RHCTICHli lOXICOLOG^ I^HYSici AN 1 AND Students KOBERT ^iiie» ii ^ '*i' ■b».. A •• ¥^', ■r. . _ ■» _•_ - ■ ^ " •il'nj > .*^ .«. ' '- ml^mjjC .i^ CORNELL UNIVERSITY. THE THE GIFT OF ROSWELL P. FLOWER FOR THE USE OF THE N. Y, STATE VETERINARY COLLEGE. 1897 Cornell University Library RA1211.K75P Practical toxicology for physicians and 3 1924 000 307 631 (->A OfTir -c - '■^,f>^ Aquifoliacese, Asclepiadacese, Apocynacese, Gentianaceas, Convolvulacese, Boraginaceee, Solanacese, Scrophulariacese, Labiatse, Primulacese, Globu- lariaceee, Plumbaginacese, Chenopodiacese, Polygonacese, Thymelseaoese, Aristolochiacese, Euphorbiacese, Buxacese, ITrticacese, Cannabaceffi, Salicacese, Araceas, Iridaceae, Amaryllidaoese, Dioscoreacese, Liliacese, ColchicaceEe, Gramineae, Coniferae, Equisetaoeae, Polypodiaceae, Fungi (Liohenes) 156-159 C. Eeview of the pharmacologically interesting Sub-kingdoms and Species of Animals 159 TABLE OF CONTENTS. XUl PAGE Table (XXXII) of poisonous animals arranged by sub-king- doms : ccelenterata, plathelminthes, nemathelminthes, moUusca, annelida, tracheata, vertebrata 160-161 D. Review of the more important pharmacological reactions, which are occasionally quoted by the author's name 163 Table (XXXIII) of the reactions of : Allen, Almen-Sohonbein- van Deen, Arnold, Baumann and Udransky, Beissenhirtz, Bettendorf, Bloxam, Bodde, Boedeker, Boettger, Bouchar- dat, Brand, Brandt, Brociner, Brouardel and Boutmy, Buckingham, Capranica, Davy, Dittmar, Dragendorff, Drechsel, Duflos, Dusart and Blondlot, Eboli, Ehrlich, Einhorn, Erdmann, Esbach, Fehling, Em. Fischer, Fre- senius, Frohde, Gaglio-Gruber, Gardiner, Gautier, Gerrard, Girard, Gmelin, Griess, Giinzburg, Gunning, Gutzeit, Hager, Hammarsten-Jafife, Heller, Herapath, Hlasiwetz, Hoffman, Hofmann, Hoppe-Seyler, Hiifner and Knop, Jacquemin, Johnson, Ittner, Kjeldahl, Knapp, Kobert, Ladendorf, Landolt, Lassaigne, Lieben, Liebermann, Liebig, Lugol, Mandelin, Marme, Marsh, Ferd. Mayer, Mehu, Vict. Meyer, Millon, MitscherUch, Molisch, Moore, Mulder, Nessler, Nylamder, Pellagri, Piria-Stadeler, Plugge, Preyer, Reinsch, Robinet, Eoussin, Rubner, Schlagdenhauffen, Scheibler, Schneider, Schonbein, Smith, Soldaini, Sonnen- schein, Spiegler, Teichmann, Trapp, Tronmier, Ultzmann, Valentin, Vitali, "Wayne, Wenzel, Weppen, Wetzel-Kunkel, Weyl, Wurster, Zaleski, Zeissl 163-173 E. Rules for the spelling and pronunciation of chemical terms. Adopted by the American Association for the advancement of science in 1891 174-176 Practical Toxicology Motto : Toxicology is the basis of morbid physiohgy and of therapeutics. GENERAL TOXICOLOGY. I. — Definition — Source ot Poisons. The layman, the lawyer, and the physician have each his own conception of the meaning of the word "poison." "We physicians regard as poisons such non-organized bodies — either inorganic or organic — that, by their chemical nature, under certain conditions, so affect one or more organs of living beings as to damage either temporarily or permanently the health, or comparatively healthy condition, of these organisms. These poisons may be developed within the organism, or may be introduced from without. This definition excludes all mechanically acting irritants, such as boiling water, powdered glass, pins, etc., as well as injurious microbes and other organisms. It also avoids the mistake, made in a great many definitions, of regarding as poisons only such pharmacological agents as injure the healthy organism ; for some agents which are well borne by the healthy organism, prove injurious in certain diseased conditions, and then are poisonous — e.g., strong coffee. It is evident that it is erroneous to designate as poisons only such substances as may cause death. Every article of food taken, with a disordered stomach as the result, is a poison in that particular instance, even though at other times it has no injurious action. We conclude, then, that for us no substances are "poisons in themselves " ; and that it is only when the particulars are known that we are able to say, in any given case, whether the substance involved can be classed as a poison or not. Then, again, the above definition is so framed as to include substances which are poisonous to plant-life. Of course it includes the so-calWd endogenous toxins, viz., poisons which are produced within the human system. From a pharmacological standpoint the above definition can be stated concisely, as follows : All pharmacological agents which, in a given case, do not act beneficially, but injuriously, are poisons. 4 GENEBAL TOXICOLOGY. It is naturally of interest to the physician, to know what position is held by the state or the country in which he lives, regarding the definition of the word "poison." Any physician may be called upon, or may be eventually forced, to express his opinion in court, as an expert, as to whether a given case is one of poisoning, or not. The statutes of the State of New York, and those of the United States, do not define the word "poison." Words are there used to indicate their general meaning, unless something is found in the context to denote some special or restricted use. According to its generally received meaning, we can say : In most cases a poison is a substance which, when given even in small doses, owing to its chemical constitution, is capable of destroying health or life. Only a few poisons are derived from the animal and mineral kingdom. By far the largest number are produced from plants, not only of the higher, but also of the lower orders. The number of those prepared synthetically by the chemist grows steadily. II.— Conditions of Poisoning-. It is quite clear that not all poisons act to the same degree; some act a thousand times — yes, even a million times — less powerfully than others. First of all, therefore, this depends upon the quality of the poison. Next, the quantity must be considered. All poisons, even the most powerful, may be given in doses so small as to have no toxic action! Starting from this inocuous amount, and gradually increasing it, we reach first the medicinal dose, viz., a quantity which, under certain conditions, has a beneficial action upon the sick ; then the toxic dose, which is harmful to both the healthy and the sick, but which does not kill ; and, finally, the fatal dose. It is a matter of great importance whether the poison be administered in substance or in diluted solution. For example, when arsenic is given in substance, the symptoms, which appear rather late, are referable to the intestines, whereas, when given in diluted solution, the general symptoms are the most prominent and appear very quickly. When given in substance, the character and rapidity of its action depend upon the solubility of the GENEBAL TOXICOLOGY. 5 poison, and also upon its physical state, viz., whether the poison is in lump or in the form of a loose powder. In case the poison is given in solution, its action is again modified according to the degree of concentration and the temperature of the solution. Hot poisoned draughts act more quickly than do cold ones. The vehicle must also be considered, for an alcoholic solution is more quickly absorbed than is an aqueous, and both of these more quickly than an oily solution. Age and method of preservation are important factors in modifying vegetable and animal poisons, as a great many of these decompose when kept for any length of time, more especially when their non-sterilized solutions are kept in a warm situation, exposed to light and in contact with oxygen. It also makes a difference whether the organism to be poisoned is a plant, an animal, or a human being. The relative susceptibility to poisons, of the different classes of plants, has not been thoroughly investigated. There is, however, great diversity in this respect among animals. Consequently, it is non-soientiflc and wrong to draw inferences regarding their efleet upon man from the action of poisons in the frog — that pet of the toxicologist. The smallest snail -will withstand more stryohnin than an adult man. Many of the strongest cardiac poisons have no action whatsoever upon insects. Great care is necessary in thus reasoning from even, the effects noted in experiments with warm- blooded animals approaching nearer to man. The rabbit can take more morpliin than can a man of fifty times the animal's weight. Doses of lead, nicotin, cytisin, etc., suflleient to fatally poison man, do not injure the goat. Amygdalin does not aflect dogs, but it kiUs rabbits. The hedgehog takes, with apparent enjoyment, a dose of caiitharides that would kill several persons under excruciating pains. The bite of the most venomous snake does not harm him ; he can even accommodate no inconsiderable quantity of hydrocyanic acid. Whereas the frog is extraordinarily susceptible to the digitalis poisons, they have no effect upon the toad. Efegarding the site of application, we must consider the various possible localities wherein a substance may demon- strate its poisonous quality, viz.: (1) The intact skin, for volatile and irritating substances, such as nicotin and can- tharidin; (2) the inflamed or lacerated skin, even for sub- stances which are non-volatile and non-inflammatory ; (3) the subcutaneous tissue ; (4) the readily accessible mucous mem- 6 GENERAL TOXICOLOGY. branes of the eye, the nose, the ear in case of a perforated drum, the mouth, the pharynx, the larynx, the urinary passages, the vagina (cases of poisoning by arsenic administered via this source are on record), the rectum (death has been observed from rectal injections of tobacco and lupine alkaloids); (5) the stomach; (6) the cavities of the body (death has often resulted from irrigation- of the pleural or peritoneal cavities with solutions of corrosive sublimate or carbolic acid); (7) the lungs (the inhalation of arsin, prussic acid, hydrogen sulfid, carbon monoxid, carbon di-oxid, has caused numerous deaths) ; (8) the circulatory system (ether, accidentally introduced into a small vein during hypodermic injection has proved fatal). Poisons act more powerfully when absorbed from the subcutaneous connective tissue than when administered internally, with the following exceptions : The neutral crotonolglycerid, which is found in large quantities in the fresh seeds of Croton Tiglium, but which is often lacking in commercial croton oil, is inactive when introduced under the skin. It possesses, however, terrific action when ' taken into the stomach. Myronio acid of mustard, as an alkaline salt has no effect when it is injected under the skin; it has, on the other hand, a strong action when taken per os by herbivora ; the same is true of amygdalin. In all three of the foregoing cases the apparent exception to the rule is explained by the fact that the substance, in itself not poisonous, is split up in the intestinal tract, giving off, amongst others, a toxic sub- stance. In the instance first mentioned, crotonolic acid is the poison thus freed; in the second, ethereal mustard oil; and in the third, hydro-cyanic acid. Some substances, such as salts of manganese, iron, tungsten, have no poisonous action when introduced into the intes- tinal tract, because under these conditions only very minute quantities are absorbed; others are rendered inert because they are excreted almost as quickly as they are taken up, curare being an example; and yet others, such as snake-poison, spider-poison, quillaic-acid, sapotoxin, ergotinio acid, are converted into non-poisonous substances within the intestine. The action of nil poisons is rendered weaker when they are taken into a full stomach than when received by that organ when empty. It must not be forgotten that the organ- ism can evacuate the poison from the stomach and intestines ; whereas we are unable, even artificially, to rid the system of poisons introduced into the subcutaneous connective tissue. Failure to observe this fact has been the cause of a number GENERAL TOXICOLOGY. 7 of fatal issues in the modern treatment of syphilis, by subcu- taneous injections of mercurial preparations. Inunction of healthy skin acts less powerfully than when applied to the inflamed or lacerated areas. The healthy urinary bladder absorbs only very small amounts of substances which are not caustic and not volatile. Absorption takes place quite freely from the surface of all parenchymatous organs, as well as from the cavities of the body. In man, age, the condition of the stomach (as to whether filled or empty), constitution, the general condition of the patient, his habits, and even race and idosyncrasy, are important factors. The Malays react differently to opium than do the Europeans : the iormer run about m an excited manner, whereas the latter are narco- tized by the drug. Children are particularly susceptible to opium on account of their not being accustomed to intoxicants ; just as old people are readily affected by vasomotor poisons, as cytisin, on account of the atheromatous condition of the arteries. Habit is a most important modifying factor. If a person daily indulges in alcohol, morpliin, opium, cocain, hashish, oaffein, nicotin, piturin, kawa, or arsenic, etc. , he not only gradually accustoms himself to large quantities of his respective drug, but finally reaches that stage when he must have it, in order to remain in a pseudo-normal condition. He has now arrived at a stage wherein the suppression of the use of the accustomed poison has a deadly toxic effect ; the system is unable to continue for a single day without the drug. In such a case, insomuch as we have a dis- turbance, causedby the withdrawal of the poison, it is therefore not a case of poisoning, in the limited sense of the term, although certainly a poisonous effect is produced. The influence of the general nutritive condition of the body has often been observed, more especially in the case of statving vagrants, who are killed by quantities of poisonous berries, putrid food, etc., which would in other and more normal individuals cause nothing more than a digestive disturbance speedily relieved by vomiting of the ingesta. Tho constitutional influence is seen to particular advantage in scrofulous children, in whom the reaction to poisons is stronger than in the healthy. By the term •idiosyncrasy (lit., a peculiar mixing together of the Juices) we under- stand the following two facts: 1st, that some people react in an abnormally strong manner to even minute doses of certain drugs; and, 2d, that some people are made seriously ill by partaking of, or even smelling, certain substances which to others are indifferent or even agreeable. Among such drugs we mention: tsalomel, morphin, tur- pentine; of the foods: lobster, raspberries, strawberries, mutton, fish,, eggs, honey, cocoa, and beans ; and of the odors : musk, sewer-gas, the scent of flowers, and the smell of toads. The drugs noted give rise to 8 GENEEAL TOXICOLOGY. symptoms such as would be caused by very large doses thereof. This observation applies especially to the cutaneous manifestations, princi- pally eruptions ; and sometimes excitation is present where we expect depression. The other substances give rise to astonishing symptoms, which we are unable to explain satisfactorily, e. g., urticaria, following the ingestion of crabs, raspberries, strawberries, or other red dishes; attacks of sneezing, when in the presence of toads; steno-cardic attacks, after partaking of beans; colic, following a single cup of cocoa; fainting spells, illusions, hallucinations, and other nervous phenomena, caused by the exquisite scent of the rose, hyacinth, violet, lily, or auricula. III.— Action and Localization of the Poisons. We are still far from understanding the ultimate cause of action of a great many poisons ; the attempt to regard every poisonous effect as a disturbed cellular isotony advances us no further in the appreciation of poisonous action. " The problem of the origin of a ganglion cell is no deeper than that of the decline of its functions from the action of morphin." In general, we distinguish two kinds of poisonous action : local and remote. By local action we mean those symptoms and changes which the poison produces at the site of application. Some agents, such as the salts of the heavy metals, will readily combine with the protein substances, thereby causing their destruction, viz., necrosis of the tissues involved ; others, as concentrated acids and caustic alkalies, act also as powerful irritants and cause a reactive inflammation; still others, as strychnin, morphin, curarin, and muscarin, cause an excitation or enfeebling of the nerves, muscles, or glands of the affected parts, without any marked apparent changes. The remote effect is produced by the absorption of the poison into the lymphatics and into the blood, causing general' symptoms, and diseases of other organs, e. g., of the kidneys, following the administration of cantharidin; of the brain, after taking opium; of the intestine, after quillaic acid. Practically, the remote action is really a local one, produced by the poisoned blood circulating everywhere. The poison as it circulates in the blood may either be decomposed, or it may enter into combination with the blood GENERAL TOXICOLOGY. 9 constituents and thus change the composition of the blood, or it may reach the various organs in its original condition. Physiology teaches us that various endosmotic changes take place in these organs, depending upon their functions, upon the formation of their constituent elements, and upon the number and arrangement of the capillaries passing through them. The chemical constitution and physical properties of the poison will determine, to a varying degree, the role it plays in these changes upon participating in the interaction of the vessels of the tissues. The presence of this foreign substance sooner or later disturbs, to a greater or less degree, the healthy condition and function of the organs particularly affected; and, again, this cannot take place without a reaction upon the whole body. The animal organism, however, possesses four means of rendering partly or entirely harmless, poisons which have entered the system : 1. Kapid elimination. Under this head, naturally, we first mention vomiting, which, fortunately, occurs so promptly following the intro- duction of most poisons into the stomach that it generally saves the life of the patient, or at least has already materially lessened the danger to life before the physician puts in an appearance."^We should call this vomiting, which takes place before the absorption of the poison, primary vomiting, in contradistinction to a secondary emesis, which takes place following absorption, and which latter is either exclusively a sign of disturbed cerebral activity, or is caused by the excretion of the poison from the blood into the stomach. In an analogous manner we must differentiate between a primary diarrhoea, which carries off the poison before absorption, and a secondary purging, which is a sign of disturbed intestinal innervation, or is -caused by the excretion of the poison from the blood into the lumen 'bf'th.e-gut.N/ Some poisons are not removed by vomiting or by purging, but appear ih the urine within a remarkably short time. Thus, for example, it is impossible to produce complete curarization by the administration of moderate though oft- repeated doses of curare, because the excretion of the poison through the kidneys takes place as rapidly as does absorptionNf The liver, pan- creas, gastric mucous membrane (for morphin), intestinal mucous membrane (for mercury), salivary glands, mammary glands, and lungs, are other channels effective in assisting the excretion of various sub- stances from the blood. Not nearly enough attention was formerly given to the excretion through the glands of the mucous membrane of the stomach. Finally, elimination takes place through the structures of the skin, especially through the sweat-glands. 