsenic. Fowler's solution is the best-known medicinal preparation of arsenic, and contains 1 grain of arsenious anhydride in 110 minims.
Symptoms.—Commence in from half to one hour. Faintness, nausea, incessant vomiting, epigastric pain, headache, diarrhoea, tightness and heat of throat and fauces, thirst, catching in the breath, restlessness, debility, cramp in the legs, and convulsive twitchings. The skin becomes cold and clammy. In some cases the symptoms are those of collapse, with but little pain, vomiting, or diarrhoea. In others the patient falls into a deep sleep, while in the fourth class the symptoms resemble closely those of English cholera. The vomited matters are often blue from indigo, or black from soot, or greenish from bile, mixed with the poison. Should the patient survive some days, no trace of arsenic may be found in the body, as the poison is rapidly eliminated by the kidneys. In all suspected cases the urine should be examined.
The symptoms of chronic poisoning by arsenic are loss of appetite, silvery tongue, thirst, nausea, colicky pains, diarrhoea, headache, languor, sleeplessness, cutaneous eruptions, soreness of the edges of the eyelids, emaciation, falling out of the hair, cough, haemoptysis, anaemia, great tenderness on pressure over muscles of legs and arms, due to peripheral neuritis, and convulsions.
Pigmentation is common; the face becomes dusky red, the rest of the body a dark brown shade. This darkening is most marked in situations normally pigmented and in parts exposed to pressure of the clothes, such as the neck, axilla, and inner aspect of the arms, the extensor aspects being less marked than the flexor. The pigmentation resembles the bronzing of Addison's disease, but there are no patches on the mucous membranes, and the normal rosy tint of the lips is not altered. The skin over the feet may show marked hyperkeratosis.
The nervous system is notably affected. The sensory symptoms appear first: numbness and tingling of the hands and feet, pain in the soles of the feet on walking, pain on moving the joints, and erythromelalgia. Then come the motor symptoms, with drop-wrist and drop-foot. The patient suffers severely from neuritis, and there may be early loss of patellar reflex. The nervous symptoms come on later than the cutaneous manifestations.
Post-Mortem Appearances.—Signs of acute inflammation of stomach, duodenum, small intestines, colon, and rectum. Stomach may contain dark grumous fluid, and its mucous coat presents the appearance of crimson velvet. Ulceration is rare, and cases of perforation still less common, the patient dying before it occurs. If life has been preserved for some days, there is extensive fatty degeneration of the organs. There may be entire absence of post-mortem signs. Putrefaction of the body is retarded by arsenic.
Treatment.—The stomach-pump, emetics, then milk, milk and eggs, oil and lime-water. Inflammatory symptoms, collapse, coma, etc., must be treated on ordinary principles. As an antidote, the best when the poison is in solution is the hydrated sesquioxide of iron, formed by precipitating tinctura ferri perchloridi with excess of ammonia, or carbonate of soda. This is filtered off through muslin and given in tablespoonful doses. It forms ferric arsenate, which is sparingly soluble. Colloidal iron hydroxide may be used instead. Dialyzed iron in large quantities is efficacious.
Fatal Dose (Smallest).—Two grains. Exceptionally, recovery from very large doses if rejected by vomiting.
Fatal Period (Shortest).—Twenty minutes. Exceptionally, death as late as the sixteenth day. The effects of arsenic are modified by tolerance, some persons being able to take considerable quantities. The peasants of Styria are in the habit of eating it.
Method of Extraction from the Stomach.—The coats of the stomach should be examined with a lens for any white particles. These, if present, may be collected, mixed with a little charcoal in a test-tube, and heated. If arsenic is present, a metallic ring will be formed in the cooler parts of the tube. If this ring be also heated, octahedral crystals of arsenic will be deposited farther up the tube, and are easily recognized by the microscope. The contents of the stomach, or the solid organs minced up, should be boiled with pure hydrochloric acid and water, then filtered. The filtrate can then be subjected to Marsh's or Reinsch's process.
Tests.—In solution, arsenic may be detected by the liquid tests. (1) Ammonio-nitrate of silver gives a yellow precipitate (arsenite of silver). (2) Ammonio-sulphate of copper gives a green precipitate (Scheele's green). (3) Sulphuretted hydrogen water gives a yellow precipitate.
Marsh's Process.—Put pure distilled water into a Marsh's apparatus with metallic zinc and sulphuric acid. Hydrogen is set free, and should be tested by lighting the issuing gas and depressing over it a piece of white porcelain. If no mark appears, the reagents are pure, and the suspected liquid may now be added. The hydrogen decomposes arsenious acid, and forms arseniuretted hydrogen. The gas carried off by a fine tube is again ignited. A piece of glass or porcelain held to the flame will have, if arsenic be present, a deposit on it having the following characters: In the centre a deposit of metallic arsenic, round this a mixture of metallic arsenic and arsenious acid, and outside this another ring of arsenious acid in octahedral crystals. The deposit is dissolved by a solution of chloride of lime, turned yellow by sulphide of ammonium after evaporation; on the addition of strong nitric acid, evaporated and neutralized with ammonia and nitrate of silver added, a brick-red colour is produced—arseniate of silver.
Reinsch's Process.—Boil distilled water with one-sixth or one-eighth of hydrochloric acid, and introduce a slip of bright copper. If, after a quarter of an hour's boiling, there is no stain on the copper, add the suspected liquid. If arsenic be present, it will form an iron-grey deposit. If this foil be dried, cut up, put in a reduction-tube, and heated, crystals of arsenious trioxide will be deposited on the cold part of the tube.
These tests are difficult to apply, but as arsenic is a ubiquitous poison, and as there are many sources of fallacy, it would be well, when possible, to obtain the services of an expert.
Biological Test.—Put the substance to be tested into a flask with some small pieces of bread, sterilize for half an hour at 120 deg. C. When cold, inoculate with a culture of Penicillium brevicaule, and keep at a temperature of 37 deg. C. If arsenic is present, a garlic-like odour is noticed in twenty four hours, due to arseniuretted hydrogen or an organic combination of arsenic. This test is delicate, and will detect 1/1000 of a milligramme, but it is not quantitative.
Other Preparations of Arsenic.—These are arsenite of potash (Fowler's solution), cacodylate of sodium, and arsenite of copper (Scheele's green), the last frequently used for colouring dresses and wall-papers. Persons using these preparations may suffer from catarrhal symptoms, rashes on the neck, ears, and face, thirst, nausea, pain in stomach, vomiting, headache, perhaps peripheral neuritis and loss of patellar reflex. The cacodylates, although formerly employed in the treatment of phthisis, should be used with the utmost caution. The arsenites give the reactions of arsenious acid.
Arsenic is eliminated not only by the kidneys and bowels, but by the skin, and in women by the menses. It may be detected in the sweat, the saliva, the bronchial secretion, and, during lactation, in the milk.
The sale of arsenic and its preparations to the public is properly hedged round with restrictions of all kinds. It is included in Part I. of the Poisons and Pharmacy Act (8 Edward VII., c. 55). No arsenic may be sold to a person under age, nor may it be sold unless mixed with soot or indigo in the proportion of 1 ounce of soot or 1/2 ounce of indigo at the least to every pound of arsenic.
Arseniuretted Hydrogen (arsine, AsH{3}) is an extremely poisonous gas, and is evolved in various chemical and manufacturing processes. When damp, Ferro-silicon evolves AsH{3} and PH{3}, both very lethal gases. Ferrochrome is used in making steel, and it also evolves PH{3}, and in such extreme dilution as 0.02 per cent. may cause death.
XXII.—ANTIMONY AND ITS PREPARATIONS
Tartar Emetic (tartarized antimony, potassio-tartrate of antimony) occurs as a white powder, or in yellowish-white efflorescent crystals. Vinum antimoniale contains 2 grains to a fluid ounce of the wine.
Symptoms.—Metallic taste, rapidly followed by nausea, incessant vomiting, burning heat and pain in stomach, purging. Dysphagia, sense of constriction in throat, intense thirst, cramps, faintness, profound depression; in fatal cases, giddiness and tetanic spasms. In chronic poisoning, nausea, vomiting and purging, weak pulse, loss of appetite, debility, cold sweats, great prostration, progressive emaciation. The symptoms in chronic poisoning may simulate gastritis or enteritis. Externally applied, it produces an eruption not unlike that of smallpox.
Post-Mortem Appearances.—Inflammation, softening, and an aphthous condition of the throat, gullet, and stomach, the last reddened in patches. In chronic poisoning, inflammation also of caecum and colon. Brain and lungs may be congested. Decomposition is hindered for long.
Treatment.—Promote vomiting by warm greasy water, or the stomach-tube may be used. Cinchona bark or any preparation containing tannin, as tea, decoction of oak bark, etc. Morphine to allay pain.
Fatal Dose.—In an adult 2 grains (same as arsenic).
Fatal Period.—Death follows in eight to twelve hours, from exhaustion.
Method of Extraction from the Stomach.—The contents of the stomach or its coats should be finely cut up and boiled in water, acidulated with tartaric acid and subjected to dialysis, or strained and filtered. Pass hydrogen sulphide through the filtered or dialyzed fluid until a precipitate ceases to fall; collect the sulphide thus formed, wash and dry it. Boil the orange-coloured sulphide in a little hydrochloric acid. If the solution be now added to a large bulk of water, the white oxychloride is precipitated, which is soluble in tartaric acid and precipitated orange yellow with hydrogen sulphide. The chloride of bismuth is also precipitated white, but the precipitate is not soluble in tartaric acid, and the precipitate with hydrogen sulphide is black.
Tests.—Soluble in water, but not in alcohol.
Heated in substance, it crepitates and chars; and if heat be increased, the metal is deposited. Treated with sulphuretted hydrogen, a characteristic orange-red sulphide is formed.