3. The organism deposits and fixes poisons, in a manner not yet 10 GENEEAL TOXICOLOGY. suffleiently understood, in several organs, especially dn the Uver, whieh certainly must be regarded as a filter for poisons--so far, at least, as enzymes (e.g., emulsin), metals (iron), metalloids {e.g., arsenic), and alkaloids {e.g., strychnin) are concerned. It is probable that, in the ease of some substances, the biliary acids play an important part in the matter. We can hardly imagine' that this disposition is accomplished' in any other way than ia the transformation of the readily soluble poisons into saline combinations,' not freely soluble (bile-acid-alkaloids), or into albumen derivatives (metalalbuminates). But, since these combinations are in no case entirely insoluble, the beneficial action of the liver only consists in the fact that it gives the acute poisoning a more protracted and consequently a milder course. 3. The organism renders the poisons innocuous by phagocytosis. This destructive crusade carried on in the interest of the body by phagocytes, which has not yet been sufficiently inquired into pharma- cologically, is applicable for certain toxalbumins (toxopepton, enzymes, as well as for heavy metals {iron, silver). 4. The organism transforms the poison into a comparatively harm- less, though readily soluble, combination. Such a transformation may consist of neutralization, oxidation, reduction, coupling, splitting and pecuUar changing of the chemical constitution. 1. As an example of poisons rendered inert by neutralization, we mention the acids, which are transformed as far as possible by the organism into the correspond- ing alkaline salts of less poisonous or absolutely non-poisonous pro- perties. So far as the stomach is concerned, the organism attempts to balance any excess of alkali by the acids of the gastric juice, and does the same thing in the blood by the decomposition of an immense number of blood corpuscles, whereby glycerin- phosphoric acid is formed from lecithin. Caustic lime is combined with carhaminic acid, and then excreted. 2. The best known example of inertia produced by oxidation is that of phosphorus, which is trans- formed into the phosphates. In an analogous manner the extremely poisonous sulftds are converted into sulfates which are relatively non- poisonous. The organic acids and their salts are oxidized to the ulti- mate degree, producing carbonates ; and it is a prominent and important fact, that in the latter case the dangerous diminution of the alkalesceney by means of these acids is transformed into an increase of alkalesceney, since even the bi-carbonates are of alkaline reaction. 3, Examples of producing inertion by means of reduction are offered in the cases of iodates, chlorates, and perchlorates, which are excreted in the markedly less poisonous form of chlorids and iodids. 4. Inertion produced by coupling is one of the most remarkable facts in physiological chemistry. An intimate knowledge of this phenomenon is as imperative for the physician at the bed-side as for the chemist entrusted with the chemical analysis of the remains. A poison can unite by coupling: (a) with sulfuric acid {e.g., phenol and oresol), (b) with glyeuronie acid (e.g., GENEEAL TOXICOLOGY. 11 camphor, borneol, menthol), (c) with glyeoeoll (e.g., henzoio acid, anisic acid, a part of salicylio acid). 5. Inertion produced by splitting occurs with tannic acid of nut-galls, and with some glycosids (e.g., saliein). 6. Examples of changes peculiar to themselves, as productive of inertion, are offered by the salts of ammonia, which are transformed into urea. The liver is the most important organ in producing changes in poisons peculiar to themselves. Coupling occurs partly in the liver and partly in the kidney. Splitting pro- cesses take place mainly in the intestinal canal, although the liver must also be considered inthis connection. For a time it seemed that we were justified in supposing that organic substances could be divided into two well defined classes, according to their respective actions exhibited within the animal body : the substances of the fatty series were sup- posed to be destroyed, while those of the aromatic series were not. To-day, we know that this does not hold good for all substances : not even Oxamid, belonging to the fatty series, a trace of which is oxidized; and Tyrosin, a member of the aro- matic series, which can be completely transformed into urea, carbon di-oxid and water. This observation, therefore, can at the present time be stated only in the following form: organic substances containing aunular linkage within the molecule are frequenly not oxidized to form carbon di-oxid, water and urea. It is immaterial whether or not they belong to the aromatic series proper. Substances not containing aunular linkage, which are oxidized with difficulty, or not at all, are mainly certain amids. One of the foremost tasks of scientific pharmacology is, to explain the relation between the chemical structure of a sub- stance and its pharmacological action. Unfortunately, it can only be said at present that uniform laws, which would be of great service to the physician, have not yet been discovered. This is neither the time nor the place to dilate upon the many interesting fundamental structures of such laws. IV.— -(Etiology and Classification of Poisoning. In medical practice we ordinarily distinguish between acute and chronic poisonings, the former including cases in which a. single large dose of poison was taken, whereas the latter are 12 GENEBAL TOXICOLOGY. such as are caused by the repeated exhibition of small doses. However, an extended experience at the bed-side reveals the fact that even acute cases may take a chronic course. i»For example, a case has been reported in which a single dose of arsenic produced in a student a trouble lasting for a number of years. Retention of the poison is not of necessity the cause of this chronicity, for it is possible that the poison may bring about long lasting pathological changes in an organ, which may endure even throughout life. Thus there are cases of stricture of the oesophagus after the exhibition of corrosive poisons, deafness or blindness after quinin, cerebral softening after <;arbon monoxid, cirrhosis of the liver after phosjpJiorus, chronic nephritis following the use of cantharides plasters, or sub- cutaneous treatment with aloin, sloughing of various parts of limbs after the use of ergot. The medico-legal classification considers only the impiilse or motive which results in the introduction of poisonous sub- stances into the organism, as in cases of murder and suicide, and in poisonings resulting from industrial pursuits, technical products, economy, and medicinal treatment. Among the poisonings arising from certain industrial pursuits, we mention : those by lead, in the cases of potters and printers; by mercury, in the manufacturing of thermometers, etc. , and of incandes- cent electric lamps ; by phenol, in the case of surgeons who worked with the phenol spray; by phosphorus, in match manufactories, &c. By poisoning from technical products, we understand not those cases which are found amongst the workmen in the manufactory, but those arising in the consumers of the manufactured product. Such are cases of poisoning by wall-papers or upholstery containing arsenic, stockings containing antimony; sleeping in newly-varnished bedrooms, &c. Economical poisoning embraces those cases produced by partaking of food improperly prepared, and consequently rendered poisonous (in- sufllciently smoked sausages, which are stufEed into casings of intes- tinal membrane; fruit cooked in copper vessels, over-kept cheese, venison of haut goUt. Medicinal poisoning includes those cases for which we physicians are responsible, and which afEord opportunity for well-founded censure to the homcBopathists and to those who adhere to cures by nature. Physiological chemistry differentiates between exogenous and endogenous intoxications, according to whether the poison GENERAL TOXICOLOGY. 13. is introduced from without or is formed within the organism. Endogenous intoxications are subdivided into retention-toxi- coses and noso-toxicoses. Retention toxicoses are developed when substances, which are nor- mal products of metabolism, are for various reasons, not excreted, and, therefore, then accumulate in the organism in excessive quantities, and thus act like poisons. It seems to be a general law of nature, that all organisms generate products of metabolism which, in excessive quantity, bring about a diseased state or even the death of the mother organism. Such retention-toxicoses occur : (1) when the skin does not allow the passage of such products of metaboUsm as normally are excreted through it, and which represents the perspiratio insensihilis. Thus are explaiaed the grave symptoms that appear in animals when their skins are varnished, or the coma, pathological euphoria, and subnormal temperature in man, in case of extensive burns; (2) when the intes- tine does not conduct ad anum those substances which it properly should excrete, a condition which not infrequently obtains in : incar- cerated hernia, volvulus, compression from tumors, clogging by faecal masses or obstruction from stricture. The more important substances causing toxic action under the foregoing conditions are : scatol, indol, methyl-mercaptane and hydrogen sulfld; (3) when the respiratory tract ceases to properly eliminate the carbon di-oxid, and .there are pro- duced as a result of poisoning thereby, cyanosis, slow pulse, dyspnoea, and spasms ; (4) when the uropoStic system, especially the kidney, does not secrete and void the urine in a satisfactory manner. The clinical picture that follows in consequence of this has long been known as ursemic intoxication, and it is probably caused by an increase of the potassium salts, creatinin, xanthin substances, acetene, fatty acids, &c. Nosotoxicoses (from T'oe'oC^meaning disease) are produced: {a) when in diseases not caused by a living contagium, qualitative and quan- titative disturbances of metabolism occur, which cannot be sufficiently brought into equilibrium despite the fact that all avenues of egress are open. Into this class we put the so-called aut-intoxications (by an excess of hydrogen sulfld, excess of lactic acid, by substances of the character of acetone, oxybutyric acid, &c.) ; also the poison of the so-called coma of carcinoma, will belong here, provided this disease is not in the future found to be of bacterial origin; then again, oxaluria, if this really exists as a disease sui generis, &c. ; (6) when in diseases recognizing a contagium vivum as their cause, poisonous products of metabolism of these micro- organisms are produced (in diphtheria, tetanus, rabies, tuberculosis), or in conditions where abnormal waste products are formed from the normal constituents of the organism or from endproducts of metabolism (ammonia from urea). We shall subdivide the intoxications into such which, as a rule, cause gross anatomical changes, and such which may 14 GENERAL TOXICOLOGY. act fatally, -without producing gross anatomical changes. Between the two we place the group of blood-poisons. "With these, the blood only is found to have changed, or at least primarily so, and the changes within the other organs are brought about in consequence. V. — The Diagnosis of Poisoning. At times the recognition of a case of poisoning is compara- tively an easy matter, while again, it may be very difficult, or even impossible. We can readily understand this when we consider the large number of poisons, how different their mode of action, and how the symptoms of one and the same poison may vary, according to the size of the dose and the form of administration. This fact becomes all the more apparent when we remember that the various symptoms (because they a,re only symptoms) may appear similarly in other diseased conditions. The following are, in general, the signs which are of importance in making a diagnosis : 1. The Symptoms. — For a great many acute cases, it is true, as the old saying has it, that poisoning, caused by the introduction of a poison from without, is probable when marked and violent symptoms suddenly appear in an individual previously perfectly healthy. But, on the one hand, people who have already been ailing may become poisoned ; and, on the other hand, this statement excludes the frequent cases of chronic poisoning. Then, again, death can be caused suddenly by such disease as cholera, rupture of the heart, apoplexy, embolism, intestinal obstruction, peritonitis due to perforation of the intestine, uraemia. The suspicious symptoms become more conclusive when they appear shortly after the partaking of any food, and especially when they appear simultaneously in several persons, and even in domestic animals. The symptoms may affect all the organs ; the most impor- tant are vomiting, diarrhoea, convulsions, paralyses, cyanosis, dyspnoea and disturbance of the pulse. The following table seems to be of practical value in making a diagnosis : TABLE OF THE MOST IMPORTANT SYMPTOMS OF ACUTE ACTION OP THE MORE COMMON POISONS. IN THE PEESEKCE OF THE rOI/IiOWING SYMPTOMS : WE SHOULD FIEST THINK Or: Death within a few moments Hydrocyanic acid, potassium cyanid, carbon di-oxid, carbolic acid GENEEAL TOXICOLOGY. 15 NO. IN THE PBESBNOE OF THE FOIiLOWING SYMPTOMS : WE SHOULD FIEST THINK OF: 2 Deep coma Alcohol, morphin, opium, chloralhy- drate and its analogues, sulfonal, chloroform and its analogues, carbon- mon-oxid, anilin oil, oxybutyric acid 3 Collapse Corrosive acids, corrosive alkalies, nicotin, arsenic, preparations of anti- mony, colchicin 4 Febrile rise of tempera- ture Phosphorus, cocain ; under certain con- ditions, all powerful convulsants, enzymes 5 Raving mania, f uribund delirium, psychical excitation Chronic alcoholism, atropin, cannabinon, camphor, physostigmin, veratrin, lead (in animals) 6 Mental depression Morphin habit, cocain habit, maydism, ergotism, etherism, saturnism, mercu- rialism, alcoholism, iodoform, carbon disulfld 7 Severe oonvulsions,even tetanus Strychnin, toxin of the tetanus bacillus, salts of ammonia, cytisin, cornutin, picrotoxin, cicutoxin, digitaliresin, cocain, santonin, guanidin, aconitin, condurangin, corydalin, gelsemin, fllicic acid 8. Paralysis generally as- cending Coniin, curare, guachamaca-poison, colchicin, ergotinic acid 9 Dilated pupils Atropin, hyosoyamin, scopolamin (hyos- cin), homatropin, cocain (contracted later on), ephedrin, aconitin, coniin, gelsemin 10 Contracted pupils Muscarin, pilocarpin, nicotin, morphin, codein, opium, physostigmin 11 Moist skin Opium, morphin, aconitin, muscarin, pilocarpin, nicotin, physostigmin, lobelin, antimony 13 Markedly dry skin, even in heated bed ; mouth and pharynx also dry Atropin, (parts of the deadly nightshade, thornapple, henbane), hyoscyamin, scopolamin, hyoscin, allantotoxin (a poison found in decaying fish) . 13 Urticaria, or scarlatinal rash Atropin, hyoscyamin, antipyrin, quinin, balsam of copaiba, cubebs, chloral hydrate, iodin, morphin 16 GENEKAL TOXICOLOGY. NO. IN THE PRESENCE OP THE PGLLO'WING SYMPTOMS : WE SHOULD FIRST THINK OP : 14 Eczematous eruption Croton oil, curcas oil, cardol, poor kinds of vanilla, dust of the bark of cin- chona, carbolic acid, tar 15 Acne pustules Bromids, compounds of/or substances containing antimony, arsenicals, eme- tin 16 Clear vesicles on the skin, or even in the mouth Preparations of cantharides, Sanunculus acris, R. sceleratus; etc. 17 Skin having a dark, muddy discoloration, but not cyanotic Argyria, poisoning by mercury, lead, copper, arsenic, (arsenical-melanosis) 18 Dark border on the gums Lead, silver, mercury, bismuth, copper 19 Discoloration of the tongue and of the mucous membrane of the mouth Reddish-yellow : salts of chromic acid and bichromates. Yellow : nitric acid, picric acid, Brown : iodin, bromin. Greenish-blue: salts of copper, Paris green. White : corrosive alkalies, corrosive acids, corrosive metallic salts 20 Specific odor of the breath Opium, alcohol, paraldehyde, amylene- hydrate, pental, chloroform, ether, brominated ether, creasote, iodin, iodoform, bromin, bromoform, phos- phorus, nitrobenzene, hydrocyanic acid , all ethereal oils, salts of tellurium, amylnitrite, ammonia 21 Salivation Pilocarpin, muscarin, nicotin, cornutin, physostigmin, oytisin, mercury, am- monia, arsenic, antimony, canthari- din, saponin substances, etc., etc. 22 Barking cough and aphonia Atropin, hyoscyamin, scopolamin, allan- totoxin 23 Oedema of the glottis All corrosive poisons 24 Pulmonary oedema Morphin, muscarin, pilocarpin, ammonia 25 Phosphorescence of the breath, of the vomit or of the urine Phosphorus GENEKAL TOXICOLOGY. 17 HO. IN THE PEESENCE OF THE POIiliOWING SYMPTOHS : WE SHOULD nr.BT THINK OF: 26 Vomiting and purging Antimony and substances containing it, arsenic and substances containing it, substances of the digitalin group, pilo- carpin, nicotin, muscarin, colchicin, corrosive poisons, colocynths, emetin, croton oil, etc., etc. 27 Vomiting without diar- rhoea Apomorphin, lobelin, cytisin. Narcissus poisons 28 Diarrhoea without vo- miting Jalap, podophyllotoxin 29 Markedly slow pulse Opium, morphin, muscarin, substances of the digitalin group (later pulse becomes accelerated), pilocarpin (later accelerated and irregular) , nicotin (acts like pilocarpin), physostigmin, lead, baryta, all narcotics 30 Greatly accelerated pulse Atropin, hyoscyamin, soopolamin, etc. 31 Wiry pulse Substances of the digitalin group, baryta, lead 33 Peripheral parts of the body becoming black and blue Gangrenous ergotism 33 Cyanosis Nitrobenzene, benzocoU, anilin, toluidin, antifebrin , exalgin 34 Icteric or pseudo-icteric, yellowish-brown dis- coloration of the con- junctiva, or of the skin Phosphorus, helvellaicacid, phallin, sola- niii, saponin substances, potassium chlorate, sodium nitrate, amyl nitrite, pyrogallol, arsin, ictrogen (in animals) 35 Icteric urine Phosphorus, toluylene diamin, phallin, cephalanthin, ictrogen (in animals) 36 Yellow skin and red- dish-yellow urine Picric acid and its salts 37 Urine the color of claret from haematoporphy- rin Sulfonal, trional 38 Urine contains blood coloring matter in solu- tion Cyclamin, solanin and other saponin substances, phallin, helvellaic acid 18 GENEEAL TOXICOLOGY. NO. IK THE PBESENOE OF THE rOLLOWING SYMPTOMS : WE SHOULD FIEST THINK OF : 39 Urine contains methae- moglobin with or without haematin Arsin, potassium chlorate, sodium ni- trite, amyl nitrite, pyrogallol, chrysa- robin, all corrosive poisons 40 Urine that reduces Fehling's solution Carbon monoxid, chloralhydrate, chlo- roform, pyrogallol, oxalic acid and its salts, formic acid, phloridcin, uranium salts, benzaldehyde (oil of bitter al- monds) 41 Urine becoming dark- green when exposed to the air Carbolic acid 43 Urine which upon ac- cess of air slowly turns scarlet Santonin 43 Acid urine, containing colorless crystals Oxalic acid and its salts 44 Urine with a marked odor Oil of turpentine (violets), other ethereal oils, methylmercaptane, ammonia, tel- lurium, asparagus 45 Anuria Oxalic acid, potassium oxalate, oxami- nic acid, oxamid, cantharidin, corro- sive sublimate and other preparations of mercury. 46 Priapism Cantharidin, poison of Gyrinus natator 47 Abortion Juniperus Sabina, Euta graveolens, Men- tha pulegium, phosphorus, cornutin 48 Where poisoning is first apparent from 13 to 34 hours after the meal Mushrooms containing phallin, arsenic not in solution 2. Exact history of the case. It is often necessary to inquire into family, social and physical conditions as well as into the history of the disease itself. If there is no reason to suspect murder or suicide, and the symptoms follow the par- taking of any food or drink, we would then suspect an acciden- tal poisoning by poisonous food. At such times there are often others than the immediate victims who have partaken with them of the same food, but who have not sought medical GENEEAL TOXICOLOGY. 19 aid because of the insignificance of the symptoms experienced in their cases. 3. Morbid anatomical changes may sometimes be noticed during life, if the mouth, pharynx, anus, faeces, urine and vomit are carefully examined. A post mortem examination decides the diagnosis. 4. The finding of poison in the sick-room, extra corpus, or, the determination of its presence in the cadaver and in its excretions by means of pharmacological, physical or chemical examination. This, naturally, affords the most reliable infor- mation, although even then we are not always furnished with conchisive proof, since a number of poisons are medicines, or even foods. Then, again, there may be accidentally brought near the cadaver such poisons as artificial flowers, colored with arsenical preparations, earth of the churchyard containing nrsenic, or, for the purpose of deception, a poison may even have been applied on or into the cadaver. In most cases, however, the due consideration of all these points will enable even the physician, who possesses but a moderate medical experience and knowledge of human nature, to decide either for or against poisoning. In cases in which the medical attendant is unable to make a positive diagnosis, he may say, that while as a physician he cannot assert posi- tively that poisoning obtains, however, as a man, he is satis- fied that such is the case . VI. — Prognosis in Poisoning. Since the chief factor of prognosis, the nature and strength of the particular poison, comes under the subject of Special Toxicology, we will here mention only a few points, calling attention to those which are of importance in all cases. In general the prognosis is more unfavorable in proportion to the size of the dose received. However, this is not always the case, as the vomiting that follows large doses, taken internally, can rid the system more or less completely of the poison; the solubility and concentration also influence the prognosis. The danger to life is increased when the poison has been intro- duced into an empty stomach or given to debilitated persons, to children and to old persons. The time that elapses before medical treatment is instituted, is also of great importance. 20 GENEEAL TOXICOLOGY. The prognosis is graver when the poison is administered suL- cutaneonsly, because in this case it cannot be removed even partially. Many cases of poisoning, particularly from mercury^ could be avoided if physicians would bear this well in mind. In cases of poisoning, it is more necessary even than in disease to make a clear distinction between the prognosis quoad vitam and the prognosis quoad valetudinem. It is by no means necessary to make a grave prognosis as to life even if the dose received be the usually fatal one. The outcome depends more upon the question whether by artificial means, it is pos- sible to remove from the stomach a large part of the poison. The hope of being able to do this is the more justified the shorter the time that has elapsed since the introduction of the poison. In the case of morphin the prognosis need not be a grave one even when the fatal dose has been injected, because a rapid excretion of the poison takes place through the gastric mucous membrane and thereby making successful treatment possible. Of the various symptoms having an important bearing upon the prognosis, Facies hippocratica and (edema of the lungs are considered the most unfavorable. Yet it must be remembered that these symptoms may often be relieved. Cold sweat is generally a very unfavorable sign, whereas convul- sions and spasms are very often borne better than would be supposed. Coma may bo made to disappear even if it has existed for hours. Cessation of the pulse, when respiration continues, even though much weakened, and, vice-versa, the cessation of respiration, with continuance of the pulse, are not. absolutely unfavorable signs, for there have been reported cases of recovery where artificial respiration had to be prac- ticed for from one to two hours, as well as other instances in which the pulse could be neither felt nor heard for from 30 to- 60 minutes. A prognosis favorable as to health, should never be given early in the case, for a great many intoxications from carbon monoxid, arsenic, lead, phospJiorus, cantharides, etc., are by no means entirely cured when the acute symptoms have been relieved and the patient already considers himself entirely recovered. These poisons may give rise to verr severe later complications. GENERAL TOXICOLOGY. 21 VII. — Treatment of Poisoning. The simplest and most natural classification of the mea as concerning us here, is into physical (mechanical), antidotal and symptomatic treatment. Prophylaxis may, in a certain sense, be considered as an additional measure. I. The Physico-mechanical treatment comprises the following manipulations : 1. Removal of the poison from wounds by pressure, suc- tion, washing, cauterization. 2. Eemoval of the poison from the stomach by means of • emetics, syphon, or stomach pump, followed by washing of the stomach. 3. Removal of the poison from the intestine by means of catharsis, or rectal flushing. 4. Reduction of the absorptive power by ligature (in bites and stings of poisonous animals) and immobilization of the extremity. 6. Artificial respiration in cases where the breathing ceases, but the upper air passages remaining free. 6. Intubation or tracheotomy in cases where the laryngeal entrance is swollen, as often occurs after drinking corrosive sublimate, acids and alkalies. 7. Electric excitation of the phrenic nerve to stimulate breathing, or irritation of the soles of the feet with the electric brush to restore lost reflexes. 8. Application of cold in the form of the ice bag, cold compresses, douches, etc. 9. Application of heat in the form of hot water bags and warm baths, in cases of poisons, such as narcotics, which greatly reduce temperature. 10. Passive motion of the extremities to stimulate circu- lation. 11. Massage, particularly in the form of stroking in the direction of the venous flow to stimulate circulation. 12. Brushing and rubbing the skin to raise its tempera- ture and to excite reflex activity. 13. Low position of the head when there is a tendency to fainting. 22 GENEBAL TOXICOLOGY 14. Administration of ice to alleviate the symptoms of inflammation caused by corrosive poisons. 15. It is often necessary to catheterize the bladder, espe- cially in morphin poisoning ; in many cases this is desirable in order to confirm the diagnosis. 16. Blood-letting, followed by transfusion of human blood or infusion of salt-sugar solution (7.5 grms. of sodium chlorid and at least 20.0 grms. of cane sugar to a liter of boiled water). In cases where there is reason to suppose that a diminished alkalescency of the tissue-juices and of the blood obtains, we can add to this solution some alkali (e. g., 1.0 grm. sodium carbonate). 17. Hot iron, Paquelin's cautery, and the galvano-caustic apparatus, for burning out poisoned wounds. II. Unfortunately the antidotal treatment is but too often nothing but symptomatic, as the poison is by no means ren- dered completely inactive by the administered antidote. Never- theless, the physician should thoroughly acquire the contenta of the following table, by virtue of which knowledge he will be often enabled to do good. Every medical man should have always prepared, in a case by themselves, everything necessary for the antidotal treatment of poison cases. Such an outfit will be discussed at the end of the present chapter. -TABLE OP THE MOST aMPORTANT ANTIDOTES. NO. ANTIDOTES SUITABLE FOE THE FOLLOWING POISOKS: 1 , Ferric hydrate and (or) magnesio hydrate Arsenious oxid, arsenic compounds in general 2 Inactive oxygen, in- haled under pressure Carbon monoxid, hydrocyanic acid, potassium cyanid, potassium chlorate^ cairin, anilin, phosphorus, arsin, nitro- benzene, pyrogallol, chloral hydrate^ morphin 3 Hydrogen peroxid, given in solution or injected subcutane- ously Phosphorus, hydrocyanic acid, carbon monoxid 4 Egg albumen stirred un- aer water Corrosive acids, corrosive salts, corro- sive alkalies GENEEAL TOXICOLOGY. 23 NO. ANTIDOTES SUITABLE FOK THE FOLLOWINO POISONS: 5 Olive oil Lead colic, corrosive poisons 6 Milk Corrosive salts 7 Milk, gelatine, glue, veg- etable mucilaginous drinks of agar-agar, gum arable, traga- canth, althea, saloop, mal low jlinseed, poppy seeds, starch Corrosive substances 8 Animal charcoal (better than vegetable char- coal), tannic acid, decoction of oak bark, walnut leaves, etc. Alkaloids, glycosids, salts of metals 9 Infusion of black coffee or Chinese tea Alkaloids, especially morphin, glycosids and salts of metals 10 lodin in solution of po- tassium iodid Alkaloids, glycosids 11 Potassium iodid Lead (chronic poisoning) 13 Sodium hyposulflte lodin or potassium iodid, chlorin, Javelle water 13 Chlorin in the form of aqua-chlori, calcaria, chlorata and natrium hypochlorosum Externally in poisoned wounds, against alkali-sulfids in gaseous form (exceed- ingly dangerous) 14 Cliromic a( id Externally in poisoned wounds 15 Potassium permangan- ate Phosphorus, hydrocyanic acid, opium, morphin, strychnin, physostigmin, coronillin ; externally in poisoned wounds 16 Sugar-lime (viz., a solu- tion of slaked lime and sugar, in water) Oxalic acid, acid potassium oxalate (C2 04 HK -f- C2 O4 H2 + 3 H 0), car- bolic acid 17 Glauber's salt Carbolic acid, baryta, lead salts (acute) 17 Blue vitriol Phosphorus, baryta 18 Atropin sulfate Muscarin, pilocarpin, arecolin, physo- stigmin, morphin, lead (colic), baryta (colic) 24 GENERAL TOXICOLOGY. NO. ANTIDOTES SUITABLE FOB THE FOLLOWING POISONS: 19- Morphin hydrochloiid Atropin (in cerebral irritation) 80 Pilooarpin hydrochlo- rid Atropin, hyoscyamin, scopolamin, hom- atropin, poison of uraemia 21 Chloral hydrate, cura- rin Strychnin, picrotoxin, cicutoxin, digi- taliresin, toxiresin, poison of the tetanus bacillus, ammonia 23 Strychnin Chloral hydrate, alcohol 23 Sodium Bulfanilate lodiii 24 Sodium carbonate lodin, corrosive acids, acid metal salts 25 Mixture of sodium car- bonate and bicarbon- ate injected into vein Beta-oxy-butyric acid (diabetic coma), potassium chlorate, cairin, anilin, arsin, nitrobenzene, phosphorus, any acid 26 Tartaric acid, malic acid Corrosive alkalies and corrosive alkaline earths 27 Magnesia carbonica and usta Corrosive acids, acid salts 28 Inhalation of ammonia Morphin, chloral hydrate, sulfonal, al- cohol 29 Inhalation of chloro- form Strychnin, picrotoxin, cicutoxin, poison of tetanus bacillus, ammonia 30 Injection of ether. Cam- Chloral hydrate, morphin, sulfonal phor, digitalein 31 Potassium ferrooyanid Copper, strychnin 83 Scopolamin Cannabinon, delirium tremens IL — TABLE OF THE MOST IMPORTANT ANTIDOTES ARRANGED IN THE ORDER OF POISONS TO BE COUNTERACTED. NO. POISONS. ANTIDOTES. 1 Acid metal salts, corro- sive acids Sodium carbonate 3 Acid salts, corrosive acids Magnesia carbonica and usta GENEEAL TOXICOLOGY. 25 NO. POISONS. ANTIDOTES. 3 Acid potassium oxalate (02 O4 HK + C2 Oi H2 ' +2H2O) Sugar-lime, viz., sugar + slaked lime dissolved in water 4 Alcohol Strychnin, inhalation of arhmonia 5 Alkaloids, glycosids, salts of the heavy metals and of alka- loids Animal charcoal, better than vegetable charcoal; tannic acid; decoctions of oak bark, walnut leaves, etc.; infu- sion of black coffee or Chinese tea (es- pecially for morphin alkaloids, etc.) 6 Alkaloids, glycosids lodin in solution of potassium iodid 7 Alkali-suJfids Chlorin in the gaseous form, for inhala- tion (very dangerous) 8 Ammonia Chloral hydrate, curarin, inhalation of chloroform 9 Anilin, arsin Inactive oxygen administered under pressure; mixture of sodium carbonate and bicarbonate injected into vein 10 Any acid Mixture of sodium carbonate and bi- carbonate injected into vein 11 Arecolln Atropin sulfate 12 Arsenious oxid, etc. Ferric hydrate and (or) magnesium hy- drate mixed with water 13 Arsin Inactive oxygen administered under pressure, mixture of sodium carbonate and bicarbonate injected into vein 14 Atropin Morphin hydrochlorid (in cerebral irrita- tion), pilocarpin hydrochlorid 15 Baryta * Glauber salts, blue vitriol, atropin sul» fate (colic) 16 Beta-oxy-butyric acid Mixture of sodium carbonate and bicar- bonate injected into vein 17 Cairin Inactive oxygen administered under pressure, mixture of sodium carbonate and bicarbonate administered into vein 18 Cannabinon, delirium tremens Scopolamin 26 GENERAL TOXICOLOGY. 26 NO. POISONS. ANTIDOTES. 19 Carbon monoxid Hydrogen peroxid, given in solution or injected subcutaneously 20 Carbolic acid Sugar-lime, Glauber salts 21 Chloral hydrate Strychnin, camphor, digitalein, inhala- tion of ammonia, injection of ether 2lA Chloral hydrate,carbon- monoxid Inactive oxygen administered under pressure 22 Chlorin Sodium hyposulflte 23 Cicutoxin Chloral hydrate, curariu, inhalation of chloroform 24 Copper Potassium ferrocyanid 25 Coronillin Potassium permanganate Corrosive substances — corrosive acids, alka- lies and salts Vegetable mucilaginous drinks of starch, agar-agar, gum arable, tragacanth; althea, saloop, mallow, linseed, poppy seeds, gelatin, glue, egg albumin stir- red under water; olive oil, milk (for corrosive salts); sodium carbonate, magnesia carbonica and usta (for cor- rosive acids); tartaric and malic acids (for corrosive alkalies and alkaline earths) 27 Delirium tremens, digi- talii'esin Chloral hydrate, curarin 28 Diabetic coma Mixture of sodium carbonate and bica'-- bonate injected into vein 29 Hydrocyanic acid Inactive oxygen administered under pressure, hydrogen peroxid given in solution or injected subcutaneously, potassium permanganate 30 Hyoscyamin, liomatro- pin Pilocarpin hydrochlorid 31 lodin Sodium suLfanilate and sodium car- bonate, sodium hyposulflte H2 Javelle water Sodium hyposulflte GENEKAL TOXICOLOGY. 27 NO. POISONS. ANTIDOTE. 33 Lead Atropin sulfate, olive oil (colic), potas- sium iodid (chronic); Glauber salts (acute from salts) 34 Moi-phin and opium Inactive oxygen administered under pressure, potassium permanganate, atropin sulfate, inhalation of am- monia, injection of ether, camphor, digitalein 35 Muscarin Ati-opin sulfate 36 Nitrobenzene Inactive oxygen administered under pressure, mixture of sod. carb. and bicarb, intravenous 37 Oxalic acid Sugar-Ume 38 Physostigmin Potassium permanganate, atropin sulfate 39 Phosphorus Inactive oxygen administered under pressure, hydrogen peroxid given in solution or injected subcutaneously, potassium permanganate, blue vitriol, mixture of sodium carbonate and bi- carbonate injected into vein. (The old antidote was oil of turpentine.) 40 Picrotoxin Curarin, chloral hydrate, inhalation of chloroform 41 Pilocarpin Atropin sulfate 43 Poisoned wounds Externally : potassium permanganate, chlorine in the form of aqua-chlori, calcaria, chlorata and natrium hypo- chlorosum, chromic acid 43 Potassium chlorate Inactive oxygen administered under pressure, mixture of sodium carbonate and bicarbonate injected into vein 44 Potassium cyanid, py- rogallol Inactive oxygen administered under pressure 45 Potassium iodid Sodium hyposulfite 46 Scopolamin, uraemic poisoning Pilocarpin hydrochlorid 28 GENERAL TOXICOLOGY. NO. POISONS. ANTIDOTES. 47 Sulfonal Inhalation of ammonia, injection of ether, camphor, digitalein 48 strychnin 4 Potassium permanganate, chloral hy- drate, curarin, inhalation of chloro- form, potassium ferrocyanid 49 Tetanus bacillus Chloral hydrate, curarin, inhalation of chloroform 50 Toxiresin Chloral hydrate, ci; rarin III. The prophylactic treatment is very largely that of hygiene and is the province of the Board of Health. 1. Articles of food, which are either decayed, or adultera- ted with poisons, should be confiscated. 2. Poisonous plants and animals should be exterminated, and a thorough knowledge of them taught in the schools. 3. Manufacturing, which is likely to lead to the poisoning of the employed, should be prohibited, or at least the surround- ings of the men who work at such industries rendered as healthful as possible. 4. The use of poisonous dyes for wall-paper, clothes, toys, food-stuffs and all sorts of utensils, should be prohibited. 5. The entrance into dwelling places of poisonous gases from sewers, water-closets, gaspipes, stoves, etc., should be prevented by sanitary regulations. 6. The dangers of certain articles of diet should be kept constantly in the mind of the public by frequent appropriate illustrations in the churches, schools, at home, &c. 7. Antidote cases, ready for use, should be kept in various quarters of the town, in village hospitals, &c. The Antidote Case. Next to the choice of the proper remedy, the success ol the treatment of a case of acute poisoning depends chiefly upon liow 'promiptly tlm antidotal treatment is begun. Hence, it ia the duty of every conscientious physician to have in constant readiness, a case containing everything necessary for coping GENEEAL TOXICOLOGY. 