A drop of the solution evaporated leaves crystals, either tetrahedric, or cubes with edges bevelled off. Sulphuretted hydrogen passed through gives the orange-red precipitate above named. Dilute nitric acid gives a white precipitate, soluble in excess, and also in tartaric acid. Marsh's and Reinsch's processes are applicable for the detection of antimony, but Reinsch's is the better. Reinsch's process gives a violet deposit instead of the black, lustrous one of arsenic.
Chloride of Antimony (Butter of Antimony).—A light yellow or dark red corrosive liquid.
Symptoms.—Violet corrosion and irritation of the alimentary canal, with the addition of narcotic symptoms. After death the mucous membrane of the entire canal is charred, softened, and abraded.
Treatment.—As for tartar emetic; magnesia in milk.
XXIII.—MERCURY AND ITS PREPARATIONS
The most important salt of mercury, toxicologically, is corrosive sublimate. Other poisonous preparations are red precipitate, white precipitate, mercuric nitrate, the cyanide and potassio-mercuric iodide. Calomel has very little toxic action. Metallic mercury is not poisonous, but its vapour is.
Corrosive Sublimate (perchloride of mercury) is in heavy colourless masses of prismatic crystals, possessing an acrid, metallic taste. It is soluble in sixteen parts of cold and two of boiling water. Soluble in alcohol and ether, the latter also separating it from its solution in water.
Symptoms come on rapidly. Acrid, metallic taste, constriction and burning in throat and stomach, nausea, vomiting of stringy mucus tinged with blood, tenesmus, purging. Feeble, quick, and irregular pulse, dysuria with scanty, albuminous or bloody urine or total suppression. Cramp, twitches and convulsions of limbs, occasionally paralysis. In poisoning from the medicinal use of mercury, there may be salivation, a coppery taste in the mouth, peculiar foetor of breath, tenderness and swelling of mouth, inflammation, swelling and ulceration of gums (cancrum oris), a blue line on the gums, and the loosening of teeth. Mercury is less quickly eliminated from the body than arsenic. In chronic cases 'mercurialism,' 'hydrargyrism,' 'ptyalism,' or 'salivation,' including most of the symptoms enumerated above. May get eczema mercuriale and periostitis. Profound anaemia often a prominent symptom; neuritis not uncommon. If fumes of mercury inhaled, mercurial tremors develop.
Post-Mortem Appearances.—Corrosion, softening, and sloughing ulceration of stomach and intestines. The mucous membrane of the oesophagus and stomach is often of a bluish-grey colour. The large intestine and rectum are often ulcerated and gangrenous. Inflamed condition of urinary organs, with contraction of the bladder.
Treatment.—Encourage or produce vomiting. Albumin, as white of egg, gluten, or wheat flour, is the best antidote. Demulcent drinks, milk, and ice. Stomach-tube to be used with care, owing to softened state of gullet and stomach.
Fatal Dose.—Three grains in a child.
Fatal Period.—Half an hour the shortest.
Method of Extraction from the Stomach.—A trial test may be made of the contents of the stomach with copper-foil. If mercury is found, the contents of the stomach may be dialyzed, the resulting clear fluid concentrated and shaken with ether, which has the power of taking corrosive sublimate up, and thus separating it from arsenic and other metallic poisons. The ether allowed to evaporate will leave the corrosive sublimate in white silky-looking prisms. Suppose no mercury is found in the dialyzed fluid, owing to the fact that corrosive sublimate enters into insoluble compounds with albumin, fibrin, mucous membrane, gluten, tannic acid, etc., we must dry the insoluble matter, and heat it with nitro-hydrochloric acid until all organic matter is destroyed and excess of nitric acid expelled. The residue dissolved in water, filtered, and tested with copper-foil, etc.
Tests.—The following table gives the action of corrosive sublimate with reagents:
1. With iodide of potassium Bright scarlet colour. 2. With potash solution Bright yellow colour. 3. With hydrochloric acid and First a yellowish and then a black sulphuretted hydrogen colour. 4. Heated in a reduction-tube Melts, boils, is volatilized, and forms a white crystalline sublimate. 5. With ether Freely soluble; the ethereal solution, when allowed to evaporate spontaneously, deposits the salt in white prismatic crystals. 6. Heated with carbonate of Globules of metallic mercury are sodium in a reduction-tube produced.
A very simple process for detecting corrosive sublimate is to put a drop of the suspected solution on a sovereign and touch the gold through the solution with a key, when metallic mercury will be deposited on the gold.
XXIV.—LEAD AND ITS PREPARATIONS
Acetate of Lead (Sugar of Lead).—A glistening white powder or crystalline mass. Soluble in water, with a sweetish taste. It is practically the only lead salt which gives rise to acute symptoms, and only when taken in large doses.
Symptoms.—Metallic taste, dryness in throat, intense thirst, vomiting, colicky pains, cramps, cold sweat, constipation and scanty urine, severe headache, convulsions.
Chronic lead-poisoning is liable to occur in those who handle lead in any form—white-lead workers, paint manufacturers, plumbers, pottery workers, etc.
In chronic lead-poisoning the most prominent symptoms are a blue line on the gums, anaemia, emaciation, pallor, quick pulse, persistent constipation, colic, cramps in limbs, and paralysis of the extensor muscles, causing 'dropped hand.' May get saturnine encephalopathies, of which intense headache, optic neuritis, and epileptiform convulsions, are the most common. Albumin in urine, tendency to gout, and in women to abortion.
Post-Mortem Appearances.—Inflamed mucous membrane of stomach and intestines, with layers of white or whitish-yellow mucus, impregnated with the salt of lead.
Treatment.—Sulphate of sodium or magnesium, or a mixture of dilute sulphuric acid, spirits of chloroform, and peppermint-water. Milk, or milk and eggs. As a prophylactic among workers in lead, a drink containing sulphuric acid flavoured with treacle should be given. Lavatory accommodation should be provided, and scrupulous cleanliness should also be enjoined in the workshops. The dry grinding of lead salts should be prohibited. The ionization method of Sir Thomas Oliver is most useful both as regards cure and also prevention of chronic poisoning by lead.
Fatal Dose and Fatal Period.—Uncertain.
Method of Extraction from the Stomach.—Dry the contents of the stomach or portions of the liver, etc., and incinerate in a porcelain crucible. Treat the ash with nitric acid, dry, and dissolve in water. The solution of nitrate of lead may now have the proper tests applied.
Tests.—Sulphuretted hydrogen gives a black precipitate; liquor potassae, white precipitate; sulphuric acid, white precipitate, insoluble in nitric acid; iodide of potassium, a bright yellow precipitate. A delicate test for lead in water is to stir the water, concentrated or not, with a glass rod dipped in ammonium sulphide: a brown coloration is produced. One-tenth of a grain of lead in a gallon of water may be detected.
Chronic lead-poisoning is an 'industrial disease,' and, being an occupation risk, its victims are entitled to compensation at the hands of their employers. In case of death, compensation has been awarded even when at the autopsy the patient has been found to have suffered from acute tuberculosis of the lungs. The responsibility of apportioning the monetary value of disablement resulting from the action of the lead rests with a judge or jury, who are guided by the expert medical evidence available.
Diachylon, or lead-plaster, is largely used as an abortifacient.
XXV.—COPPER AND ITS PREPARATIONS
Poisoning with copper salts is rare. The most important are the sulphate, subacetate, and arsenite.
Sulphate of Copper (bluestone, blue vitriol) in half-ounce doses is a powerful irritant. Has been given to procure abortion.
Subacetate of Copper (verdegris) occurs in masses, or as a greenish powder. Powerful, astringent, metallic taste. Half-ounce doses have proved fatal.
Symptoms.—Epigastric pain, vomiting of bluish or greenish matter, diarrhoea. Dyspnoea, depression, cold extremities, headache, purple line round the gums. Jaundice is common. A chronic form of poisoning may occur, with symptoms closely resembling those of lead.
Post-Mortem Appearances.—Inflammation of stomach and intestines, which are bluish or green in colour.
Treatment.—Encourage vomiting. Give albumin or very dilute solution of ferrocyanide of potassium.
Method of Extraction from the Stomach.—Boil the contents of the stomach in water, filter, pass hydrogen sulphide, filter, collect precipitate and boil in nitric acid, filter, dilute filtrate with water and apply tests. In the case of the solid organs, dry, incinerate, digest ash in hydrochloric acid, evaporate nearly to dryness, dilute with water, and test.
Tests.—Polished steel put into a solution containing a copper salt receives a coating of metallic copper. Ammonia gives a whitish-blue precipitate, soluble in excess. Ferrocyanide of potassium gives a rich red-brown precipitate. Sulphuretted hydrogen gives a deep brown precipitate.
XXVI.—ZINC, SILVER, BISMUTH, AND CHROMIUM
The salts of zinc requiring notice are the sulphate and chloride.
Sulphate of Zinc has been taken in mistake for Epsom salts. In large doses it causes dryness of throat, thirst, vomiting, purging, and abdominal pain.
Post-Mortem Appearances.—Those of inflammation of digestive tract.
Treatment.—Tea, decoction of oak-bark, carbonate of potassium or sodium as antidote.
Chloride of Zinc.—A solution containing this substance (230 grains to the ounce) constitutes 'Burnett's disinfecting fluid.' It is a corrosive poison.
The symptoms are burning sensation in the mouth, throat, stomach, and abdomen, followed by vomiting, diarrhoea, with tenesmus and distension of the abdomen. The vomited matter contains shreds of mucous membrane with blood. There is profound collapse, cold surface, clammy sweats, weak pulse, with great prostration. The treatment is to wash out the stomach with large and weak solutions of carbonate of sodium. Mucilaginous drinks may be given, and hypodermic injections of morphine are useful to allay the pain.
Method of Extraction from the Stomach.—Dry and incinerate the tissues in a porcelain crucible, digest ash in water, apply tests.
Tests.—Ammonia, a white precipitate soluble in excess, reprecipitated by sulphuretted hydrogen; ferrocyanide of potassium, a white precipitate; sulphuretted hydrogen, a white precipitate in pure and neutral solutions. Nitrate of baryta will show the presence of sulphuric acid, and nitrate of silver of hydrochloric acid.
Silver.—Nitrate of silver is a powerful irritant.
Tests.—Black precipitate with sulphuretted hydrogen; white with hydrochloric acid.
Treatment.—Common salt.
Chronic nitrate of silver poisoning is characterized by argyria. The gums show a blue line, which is darker than that produced by lead, and the skin presents a greyish hue, which is permanent.
Bismuth.—The bismuth salts are not poisonous, but may contain arsenic as an impurity, although this is far less common than it was some years ago.
Chromic Acid, Chromate, Bichromate of Potassium.—These act as corrosives when solid or in concentrated liquid forms. In dilute solutions they act as irritants. Used as dyes; have proved fatal more than once. Those engaged in their manufacture suffer from unhealthy ulcers on the nasal septum and hands. The former may to some extent be prevented by taking snuff. Lead chromate (chrome yellow) is a powerful irritant poison. Two drachms of the bichromate caused death in four hours.
Tests.—Yellow precipitate with salts of lead, deep red with those of silver.
Treatment.—Emetics, magnesia, and diluents. Washing out of the stomach with weak solution of nitrate of silver.
XXVII.—GASEOUS POISONS
Carbon Dioxide.—Carbon dioxide is a product of combustion and respiration, and is generated in many ways during fermentation. It is a constituent of choke damp due to explosions in coal-mines, and is given off from lime-kilns, brick-kilns, and cement-works. It is often met with in dangerous quantities in wells and in brewers' vats. From 10 to 15 per cent. in the atmosphere would prove fatal, but even 2 per cent. inhaled for long would produce serious symptoms. The proportion usually present in air is 0.04 per cent.
Symptoms.—Inhalation of the pure gas causes spasm of the glottis, insensibility, and death from asphyxia, at once; diluted, causes sense of weight in forehead and back of head, giddiness, vomiting, somnolence, loss of muscular power. Insensibility, stertorous breathing, lividity of face and body, and death from asphyxia. Convulsions occasionally.
Post-Mortem Appearances.—Face swollen and livid, or calm and pale; lividity is most marked in eyelids, lips, ears, etc.; limbs usually flaccid, abdomen distended; right side of heart, lungs, and large veins, gorged with dark-coloured blood. Brain and membranes congested.
Treatment.—Pure air, cold affusion, stimulants, artificial respiration, galvanism, inhalation of oxygen, venesection, transfusion.
Carbonic Oxide.—This is one of the most poisonous of gases. It is evolved in the process of burning charcoal and coke in stoves or furnaces. Water-gas, obtained by passing steam over heated coke, contains 40 per cent. of the substance, the remainder being chiefly hydrogen. It forms the chief part of the deadly 'choke damp' after an explosion in a mine. Two per cent. in the atmosphere is immediately fatal.
Symptoms.—When in large amount, insensibility comes on at once; when in very small amounts, headache, giddiness, noises in the ears, nausea, and vomiting, with prostration, insensibility, and coma. There may be convulsions. Even in cases which recover, permanent impairment of the brain may result.
Post-Mortem Appearances.—The blood is bright red in colour, due to the interaction of carbonic oxide with haemoglobin. A rosy hue of the skin-surface and viscera is often noticed. Bright red patches of colour are found over the surface of the body. The spectrum of the blood is characteristic.
Treatment.—Ammonia to the nostrils, inhalation of oxygen, cold douche in moderation, artificial respiration, transfusion of blood.
Coal Gas.—Coal gas contains light carburetted hydrogen or marsh gas, olefiant gas, ammonia, sulphuretted hydrogen, carbonic acid, carbonic oxide, free hydrogen, and nitrogen. Coal gas has an offensive odour, burns with a yellowish-white flame, yielding water and carbonic acid. Cases of poisoning often due to escape of gas into the room.
Symptoms.—Headache and giddiness, foaming at mouth, vomiting, convulsions, tetanic spasms, stertorous breathing, dilated pupil. The breath smells of gas; there is profound stupor; the patient, if alive, exhales gas from the lungs when removed into a fresh room or into the air. Smell of gas in the room and in patient's breath.
Post-Mortem Appearances.—Pallor of skin and internal tissues; florid colour of neck, back, and muscles, if much CO present in the coal gas; fluid florid blood; infiltration of lungs.
Treatment.—Fresh air, artificial respiration, cold affusion, diffusible stimulants; inhalation of oxygen freely.
Sulphuretted Hydrogen is characterized by its odour, like that of rotten eggs. It is extremely poisonous.
Symptoms.—Giddiness, pain and oppression in stomach, nausea, loss of power; delirium, tetanus, and convulsions.
_Post-Mortem Appearances._—Fluid and black blood (sulph-haemoglobin), smell of H_{2}S on opening the body; loss of contractility of muscles, rapid putrefaction.
Treatment.—Fresh air, stimulants, inhalation of chlorine.
Tests.—Acetate of lead throws down a brown or black precipitate according to the quantity of the gas.
Sewer Gas.—Cesspool emanations usually consist of a mixture of sulphuretted hydrogen, sulphide of ammonium, and nitrogen; but sometimes it is only deoxidized air with an excess of carbonic acid gas.
Symptoms.—If poison concentrated, death may ensue at once; if gas diluted, or exposure only short, insensibility, lividity, hurried respiration, weak pulse, dilated pupils, elevation of temperature to 104 deg., tonic convulsions not unlike those of tetanus.
Treatment.—Fresh air, oxygen, with artificial respiration. Stimulants, hypodermic of strychnine, and alternate hot and cold douche.
Irritant Gases are—(1) Nitrous acid gas; (2) sulphurous acid gas; (3) hydrochloric acid gas; (4) chlorine; (5) bromine; (6) ammonia. They have the common property of causing irritation and inflammation of the eyes, throat, and air-passages, and may cause spasm of the glottis, bronchitis, and pneumonia.
Sulphurous Acid Gas.—One of the products of combustion of common coal.
Hydrochloric Acid Gas.—Irrespirable when concentrated, and very irritating when diluted. Very destructive to vegetable life.
Chlorine.—Used in bleaching, and as a disinfectant. Greenish-yellow colour, suffocating odour. In poisoning, inhalation of sulphuretted hydrogen gives relief.
XXVIII.—VEGETABLE IRRITANTS
The chief vegetable purgatives are aloes, colocynth, gamboge, jalap, scammony, seeds of castor-oil plant, croton-oil, elaterium, the hellebores, and colchicum. All these have, either alone or combined, proved fatal. The active principle in aloes is aloin; of jalap, jalapin; of white hellebore, veratria; and of colchicum, colchicin. Morrison's pills contain aloes and colocynth; aloes is also the chief ingredient in Holloway's pills.
Symptoms.—Vomiting, purging, tenesmus, etc., followed by cold sweats, collapse, or convulsions.
Post-Mortem Appearances.—Inflammation of alimentary canal; ulceration, softening, and submucous effusion of dark blood.
Treatment.—Diluents, opium, stimulants, abdominal fomentations, etc.
Certain of these irritant poisons exert a marked influence on the central nervous system, as the following:
Laburnum (Cytisis Laburnum).—All parts of the plant are poisonous; the seeds, which are contained in pods, are often eaten by children. Contains the alkaloid cytisine, which is also contained in arnica. It has a bitter taste, and is powerfully toxic. Symptoms are purging, vomiting, restlessness, followed by drowsiness, insensibility, and convulsive twitchings. Death due to respiratory paralysis. Most of the cases are in children. Treatment consists of stomach-pump or emetics, stimulants freely, artificial respiration, warmth and friction to the surface of the body.
Yew (Taxus baccata) contains the alkaloid taxine. The symptoms are convulsions, insensibility, coma, dilated pupils, pallor, laboured breathing, collapse. Death may occur suddenly. Treatment as above. Post-mortem appearances not characteristic, but fragments of leaves or berries may be found in the stomach and intestines.
Arum (Arum Maculatum).—This plant, commonly known as 'lords and ladies,' is common in the woods, and the berries may be eaten by children. It gives rise to symptoms of irritant poisoning, vomiting, purging, dilated pupils, convulsions, followed by insensibility, coma, and death.
Many plants have an intensely irritating action on the skin, and when absorbed act as active poisons.
Rhus toxicodendron is the poison oak or poison ivy. Poisoning by this plant is rare in England, though not uncommon in the United States. Mere contact with the leaves or branches will in many people set up an acute dermatitis, with much oedema and hyperaemia of the skin. The inflammation spreads rapidly, and there is formation of blebs with much itching. There is often great constitutional disturbance, nausea, vomiting, diarrhoea, and pains in the abdomen. The effects may last a week, and the skin may desquamate.
Primula obconica is another plant which, when handled, gives rise to an acute dermatitis of an erysipelatous character. The face swells, and large blisters form on the cheeks and chin.
XXIX.—OPIUM AND MORPHINE
Opium.—The inspissated juice of the unripe capsules of the Papaver somniferum. As a poison it is generally taken in the form of the tincture (laudanum), which contains 1 grain opium in 15 minims. Opium is found in almost all so-called 'soothing syrups' for children, and in Godfrey's cordial, Dalby's carminative, and Collis Browne's chlorodyne. Laudanum contains 1 per cent. morphine, and it, along with all other preparations (e.g., paregoric) which contain 1 or more per cent. morphine, are included in Part I. of the Schedule of Poisons, and come under the Dangerous Drugs Regulations.
The most important active principles of opium are the alkaloids morphine and codeine.
Symptoms usually commence in from twenty to thirty minutes: Giddiness, drowsiness and stupor, followed by insensibility. Patient seems asleep; may be roused by loud noise, but quickly relapses. Breathing slow and stertorous, pulse weak, countenance livid. As coma increases, pulse becomes slower and fuller. The pupils are contracted, even to a pin's point; they are insensible to the action of light. In deep, natural sleep the eyes are turned upwards and the pupils contracted. Bowels confined, skin cold and livid or bathed in sweat. Temperature subnormal. Nausea and vomiting are sometimes present. Remissions are not infrequent, the patient appearing about to recover and then relapsing. Haemorrhage into the pons may give rise to contracted pupils. Young children and infants are specially susceptible to the poison.