29 with accidents &c., caused by poisoning. This will enable him to hurry to the scene of accident at a moment's notice. However, this is only possible when there has been made a careful, compendious selection of the necessary articles, as otherwise the volume and weight of the armamentarium would not admit of ready and comfortable transportation. For each physician to prepare such a case according to his own ideas, would necessitate the expenditure of a great deal of thought, time and money. A much more economical plan would be for a number of physicians to arrange at the same time to supply themselves with such cases, and for this reason the author has described an outfit which is prepared and put upon the market by Ehrhardt & Metzger, of Darmstadt. Whether the physi- cian uses this or any other case, the contents should be practically the following : In the first place, a small book on poisoning, such, e.g., as the present, or a better one. Apparatus for chloroforming, for subcutaneous injection, for washing of the organism (salt-sugar transfusion), for wash- ing the stomach, for opening the mouth and holding it so, for retracting the tongue, for auscultation, for external friction (Luffa-sponge), for catheterizing; and for performing a few simple chemical tests (sugar in the urine, Froehde's reaction for morphin, etc.), a medicine glass, graduated cylinder and filter paper are necessary. As for instruments, it is desirable to have a few forceps, including artery-forceps, a scalpel, for blood-letting, etc., and a few needles ; and in the line of bandaging material, silk, sponges, cotton and gauze bandages. Of medicines and reagents, some should be in solution and some in solid form. As regards the solutions we need, first, sterilized solutions for subcutaneous injection, in small, sealed glass tubes, especi- ally of apomorphinum hydrochl. 0,01 : 1,0, atropinum sulfuric 0,001 : 1,0, curarinum 0,01 : 1,0, digitaleinum 0,01 : 1,0, diure- tinum lithio-benzoic, 0,2 : 1,0, morphin hydrochl. 0,02 : 1,0 and 0,03 : 1,0, pilocarpinum hydrochl. 0,01 : 1,0, scopolaminum hy- ~ drobrom. 0,0005 : 1,0, strychninum nitricum 0,005 : 1,0. 3C GENEEAL TOXICOLOGY. Of other fluids necessary, we mention liquor ferri sulfurici oxydati (for the preparation of the antidote for arsenic), chloro- form, olive oil, cognac or whiskey, ether, ether aceticus, satur- ated hydrogen peroxid solution, liquor ammonii caustici, liquor ammonii acetici, spirits of turpentine, spirits of cam- phor, acetic, hydrochloric, and nitric acids, concentrated sulfu- ric acid, liquor ferri sesquichlorati, phospho-tungstic acid, phospho-molybdic acid, mercuric-iodid in potassium-iodid, tincture of guaiac, Fehling's solution, solution of iodin in potassium iodid (1,0 pot. iod. + 0,1 iodin -{- aq. dist. ad. 10,0), liquor plumbi subacetici, solution of argentic nitrate, solution of sodium sulf-anilate, sugar-lime solution and dis- tilled water. 01 substances in the form of powder, there should be on hand calcium carbonicum praecipitatum, magnesium sulfuri- cum, natrium sulfuricum, barium chloratum, tragacanth, agar- agar, starch, citric acid, tartaric acid, malic acid, magnesia usta ponderosa, magnesium carbonicum, ground roast coflfee, cuprum sulfuricum, acidum picro-nitricum, potassium ferro- cyanid, sodium molybdaenicum, plumbic acetate, powders of tartar emetic 0,1 -(- rad. ipecac. 1,0, others of calomel 0,5 + tub. jalap. 1,0, and lastly a mixture of tub. jalap 10,0 -j- cream of tartar 20,0. In the line of aseptic, compressed tablets for the purpose of preparing solutions for subcutaneous injection, it is prefera- ble to have those which correspond to the solutions mentioned above. Of other compressed powders and the like we mention such of charcoal, salt, potassium permanganate, sulfonal, potassium chlorate, tannin, soda, sodium bicarbonate, cath- artic acid ; cough powders, opium with extr. ligni. camp.; sublimate and salt; calomel and jalap; opium and pulvis gummosus ; ammonium-chlorid and licorice ; and then, for washing the organism, sugar 2,0 + salt 0,75 + potassium carbonate 0,05, -|- sodium carbonate 0,05. Ten of these powders in a liter of boiled water, make a solution suitable for introduction into the veins, which, however, must be filtered before using. Sundry other substances to be considered are : supposito- ries for checking diarrhoea, for purging and for producing a GENERAL TOXICOLOGY 31 sedative effect; adhesive plaster, &c., mustard paper, litmus paper, chloral capsules, lanolin salve, paraffin salve, &c. In addition, the larger hospitals should keep in readiness means for stimulating the phrenic nerve, for performing tracheotomy, for inhalation of oxygen, a spectroscope (for blood, &c.), a laryngoscope (in case of oedema of the glottis), as well as larger handbooks on poisons. "VIII. — Pathological Demonstration of Poisoning. There are many cases of poisoning which cannot as yet be pathologically demonstrated, because the changes are not such as to be seen at a glance, but where resort must be had to the microscope. For years we have endeavored to bring this science, "pharmacopathology," into renown with the medical profession. "We have been able, partly by ourselves and partly in conjunc- tion with the gentlemen working in our institute, to show the pharmaco-pathological chauges in poisoning with sodium oxalate, iron, manganese, chromium, silver, copper, quillaic acid, sapotoxin, cyclamin, senegin, sodium crotonolate, podophyllo- toxin, ergot, &c., or to study more closely those changes already known, and to represent them by diagram. The characteristic changes from which we are often able to conclude as to the nature of the poison, are found in the kidneys, liver, spleen, heart, blood, intestinal canal and lungs. But all of these chauges are characteristic only when an early autopsy is made. Unfortunately, the physician has no right to make a post- mortem examination in a case of poisoning directly after death- he is obliged to wait until an inquest is held. In this way the most valuable time is generally lost, so that the various organs are usually not fit for microscopical examination. The physician should, however, do all in his power to have the autopsy held as soon as possible. Coboneb's Inquest. — The conduct of a coroner's inquest, the manner of holding the same, taking testimony, procuring services of experts, &o., is, in the U. S. of America, entirely in the discretion of that official. Chemical analyses may be performed at such time and place as the chemist chooses. All the world may attend the inquest. 32 GENEEAL TOXICOLOGY. Regarding the bacteriological examination, it must not be forgotten, that even "normal" cadavera contain micro-organ- isms other than those in the intestinal canal; of these we mention bacillus lactis aerogenes, bacillus coli communi, proteus vulgaris, proteus Zenkeri, bacillus albus cadaveris, bacillus citreus cadaveris, &c. It is not yet known whether poisons favor the development of certain microbes of impor- tance in diagnosis. With reference to the chemical examination, it is import- ant to remember that the cadavera of man and of all other mammals first enter a stage of acid reaction, and then, by disintegration of the nitrogen-containing component of albumin into bases, undergo alkaline . reaction. The latter makes itself known by the ammoniacal odor. Independently, the sulfur of the albuminous substances is gradually transformed into simpler combinations, and finally is converted into hydrogen sulfid or ammonium sulfid, and is then detected by the odoi\ Some poisons favor this change, others retard it. Hydrogen sulfid converts the haemoglobin of the blood into sulf-met- haemoglobin and, finally, ferrous sulfid is produced. Both of these give to the corpse a green color. Mummification and the formation of adipocire are two remarkable changes which may take place in normal corpses as well as in those due to poison- ing. The chemistry of these changes has, as yet, not been sufficiently investigated. By decay, we understand a transfor- mation which takes place in corpses resting in a soil contain- ing atmospheric air. This transformation, which takes place in corpses of non-poisoned as well as in those of poisoned individuals, does not give rise to bad odors, since it is com- bined with oxidatio)!, the final products being : water, carbon di-oxid, nitrates, sulfates and phosphates. The following table contains some of the most conspicuous changes in the cadaver. It will facilitate the recognition of conditions in the autopsy : GENEEAL TOXICOLOGY. 33 TABLE OP PATHOLOGICO-ANATOMICAL FINDINGS, OHAEACTEKISTIC IN CERTAIN OASES OF POISONING. NO. FINDING : POINTS TO POISONING BY: 1 Defluvium capillorum in non- syphilitic individuals Arsenic, when the course is not very acute 3 Green discoloration of hair Copper, in chronic cases 3 Contraction of pupils still pre- sent at time of autopsy Physostigmin 4 Marked dilation of pupils still present during autopsy Atropin, scopolamin, hyoscyamin 5 Extensive papular, pustular, or ulcerative changes of the skin Corrosive acids, alkalies, chro- mates, carbolic acid, iodin, bro- min, ergot 6 Atrophy of muscles Lead, arsenic, ergot, poison of Lathyrus 7 GrifBn-claw (Greifenklaue) Ergot, administered some time previous to death 8 Icteric and pseudo-icteric dis- coloration of the skin See page 17, No. 84 9 Skin shows black patches Silver, arsenic 10 Post-mortem spots of marked- ly bright red color Hydrocyanic acid, potassium cy- anid, carbon monoxid 11 Multiple haemorrhages into the skin Phosphorus 13 Cadaver markedly well pre- served, or mummified Arsenic 13 Dry gangrene of some of the limbs Sphacelinic acid 14 Corrosion of lips and corners of mouth Corrosive alkalies, corrosive acids, free haloids, corrosive salts 15 Perforation of nasal septum in non-syphUitic individuals Chromates (protracted action in the form of dust) 16 Perforation of frenulum prae- putii in persons not suffer- ing from genito-urinary dis- eases Chromates (protracted action on the epidermis) 34 GENERAL TOXICOLOGY. NO. FINDING : POINTS TO POISONING BY : 17 Dark line on the gums Lead, mercury, silver, bismuth 18 Stomatitis, glossitis and loose teeth Mercury, bismuth 19 Necrosis of jaw Phosphorus (inhaled) 20 Gastro-adenitis Phosphorus, arsenic, antimony 21 Mineral particles in gastro- intestinal canal Arsenious oxid, metallic arsenic, arsenious sulfid, antimony, anti- monious sulfld, calomel, mercu- ric oxid, mercuric iodid, chrom- ium preparations 33 Green shining particles Cantharides 33 White crystals of the appear- ance of flour, solidly attach- ed to the walls of the in- testine Oxalic acid, acid potassium ox- alate 34 Small pieces of wood in the gastro-intestinal canal Phosphorus (matches) 25 Leaves of a dicotyledon in the gastro-intestinal canal Hyoscyamus, Datura stramonium, Atropa Belladonna, Nicotiana tabacum, Aconitum napellus 36 Fragments of hair - coated seeds in the gastro-intestinal canal Strychnos nux vomica (bachelor- buttons) 37 Seeds or fragments of non- hair-coated seeds in gastro- intestinal canal Cytisus-laburmun, Hyoscyamus, Datura stramonium, Eioinus 38 Particles of plant belonging to the coniferae in the gastro- intestinal canal Sabina, Thuja, Taxus 39 Particles of mushrooms in the gastro-intestinal canal Amanita muscaria, Agaricus phal- loides, Helvella 30 Cavities of the body and en- trails presenting the odor of garlic Arsenic, tellurium, ether bromatus (ethyl-bromid or hydro-bromic ether), phosphorus 31 Cavities of the body and en- trails pervaded by odor of bitter almonds Hydrocyanic acid, potassium cy- anid, nitrobenzene GENERAL TOXICOLOGY. 35 NO. FINDING : POINTS TO POISONING BY : 33 Cavities of the body and en- trails smell like spirits of turpentine Sabina, Thuja, Taxus, Euta 33 Cavities of the body and en- trails have a pleasant odor Eau-de-cologne, perfumed cor- dials, amyl-nitrite 34 Cavities of the body and en- trails smell of acetone Ethyl-di-acetic acid (ethyl-aceto- acetic ester), formed in diabetes 35 Cavities of the body and en- trails have other peculiar odors Alcohol, ether, amylene, amylene- hydrate, chloroform, camphor, anilin, carbolic acid, nicotin, iodin, bromin, chlorin, hydrogen sulfid, ammonia, hydrochloric acid, acetic acid, opium 36 Contents of stomach and in- testine luminous in the dark Phosphorus 37 Walls and contents of gastro- intestinal canal markedly acid Acids, acid-salts 38 Walls and contents of gastro- intestinal canal markedly alkaline Potassium cyanid, caustic alkalies, alkaline earths 39 Walls and contents of the gastro-intestinal canal turn black on touching -with am- monium sulfid, or on ex- posure to its vapors Lead, bismuth, mercury, copper 40 Villi of small intestine turn black spontaneously Silver 41 Walls and contents of the up- per intestinal canal of a yellowish color Nitric acid, picric acid, picrates, plumbic chromate 4a Walls and contents of the upper intestinal canal of a greenish color Scheele's green, Sohweinf urt green (Paris green), oupric sulfate, ver- digris 43 Walls and contents of the upper intestinal canal of a brownish color Iodin, bromin, potassium chro- mate, phosphorus (icteric) 44 Walls of large intestine dark colored Bismuth 86 GENEEAL TOXICOLOGY NO. FINDING ; POINTS TO POISONING BY : 45 Lower portion of small intes- tine and the entire large in- testine dysenteric Mercury, arsenic, antimony 46 The entire intestine dysen- teric Castor beans (Ricinus) 47 Multiple haemorrhages' into the gastro intestinal canal Phosphorus, arsenic, baryta 48 Fatty liver Phosphorus, phallin, Poley-oil, arsenic, antimony, ammonia, iodin 49 Fatty degeneration of heart, kidneys, and muscles Phosphorus, phallin, arsenic, anti- mony, ammonia, iodin 50 Kidney produces a grating sound on cutting Mercury, oxalic acid, oxamid, lead (in chronic cases) 51 The glomeruli appear as black spots upon the cut surface of the kidney Silver (in chronic cases) 52 Glomerulo-nephritis Cantharidin, iodin, osmic acid and its salts 53 Even maoroscopically, the kidney shows reddish brown cylinders Corrosive acids, corrosive alkalies, corrosive salts, phallin, cycla- min, helvellaic acid, potassium, chlorate, etc. 54 Liver, on cut surface, shows black discoloration of the connective tissue and vessels Silver (in chronic cases) 55 Pulmonary oedema Muscarin, pilocarpin, nicotin, mor- phin 56 Diseased condition of the spinal cord Ergotism, lathyrism, pellagra When preserving blood for spectroscopic examinatioD, we- must remember that some blood changes, as, for example, th& formation of methaemoglobin, are very transient, therefore,, this examination must be made at once, if, indeed, we wish to- draw conclusions from methaemoglobin formation. Other changes, such as the presence of carbon monoxid-haemoglobin,. GENERAL TOXICOLOGY. 37 which can be detected by the spectroscope, may be preserved by excluding the air from the blood as completely as possible. This result is most readily obtained by sealing the blood in glass tubes. The more detailed examination of particles of poison and of the suspicious contents of the gastro-intestinal tract, is left in the hands of the chemist. However, the coroner can order that the examination be made under the supervision, or with the assistance, of a physician. But, as a rule, this is not done. Nevertheless, the physician is often enabled to draw important conclusions as to the nature of the poison at the time of the autopsy, even when there are present no extensive anatomical changes and without the aid of finer chemical tests. To this end he must direct particular attention to the points given in the above table, during the examination of the vomit, and of the remaining particles of food-stuff, and during the autopsy. IX.— Clieinical Detection of Poisoning. I. — GENERAL REMARKS ON THE CHEMICO-LEGAL EXAMINATION. The detection of a poison by chemical means has, natur- a,lly, great weight as evidence, since the actual finding of the " corpus delicti" more completely establishes the fact of intro- duction of the poison into the body than could anything else. However, this actual finding of the poison does not prove, by any means, that death, in any particular case, was caused by it. For, in the first place, we have to consider that most poisons serve as medicines; secondly, the possibility of intro- duction of the poison post mortem, with the intention of exciting suspicion. In this latter case, the anatomical changes, peculiar to the poison in question, will be wanting. Besides, in such a case, the poison will have penetrated through the walls of, and into neighboring organs, in obedi- ence to physical laws, and will not have been carried by the blood to remote organs. However, in cases where artificial respiration had been practiced for some length of time, or where the corpse had been moved about to a great extent, the poison, introduced post mortem, may reach the most remote organs within a comparatively short time. Therefore, as a 38 GENERAL TOXICOLOGY. rule, the detection of a poison is of value as conclusive proof only, when the symptoms during life, and the change found in the autopsy correspond to those, typical of this particular poison. On the other hand, this detection is not absolutely necessary; that is to say, we are by no means justified in con- sidering the question of poisoning as dismissed, because the expert failed to find any poison at all. The poison may have been voided by vomiting or by the organs of excretion; it may have decomposed or oxidized (e. g., phosphorus). In such instances we would find nothing, or merely chemically altered products, none of which would be of much value as conclusive evidence (e. g., phosphoric acid, which occurs normally in every part of the body). We mention further the difficulty of research, which obtains in case of some organic substances, used in minimal quantities, which call for the exercise of the greatest caution and skill upon the part of the expert. He confronts the utmost difficulties. He must separate the poison from a large bulk of organic material, in which he must search for it, and obtain it in a pure condition, to be valuable as proof. An especial difficulty is caused by the fact, that in corpses- of non-poisoned individuals, substances may spontaneously form, which are of greatest chemical similarity to our most poisonous alkaloids. This is true to such an extent, with reference to the general group reagents, that those poisons have not only been mistaken for true alkaloids in the past, but this error is scarcely avoidable even at present. These substances we call, following the procedure of the late Italian chemist, Selmi, " ptomaines." (The word should rather be : " ptomatines," as grammatically the correct, from Ttrwpia, Tttoojxarof^. The difficulty is still further increased, since these pubstances may give rise to errors due, not only to their chemical behavior, but also concerning the pharmacological action, as some of them are exceedingly poisonous, and in action closely resemble vegetable poisons. According to Beieger, one of them, the cadaver-muscarin, is identical with the muscarin of Amanita muscaria, both in chemical com- position and in its action upon the glands, heart and pupil. In doubtful cases of poisoning by vegetable poisons, it is consequently imperative to prove the presence of the poison. GENEEAL TOXICOLOGY. 