Diagnosis is not always easy, and one has to differentiate poisoning from cerebral apoplexy. In the latter one can seldom rouse the patient, the pupils are often unequal, and hemiplegia is present. In compression of the brain, fracture of the skull may be present, subconjunctival haemorrhages may be seen, the pupils are unequal and dilated, and the paralysis increases. In uraemic or diabetic coma the urine must be examined.
The habitual use of opium is not uncommon, and opium-eaters are able to take enormous quantities of the drug. The opium-eater may be known by his attenuated body, withered yellow countenance, stooping posture, and glassy, sunken eyes.
Post-Mortem Appearances.—Not characteristic. Turgescence of cerebral vessels. There may be effusion under arachnoid, into ventricles, at base of the brain, and around the cord. Rarely extravasation of blood. Stomach and intestines usually healthy. Lungs gorged, skin livid.
Fatal Period.—Usually nine to twelve hours; but in many cases, if life is prolonged for eight hours, recovery takes place.
Fatal Dose.—Four grains of opium is the smallest fatal dose in an adult, or one drachm of laudanum; children are proportionately much more susceptible to the action of opium than adults.
Treatment.—Stomach-tube, emetics, strong coffee or tea, ammonia to nostrils. Give 10 grains of permanganate of potassium in a pint of water acidulated with sulphuric acid, and repeat the dose every half hour. Belladonna by mouth, or atropine hypodermically. Patient must be kept roused by dashing cold water over him, flagellating with a wet towel, walking about, etc. In conditions of collapse, however, this treatment must not be continued, but everything should be done to preserve the strength. Treatment must be continued as long as life remains.
Method of Extraction from the Stomach.—Opium itself cannot be directly detected, but we test for morphine and meconic acid. These may be separated from organic mixtures thus: Boil the organic matter with distilled water, spirit, and acetic acid; filter, and to the fluid passed through add acetate of lead till precipitate ceases. Filter. Acetate of morphine passes through, and meconate of lead remains. The solution of acetate of morphine may be freed from excess of lead by hydrogen sulphide and filtered, excess of hydrogen sulphide driven off by heat, and tests applied. Put the meconate of lead with water into a beaker and pass hydrogen sulphide; sulphide of lead is formed, and meconic acid set free. Filter. Concentrate the solution of meconic acid, allow a portion to crystallize, and apply tests.
Tests.—Morphine and its acetate give an orange-red colour with nitric acid, becoming brighter on standing; decompose iodic acid, setting free iodine; with perchloride of iron, gives a rich indigo-blue; with bichromate of potassium, a green turning to brown. When the alkaloid is heated in a watchglass with a drop of strong sulphuric acid until the acid begins to fume, and is then allowed to get quite cold, a drop of nitric acid produces a brilliant red colour. The iodic acid test is very delicate, but requires great care, and may be used in the presence of organic matter.
Meconic acid gives a blood-red colour with perchloride of iron, not discharged by corrosive sublimate or chloride of gold. The similar colour produced by sulpho-cyanide of potassium and perchloride of iron is discharged by chloride of gold and corrosive sublimate.
Morphine Habit.—Individuals who have acquired this habit take the drug usually by hypodermic injection. The victim suffers from nausea and vomiting, and becomes so mentally debilitated that asylum treatment is required.
XXX.—BELLADONNA, HYOSCYAMUS, AND STRAMONIUM
Belladonna.—The root, leaves, and berries, of the Atropa belladonna are poisonous from the presence of alkaloid atropine.
Symptoms.—Dryness of mouth and throat, intense thirst, dysphagia and dysphonia, quick pulse, noisy delirium and stupor. Strangury and haematuria, and redness of the skin, especially of the face, like that of scarlatina, have been noticed. Dilatation of the pupil occurs, whether the poison be taken internally or applied locally to the eye.
Post-Mortem Appearances.—Congestion of cerebral vessels, dilated pupils, red patches in alimentary canal.
Treatment.—Wash out the stomach freely; a hypodermic injection of apomorphine as an emetic, followed by hypodermic injections of pilocarpine or morphine. Tea, coffee, or tannin, to precipitate the alkaloid.
Tests.—Atropine may be recognized by its action on the pupil. The chloro-iodide of potassium and mercury precipitates it from very dilute solutions.
Hyoscyamus (Henbane).—Hyoscyamus niger.
Stramonium (Thorn-Apple).—Datura stramonium.
Symptoms.—Identical with those of belladonna and hyoscyamus, the post-mortem appearances and treatment being also the same.
Cannabis Indica (Indian Hemp).—When smoked, produces intoxication and mania. Hashish, used in the East as a narcotic, may cause persons to run 'amok' and commit murder.
XXXI.—COCAINE
Cocaine.—Any dose above 1/2 grain applied to a mucous membrane or injected hypodermically may give rise to alarming symptoms. These are intense pallor, faintness, giddiness, dilatation of pupils, paroxysmal dyspnoea, rapid, intermittent, and weak pulse, nausea and vomiting, intense prostration verging on collapse, and convulsions. The patient may recover if allowed to remain in a recumbent position, but stimulants by mouth—e.g., ammonia—and the hypodermic injection of brandy or ether may be necessary, with the inhalation of nitrite of amyl.
For care in the prescribing of cocaine see under the 'Dangerous Drugs Act, 1920' (p. 82).
The Cocaine Habit consists in the self-administration of the drug hypodermically. It induces excitement, which is followed by prostration. In time melancholia or mania develops, with great irritation of the skin ('cocaine bugs').
XXXII.—CAMPHOR
The liniment, oil, and spirit have been poisonous in large dose.
Symptoms.—Odour of breath, languor, giddiness, faintness, dimness of vision, difficulty of breathing, delirium, convulsions, with hot skin, flushed face, and dilated pupils.
Fatal Dose.—Thirty grains.
Cocculus Indicus.—The fruit of Anamirta cocculus. Contains a poisonous active principle, picrotoxin; used to adulterate beer, and by poachers to stupefy fish.
Symptoms.—Convulsions, followed by stupor and complete loss of voluntary power.
XXXIII.—TETRACHLORETHANE, ETC.
Tetrachlorethane ('Cellon').—Acetylene tetrachloride; vapour has caused poisoning in aeroplane ('dope') and cinema film works.
Symptoms.—Gastric symptoms and marked jaundice. This may be followed in days or weeks by stupor, coma, death.
Post-Mortem.—Fatty degeneration of internal organs, chiefly liver.
Trinitrotoluene (T.N.T.).—An explosive solid which stains the skin an orange colour; may be absorbed through skin or be inhaled.
Symptoms.—Shortness of breath, headache, drowsiness. Later, skin irritation, gastritis, jaundice, blood degeneration.
Treatment.—Remove from work, rest in bed, diuretics, purgatives, alkalies.
XXXIV.—ALCOHOL, ETHER, AND CHLOROFORM
Alcohol, ether, and chloroform, induce general anaesthesia, often preceded by delirious excitement, and followed by nausea and vomiting. When they cause death, it is by inducing a state like apoplexy or by paralyzing the heart.
Alcohol.—Absolute alcohol is ethyl hydroxide (C{2}H{5}OH) with not more than 1 per cent. by weight of water. Rectified spirit (spiritus rectificatus) contains 90 per cent. of alcohol. Methylated spirit consists of rectified spirit with 10 per cent. of wood spirit. Proof spirit contains a little over 49 per cent. of absolute alcohol; brandy or whisky, 53 per cent.; port wine, 20 to 25 per cent.; ales and stout, 4 to 6 per cent.
Symptoms.—Acute poisoning; confusion, giddiness, staggering gait, headache, passing into stupor, with subnormal temperature, and coma. Vomiting may occur and recovery ensue, otherwise collapse sets in. Pupils usually dilated.
Dipsomaniacs suffer from indigestion, vomiting and purging, jaundice, albuminuria, diabetes, cirrhosis of liver, degeneration of kidneys, congestion of brain, peripheral neuritis, alcoholic insanity, and various forms of paralysis. In the acute form delirium tremens is the most common manifestation.
Post-Mortem Appearances.—Deep red colour of lining membranes of stomach. Sometimes congestion of cerebral vessels and meninges. Lungs congested, blood fluid. Rigor mortis persistent.
Fatal Dose.—Death from 1/2 pint of gin and from two bottles of port, but recovery from larger quantities.
Fatal Period.—Average about twenty-four hours.
Treatment.—Stomach-tube, cold affusion, electricity, injection of a pint of hot coffee into the rectum. Give chloride of ammonium in 30 grain doses to prevent delirium; strychnine or digitalin hypodermically.
Method of Extraction from the Stomach.—Neutralize the contents of the stomach, if acid, with sodium carbonate; place them in a retort and carefully distil. Collect the distillate, mix with chloride of calcium or anhydrous sulphate of copper, and again distil. Agitate distillate with dry potassium carbonate, and draw off some of the supernatant fluid for testing.
Tests.—Odour. Dissolves camphor. With dilute sulphuric acid and bichromate of potassium turns green, and evolves aldehyde. Product of combustion makes lime-water white and turbid.
Methyl Alcohol: Wood Naphtha.—Used to produce intoxication by painters, furniture-polishers, etc.
Symptoms are those of alcoholic poisoning, but vomiting and delirium are more persistent. Total or partial blindness may follow as a sequel of optic atrophy. A fatal result not infrequently follows.
The following table gives the points of distinction between concussion of brain, alcoholic poisoning, and opium poisoning:
CONCUSSION OF BRAIN. ALCOHOL. OPIUM.
1. Marks of violence 1. No marks of violence, 1. As alcohol. on head. unless person has fallen. History will be of use.
2. Stupor, sudden. 2. Excitement precedes 2. Symptoms slow. sudden stupor. Drowsiness, stupor, lethargy.
3. Face pale, cold; 3. Face flushed; pupils 3. Face pale; pupils pupils sluggish, generally dilated. contracted. sometimes dilated.
4. Remission rare. 4. Partial recovery may 4. Remission rare. Patient recovers occur, followed by slowly. death.
5. No odour of alcohol 5. Odour of alcohol 5. Odour of opium in in breath. in breath. breath.
Ether is a volatile liquid prepared from ethylic alcohol by interaction with sulphuric acid. It contains 92 per cent. of ethyl oxide (C{2}H{5})O. It was formerly called 'sulphuric ether.' It is a colourless, inflammable liquid, having a strong and characteristic odour, specific gravity 0.735. Purified ether from which the ethylic alcohol has been removed by washing with distilled water, and most of the water by subsequent distillation in the presence of calcium chloride and lime. It is this preparation which is used for the production of general anaesthesia. It has a specific gravity of 0.722 to 0.720, and its vapour is very inflammable.
Symptoms.—When taken as a liquid, same as alcohol. When inhaled as vapour, causes slow, prolonged, and stertorous breathing; face becomes pale, lips bluish, surface of body cold. Pulse first quickens, then slows. Pupils dilated, eyes glassy and fixed, muscles become flabby and relaxed, profound anaesthesia. Then pulse sinks and coma ensues, sensation being entirely suspended. Nausea and vomiting not uncommon.
Post-Mortem Appearances.—Brain and lungs congested. Cavities of heart full of dark, liquid blood. Vessels at upper part of spinal cord congested.
Treatment.—Exposure to pure air, cold affusion, artificial respiration, galvanism.
Method of Extraction from the Contents of the Stomach.—Same as for alcohol. During distillation pass some of the vapour into concentrated solution of bichromate of potash, nitric and sulphuric acids, and note reaction as for alcohol.
Tests.—Vapour burns with smoky flame, depositing carbon. Sparingly soluble in water. With bichromate of potash and sulphuric acid same as alcohol.
Chloroform.—A colourless liquid, specific gravity 1.490 to 1.495, very volatile, giving off dense vapour. Sweet taste and pleasant odour.
Symptoms.—When swallowed, characteristic smell in breath, anxious countenance, burning pain in the throat, stomach, and region of the abdomen, staggering gait, coldness of the extremities, vomiting, insensibility, deepening into coma, with stertorous breathing, dilated pupils, and imperceptible pulse. When inhaled, much the same as ether, but produces insensibility and muscular relaxation more rapidly. It would be impossible to instantly render a person insensible by holding a pocket-handkerchief saturated with chloroform over the face. Statements such as this, which are often made in cases of robbery from the person and in cases of rape, are incredible.
Delayed Chloroform-Poisoning.—Death may take place in from four to seven days after chloroform has been administered, especially in the case of children. The internal organs are found to be fattily degenerated, and death is thought to be due to acetonuria.
Post-Mortem Appearances.—Cerebral and pulmonary congestion. Heart empty, or right side distended with dark blood.
Treatment.—Stomach-tube and free lavage; cold affusion; drawing forward tongue; artificial respiration; galvanism and suspension with head downward. Inhalation of nitrite of amyl; strychnine hypodermically.
Fatal Dose.—When swallowed, from 1 to 2 ounces.
Method of Extraction from the Stomach.—By distillation at 120 deg. F. The vapour, as it passes along a glass tube, may be decomposed by heat into chlorine, hydrochloric acid, and carbon—the first shown by setting free iodine in iodide of starch, the second by reddening blue litmus-paper, and the last by its deposit.
Tests.—Taste, colour, weight; burns with a green flame; dissolves camphor, guttapercha, and caoutchouc.
Iodoform.—Poisoning may result from its use in surgery. It produces delirium, sleepiness, and coma. It may lead to mental weakness or optic neuritis.
XXXV.—CHLORAL HYDRATE
It was formerly largely used as a hypnotic, and many fatal consequences ensued. It is prepared from alcohol and chlorine.
Symptoms.—Deep sleep, loss of muscular power, diminished or abolished reflex action and sensibility, followed by loss of consciousness and marked fall of temperature. Pulse may become quick, and face flushed or livid and bloated. Prolonged use of this drug may produce a peculiar eruption on the skin. Supposed to act in the blood by being decomposed into chloroform and sodium formate. Its effects are due chiefly to depression of the central nervous system, the medulla being the last part of the nervous system to be attacked.
Method of Extraction from the Stomach.—By distillation in strongly alkaline solutions, when it may be obtained as chloroform and tested as such.
Treatment.—Stomach-tube or emetic. Hypodermic injections of strychnine. Keep patient warm, and inject a pint of hot strong coffee into the rectum. Nitrite of amyl and artificial respiration.
Tests.—Heated with caustic potash, it yields chloroform and potassium formate. The chloroform is readily recognized by its odour, and, if the solution be concentrated, by separating as a heavy layer at the bottom of the test-tube.
XXXVI.—PETROLEUM AND PARAFFIN-OIL
Cases of poisoning by petroleum and paraffin are common, and occur chiefly in children.
Petroleum is a natural product, and is a mixture of the higher saturated hydrocarbons. The crude petroleum is purified by distillation, and is then free from colour, but retains its peculiar penetrating odour. Different varieties are sold under the names of cymogene, gasolene, naphtha, petrol, and benzoline. Benzoline is highly inflammable, and is often called mineral naphtha, petroleum naphtha, and petroleum spirit. Benzoline is not the same as benzene or benzol, which is one of the products of the dry distillation of coal.
From its very general use as a fuel in motor-cars many accidents have happened from inhaling the vapour of petrol. It gives rise to coldness, shallow respiration, syncope, and insensibility, but seldom death.
Paraffin, also known as kerosene and mineral oil, is a mixture of saturated hydrocarbons obtained by the distillation of shale.
By the retailer the terms 'petroleum' and 'paraffin' oil are used indifferently, and each is sold for the other without prejudice.
Symptoms.—These substances are not very active poisons, and, as a rule, even children recover. The breath has the odour of paraffin, the face is pale and cyanotic, hot and dry, and there may be vomiting. Death may result from gastro-enteritis or from coma.
Fatal Dose.—In the case of an adult, 1/2 pint should not prove lethal, and patients have recovered after drinking a pint.
Treatment.—Emetics, purgatives, and stimulants.
XXXVII.—ANTIPYRINE, ANTIFEBRIN, PHENACETIN, AND ANILINE
Many of the synthetical coal-tar products now so largely employed as analgesics are powerful toxic agents.
Phenazone, Antipyrine, or Analgesin, is a complex benzene derivative prepared from aniline, aceto-acetic ether, and methyl iodide. It is in colourless, inodorous, scaly crystals, which have a bitter taste. It is soluble in its own weight of water.
Tests.—Can be extracted from an alkaline solution of chloroform. The residue left on the evaporation of chloroform should be employed for testing. If heated with strong nitric acid and allowed to cool, a purple colour is produced. Ferric chloride gives a blood-red coloration, destroyed by the addition of mineral acids.
Treatment.—Stimulants freely, inhalation of oxygen, patient to be kept in the recumbent position.
Acetanilide, Antifebrin, Phenylacetamide (a constituent of 'Daisy' or 'headache' powders), is obtained by the interaction of acetic acid and aniline. It is in colourless, inodorous, lamellar crystals, which have a slight pungent taste. It is insoluble in water.
Tests.—May be extracted from acid solutions by ether or chloroform. If heated with solution of potassium hydroxide, odour of aniline is given off; if liquid, when it is warmed with a few drops of chloroform, a penetrating and unpleasant odour of isocyanide.
Treatment.—Emetics, stimulants, inhalation of ether, recumbent position.
Phenacetin, Phenacetinum, is produced by the interaction of glacial acetic acid and para-phenetidin. It is in white, tasteless, inodorous, glistening, scaly crystals, insoluble in water. Of all the members of the group, it most rarely produces toxic symptoms.
Treatment.—As for the other members of this group.
Exalgin, Aspirin, etc., as well as the above, may all act as poisons to certain persons, and even small medicinal doses may cause serious and even fatal consequences.
Symptoms (more or less common to all).—Nausea, vomiting, hurried respiration, marked cyanosis, syncope. Persistent sneezing and widespread urticaria may be present; collapse.
Aniline is an oily liquid, heavier than, and not soluble in, water. It is colourless or reddish-brown; it has a peculiar tar-like odour; it is soluble in alcohol, and forms a soluble sulphate with sulphuric acid. A solution of bleaching-powder gives with solution of the sulphate a purple colour changing to red-brown.
Symptoms.—Nausea, vomiting, giddiness, intoxication, drowsiness, gasping for breath, feeble pulse, and marked cyanosis. In its industrial use it may act as a poison either by inhalation of the fumes or by absorption through the skin. The symptoms then are mainly those of peripheral neuritis with blindness.
Fatal Dose.—About 6 drachms.
Treatment.—Wash out stomach; stimulants, artificial respiration, inhalation of oxygen, transfusion.
Nitro-benzol (Artificial Oil of Bitter Almonds).—It is used in perfumery, but is very poisonous when swallowed, or inhaled, or absorbed through skin. It is used in the manufacture of aniline dyes, and may act as an industrial poison. The symptoms closely resemble those of aniline poisoning, but there is perhaps greater mental confusion.
Fatal Dose.—Eight to ten drops have caused death.
Treatment.—Emetics, stimulants, transfusion of saline or blood, pituitrin, strychnine, or digitalin hypodermically.
Nitroglycerine gives rise to intense and persistent headache ('powder headache'). Throbbing and pulsation of all the arteries in the body; flushing of the face and collapse may follow.
Dinitrobenzene causes symptoms resembling nitro-benzol poisoning, and when acting as a chronic poison gives rise to weakness, jaundice, peripheral neuritis.
XXXVIII.—SULPHONAL, TRIONAL, TETRONAL, VERONAL, PARALDEHYDE
These are dangerous drugs. The ordinary symptoms of the group are noises in the ears, headache, vertigo, inability to stand or to walk properly, insensibility, and cyanosis.