39 not merely by ctemical means, but additionally, by the phar- macological experiment. Here the situation obtains, for which the German law provides, that the chemical investigation should be made in conjunction with a physician (specialist in pharmacology) for the purpose of physiological detection of the poison. It is possible to conclude with certainty, that the deceased suc- cumbed to a particular poison, only, when the chemist and the pharmacologist arrive at the same diagnosis, and when this diagnosis corresponds with the symptoms, observed during life, by the attending physician. It cannot and it should not be considered the duty of the physician to make the purely chemical investigation of rem- nants of food, of the vomit, of ejections, of the contents of the stomach and intestine. But he should know the course of analysis so as to be able to understand and, possibly, to criti- cise the testimony of the chemist. We shall, therefore, discuss this important topic somewhat minutely in a later chapter. The vessels in which the substances are handed over to the expert chemist, must be well closed and also sealed. The examination must be made in a room used, for the time being, for this analysis exclusively, and accessible only to the chemist. All necessary apparatus and utensils must be chemi- cally pure. It has frequently happened that poison, chiefly arsenic, was introduced into the material by the reagents used. All reagents must therefore be tested particularly in regard to their purity. The assurance that they were purchased as "chemically pure" does notsufiSce. The precautions observed to prevent such an introduction of poison during the course of analysis, must be especially mentioned in the oificial report of the chemist. Fortunately, we have at our disposal means and ways of forensic chemical analysis for the detection of all conceivable poisons. It is desirable, in order to test for all of these, to divide the suspicious material into five portions. I, serves for the detection of volatile substances; II, for acids and alkalies; III, for alkaloids and glycosids; IV, for metals; and V, is reserved in case of accidents or need. One portion may be used for different purposes, e. g., detection of volatile matter 40 GENERAL TOXICOLOGY. and metals. ""Lastly, we should also have a sixth portion to use for the purpose of making so-called preliminary tests. It is desirable, and the law of certain countries prescribes for all cases of forensic chemical research, that the poison be presented to the judge and the jury in a permanently stable condition, capable of impressing the senses. Forensically this is called the corpus delicti. Of such we mention the platinum double-salts of ammonia and of alkaloids, Prussian blue from hydrocyanic acid, mirrors and spots of arsenic and antimony, pliospliorus as such, mercury in the form of red mercuric iodid, oxalic acid as calcium oxalate, fragments of the elytra of cantharides, seeds of Hyoscyamus, hulls of berries of Atropa Belladonna, leave-fragments of Digitalis purpurea, &c. We will never be able to obtain the total quantity of the poison from the cadaver, for the reason that this would necessitate working the latter up in its entirety. II. — THE SO-CALLED PEELIMINARY TESTS. The table p. p. 33-36 contains some points to be consid- ered here, such as: reaction, identification of vegetable fragments, of elytra of cantharides, fragments of arsenic, &c. Without detriment to the material, the physician in charge of the case may establish to a degree some of the same facts that will be afterwards ascertained by the chemist. It is left to his good will as to whether or not he will make a test by applying his tongue to some of the material ; the chemist must do this. A further test with reagent-paper, applicable by the phy- sician at the time of death, consists in exposing to the vapors arising from the contents of the stomach, a piece of reagent- paper moistened with newly prepared guaiac-tincture and cupric sulfate, in a closed bottle, at the temperature of the room. If this is turned blue, the suspicion of the presence of hydrocyanic acid is justified. A strip of plumbic acetate-paper and another one of argentic nitrate are consecutively intro- duced into the bottle and fastened between the neck and stopper. The bottle is gently warmed by dipping it into warm water. If both strips are blackened, hydrogen sulfid or ammonium sulfid are present, which of course may have been GENERAL TOXICOLOGY. 41 produced by putrefaction. If only the silver-paper is black- ened, phosphorus is present. There are two additional preliminary tests to be consid- ered by the chemist, that by means of metal strips and the dialytic one. The Test by Means of Strips of Metal^-The contents of the stomach and intestines, or the disintegrated organs are finely distributed in water, and the faintly acidulated magma is introduced into four vessels. Into these we put bright plates of the following kind : into the first, zinc ; second, iron ; third, copper ; fourth, a zinc-platinum-coxnple. The zinc turning black indicates a likelihood that a metal is present ; if the iron turns red, copper is indicated; if the copper receives a silvery white coating, this shows the presence of mercury. If the platinum turns black, antimony is present. If the copper did not change and we proceed to heat it in the liquid, acidulated with hydrochloric acid, it may turn gray; this shows the presence of arsenic. The gray film dissolves on warming in ammonia, giving a solution that allows of the detection of copper-arsenid. The Test by Dialysis, invented by Graham, depends upon the fact that all crystalloids will pass comparatively readily through parchment-paper into distilled water, and thus allow of a separation from albumin, mucin, glue, blood-coloring matter, &c. Poisons, as strychnin, mor'phin, atropin, have thus frequently been found, quickly and surely. in. —SUBSTANCES THAT MAY BE DETECTED BY MEANS OF DISTILLATION. In case the material to be examined is strongly alkaline from the outset, the substances are directly distilled, furnish- ing ammonia and the so-called higher ammonias {methylamin, ethylamin and the diamin-bodies, &c). Nicotin and coniin, which under these circumstances may also distil off, at higher temperature, we generally test for when approaching the alkaloids. We shall later refer to anilin, which may be found at this stage. If the alkaline reaction was caused by potas- sium cyanid, the decomposing influence of carbon dioxid of the air will cause the passage of some hydrocyanic acid into the distillate. 42 GENERAL TOXICOLOGY. If chloral hydrate was present, the decomposing action of strong fixed alkalies will give ns chloroform in the distillate. The following table contains a sketch of the most impor- tant substances which can be separated by means of distilla- tion. (The abbreviation ppt. signifies: precipitate.) TABLE OF VOLATILE POISONS SEPARATED BY DISTILLATION. I. From alkaline solutions we obtain: ammonia, the frequently occurring cadaver poisons, such as amins, diamins, etc., and volatile alkaloids. II. From acid solutions, acccrding to Dragendoeff, the following are obtained : 1. Vapors which pass over, colorless; distillate neutral. (a) EASILY VOLATILE SUBSTANCES; ODOE OP ALCOHOL, ETHEE, etC. Vapors contain chlor- al. They furnish CaCla when passed over glowing lime in a current of steam. 1. Distillate warmed with alcoholic KOH and anilin, productive of iso-nitril-reaction : Chloroform. 3. Distillate does not furnish isoniti'il: Ethylene chlorid, boiling point + 85° C. , or Araiis Ether, volatile at + 105° C. The filtrate upon ad- dition of iodin + KOH gives the iodo- form reaction. 1. It has the odor of : Alcohol. 3. It has the odor of : Ether. 3. When heated with Ba (0H)2 it furnishes bar- ium-acetate : Acetic ester. 4. The iodoform precipitate is amorphous : Acetone. The distillate smells of Benzene, Petroleum , etc. It consists of ■ water and oily drops on top of it. 1. These furnish with HNOa Nitro-benzene : Benzene. 3. They furnish nothing : Petroleum. The distillate smells of rotten eggs. With acid solution of plumbic acetate, black pi)t. Hydrogen sulfid. Will rapidly discolor a 1 p. c. blood solution. The distillate is of fetid, alliaceous odor. With NHs and sugar of lead solution it produces a black ppt. Carbon-disiilfid. It will not change a 1 p.c. blood solution. GENEEAL TOXICOLOGY. 43 (6) DIFFICULTLY VOLATILE BODIES. A larger amount must be distilled off; then agitate the distillate with ether. Ether residue : Smells of ethereal oil, and is liiqiiid. 1. Smells of: Spirits of Turpentine, Oil of Rue, Oil of Ledum, Oil of Sarin . 3. Smells of: Oil of bitter almonds. (a) It will produce anilin when treated with Zn and HSOi Nitrobenzene. (b) It will not give this reaction, but when oxi- dized at the air produces benzoic acid : Bcuzaldebyde (oil of bitter almonds). 3. It has a pungent odor causing inflammation of eyes and nose: Kluslard-oil, sarlic-oll. Smells of ethereal oil, and is Solid. 1. H2SO4 will color red, brown to violet: Ledum-camplior. 2. H2S04 wiU produce a red color, only upon ad- dition of acetic acid containing a trace of iron : Thymol. 3. H2SO4 produces 720 color: Cainphor. 4. Of intensely yellow color, hexagonal plates ; specific odor of: Iodoform. {Bromoform, in contradistinction to iodoform, is liquid, and can be distilled). Smells of creasote... - 1. With ferric chlorid + water, blue violet: free Phenol. 3. With Fe^Cle + alcohol, green: Creasote. Both substances, when applied to the epidermis, produce white spots and deaden the sensibility. The coupled phenol, e.g, of the liver, can not be directly obtained by this method; see p. Is solid It smells of chloral, and produces with KOH chloroform: Chloral hylicatlon, general- y recovery ; inter- nal) y, when tried on animals, death with paralysis and spasms. Death with oe- dema of the lungs, uncon- sciousness, par- alytic pheno- mena, and low- ering of temper- ature. Death in deepest coma on first day. In case of re- covery, persistent anuria, voiding of urine rich in crystals, and of reducing action; gastritis and fee- bleness maintains for a long time. Death with unconscious- ness, and almost simul- taneous cessation of tha heart's action and of brea- ing; spasms rare with man, but present witU animals, as a rule. Externally, the specific action is seen. The odor of the acid Is per- ceptible^ Specific odor of breath and of vomit. Urine contains sugar ; oc- tahedral crystals of potas- sium oxalate in the urine and faeces. Specific odor; rapid col- lapse ; urine dark and frea from sulfates, becoming still darker on contact wita the air. For external in- jury, cooling com- presses and ice ; Internally, as with acetic acid. Same as with mineral acids : chalk,soda,mag- uesia. Calcium saccharate, chalk, lime-water, magnesia, al- bumin, mucilagmous sub- stances, sweet milk. Washing of stomach with calcium saccharate ; inter- nally and hypodermical- ly sodium sulfate ; analep- tics. After Internal ac- tion the finding is similar to that by acetic aeid : blood is said to be of a remarkably bright color; urine con- tains formic acid; all organs have characteristic od- or. Violet post- mortem spots ; oesophagus, sto- mach, and con- tents of stomach brownish-black, often also the duodenum. Acid, grayish - brown masses in small Intestines; peri- toneum grayish- violet. Oesophagus and duodenum freauently whitish and cauterized. Sometimes the intestinal tract almost normal. In the stomach, frequently lentil - shaped haemorrhages; crystals upon mucous coat of intes- tines, as also in kidneys and urine; small quanti- ties of oxalates in urine are physiological. Mouth, throat and oesopha- gus may show Inflamma- tion ; stomach, relatively little inflammation ; bron- cho-pneumonia, nephritis, degeneration of the liver: in urine, phenol, partly as such, partly coupled; al- bumin, and blood ; also the liver contains free and coupled phenol. The distillate con- tains the acid, no- ticeable by its od- or. Ammoniaeal- argentic nitrate solution is reduced to silver even in m the cold. Eeh- ling's solution Is reduced on warm- ing. In cases of fever and of liver troubles, formic acid (CH2O2) is formed spontane- ously. The distillate smells of vine- gar and is color- ed a deep wine- red by ferric ohlorid. Sodium acetate heated with alcohol and cone, sulfuric aeid yields odor of acetic ester: when heated with arsenic, od- or of kakodyl. Boiling alcohol, acidulated with hydrogen chlorid ex- tracts the aeid, which is obtained from residue of evaporation by extraction with water. This yields characteristic ppts. with lime-water and with plum- bic acetate solution. The crystals of calcium oxalate have the appearance and shape of an envelope. The acid distillate contains free phenol, which is turn- ed lilac with ferric chlorid ; with bleaohing-powder and ammonia, blue; with mer- curous nitrate (contain- ing nitrous acid), rose-red; with bromin-water, crys- talline tri-brom - phenol- bromid ppts. The cou- pled phenol of the urlna and the organs must be liberated by boiling with, diluted sulfuric acid. 84 SPECIAL TOXICOLOGY. The salts of most of tlie acids, if of neutral reaction and if not applied in a too concentrated condition, are non-poisonous. Exceptions are salts (^oxalic acid and of chromic acid, the salts, of which latter, and of the mentioned osmic add, remain toxic to a high degree. The nitrites are also poisonous, but they will be treated of with the blood-poisons. As an appendix to the acids or their respective neutral derivatives, we must mention salol, which in itself behaves indifferently, but which decomposes into phenol and salicylic acid in contact with wounds, or under the pancreatic influence. Salicylic acid acts similar to phenol. The principal symptoms which it ordinarily produces are : violent perspiration, disturbances of memory, buzzing in ears, hsemmorrhages into the retina and into the labyrinth. Much less poisonous than phenol, though chemically and physiologically approaching it, are cresol, quinol, catechol, resorcinol and guaiacol. II. — COEKOSIVE HALOIDS. The action of chlorin is closely allied to that of hydrochloric acid, since in presence of aqueous vapor it is transformed into HCl. All of the recorded cases of poisoning refer to inhalations,, chlorin being a gas. Concerning hromin, which is a liquid, we have the record of inhalations as well as of internal and external applications. lodin is a solid, and the cases of inhalations are greatly in the minority. Generally we find cases of injecting or of taking per os solutions of free iodin (in alcohol or in potassium iodid-solution). But we meet cases, where also preparations such as the alkaline salts of iodin had been applied, from which iodin may be liberated within the organism, be it by nitrous acid of the nasal mucus, or in particular, by yet unknown enzymes of fungii of suppuration. "We find here a key to understanding how it is that a certain person may tolerate 30 grammes oi potassium iodid, while another one will be severely poisoned by 1 gramme. "Ereefluorin is a substance of such rare occurrence that it hardly needs to be mentioned. On inhaling it, it is at once transformed into hydrofluoric acid, ozone being produced at the same time. Consequently it is strongly corrosive. Its action resembles that of hydrochloric acid. Sodium Jluorid, internally or hypodermically applied gives rise to the formation of hydrofluoric add within the stomach which may cause nausea, salivation and gastritis. A large- SPECIAL TOXICOLOGY. 85 amount of the sodium fluorid taken, will be deposited in the bones in the form of caMum fluorid or fluorspar. The fol- lowing tables (pages 86-87) embody the salient points in regard to CI, Br and I. Concerning the quantitative relations of absorption of the inhaled poisonous gases, we have the rule, which by no means holds only for chlorin and bromin, that the absorption of the gases, readily soluble in water, occurs to a remarkable degree, and even takes place to the greatest extent within the nose itself. IIL — COEEOSIVE COMPOUNDS OP THE ALKALIES AND ALKALINE EAETHS, The intoxications which pertain here, are similar to those brought about by the acids, by the fact that immediately after introduction, there begin violent pains, based upon cauteriza- tion in the mouth, throat, oesophagus, stomach and abdomen. As with the acids, we may also here find that peritonitis follows, that a part of the blood is changed to hsematin (alkali-hsema- tin), and that, in case of survival, strictures are formed mainly of the oesophagus. We cannot state the exact size of the fatal dose for alkalies any more than for acids. A cardinal difference between intoxication by means of lyes, as contrasted to that by acids, consists in this: the corroded parts do not turn dry and brittle, as in the case of acids, but become soft and pulpy. This happens in consequence of a colloidal swelling of the formed alkali-albuminates, which in presence of much water, will even be partially disolved. In medical jurisprudence this process is called colliquation. Oartilage and horny tissue will also swell and eventually dissolve in caustic alkalies, thus, e. g., hair and skin. The destructive action of the caustic alkalies always furrows deeply, and extends widely into the tissue around the cauterized spot. It is quite common for the action of caustic alkalies, as with acids, to leave contracted scars upon the skin. Alkcdi-svlflds and ccddum sulfid act in two ways, viz : corrosively, and, in addition, in a specific manner similar to hydrogen sulfld. They will be mentioned again with the latter. The action of caesium and rubidium is similar to that of potassium; that of lithium holds a place midway between rubidium and sodium. Strontium acts similar to barium, but it is less poisonous than barium. All other particulars in regard to alkalies and alkaline earths are shown in the table (pages 88-89). 86 SPECIAL TOXICOLOGY. o n i Solid iodin; iodin vapors; tincture of iodin; iodin-paraffin; iodin-glycerin; Lugol's solution; iodin-alkalies; and iodoform. 13 o . XD (D ■Sg 3g Inhalations of the vapors in technical pursuits; injections into cavities of the body of solutions containing iodin ; decomposition of potassium iodid with liberation of iodin by pus- bacteria or by their products of meta- bolism. It is said that internally 3 grams are fatal. With animals intra-venous injection of 4 mgr. per kilo-gram, of body-weight are fatal. Formation of iodin - albuminates which rapidly further decompose. Iodin being less volatile than the foregoing two halogens, acute poison- ing by inhalation rarely occurs, if at all. In contact with dissolved iodin, all mucous membranes are severely inflamed, also the epidermis. Iodin causes albuminuria,hs6moglobinuria, bronchitis, dyspnoea, asthma, a pecu- liar nasal catarrh, somnolency. 1 Liquid bromin, bromin vapor and bromin-water are to be considered, the bromin sticks contain free bromin and Kieselguhr (infusorial earth) and are of secondary importance. Two cases of internal fatal poisoning; sporadic cases of external corrosion and of inhalation. Unavoidable inhalation of vapors in laboratories and in photographic workshops. Internally the large amount of 30.0 grams; when inhaled .06 grams per mile, have proved fatal. Formation of bromin substitution products of the albuminous sub- stances and epithelia. Upon moist mucous linings HBr is formed of action analagous to HCI. Bromin, as well as HBr, irritate all the respiratory mucous linings and cause broncho - pneumonia, etc. If the stomach is filled with albuminous food, the bromin is less dangerous. Centrally , we find narcosis and stupor. s w o Chlorin vapors in bleacheries; in chlo- rid of lime factories; manufacture of disinfectants, chemical laboratories, in eau de Javelle (Labarraque's solu- tion). t. II ■! § a 2- ■■Jig •2 2 M a -2=3 .at:; 2% ^1 3 o Unavoidable inhalations of the vapors while working in the presence there- of ; hypochlorites are even decom- posed by the C Oa of the air. Internally, large doses are withstood; when inhaled, often .06 grams per mile, fatal. Destruction of all substances contain- ing albumin and all epithelia, with the formation of chlorinated products of decomposition. Upon the moist mucous membranes, the chlorin is changed partly into hydrochloric acid and then acts as does this (see page 83j. Both chlorin and hydro- chloric acid irritate and cause, e. g., broncho-pneumonia, cauterization of the eyes, nose, etc., and decomposi- tion of the blood. o CO 1 6 i o Q < SPECIAL TOXICOLOGY. 