The most interesting point is the condition of the urine. In cases of poisoning it is dark or reddish-brown in colour, due to the presence of haematoporphyrin. It contains albumin and casts, but no red corpuscles. In cases of haematoporphyrinuria the prognosis is bad, and it is said that these cases invariably end fatally.
Treatment.—In an ordinary case emetics, strong coffee, hypodermic injections of strychnine, saline injections, and transfusion.
Cases of chronic poisoning from the 'als' are not uncommon, and are increasing in frequency. Hypnogen is apparently identical with veronal.
All the above-named aniline derivatives are included in Part I. of the scheduled poisons.
XXXIX.—CONIUM AND CALABAR BEAN
Conium Maculatum (Spotted Hemlock).—All parts of the plant are poisonous, often mistaken for parsley. Contains the poisonous principle coniine, a volatile liquid alkaloid with a mousy smell; insoluble in water; soluble in alcohol, ether, and chloroform. It also contains methyl coniine.
Symptoms.—Dryness of throat, headache, dilated pupil, dysphagia, loss of muscular power, passing into complete paralysis. Delirium, coma, and convulsions, occasionally.
Post-Mortem Appearances.—Congested brain and lungs; redness of the mucous membrane of the stomach. The stomach and intestines should be examined for fragments of the leaves and fruit, recognized by their microscopical appearances.
Treatment.—Emetics, tannic acid or gallic acid. Diffusible stimulants.
Method of Extraction from the Stomach.—Use Stas-Otto process.
Tests.—The mousy odour. Deepened colour and dense white fumes with nitric acid. Pale red, deepening, with hydrochloric acid.
There are several other umbelliferous plants which are poisonous. The water hemlock (Cicuta virosa) produces symptoms not unlike those of hemlock; it has been mistaken for parsnip and celery. It contains an active principle, cicutoxin, which in some respects is allied to strychnine and picrotoxin. The fool's parsley, or lesser hemlock (AEthusa cynapium), is another member of this group, although doubt has been expressed as to whether it is really poisonous. The water dropwort (Oenanthe crocata) is undoubtedly poisonous, especially to cattle. In man it produces abdominal pain with diarrhoea and vomiting; dilated pupils, slow pulse, and cyanosis; delirium, insensibility, and convulsions. The post-mortem appearances are not characteristic, but the stomach and intestines should be examined for portions of the plant.
Calabar Bean or Physostigma.—The bean of Physostigma venenosum contains the alkaloid physostigmine or eserine, with the antagonistic alkaloid calabarine.
Symptoms.—Vomiting, giddiness, irregular cardiac action, contraction of the pupils, paralysis of lower extremities, and death from asphyxia.
Treatment.—Emetics; hypodermic injection of 1/50 grain sulphate of atropine, repeated if necessary.
Method of Extraction from the Stomach.—Use Stas-Otto process.
Test.—The contraction of the pupil which it causes.
XL.—TOBACCO AND LOBELIA
Tobacco.—Nicotiana tabacum owes its poisonous properties to its alkaloid nicotine, a volatile, oily, amber-coloured liquid, with an acrid taste and ethereal odour; soluble in water, alcohol, ether, and chloroform. The drug has an intense depressant action on the heart and respiratory centre.
Symptoms.—Giddiness, fainting, nausea, and vomiting, with syncope, muscular tremors, stupor, stertorous breathing, and insensible pupil. Death has occurred after seventeen or eighteen pipes at a sitting.
Post-Mortem Appearances.—Not uniform or characteristic. General relaxed condition of muscles; engorgement of cerebral and pulmonary vessels. Congestion of gastric mucous membrane.
Treatment.—Emetics, stimulants, hypodermic injection of 1/25 grain of strychnine. Warmth to the surface by hot bottles, hot blankets.
Method of Extraction from the Stomach.—Digest the contents of the stomach in cold distilled water and very dilute sulphuric acid; strain, filter, and press residue. Evaporate the filtrate to half its bulk, digest with alcohol, and evaporate alcohol off in a water-bath. Dissolve residue (sulphate of nicotine) in water, and make solution alkaline with potash; then shake with ether in a test-tube. Remove ether and allow it slowly to evaporate. Test resulting alkaloid.
Tests.—No change of colour with the mineral acids. White deposit with corrosive sublimate. Sulphuric acid and bichromate of potassium give a green colour, oxide of chromium. Precipitate with bichloride of platinum and with carbazotic acid.
Lobelia Inflata (Indian Tobacco).—Much used in America by the Coffenite practitioners, and a valuable remedy for asthma.
Symptoms.—Nausea, vomiting, giddiness, cold sweats, prostration. Headache, giddiness, tremors, insensibility, and convulsions.
XLI.—HYDROCYANIC ACID
Prussic Acid is the most active of poisons. The diluted hydrocyanic acid of the Pharmacopoeia contains 2 per cent. of hydrocyanic acid, Scheele's 4 per cent. It is a colourless liquid, feebly acid, with odour of bitter almonds.
Cyanide of Potassium is largely used in photography and in electro-plating, and is also poisonous. It often contains undecomposed carbonate of potassium, which may act as a corrosive poison and cause erosion of the mucous membranes of the lips, mouth, and stomach.
Oil of Bitter Almonds, used as a flavouring agent, may contain (when improperly prepared) from 5 to 15 per cent. of the anhydrous acid.
Symptoms.—The symptoms usually come on in a few seconds, and are of the shortest possible duration. There is a sudden gasp for breath, possibly a loud cry, and the patient drops down dead. If the fatal termination is prolonged for a few minutes, the symptoms are intense giddiness, pallor of the skin, dilatation of the pupils, laboured and irregular breathing, small and frequent pulse, followed by insensibility. There may be convulsions or tetanic spasms, with evacuation of urine and faeces. Death results from paralysis of the central nervous system, but artificial respiration is useless, as the drug promptly arrests the heart's action. It also kills the protoplasm of the red blood-corpuscles, rendering them useless as oxygen-carriers.
Post-Mortem Appearances.—Skin livid, pale, or violet, with bright red patches on the dependent parts. The gastro-intestinal mucous membrane is bright red in colour, owing to the presence of cyanmethaemoglobin. Hands clenched, nails blue, jaws fixed, froth about mouth. Eyes prominent and glistening, odour of acid from body, venous system gorged.
Treatment.—Empty the stomach by the tube at once, and wash it out with a solution of sodium thiosulphate. Strong ammonia to the nostrils. Stimulants freely—brandy, chloric ether, ammonia, sal volatile ad libitum. If patient cannot swallow, inject hypodermically either brandy or ether. Hypodermic injection of 1/50 grain atropine. Douche to the face, alternately hot and cold. Death commonly occurs so rapidly that there is no time for treatment.
Fatal Dose (Smallest).—Half a drachm of the B.P. acid, equal to 0.6 grain of the anhydrous. Recovery from 1/2 ounce of the B.P. acid. These records are fallacious, for in specimens the percentage of anhydrous acid varies enormously. Practically, 1 grain of the anhydrous acid is fatal.
Fatal Period.—From two to five minutes after a large dose, but may be less.
Method of Extraction from the Stomach.—Having previously carefully fitted a watchglass to a wide-mouthed bottle, nearly fill the bottle with the contents of the stomach, blood, secretions, etc. Place a few drops of a solution of nitrate of silver on the concave surface of the watchglass, and cover the mouth of the bottle with it. The vapour of hydrocyanic acid, if present, will form a white precipitate which may be tested. Other watchglasses, treated with sulphide of ammonium or sulphate of iron and liquor potassae, will give the reactions of the acid with appropriate tests. This method removes all objections as to foreign admixture. If the acid is not at first detected, gentle warming of the bottle in a water-bath will assist the evolution of the vapour. The vapour may be obtained by distillation, but this process is open to objections to which the other is not. In some cases it becomes changed in the body into formic acid, which should therefore be sought for.
Tests.—With nitrate of silver a white precipitate, insoluble in cold, but soluble in boiling, nitric acid. The precipitate heated, evolves cyanogen, having an odour of peach-blossoms, and burning, when lighted, with a pink flame. Liquor potassae and sulphate of iron give a brownish-green precipitate, which turns to Prussian blue with hydrochloric acid. Liquor potassae and sulphate of copper give a greenish-white precipitate, becoming white with hydrochloric acid. Sulphide of ammonium gives sulpho-cyanide of ammonium. This develops a blood-red colour with perchloride of iron, bleached by corrosive sublimate.
XLII.—ACONITE
Aconite (Aconitum Napellus, monkshood).—Root and leaves. Poisonous property depends upon an alkaloid, aconitine. Aconite is one of the constituents of St. Jacob's Oil.
Symptoms.—Numbness and tingling in mouth, throat, and stomach, giddiness, loss of sensation, deafness, dimness of sight, paralysis, first of the lower and then of the upper extremities, vomiting, and shallow respiration. Pupils dilated. Pulse small, irregular, finally imperceptible. The mind remains unaffected. Death often sudden.
Post-Mortem Appearances.—Venous congestion, engorgement of brain and membranes.
Treatment.—Emetics, stimulants freely. Best antidote is sulphate of atropine, 1/50 grain hypodermically, and also strychnine. Digitalis also useful. Warmth to whole body. Patient to make no exertion.
Fatal Dose.—Of root or tincture, 1 drachm.
Fatal Period.—Average, less than four hours.
Method of Extraction from the Stomach, etc.—Extraction from contents of stomach by Stas-Otto process. It may be found in the urine; gives usual alkaloidal reactions, but no distinctive chemical test known.
Tests.—Chiefly physiological; tingling and numbness when applied to tongue or inner surface of cheek. Effects on mice, etc. A cadaveric alkaloid or ptomaine has been found in the body, possessing many of the actions of aconitine. The presence of this substance was suggested in the Lamson trial.
The Indian aconite, Aconitum ferox, the Bish poison, is much more active than the European variety. It contains a large proportion of pseudaconitine, and is frequently employed in India, not only for the destruction of wild beasts, but for criminal purposes.
Aconitine varies much in activity according to its mode of preparation and the source from which it is derived. The most active kind is probably made from A. ferox.
XLIII.—DIGITALIS
All parts of the plant Digitalis purpurea (purple foxglove) are poisonous. Contains the glucoside digitalin and other active principles.
Symptoms.—Nausea, vomiting, purging, and abdominal pains. Vomited matter grass-green in colour. Headache, giddiness, and loss of sight; pupils dilated, insensitive; pulse weak, remarkably slow and irregular; cold sweat. Salivation occasionally, or syncope and stupor. Death sometimes quite suddenly.
Post-Mortem Appearances.—Congested condition of brain and membranes; inflammation of gastric mucous membrane.
Treatment.—Emetics freely; infusions containing tannin, as coffee, tea, oak-bark, galls, etc. Stimulants. Hypodermic injection of 1/120 grain of aconitine.
Method of Extraction from the Stomach, etc.—Use Stas-Otto process.
Tests for Digitalin.—A white substance, sparingly soluble in water, not changed by nitric acid; turns yellow, changing to green, with hydrochloric acid. The minutest trace of digitalin moistened with sulphuric and treated with bromine vapour gives a rose colour, turning to mauve. This is very delicate, but in experienced hands the physiological test is more reliable. The chemist who has had no practical experience in pharmacological methods would be wiser to keep to his chemical tests.
XLIV.—NUX VOMICA, STRYCHNINE, AND BRUCINE
Nux Vomica consists of the seeds of the Strychnos nux vomica. From these strychnine and brucine are obtained. The symptoms, post-mortem appearances, and treatment, of poisoning by nux vomica are the same as for strychnine.
Strychnine is a powerful poison, and forms the active ingredient of many 'vermin-killers.' It occurs as a white powder or as colourless crystals, with a persistent bitter taste; very slightly soluble in water; more or less soluble in benzol, ether, and alcohol.
Symptoms.—Sense of suffocation, twitchings of muscles, followed by tetanic convulsions and opisthotonos, each lasting half to two minutes. Mental faculties unaffected, face congested and anxious; eyes staring, lips livid; much thirst. The period of accession of the symptoms varies with the mode of administration of the poison. Symptoms, as a rule, come on soon after food has been taken. Patient may die within a few hours from asphyxia or from exhaustion.
In Tetanus there is usually history of a wound; the symptoms come on slowly; lockjaw is an early symptom, and only later complete convulsions; the intervals between the fits are never entirely free from rigidity. Death is delayed for some days.
Post-Mortem Appearances.—Heart empty, blood fluid, rigor mortis persistent. Hands usually clenched; feet arched and inverted. Congestion of brain, spinal cord, and lungs.
Treatment.—Emetics or stomach-pump if the patient is deeply anaesthetized. Tannic acid and permanganate of potassium. Bromide of potassium 1/2 ounce with chloral 30 grains, repeated if necessary.
Fatal Dose (Smallest).—Quarter of a grain.
Fatal Period (Shortest).—Ten minutes; usually two to four hours.
Method of Extraction from the Stomach.—The alkaloid may be separated by the process of Stas-Otto.
Tests.—Strychnine has a characteristic, very bitter taste; it imparts this taste to even very dilute solutions; it is unaffected by sulphuric acid, but gives a purple-blue colour, changing to crimson and light red, when the edge of this solution is touched with dioxide of manganese, potassium bichromate, ferricyanide of potassium, or permanganate of potassium. This test is so delicate as to show the 1/25000 of a grain of the alkaloid. A very minute quantity (1/5000 grain) in solution placed on the skin of a frog after drying causes tetanic convulsions.
Brucine.—This alkaloid, found associated with strychnine, possesses the same properties, though in a less powerful degree. Nitric acid gives a blood-red colour, changed to purple with protochloride of tin.
XLV.—CANTHARIDES
Cantharides.—Spanish fly, or blistering beetle, is the basis of most of the blistering preparations. It is sometimes taken as an abortifacient or given as an aphrodisiac, but whether it has any such action is open to question. It acts as an irritant to the kidneys and bladder, and sometimes produces haaematuria and a good deal of temporary discomfort.
Symptoms.—Burning sensation in the throat and stomach, with salivation, pain and difficulty in swallowing. Vomiting of mucus mixed with blood. Tenesmus, diarrhoea, the motions containing blood and mucus. Dysuria, with passage of small amounts of albuminous and bloody urine. Peritonitis, high temperature, quick pulse, headache, loss of sensibility, and convulsions.
Post-Mortem.—Gastro-intestinal mucous membrane inflamed, with gangrenous patches. Genito-urinary tract inflamed. Acute nephritis.
Treatment.—An emetic of apomorphine; demulcent drinks, such as barley-water, white of egg and water, linseed-tea and gruel (but not oils), with a hypodermic injection of morphine to allay pain.
Tests.—The vomited matter often contains shining particles of the powder. The urine will probably be albuminous.
XLVI.—ABORTIFACIENTS
Emmenagogues are remedies which have the property of exciting the catamenial flow; ecbolics, or abortives, are drugs which excite contraction of the uterus, and are supposed to have the power of expelling its contents. The vegetable substances commonly reputed to be abortives are ergot, savin, aloes (Hierapicra), digitalis, colocynth, pennyroyal, and nutmeg; but there is no evidence to show that any drug possesses this property. Lead in some parts of the country is a popular abortifacient. A medicine may be an emmenagogue without being an ecbolic. Permanganate of potassium and binoxide of manganese are valuable remedies for amenorrhoea, but will not produce abortion. The vegetable substances frequently used as abortives are savin and ergot.
Savin (Juniperus Sabina).—Leaves and tops of the plant yield an acrid oil having poisonous properties, and which has even produced death.
Symptoms.—Those of irritant poisons. Purging not always present, but tenesmus and strangury.
Post-Mortem Appearances.—Acute inflammation of alimentary canal. Green powder found. This, washed and dried and then rubbed, gives odour of savin.
Test.—A watery solution of savin strikes deep green with perchloride of iron, and if an infusion of the twigs has been taken the twigs may be detected with the microscope. The twigs obtained from the stomach, dried and rubbed between the finger and thumb, will give the odour of savin.
Ergot (Secale Cornutum).—A parasitic fungus attacking wheat, barley, oats, and rye, which is reputed to have the power of causing contraction of unstriped muscular fibre, especially that of the uterus.
Symptoms.—Lassitude, headache, nausea, diarrhoea, anuria, convulsions, coma. Small quantities frequently repeated have in the past produced gangrene of the extremities, or anaesthesia of fingers and toes.
Tests.—Lake-red colour with liquor potassae; this liquid filtered gives a precipitate of same colour with nitric acid.
XLVII.—POISONOUS FUNGI AND TOXIC FOODS
Fungi.—Of the poisonous mushrooms, the Amanita phalloides and the fly agaric, or Agaricus muscarius, are the most potent. The active principle of the former is phallin, and of the latter muscarine. The Amanita phalloides is distinguished from the common mushroom (Agaricus campestris) by having permanent white gills and a hollow stem. The Agaricus muscarius is bright red with yellow spots. Phallin is a toxalbumin which destroys the red blood-corpuscles, causing the serum to become red in colour and the urine blood-stained. Fibrin is liberated, and thromboses occur, especially in the liver. The symptoms may be mistaken for phosphorus-poisoning or acute yellow atrophy of the liver. Muscarine affects the nervous system chiefly.
Edible fungi have an agreeable taste and smell, and are firm in substance. Poisonous fungi have an offensive smell and bitter taste, are often of a bright colour, and soon become pulpy.
Symptoms.—These may be of the narcotic or irritant types. Usually, however, there is violent colic, with thirst, vomiting, and diarrhoea, mental excitement, followed by delirium, convulsions, coma, slow pulse, stertorous breathing, cyanosis, cold extremities, and dilated pupils.
Post-Mortem.—In phallin-poisoning the blood remains fluid; numerous haemorrhages are present, with fatty degeneration of the internal organs.
Treatment.—Use the stomach-tube to give a solution of permanganate of potash, emetics, followed by a hypodermic injection of 1/50 grain of atropine. Transfusion of saline fluid. A dose of castor-oil would be useful.
Foods.—The kinds of food which most frequently produce symptoms of poisoning are pork, veal, beef, meat-pies, potted and tinned meats, sausages, and brawn. Sausage-poisoning is common in Germany. It is not necessary that the food should be 'high' to give rise to poisoning. It may arise from the use of the flesh of an animal suffering from some disease, from inoculation with micro-organisms, or from the presence of toxalbumoses or ptomaines. Many diseases, such as diarrhoea, enteric fever, and cholera, and perhaps tuberculosis, may be caused by eating infected food. Trichiniasis may also be mentioned. Tinned fish often gives rise to symptoms of poisoning, and shell-fish are not uncommonly contaminated with pathogenic micro-organisms. Mussel-poisoning was formerly supposed to be due to the copper in them derived from ships' bottoms, but it is more probably the result of the formation of a toxine during life, and not after decomposition has set in. Milk, too, may give rise to gastro-intestinal irritation from the occurrence in it of chemical changes. There have been epidemics of poisoning from eating cheese containing tyrotoxicon. Ergotism from eating bread made with ergotized wheat is now rare, but pellagra from the consumption of mouldy maize, and lathyrism, due to the admixture with flour of the seeds of certain kinds of vetch, are still common in Southern Europe.
Symptoms.—The symptoms which result from the ingestion of poisonous meat are often very severe. In some cases their appearance is delayed from twenty-four to forty-eight hours. They may resemble those of an infectious disease or those of acute enteritis. Usually there are headache, anorexia, rigors, intestinal disturbance, pains in the back and limbs, and delirium. Sometimes the symptoms resemble atropine-poisoning, a condition due to ptomatropine.
Treatment.—Emetics, purgatives, stimulants, with hypodermic injections of strychnine and atropine along with stimulants.