87 1.. ■B g a a 9 cS o ""^£ o o o fl, V o ^ rS -j^ > t^-H ' as a s ^^ •a (s ■Sfj^'Sy a o 3 c 3 o ■" o (4 g-o I a O g tiO'2 O Hew ^ to'-fl ftcs S,ca -H N a H Oi.-S C8 g^fli^^ a .3 O 2 08 s -s ? 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IV. — COEEOSIVE SALTS. Salts of the metals in general, not only of the alkali-and alkaline earth-metals, salts of the haloids and of the metal- loids, can all of them act as corrosives. From a theoretical standpoint, we have to consider the possibility of four different kinds of sach action: corrosion, in consequence of (1) acid reaction; (2) of strongly alkaline reaction; (3) of salt action purely; (4) of salt-action as well as of that of acid or alkaline. The diluted solutions of all acid salts cauterize in conse- quence of acid reaction, e.g.: potassium acid svlfate, which in imbibing plastered wines for some length of time, acts detrimentally ; cream of tartar or potassium acid tartrate, acid potassium oxalate, used so largely for the removal of ink- stains. This latter substitute is frequently mistaken for Epsom- salts, or used carelessly, and even its solutions produce genuine corrosion. Many others might be mentioned. It is evident that the corrosion will be more intense and more similar to the action of acids, in proportion to the stronger acidity of the solution. Corrosion in consequence of strong alkaline reaction will be produced by solutions of certain salts of alkaline reaction, viz: potassium-, sodium-, or ammonium-carbonate, etc. It is obvious that in these cases the corrosion will be proportional to the alkalescence and analogous in the main to corrosion by free bases. Corrosion by means of salt- action purely, is peculiar to even the most indifferent of all salts, viz: the common table salt, sodium cMorid, as such, or in concentrated solution. There are on record fatal cases of grave intoxication, of corrosive character, of man and domestic animals, caused by sodium chlorid, sodium sulfate, (Glaubee's salt), magnesium sulfate (Epsom salts), potassium chlorate, potassium sulfate (Sal polychrest), potassium- and sodium-nitrate (nitre, saltpetre or Chili saltpetre): Solutions of a certain concentration of each of these neutral salts, behave quite indifferently when in contact with the mucous linings; and in such strength we call it, with regard to the cells of our body, non-poisonous or isotonic. For sodium chlorid this is a solution of 0.75 per cent. Weaker solutions are called hypisotonic, and more concentrated ones hyperiso- tonic. The hypisotonic solutions cause symptoms of intoxication similar to the effects of distilled water, viz., they produce a SPECIAL TOXICOLOGY. 91 colloidal state of the cells; the hyperisotonic ones cause shrivelling and decay of those cells which are directly concerned, and a reactive inflammation around them. It remains an arbitrary matter in how far we should call these processes corrosion. Concerning the isotonic solutions^ naturally they have a physiological action in addition to a chemical one. Isotonic solutions of potassium salts retain ■ always a specific exciting action upon the heart, and in larger doses they have a paralyzing effect thereon. On the other hand, corresponding solutions of sodium salts are devoid of any such action. With regard to toxic qualities, the salts of rubi- dium., caesium and lithium occupy a middle position. Isotonic solutions of salts of barium remain highly poisonous, those of strontium are less active, and those of magnesium still less toxic. Internally applied, magnesium salts will merely cause diarrhoea; salts of strontium will show a diuretic effect. The haloid-salts containing oxygen, differ materially from those free of oxygen. We have already mentioned that isolonic solutions of the alkali-chlorids are toleraby indifferent; the alkali-chlorates^ have frequently proved fatal. We shall again refer to the latter when treating of the blood-poisons. The same obtains for alkali-iodates and hromates. The poisonous part in these cases is not the haloid, but oxygen, which can be proved to separate from, or to allow of the separation of the haloid, so that the oxygen-free compounds reappear in the urins. Some of the salts of metalloids, as, e. g. sodium arsenite, are poisonous to a high degree, even in greatest dilution. Later on we shall again refer to this point. The corrosion produced by the action of the salt, as well as by that of acid or alkali, is, of course, twofold: The salts of the heavy metals show a combination of salt-action and acid- action, even if they are not of acid reaction. This takes place,- because the albuminous substances combine with metal-oxids, forming peculiar metal-albuminates, insoluble in water. If a simple salt of a metal is brought together with albumin in. neutral solution, a precipitate forms consisting of albumin, metal-oxid and the acid in question. The latter, however, may be washed away from the precipitate, to which it does not closely adhere. The circulating blood, e. g. may do this and then the acid as such can act, causing the symptoms described. Consequently two factors enter into corrosion by metal-saltSy 92 SPECIAL TOXICOLOGY. viz: the action of the metal-oxid, consisting in changing living albumin into dead metal-albuminate, and the action of the acid, which latter represents ordinary acid-corrosion. From the foregoing it follows that the intensity and the character of the action of metal-salts must be conditioned partly by the nature of the metal-albuminate produced, partly by the quan- tity as well as the properties of the liberated acid. The latter may be only slightly corrosive and it may be contained in relatively small quantity in a basic salt, whose metal-oxid forms an insoluble, tough mass with the nitrogenized tissues (epithel and albumin). This mass will adhere closely to the lower layers of tissue, so that the scab formed prevents further penetration of the poison. In such cases, as we find them with zinc and silver, the corrosion is restricted to the surface. But the metal-oxid does not always form an insoluble, solid scab with the tissue ; frequently, a soft, semi-fluid pap is produced, which is of no effect to protect the underlying parts from further penetration of the poison. With the soluble metal-chhrids, the action of the liberated hydrochloric acid is the main feature, e.g., they cause symptoms similar to those described for hydrochloric acid. In addition, the action of /ree chlorin obtains, thus increasing the destructive capacity. It is obvious that in all cases a reactive inflammation follows, provided the case was not immediately fatal. Of the following two tables, the second one refers to the more important heavy metals, excepting lead, bismuth and tin ; the first one contains all those members of the nitrogen-group, exclusive of nitrogen itself, which are poisons in an oxidized state. Phosphorus will be treated of later on; though belonging to the nitrogen-group, it is only poisonous in an oxygen-free state and hardly corrosive. Of the heavy metals forming corrosive salts, which here- tofore have been toxicologically of minor importance, uranium is the most poisonous one. Even if hypodermically injected in the form of non-corrosive double-salts, it produces paren- chymatous nephritis, hsemorrhagic enteritis, hepatitis, etc. JIven in a still smaller dose, it causes glycosuria. Metals now used to a large extent, as aluminium and gold, are, properly speaking, non-dangerous. Iron, nicTcel, coialt, silver, manganese, and a great many other heavy metals pass exclusively from the blood into the intestine, being secreted by Liebekkuehn's SPECIAL TOXICOLOGY. 93 glands. In case of the circulation of very large quantities within the blood, they are in the beginning partially secreted by the kidneys, causing parenchymatous nephritis. But the main quantity of the metals circulating with the blood is retained by the liver, from where it is slowly transported toward the intestine by lencocytes. V. — ^INOEGAinO SUBSTANCES WHOSE C0BB08IVE ACTION IS OE MINOR IMPORTANCE COMPARED TO OTHER ANATOMICAL CHANGES CAUSED BY THEM. In the table (pages 98-99) only four substances are dis- cussed, viz.'. tin, lead, bismuth and 'pliosphorvs. It is difficult to draw a line between three of them and those metals treated of in the last chapter. But if we consider the most common forms of intoxication which they produce, we find that the former may be differentiated by the fact that corrosion proper is with .them a very insignificant feature, if not totally absent. Admittedly, many points of analogy exist between the action of 'phosphorus and arsenic; however, the total phenomenon of intoxication shows many differences between the two. Pfios- phorus is poisonous in itself ; its different states of oxidation are not. Arsenic is non-poisonous in itself ; its combinations with oxygen are. Phosphorus, as such, is hardly corrosive; while arsenic is very strongly so. VI. — ORGANIC SUBSTANCES CAUSING GROSS ANATOMICAL CHANGES. In a wider sense, the substances belonging to this group being very numerous, we shall here omit those which, at the same time, are strong heart- or blood-poisons. We shall then later see that they produce changes of other parts of the body in addition to those of the heart or blood. Some others, as colchidn, will produce gross anatomical changes in a lower animal, if the experiment is suitably arranged. But, hereto- fore, they have alwas proven fatal to man without offering any pathologico-anatomical finding. The principal and not neces- sarily the local action of the poisons will be here mentioned. Some of them, as, e.g., the poison of lathyrus, while not at all producing changes at the place of application, does present very peculiar effects in other parts of the body. It is permis- sible in adhering to the nomenclature of therapeutics, to denote as " Aoria " the substances which are extraordinary by their powerful local irritation. "94 TABLE OF INTOXICATIONS CAUSED BY: AESENIO AND ITS COMPOUNDS. SOUECB. Metallic arsenic, also called cobaltum; arsenious oxid (AS4O8). generally called arsenic; arsenic acid (H8ASO4) ; potassium arsenite (Fowler's solution); sodlnm arsenite (Pearson's solution) ; realgar (AsaSa); orpimentfAsaSa); Seheele's green; hydrogen- copper arsenite (HCuAsOa); Sehweinfurt green: double cuprio met- arsenite and acetate. Stat. Most frequent intoxications lor last two centuries, even now not rare ; mortality low. .fflno. Murder, suicide ; food containing arsenic ; drinks ; utensils for daily use ; wall- papers; clothes; medicinal poisoning. The poison may be resorbed by the stomach, lungs, skin or even by the vagina. Grass, growing in the neighborhood of arsenic furnaces, and affected by the vapors, may cause intoxications of domestic animals. Dos. LET. 0.1 gram, arsenic ; generally much more Is used. Act. Local cauterization, paralysis of the splanohnics, paralysis of the heart, degenera- tion of the albumin of the body, disturbance of activity of the central-nervous system and skin; voided by means. of all glands; in case of small doses, the action of arsenic preparations is slow. Sympt. Acute poisoning: Disagreeable sensations in throat, vomiting and purging, diffi- culty in swallowing, dizziness, headache, pain in limbs, weakness of pulse, cyanosis, cold extremities, fainting, formication, spasms, general paralysis, eczema, erythema, pseudo-erysipelas, catarrh of mucous linings, salivation. Ghronic poisoning : Catarrh of stomach and intestines, nasal catarrh, bronchitis, laryngitis, conjunctivitis, anaemia, universal eczema. Herpes Zoster (melanosis), dermatitis squamosa, degeneration of mental faculties, paralysis of lower ex- tremities, anesthesia, paresthesia, multiple neuritis, amauroses, epileptiform seizures, nephritis, hepatitis, atrophy of muscle. DiAGN. Proof of the presence of the poison in the vomit, urine, and faeces ; in acute cases, the cholera-like, rice-water diarrhoeas are important for diagnosis. The mummi- fl.cation, according to Zaaijer, is without value. Theb. After repeated very thorough washings of the stomach, give internally, the anti- dote—magnesia usta and ferrous sulfate newly mixed ; afterwards diuretics, hot baths, and electricity to stimulate the activity of the glands. P.-Mtm. Contents of the stomach haematic ; mucous lining partly velvet-like and swollen, reddened, ulcerated, after large doses necrotic ; parenchymatous gastro-adenitis ; multiple haemorrhages in intestines; marrow like Infiltration of the plaques; dysenteric, fatty degeneration of kidney, liver, heart and vessels, body well pre- served, mummification may be absent; in chronic cases, degeneration of muscles and nerves. Detect. The clear solution, prepared according to Fresenius-Babo. is treated energetically with hydrogen sulfld ; the yellow precipitate is dissolved in hot ammonium sulfid ; altered, evaporated, and fused with a mixture of sodium carbonate and sodium nitrate. The fused mass is dissolved in water ; the filtrate heated with sulfuric acid and conveyed into Marsh's apparatus, in which hydrogen is developed frpm e. p. zinc anddil. sulfuric acid; arsin(AsH8)isformed, which, when passed through a calcium chloridtube, and then through a strongly heated glass tube, gives an arsenic-mirror. In a solution of argentic nitrate, arsin forms a black precipitate of metallic silver. In case .small pieces of arsenic have been found in the body, one of them is thrown on a piece of glowing charcoal, giving rise to vapors of a garlicky odor. If another small piece Is reduced in a narrow glass tube with charcoal, and the black arsenic-mirror which is formed is heated with potassium acetate, it gives rise to the odor of kakodyl. Concentrated solution of stannous chlorid will deposit in aqueous solutions of arsenious acid, brown flakes of reduced arsenic. The arsenic-mirror is soluble in sodium hypochlorite. ARSENIC, ANTIMONY AND BOEON. 95 ANTIMONY AND ITS COMPOUNDS. BOKON AND ITS COMPOUNDS. Almost exclusively tartar emetic, and perhaps the faintly poisonous sulfur auratum. SbaSs (antimony penta-sulfld) are of importance. Only boraoic acid B(0H)3 to be considered, and sodium bi-borate (borax, Na2B407, 10H2O). Formerly murders, medicinal poisoning, and mistakes were more common than now. The mortality is greater than with arsenic, since the intoxications are generally of a more profound nature. Fatal terminations rare; intoxi- cations not infreQuent. Technical and medicinal use. Tartar emetic is resorbed by all parts of the body. Anilln colors that had been fixed by means of antimony have caused intoxications, Use of boraolo acid in surgical dressing and in washing of blad- der; internal application of both preparations, even hypodermic- ally. Scarcely smaller than with arsenic. Yery much greater than with arsenic. Very similar to arsenic, only that the oxygen-compounds of the latter are more easily resorbed than those of anti- mony. Voided by means of all glands. Upon the epider- mis, arsenic is slightly less irritating than antimony. Irritation of first passages ; dis- turbances of alimentation; fee- bleness of heart ; decomposition of the blood. Acute poisoning: Nausea, metallic taste, salivation, non- appeasable vomiting, inflammation of mucous lining of mouth; cholera-like diarrhoea, cold skin, quick, small pulse, dizziness, unconsciousness, spasms in calves of legs, convulsions, collapse. Ghronic poisoning: Catarrh of stomach and intestines, numbness, vertigo, loss of voice, weakness of muscles, cold skin, weak pulse, albuminuria, profuse diarrhcea, prostration, collapse. Acute poisoning: Vomiting, darkening of the field of vision, paresis of muscles, weakness of heart, purple exanthema, hsem- morrhages of bladder. Ghronic poisoning: Chronic ca- tarrh of stomach and intestine, with loss of appetite ; stools con- tain undigested masses; saliva- tion, marasmus, ansBmia. The unceasing vomiting and cholera-like diarrhoea indi- cate either arsenic or antimony. The analysis decides. Is insured by the proof of poison in urine. After thorough washing of the stomach, internal adminis- tration of tannin, magnesia, albumin, milk, analeptics. Diuretics ; washing of the organ- Ism. Inflammation of flrst passages; parenchymatous gastro- adenitis ; intestines as with arsenic ; fatty degeneration of kidneys, liver, heart and vessels ; also pneumonia has been observed ; inflammatory changes in mouth more f reauent than with arsenic; swelling, pustules, aphthae. The oeso- phagus may show the same appearances. No satisfactory post-mortem has so tar obtained with man. With animals, we find gastro-enteritis, but less than with arsenic. Organic masses destroyed as with arsenic; precipitation and redissolving also same as for As. The residue when fused with sodium carbonate and sodium nitrate allows arsenic to go Into agiueous solution, while antimony remains in- soluble. In Marsh's apparatus, antimony also gives a mirror, which consists, not of brown, but black, velvet- like spots insoluble in sodium hypochlorite. If stibin is passed into argentic nitrate solution, we get a black pre- cipitate, but this is not metallic sliver, but AgaSb. The filtrate contains no 8b. while in case of As, all the As is found in theflltrate. NHa produces conseauently no yellow precipitate, as in the case of arsenic, with the antimony filtrate. The organic masses having been destroyed, the boraoic acid ob- tained is mixed with sulfuric acid to a mush ; alcohol is added and ignited; the flame is green. In case copper is present, it is to be separated before this test can be applied, as it also turns the flame green. The same holds good for baryta and thallium. If a piece of turmeric paper is put into a solution of a borate con- taining hydrochloric acid, it will appear brown on drying. 