XLVIII.—PTOMAINES OR CADAVERIC ALKALOIDS
Every medical man, before presenting himself to give evidence in a case of suspected poisoning, should make himself thoroughly acquainted with recent researches on the subject. Ptomaines are, for the most part, alkaloids generated during the process of putrefaction, and they closely resemble many of the vegetable alkaloids—veratrine, morphine, and codeine, for example—not only in chemical characters, but in physiological properties. They are probably allied to neurine, an alkaloid obtained from the brain and also from the bile. Some of them are analogous in action to muscarine, the active principle of the fly fungus. Some are proteids, albumins, and globulins. Ptomaines may be produced abundantly in animal substances which, after exposure under insanitary conditions, have been excluded from the air. Ptomaines or toxalbumins are sometimes found in potted meats and sausages, and are due to organisms—the Bacillus botulinus, the B. enteritidis of Gaertner, the B. proteus vulgaris, or the B. aertrycke (which is perhaps the most common of all). The symptoms produced by the latter are usually vomiting, abdominal pain, pains in the limbs and cramps, diarrhoea, vertigo, coldness, faintness, and collapse. The symptoms of botulism are dryness of skin and mucous membranes, dilatation of pupils, paralysis of muscles, diplopia, etc. Articles of food most often associated with poisoning are pork, ham, bacon, veal, baked meat-pie, milk, cheese, mussels, tinned meats.
In a case of suspected poisoning, counsel for the defence, if he knows his work, will probably cross-examine the medical expert on this subject, and endeavour to elicit an admission that the reactions which have been attributed to a poison may possibly be accounted for on the theory of the formation of a ptomaine. There is practically no counter-move to this form of attack.
INDEX
Abdomen, injuries of, 29
Abortifacients, 147
Abortion, criminal, 42
Acetanilide, 136
Acetate of lead, 116
Aconite, 143
Adipocere, 18
Adultery, 62
Age, determination of, 12
Alcohol, 130
Alcoholic insanity, 76
Alkaloids, 93
Alum, 103
Ammonia, 102
Anaesthetics, death from, 19
Aniline, 136
Antifebrin, 136
Antimony, 112
Antipyrine, 135
Aqua fortis, 97
Arsenic, 107
Arsenious acid, 107
Artificial oil of bitter almonds, 137
Arum, 124
Asphyxia, 13
Assaults, 21
Assizes, 7
Atropine, 127
Barberio's test, 58
Barium salts, 104
Belladonna, 127
Bestiality, 59
Bichromate of potassium, 119
Bismuth, 119
Blackmailing, 60
Bladder, injuries of, 30
Blood-stains, 30
Born in wedlock, 52
Botulism, 151
Brain, injuries to, 26
Breslau's life test, 49
Brucine, 146
Bruises, 22
Bullet wounds, 24
Burnett's fluid, 119
Burns, 22
Cadaveric alkaloids, 150 rigidity, 17
Calabar bean, 139
Camphor, 129
Cantharides, 146
Carbolic acid, 100
Carbonic acid gas, 120 oxide, 121
Carnal knowledge, 55
Cellon, 129
Chemical analysis, 91
Chest injuries, 28
Chloral, 134
Chlorate of potassium, 103
Chloride of zinc, 119
Chlorine, 122
Chloroform, 19, 132
Choke-damp, 121
Chromium, 119
Chronic lead-poisoning, 117
Clothing, fibres of, 34
Coal-gas, 121
Cocaine, 128
Cocculus indicus, 129
Cold, death from, 39
Coma, 14
Common witness, 2
Concealment of birth, 45 of pregnancy, 45
Conium, 138
Contused wounds, 24
Cooling, rate of, 16
Copper, 117
Coroners, 4
Coroner's court, 4
Corrosive sublimate, 113
Corrosives, 86
Cretinism, 69
Crimes, 1
Criminal abortion, 42
Criminal Appeal Court, 8 courts, 7
Cross-examination, 3
Crown Court of Assize, 7
Culpable homicide, 21
Cut throat, 28
Dangerous Drugs Bill, 82
Death in the foetus, 50 signs of, 16
Delivery, 41
Dementia, 70
Depositions, 6
Determination of sex, 11
Diachylon pills, 117
Diaphragm, wounds of, 29
Digitalis, 144
Dinitrobenzene, 137
Divorce, 60
"Dope," 129
Drowning, 36
Duration of pregnancy, 50
Dyeing of hair, 11
Dying declarations, 10
Ecchymosis, 22
Electricity, 38
Epilepsy, 65, 75
Ergot, 148
Ether, 132
Evidence, giving of, 2
Examination-in-chief, 3
Experiments on animals, 85
Experts, 2
Eye injuries, 27
Face injuries, 27
Feeble-minded, 69
Fees for medical witness, 5, 7
Feigned diseases, 63
Felony, 1
Ferro-silicon, 111
Finger prints, 11
Florence's test, 58
Foeticide, 42
Foods, poisonous, 150
Found dead, 5
Fruit stains, 33
Fungi, 148
Gaseous poisons, 120
General paralysis, 71
Genital organs, wounds of, 30
Grand jury, 8
Gunshot wounds, 24
Haemin crystals, 32
Hair, detection of, 33 dyeing of, 11
Hanging, 35
Head injuries, 26
Heart, injuries of, 29
Heat, death from, 39
Hemlock, 138
Henbane, 128
Homicide, 21
Hydrochloric acid, 98 gas, 122
Hydrocyanic acid, 140
Hyoscyamus, 128
Hypostasis, 16
Identification of dead, 12
Identity, personal, 10
Idiocy, 68
Imbecility, 69
Impotence, 54
Incest, 59
Incised wounds, 23
Indecent assault, 57
Indictable offences, 2
Inebriates Act, 78
Infanticide, 44
Inheritance, 54
Injuries, 21
Insanity, 67-76
Intestines, wounds of, 30
Iodide of potassium, 104
Iodine, 104
Irritants, 87 gases, 122 vegetable, 123
Judicial separation, 62
Jury, coroner's, 4
Kidney, injuries of, 30
Kleptomania, 73
Laborde's method, 37
Laburnum, 123
Lacerated wounds, 24
Lead, 116
Lee-Metford bullet, 24
Legitimacy, 52
Lightning, 38
Live-birth, 44-46
Liver, injuries of, 29
Lobelia, 140
Lucid intervals, 73
Lumbago, 66
Lunacy, 67 certification, 77
Lungs, injuries of, 29 evidences of live-birth from, 47
Magistrate's court, 7
Malingering, 63
Malpractice, 20
Malum regimen, 21
Mania, 71
Manslaughter, 21
Marriage, 60
Marsh's process, 110
Martini-Henry bullet, 25
Maturity of infant, 45
Mauser bullet, 25
Medical evidence, 2
Mentally deficients, 70
Mercury salts, 113
Methyl alcohol, 131
Mineral acids, 94
Misdemeanour, 1
Monkshood, 143
Monomania, 72
Morphine, 127
Murder, 21
Muriatic acid, 98
Naphtha, 135
Nitrate of silver, 119
Nitric acid, 95
Nitro-benzol, 137
Notes, 9
Nux vomica, 145
Oaths Act, 9
Oil of bitter almonds, 141
Opium, 124
Oxalate of potash, 99
Oxalic acid, 98
Paraffin oil, 135
Paranoia, 73
Personal identity, 10
Petroleum, 134
Petty Sessions, 7
Phenacetin, 136
Phenol, 100
Phosphorus, 105
Phossy-jaw, 106
Physostigma, 139
Picrotoxin, 129
Poison, definition of, 80
Poisonous foods, 149
Poisons acting on the brain, 88 classification of, 84 detection of, 91 evidence, 85 scheduled, 81 symptoms and post-mortem appearances, 86 treatment of, 90
Potash, 101
Precipitin test for blood, 33
Pregnancy, 40, 50 insanity of, 73
Presumption of death, 20 survivorship, 21
Primula, 124
Privilege, 8
Procurator Fiscal, 7
Prussic acid, 140
Ptomaines, 150
Puerperal mania, 73
Punctured wounds, 23
Purgatives, 123
Putrefaction, 18
Quarter Sessions, 7
Railway spine, 27
Rape, 55
Reception orders, 77
Rectified spirit, 130
Re-examination, 3
Reinsch's process, 110
Reports, medical, 9
Responsibility, 76
Resuscitation, 36
Rhus, 124
Rigor mortis, 17
Rust stains, 33
Sale of arsenic, 111
Saponification, 18
Satyriasis, 73
Savin, 147
Scars, 11
Schiller's method of resuscitation, 36
Scheduled poisons, 81
Scotch oath, 9
Secrets, professional, 8
Self-inflicted wounds, 24
Seminal stains, 58
Sewer-gas, 122
Sex, determination of, 11
Signs of death, 16
Silver, 118
Skin diseases, 66
Soda, 101
Sodomy, 59
Spanish-fly, 146
Spectroscopic examination of blood, 32
Spinal cord injuries, 27
Spleen, injuries of, 29
Staining, post-mortem, 16
Starvation, 38
Stas-Otto process, 92
Status lymphaticus, 15
Sterility, 54
Stomach, injuries of, 29
Stramonium, 128
Strangulation, 35
Strychnine, 145
Sudden death, 13, 15
Suffocation, 34
Sugar of lead, 116
Sulphonal, 137
Sulphuretted hydrogen, 122
Sulphuric acid, 95
Sulphurous acid gas, 122
Summary offences, 2
Sunstroke, 39
Superfoetation, 53
Syncope, 13
Tartar emetic, 112
Tattoo marks, 10
Teichman's crystals, 32
Tetanus, 145
Tetrachlorethane, 129
Tetronal, 137
Throat injuries, 28
Tobacco, 139
Treason, 1
Trinitrotoluene, 129
Trional, 137
True bill, 8
Undue influence, 74
Unnatural offences, 59
Unsound mind, 67
Veronal, 137
Viability, 51
Vitriol, 95
Voidable marriage, 63
Witnesses, 2
Wounds, 21
Yew, 124
Zinc, 118
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