96 TABLE OF INTOXICATIONS PEODUCED BY SOME IMPOETANT MESOUBY. SIIiVEB. SOUECE. The most important compound is corrosive sublimate (mereurie ohlorid), HgCh; also the red oxid, HgO, and all other mercuric com- pounds are strongly corrosive. The merourous salts and metallic mercury are also poisonous but less corrosive. Almost exclusively lunar-caustic, ^gNOs. Argentic nitrate. Stat. The most Ireauent intoxications of the day. Now very rare; formerly more frequent. ^TIO. Used as medicine internally, externally and hy- podermically ; technical applications, and acci- dents. Accidents ; medicinal poisoning. DOS.LKT. 0.18 grams, corrosive sublimate. More than 30.0 grms. of argentic nitrate. Act. Local corrosion ; also corrosion at places where voided in large intestine, lower small intestine, and mouth ; necrobiosis of the epithelia of the convoluted tubules of the kidneys ; weakening of the central- nervous system with various phenomena of excitation. The intoxication sets in late after hypodermic injection of metal- lic mercury (gray oil). Local corrosion and formation of superficial dry scabs ; formation of a black organic compound in the connective tissue of inner organs, and at places where voided in small intestines, and skin. Sympt. Acute Poisoning: After internal application of the corrosive salts of mercury, metallic taste, stomatitis, salivation, glossitis, bloody vomit, dysenteric diarrhoea, anuria, oedema of glottis, great weakness, inanition, collapse, black edges on the gums. After hypodermic injection, local swelling and painf ulness at the place of appli- cation, and also of the surrounding parts. Qhronic Poisoning : Tremor, erethism, cachexia, necrosis of the jaw, chronic nephritis, rarefy- ing ostitis, paresis of muscles. V Acute Poisoning; White scabs io mouth.oesophagus andstomach(?) : griping; vomiting of light-colored masses, which turn black when exposed to light. Chronic Poisoning: Ulceration of stomach; blackening of cuticle (argyria), of the halr-foUioles, of the glands of perspiration, of lips, of the gums. Even if the skin is blackened strongly, euphoria may maintain for years. DiAGN. Appearance of the mouth, and electrolytical proof of presence of mercury in the fssces, vomit and urine. Discoloration of the skin in chronic eases ; of the vomit in acute cases. The discoloration remains for life. Theb. Potassium chlorate for a gargle ; albumin, mu- cilaginous drinks, milk. In chronic cases, warm baths (Turkish). Potassium iodid and sulfur-baths do not act specifically. In acute eases, sodium ohlorid (table-salt),albumin, milk. Nothing can be done in chronic cases. P.-Mtm. Teeth loose ; tongue and gums swollen, ulcer- ated and bleeding; stoinach less inflamed than lower small intestiae : main lesion in the large intestine, which is much inflamed and sug- gestive of the most pronounced bloody dysen tery; appendicitis only with herbivora; kidneys have casts containing calcium carbonate; heart, liver, etc., degenerated; peritonitis; loosening of the epiphyses of the long bones ; edulla of bones much reddened; phenomena of inflam- mation of the central-nervous system. In acute cases, gastro-enteritis ; in chronic oases, ulcus ventriculi,and. besides all the parts mentioned above, the blackening of the glo- meruli of the kidneys, Glisson's capsule of the liver, the villi of the small intestinei, the eduUa of the bones, etc. Microscopic sections of the blackened organs will be decolorized by potassium oyanid. Detect. By electrolysis, we may even prove the presence of mercury in the organic masses without des- troying them, but it is better to treat them ac- cording to Fresenius-Babo, and ppt. the metal as black sulfld; or by alkalies, as yellow oxid; or by potassium iodid, as red iodid. The hydrogen sulfld ppt. is dissolved, for proofs by further reactions, in aqua-regia. All mercury-compounds, upon heating in igni- tion-tube with soda, yield metallic mercury. (Compare page ll.) Even micro-ehemioally, we can prove mercury in the epithelia of the intes- tines and in the kidneys by means of ammo- nium sulfld. Upon treatment according to Fre- senius-Babo, the silver results as a ppt. (AgCl), which is soluble in ammonia. If the organs are simply ashed and then treated with nitric aeid, silver nitrate is formed. A solution of this gives with potas- sium cyanid a white ppt.; with potassium chromate, an indian- red ppt. Microscopic sections that have been decolorized, by potas- sium oyanid will again turn black with hydrogen sulfld. HEAVY METALS WHOSE SALTS AEE STRONG COBEOSIVES. 97 CHBOMIUM. COPPBE. ZINC. Chromic acid (CrOa or H20rO4); potassium chromate (KCviOtj; Sotassium acld-ohromate (Kz raOT); ohromalum, CiiSO^hK + 12H2O. Blue-vitriol (0uSO46H2O); eu- prie acetate in genuine verdi- gris, and cupric arsenite and acetate in Paris-green; basic ouprio oarbonate.eupric arsen- ite, cupric phyllocyapinate. Zinc ctilorid, ZnOh; zinc sulfate (white vitriol. ZnSO« 7H2O); zinc oxid, ZnO; zinc carbonate. (Calamine, Smith- sonite.) Formerly, mainly in England, Ireauent ; now everywhere rare. Formerly frequent in France ; now everywhere rare. In England, even to-day fre- quent ; elsewhere rare. Manufacture of chromium-pre- parations ; medicinal use ; ac- cidents. Accidents by vitriol much used technically: addition of copper to vegetables very rare ly poisonous. Murder, suicide, medicinal and oeeonomic poisoning ; mainly accidents. 1.0 grm. of potassium acid ehromate; much more of the salts of the oxlds. 10.0 grms. of the sulfate or acetate should be sufQcient. 7.6 grms. zinc sulfate; 6.0 grms. zinc chlorid. Local corrosion and Inflamma- tory action at places where voided, e.g., in kidneys andmu- cous lining of intestines; for- mation of met-heemoglobin by means of the acid and acid- salts ; grave impairment of the central-nervous system. Strong corrosion of the first passages mainly by vitriol; formation of met-hsemoglo- bin; marked effect upon the central nervous system ; par- alysis of the musculature ; dis- charge of copper by the glands of the intestines, saliva, bile, urine, and skin. Same as copper, only zinc less poisonous and has more of a sedative action on the nervous system; voided main- ly by the glands of the sto- mach; only sparingly of ac- cumulative action. Acute Poisoning: The swollen and ulcerated mucous lining of the mouth is at first colored yellowish-red, afterward blu- ish-green ; bluish-green to yel- low vomit ; violent colic ; thin, bloody stools ; thready pulse ; scanty urine containing albu- min. Gkronic Poisoning: In case of handling dusting chromates. ulcerations of the hands, arms, penis, septum of nose; bron- chitis, conjunctivitis, and ne- phritis. Aoute Poisoning ; Green scabs in mouth, green vomit, abom- inable metallic taste, saliva- tion, sensitiveness and infla- tion of abdomen, brownish- red diarrhoea, small pulse, skin cold, icterus, paresis of limbs, collapse. Chronic Poisoning : Pale-green appearance, copper -edge on teeth, copper-colic, catarrh of stomach and intestines, mar- asmus, copper-paralyses (?). Acute Poisoning: Mucous lin- ing of mouth bloody or white and wrinkled; strong metallic taste; salivation; vomit whit- ish, later of blood - color, mainly after ZnOla ; diarrhoea of coffee-brown color; general debility, vertigo, cramps in calves of legs, cold perspira- tion. Chronic Poisoning : Catarrh of stomach and intestines, fever of . brass - founders, chills, pains in back, weakness of muscles, pains in forehead, perspiration, gradual con- valescence. Characteristic discoloration of the mouth in acute cases ; ul- ceration of septum of nose and skin in chronic ones. Characteristic discoloration of mouth and vomit, and in chronic cases of hair and skin. We must determine the pre- sence of a colorless metallic poison which is neither mer- cury, silver, nor lead. Washing of stomach with so- dium bi-earbonate ; internally, magnesium carbonate or plumbic acetate. Washing of the stomach with potassium f erro-cyanid ; in- ternally, albumin, milk, mag- nesium oxid ; later on, Turk- ish and Russian baths, and electricity. Same as with copper ; in ad- dition, tannin and alkaline phosphates. Mucous lining of mouth swol- len, ulcerated and discolored. Mucous lining of stomach ee- chymosed and ulcerated, as also those of small and mainly of large Intestine; fatty de- feneratlon of liver and heart; idneys show exudates and necrosis of the epitlielium of the convoluted tubules. In cjironic cases, rhino-necrosis, ulceration of skin and bron- chitis. Gastro-enteritis from mouth to anus ; perforation of stom- ach, small and large intes- tines; greenish mucous lin- ing of intestines, which turns deep-blue when touched with ammonia ; ecchymosis of ser- ous membranes; fatty degen- eration of liver and heart; parenchymatous nephritis ; atrophy of muscles (?). Mucous lining of mouth tan- ned; mucous lining of stom- ach corroded and eeehymos- ed— even detached in shreds ; walls of stomach leather-like ; small intestine hypereemic; soft membranes of the brain ; lungs and kidneys rich in blood, and in severe cases the latter evidence parenchyma- tous inflammation. After Fresenius-Babo, a green liouid, from which ammonium sulfld will put. grayish-blue hydrate, which, when dissolv- ed in alkalies and treated with plumbic peroxid, will give a yellow solution ; decant or fil- ter this, and add acetic acid, which will ppt. plumbic chro- mate of yellow color- Free chromic acid will be reduced by alcohol when heated, turn- ing green. Hydrogen peroxid will give blue coloration sol- uble in ether. After treatment, according to Fresenius-Babo, a liauid is obtained, colored green by cupric chlorid andT turning deep-blue uPou addition of ammonia. (With chromium the green coloration is due to chromic chlorid.) Hydrogen sulfld will ppt. black cupric sulfld, and potassium ferro- cyanid will give a brownish- red ppt. (KOH blue ppt., see page .) The copper is con- tained in the blood, not in the serum, but united with the bsemoglobin. After Fresenius-Babo's treat- ment, we obtain a colorless solution, from which, after preceding neutralization, am- monium sulfld will ppt. white zinc sulfld. Potassium hy- drate and ammonia ppt. white zinc hydrate, soluble in ex- cess. Alkali-carbonates ppt. insoluble zinc carbonate. Potassium ferro - cyanate fpts. white zinc f erro-oy anate. n the blood, zinc is combin- ed with the hssmoglobin. 98 TABLE OF INTOXICATIONS CAUSED BY TIN. JjTHAD SOUKOE, The soluble salts formed from metallic tin in preserve-cans. In former times, occasionally stannic ohlorid (SnCU) con- tained in spiritus fumans Li- bavii. Only sugar of lead has actually to be considered as a corrosive compound ; generally we have to deal with the non-caustic oxid, viz.: litharge PbO; minium PbsO«; with white lead, plumbic chromate, or water or food containing lead, and with lead sub- aoetate. Stat. Genuine, pure tin-poisoning rare. Mortality very rare. To-day one of the most common intoxioations ; formerly, however, yet more frequent. Fatal cases now very rare. Mortality now very low. .fflTIO. Generally from partaking of canned vegetables, etc. Partaking of water that has stood in lead-pipes for a long time; sometimes in wine and food: toys containing lead; handling leaden objects (plumbers, lead-burners, and painters). Toys. Lead sub-acetate [PWCaHaOzh+aPbO] solutions, more than 20.0 gms. ; sugar of lead, plumbic acetate [Pb(C2H302)2+8H201. more than 60 gms. Dos. LET, Act. Unknown, but very high ; only one fatal case so far. Cauterization only through stannic chlorid; paralysis of the central-nervous system; Eareses and paralyses; voided y the inflamed mucous lining of the intestines; development very slow; deposits of tin In the brain, marrow, liver, kid- neys and muscles. Metal-tan at place of application, but only after large doses. After resorption, as observed in ani- mals, excitation; and with man, paralyses of the central-nervous system, alimentation damaged, tetanic contractions of intestines, ample deposit of uric acid in kidneys, atrophy of muscles. Develop- ment very chronic ; deposit of lead in many organs ; voided by the glands of the intestines, kidneys, skin, saliva, and milk. Stmpt. Gastro-enteritis, purging and vomiting, marasmus, chronic catarrh of stomach and intes- tines, pareses of muscles, at- axia, impaired muscular sense, urine contains albu- min. In case of severe acute poisoning, salivation, metal- lic taste, lead-border on teeth, whitish-gray colora- tion of the mouth, spasms of the stomach, abdom- inal colic, constipation, perspiration, formication, pulse hard and much retarded, anEBsthesia, stupor, unconsciousness, paralysis of the extremities (wrist drop) ; with animals, spasms and raving mania. In chronio cases, disturbances in general, colic, arth- algia, auEBSthesia, amblyopia, amauroses, delirium, eclampsia, paralyses of the extensors (Kadialis), gouty kidneys. ^^^^^^^ DiAGN. By anamnesia. Colic with constipation, retardation of pulse, lead- edge on teeth, paralysis of the extensors (Badialis). Thee. Hot baths; avoiding of any- thing containing tin and of tin-lined vessels containing acid food. Empty at once tin preserve-cans. In aaute cases, sodium- or magnesium sulfate, al- bumin, milk. In chronio cases, potassium iodid, hot baths, electricity ; in case of colic, atropin hy- podermioally, as well as large doses of olive-oil and opium internally. Prophylactic treatment very important. P.-Mtm. No autopsy on man. Chronio state of excitation of mucous lining of stomach and intes- tines; grayish-brown colora- tion m the neighborhood of the lleo-CEecal valve ; swelling of the follicles. Cauterization of the intestinal tract very rare; diminution of the elasticity of the walls of the ar- teries in consequence of alteration of the endothe- lium and of the musculature ; atrophy of the ex- tensors of the lower part of the arm, and, inde- pendently of this, of their nerves. Kidneys con- tracted and gritty from urates; formation of vacuoles and turbid swelling of the parenchyma of the liver and many other organs ; accumulation of serous fluid under the membranes of the brain and spinal cord. Detect. Tin is obtained together with antimony and arsenic in the ppt. with H2S of the liquid ob- tained, according to Tresen- ius-Babo. The leather-yellow stannous sulfld is soluble in ammonium sulfld and in al- kaline sulflds, but Insoluble in ammonia. Potassium cy- anid reduces tin compounds when heated, without vola- tilization. From dilute gold- solution, stannous chlorid will ppt. Cassius purple of gold. Treatment according to Fresenius-Babo, but filter while boiling - hot. The filtrate will deposit, when cool, plumbic ohlorid; HzS will ppt. black plumbic sulfld ; H2SO4 ppts. white plumbic sulfate ; HCl ppts. plumbic ohlorid, insoluble In ammonia and not changed by it In color. Before the blow- pipe with soda, in reduction-flame, metallic lead is formed. Yellow potassium ferro-cyanid ppts. plum- bio ferro-cyanid which Is white. The presence of the metal has been proved in the bones, kidneys, liver, spinal cord, brain, linings of the Intestines, and muscles of the heart. Even during the life of the patient, lead will sometimes be proved to exist in the urine and fasces and upon the skin. Urine and fasces must be previously destroyed. The skin will turn black when treated with ammonium sulfld. TIN, LEAD, BISMUTH AND PHOSPHORUS. 99 BISMUTH. Bismuth sub-nitrate; bismuth citrate with ammonium ci- trate. In the last decade a little more freauent than formerly; gen- erally rare; mortality very low. PHOSPHOBUS. Only the non-oxidized, free yellow phosphorus and phosphin (PHaor P2H4)are to be considered. The oxygen compounds of phosphorus are non-poisonous, therefore also phosphorous acid often found in the corpse, phosphoretted oil, phosphorus- matches, phosphorus-salves, are of strong action ; red phos- phorus acts but to a trifling extent. Until lately a very freauent intoxication, which, e.g., in Prance, formed 33 p.o. of all poisoning cases ; mortality, 65 p.e. Used in surgical dressings, in- ternally for summer com- plaints of children and others. Manufacture of phosphorus and phosphorus-matches ; mur- der, suicide, abortion, accidents. Unknown, but very large; only a few fatal oases on record. Even .05 gms. may prove fatal after internal application. The amount of vapor necessary to cause necrosis of the jaw is stiU unknown. Cauterization of the mouth scarcely present, but there is inflammation of the mouth and inflammation of the colon by voidin g of the bismuth ; ne- rfiritis, from the same cause. With animals, spasms' anala- gous to lead -spasms; with man, paralyses. Voiding also by the milk. Very slow, since resorption is slow ; local excitation may be absent ; grave disturbauces of metabolism ; degeneration of the body-albumin to fat, leuoin, tyrosin, sarcolaetie acid, and phosphorus-bases. Multiple hsemorrhages by degeneration of the vessels ; very pronounced icterus ; fatty infiltration and degeneration of the liver, later cirrhosis ; fatty degeneration of the kidneys and heart ; in ease of the kidneys, ending with shrivelling. The inhaled vapor will produce ostitis and necrosis of the jaw, particularly when the teeth are ulcerated. Stomatitis and black discolor- ation of the gums, glossitis, catarrh and ulceration mainly of the large intestine, albu- minuria. If introduced into the pleura, pleuritis ; into the cavity of the abdomen, peri- tonitis. Vomiting of matter of an odor of garlic and luminous in the dark ; then for two days, euphoria, then icterus ; pain ia the stomach ; vomiting of masses containing bile and blood ; sensitiveness of the abdomen ; increase of liver-dullness ; tha breath is luminous in the dark ; hsemorrhages of nose, uterus, etc., and into the skin eoohymoses ; headache, somnolence, fever, small, rapid pulse ; renewed vomiting of dark bloody masses; coma, death. In the urine, biliary matters, fat, blood, leucin, tyrosin. lactic acid, bases containing phospho- rus, and casts. Discoloration of the mouth and inflammation character- istic. The odor and luminosity of the vomit, icterus, hasmorrhagea into the skin and urinary tests insure diagnosis. Iron saocharate for counter- acting H2S in intestine ; aaue- ous diuretics ; potassium chlorate for a gargle; use of baths of unknown effect. Cupric sulfate as an emetic; washing of the stomach with potassium permanganate in solutions of 0.6 p.o. or with hydro- gen peroxid ; give several times a day one or two capsules containing 1.0 gm. of old oil of turpentine ; alkaline drinks to increase the alkalesceney of the blood ; transfusion and wash- ing of the organism with solutions containing common salt, sugar, and soda. State of mouth similar to mer- cury; large intestine black and ulcerated; microscopic- ally, brownish-black granules of bismuthlo sulfld are found in the vessels of the mucous lining; stomach and small intestines but little inflamed. The highest degree of icterus of the skin, the solera, and all inner parts ; multiple hsemorrhages into the skin and into the organs most varyingly, in particular underneath the pleura : in the stomach, gastro-adenltis, which freauently extends into the duodenum; catarrh of the bile-ducts; liver in the beginning greatly enlarged, soft as butter and of a saffron- color and very fatty, later on small; all cells are filled with drops of fat ; the microscopic finding of the kidney is similar. Muscles of the heart and skeleton show fatty degeneration. The capillaries of the cortex of the brain show fatty degener- ation. T^hejaAvshowsnew-formation^n)^^ Liquid obtained according to Fresenius-Babo will allow the bismuth to be pptd. as brown sulfld, insoluble in ammonium sulfld, but soluble in cone. HCl or in HNOa. It the liauid be cautiously evap- orated and then poured into much water, there will be a white ppt of BiOCl. The chlorid is soluble in alcohol and will not ppt. on addition of H2SO4; the aaueous solu- tion will be pptd. by alkalies ; this ppt. is insoluble in KOH. It is questionable whether or not there are other black com- pounds besides bismuthlo sulfld present in the intestinal mucous-coat. The organic masses are acidulated with H2SO4 and heated ia a flask supplied with descending condenser (Mitcherlioh's ap- paratus). Phosphorus passes over with the aqueous vapor, and is luminous in the dark, provided that alcohol, ether, oil of turpentine, cupric sulfate, and hydrogen peroxid, etc., are absent. Argentic nitrate-paper will be blackened by vapors of phosphorus, but not so plumbic acetate-paper. Hydrogen developed from zinc and HCl in the presence of phosphorua contains phosphin, and will burn with a green flame. In a. solution of argentic nitrate, phosphin will cause a black ppt. of argentic phosphid. It is also practical to extract the parts of the cadaver with a mixture of carbon di-sulfld and ether- alcohol. Then add copper-turnings to the extract, upon. which cupric phosphid will deposit. On taking out the copper, washing well and treating with Zn and H2SO4, phosphin will generate. Phosphin may Do formed from phosphorous acid in the same manner as from phosphorus, by means of Zn and HCl. It has never yet been observed that from corpses of ther non-poisoned, under the influence of cadaver-bacteria, phos-. phin had formed from phosphorus-compounds normally pre.*, sent in the body. . 100 SPECIAL TOXICOLOGY. All substances belonging to the acria have in common th& following action : They produce, in the first place, a dilatation of the vessels of the skin, of the mucous membranes (especially in the intestinal canal), and of the subcutaneous connective tissue. This then causes hypersemia, manifested by reddening, swelling, and elevation of temperature on the part of the body concerned. The process may stop there and retrocede without having been actually detrimental. But if the irritating action of the poison extends further, coagulable serum, viz., so-called plasma, will exude from the capillaries, the direct result of which is an excessive engorgement of the lymphatics by the normal alimentary liquid of the tissue. Thus oedema is produced. The plasma by coagulation, may separate fibrin. Soon after exudation of the plasma, as a rule, a stage of emigration of leucocytes follows. The artificial production of this passage of leucocytes as observed under the microscope, in the tongue or the mesentery of the frog, or in the mesentery of all warm- blooded animals alike, we call Cohnheim's experiment. This experiment is of great significance in pharmacology, because there exist not only numerous substances which, just like the acria, favor its perfection, but reversedly, others as, e. g., quinin, which prevent the emigration of leucocytes. It is of additional importance to know that in case of inflammation, besides the leucocytes, red blood-corpuscles, although in much smaller number, also pass through the walls of the vessels ; this occuring, as a rule, at points where leuco- cytes had previously made their egress, through the orifices in the walls of the vessels between the endothelial cells, viz., the so-called stomata or stigmata of the cement-substance. This diapedesis of the moveless red blood-corpuscles fol- lows much more abundantly in case of venous engorgement as when inflammation is present. This proves that the mere filtration-pressure is indeed capable of forcing soft lumps of protoplasm through the endothelium. We may suppose, therefore, that in case of inflammation, also a favoring action for the passage of leucocytes is to be attributed to the blood- pressufe. However, the significance of this factor is materially les~ SPECIAL TOXICOLOGY. 101 sened in the case of inflammation, as here the pressure in the vessels concerned is more frequently reduced than increased. Under these conditions another factor obtains which is suited to much more than compensate for the reduction of the blood- pressure, viz., a greater penetrability of the walls of the ves- sels. The explanation of this process is to be found in the fact that when inflammation is present, the serrated and tortuous lines of the cement-substance between the endo- thelial cells of the vessels are broadened,- and the stomata contained in them enlarged and increased in number, thus allowing dissolved colloids to pass out. It seems that this change is explained in a purely physical manner by the dilatation of the tubes of the endothelial intima, following of necessity upon the increased caliber of the vessel as a whole. After the retardation of the blood-current had been perfected by the cause of the inflammatory process acting upon the walls of the vessel, and widening its lumen, then the wall whose repose depends upon adherence of the liquid, will be exten- ded ; into this the leucocytes are pushed, because of the small amount of vis viva which they possess. They are, so to say, pushed aside by the red blood-corpuscles, and accumulate more and more in the layer which is in relative repose. This is the stage of edge-layer formation. The leucocytes, in contact with the wall of the vessel, now changed by the agency causing the inflammation, are induced loj this same agency, acting in a che mo-tactile manner, to abandon the globular form, their form of rest, and to emigrate by amoeboid movement towards the chemo-tactile centre. In consonance with or after the passage of the leucocytes, an exudation of plasma may occur, which soon coagulates to fibrin. This, however, is immaterial since the now following histolysis, viz., the envelopment by pus, emanating from the leucocytes of smaller or larger parts of tissue, redissolves the fibrin. We can perhaps best comprehend this liquefaction- process by assuming thst a digesting enzyme is furnished by "the leucocytes to the surrounding bodies ; this is then sup- posed to change them into propeptones (albumoses), liquefying them at the same time. In fact, pus will always give the peptone-reaction, which, however, is also peculiar to the 102 SPECIAL TOXICOLOGY. albumoses. It is not proven that genuine peptone is formed in this case. The histolytic process need not of necessity dissolve uniformly the whole piece of tissue affected by the excitating agent ; it mainly concerns the circumference, while the central part, where the action was most intense, will become necrotic and isolated, and, if possible, eventually breaking through the skin, be thrown off. All of the occurren- ces thus far discussed are together called, according to old tradition, "inflammation." Preferably this aseptic inflamma- tion changes into a bacterial one, since enzymes, which may happen to be in the blood or in the neighborhood of the centre of attack, will be attracted by this process of disease, and will greatly multiply in this disturbed seat. Thus it happens that the physician never witnesses an aseptic inflammation proper. The difference in appearance of an inflamed central seat without bacteria, and one with bacteria, is to be found in the number of leucocytes ; as soon as the enzymes step in, the emigration of the leucocytes increases as well as the histolysis which they cause. We have now to consider as a particular kind of inflam- mation, that which is achieved by coagulation of blood and lymph ; this is the case, e. g., in the wall of the stomach when there exists intoxication by acids. Some poisons, as ahrin and ricin, bring about such a coagulation of vessels exclusively, without simultaneous cauterization. In conclusion, we note that a part of the body may become hypersemic to such a degree, that in the very beginning a genuine inflammation is simulated, but from this under certain conditions, the true inflammatory process later on really follows. This may occur in a purely nervous manner by paralysis of the vasomotor governing a given locality. This holds true mainly for the intestinal canal, with poisons which paralyze the splanchnic nerves, as, e. g., snake-poison. A. A. — ANIMAL POISONS. (TABLE, PAGES 106-107.) Experiments with chemically pure, exactly analyzed sub- stances have been perfected only with cantharidin, which is the anhydrid of cantharidic acid of analogous action. In toad- poison, we have to deal with a mixture of carfi^/Zamm-substan- SPECIAL TOXICOLOGY. 103 ces, to which reference will be made later, with phrynin. This latter most interests us here, but chemically it is still awaiting research. For the garlic-toad, still another substance of an alliaceous odor, is to be considered. The toad-poison is contained not only in the secretion of the poison-glands, but also in the blood. The samandarin or salamandrin, of fhejire- salamander has an alkaloidal character; it is a violent local excitant and kills under tetanic convulsions similar to strych- nin. The poison of the water-salamander, triton cristatus, is not identical with the foregoing, but it also causes very pronounced excitation. The poison of scorpions (huthus, scorpio, euscorpius) is of action similar to the preceding ones, but it is of albumin- ous nature. The genuine spiders possess, just as the animals mentioned above, genuine poison-glands, while these are missing in the pseudo- spiders, which, however, produce an excitating saliva. The genuine spiders may contain the poison, aside from the poison-gland, in the juices of all other parts of the body. This is particularly true of the diadem-spider, whose poison from its poison-gland acts less strongly than that of the body-juice. All spider-poisons are toxalbumins which are to a greater extent digested within the stomach of warm- blooded animals, while they possess a terrible action when starting from the blood or the subcutaneous connective tissue. However, it is said of dogs that they will partially void through the mucous lining of the stomach, snahe-poison, begin- ning from within the blood-circulation. By the iexTO. fish-poison, used in a wider sense, we understand not only the poison produced by certain fish in a state of health, but also such toxic products as generate in diseased or rotten fish. We shall here discuss only the first-named, which, however is subdivi- ded into two classes : (1) Some fish possess genuine poison- glands which are in connection with thorny fins, while (2) others carry the poison in a form not available against themselves, within the blood {ed-poison), or produce it within the genitals {fugu-poison). The action of the latter starts from the intesti- nal canal of man, even if the fish had been partaken of in a boiled state. Toxicologically, the most important animal poison is snaJce-poison, of which there exist many kinds. Some of them are not rendered wholly inocuous by boiling for a 104 SPECIAL TOXICOLOGY. short time, and most kinds produce both local and remote marked effects. B. B. — VEGETABLE POISONS. (TABLE, PP. 108-110.) The great majority of the numerous pertaining vegetable poisons are mainly of local action. In regard to up-to-date chemical research, this branch of our subject is as defective as that of the animal poisons ; consequently we must not be sur- prised to learn that satisfactory experiments also are unfortun- ately missing. But the practicing country-physician is inter- ested in these poisons, because it is not a rare thing for him to see light and more severe intoxications caused by them in children, and in domestic animals. Therapy is generally of one kind. It consists in ridding the stomach of the poison and in administering cooling and mucilaginous drinks. In case of external intoxication, ice-compresses are indicated. Many of the poisonous plants in question share in commoE the feature that on drying, they either partly or wholly los» their toxic quality, and consequently render experimenta- tion with these poisons a difficult matter. Did not space forbid it, we might greatly increase the number of substances contained in the following tables by enumerating all of the spices as well as the drastica. So it may at least suffice to mention these two classes of substances. Finally, the so-called sopojim-substances belong in a certain sense in this place. It is true that they are not excitants of the epidermis, yet producing violent effects upon mucous membranes, causing conjunctivitis and keratitis with the eye, acute nasal coryza with accompanying sneezing, and watery secretion, and furthermore, gastroenteritis. But in so much as all of these saponin-substances possess in addition still another, quite peculiar, action upon the blood, it would seem more suitable, in order not to excessively increase the number of vegetable poisons, to briefly mention them here, enumera>. ting and discussing them more in detail when we are consid- ering the blood-poisons. The last table mentions three kinds of intoxication, markedly varying from those of the preceding one, the charac- teristic feature consisting in anatomical changes not of the alimentary tract, but of other organs, above all in the nervous system. We thus conclude the series of vegetable poisons, SPECIAL TOXICOLOGY. 105 whicli cause gross anatomical changes, and stop to merely mention the excitating enzymes of the micro-organisms, e. g., streptococcus. 0. 0. — ^AETIPICIALLY PBEPABED POISONS. The large number of existing artificially prepared substan- ces which cause anatomical changes, have but small interest for the practicing physician. We enumerate : chrysoidin, malachite-green, Bismarck-brown, fast yellow, wasserblau, fast blue, spritblau, methylene-blue, Victoria-blue, neublau, methyl- violet, gentian-violet. These are said to cause local manifes- tations of excitation and other phenomena of intoxication in workmen handling them for some time, and with animals after much dosing. When considering the blood-poisons we shall mention a few other dye-stuffs. B. — BLOOD-POISONS. (TABLES, PP. 113, 115, 118.) It is impossible to understand the protean action of poisons of this group before having elucidated their behavior with reference to the blood. In frcuxi this is hardly ever the sole change which they cause, but it is the one which may be readily studied extra corpus and which strikes the keynote for the understanding of most of the other actions. We here present an abstract of the gross anatomical changes of the blood, caused by corrosive acids, alkalies and caustic salts. The poisons here discussed and considered in their action eodra corpus, do not act upon the serum but solely upon the corpuscles. Every one of these actions upon the blood may therefore be studied on red blood-corpuscles suspended in phy- siological sodium chlorid-solution. However, the manner of action differs. A first group of blood poisons changes the phy- sical condition of the red corpuscles in such a manner as to render them gummy, so that on mutual contact they will stick to each other and form lumps having the appearance of red sealing-wax. These clog up the vessels and thus cause the grav- est disturbances of blood-circulaljion. We will only mention one of these poisons, ridn, contained in the seeds of ricinus com- munis, (euphorhiaceae). We find, on taking castor-beans inter- nally, or the pressed cakes of castor-beans, since the castor-oil does not participate in this action, that an indeterminable amount of ricin, of albuminoid character, is deprived of its 106 TABLE OP INTOXICATIONS CAUSED BY OANTHAEIDIN. TOAD-POISON. AOULEiTai-POISON. SOUBCE. Lytta vesloatoria L., oanthari- des, Spanish fly; Meloe pros- earabEBus L., Meloe majalis L., Mylabris, Cantharis. Our Lytta does not contain above 0.6 P.O. cantharidin ; the Ar- gentinian, 2.6 p.e. ; the differ- ent Icinds of Mylabris of the trade, l.o p.e,; the different Meloes much less. Emplas- trum cantharidum, tlnot. can- tharidum, potassium canthar- idate. Bufo cinereus L., common toad; Bufocalamita.cross- toad; Bufo viridis Laur., green Italian toad; Pipa. Pelobates fuscus, garlic- toad ; Bombinator igneus, Alytes obstetrieans. Juice of poisonous glands. Apis melllflca L., honey bee ; Xylooopa violaoea Pabr., wood-bee; Bom- bus hortorum, and B. lapidarius, bumble-bee ; Vespa vulgaris L., wasp; T. crabro, hornet; Por- miea rufa, forest ant; Formica herculanea; Ponera; Myrmica; At- tus ferox; Culex, gnat; Tabanus, gad-fly (horse fly). Stat. Tardieu quotes 23 oases in 12 years; now rarer. Mortality great. Only slight external in- toxications are known. Known isolated fatal oases in man and the horse. ^TIO. Murder, suicide, quack prac- tice, medicinal poisoning, mis- take. On touching the animals, secretion may come in con- tact with the human skin, eye, nose or mouth. Attack by a swarm; emptyins of a bee-hive ; irritating the animals. DOS.LET. 1.5 freshly powdered canthari- des ; 30.0 tincture; 15.0 plaster. Unknown, and not the same in all species of toads. Unknown, and varying with the different spe- cies of animals. Act. Strongest local excitation at the place of application and where voided (kidneys). Priap- ism. Excitating action upon brain and spinal cord. Severe local excitation. After resorption, the heart and vessels are influenced in a manner simulating the action of digitalin. Strong local irritation around the stung point, in which the sting fre- quently remains. Btmpt. Skin blisters; internally burn- ing and blistering in mouth; difficulty of swallowing; sali- vation; vomiting and bloody stools; violent pains in kid- neys and urethra ; urine very scant, containing albumin and blood. Burning and itching.main- ly of the mucous mem- branes ; conjunctivitis ; ke- ratitis; swelling of the nose ; inflammation of mouth ; retardation of pulse; increased blood- pressure; nausea, vomit- ing, diarrhoea. Reddening, swelling, burning, itching, extra- vasation, collateral oed- ema; fainting, delirium, vomiting, aphonia, ur- ticaria. The tempera- ture of the body may rise or fall. DiAGN. Formation of blisters and presence of green particles of the elytra. The handling of squirting toads. The presence of the animals or of the re- maining sting. Thee. Repeated energetic washing of stomach. Internally, muci- laginous drinks with addition of opium. Cupping near the kidneys. Warm, protracted sitz- baths. Avoid oily inter- nal medicines. Local cooling by means of ice. Cooain. The injured eyes must be treated by a specialist. Local cooling by means of moist earth, scraped or sliced raw potato, cold water, ice, touch- ing with ammonia. No scratching permissible. Cooain, P.-Mtm. Gastroenteritis heemorrha- giea, particularly also of duo- denum ; glomerulo-nephritis ; congestion and eechymosis of ureters, of bladder and of urethra. The contents of the blisters is serous. Accounts referring to man are not recorded. Leu- coma, in the eye. The skin of the lips is exfoliated. With frogs, the heart stands still In systole. Inflammation of skin from slighthest to se- verest degree, with par- tial gangrsene and sup- puration. Nothing de- finite known about changes of inner organs. Detect. In case powders or plasters had been used, the finding of green particles is diagnostic. To prove the presence of can- tharidin, boil with KOH, form- ing potassium cantharidate, acidulate with H2SO4, and shake with chloroform. The residue of evaporation is dis- solved in formic acid, and, on again evaporating, doubly-re- fraetive crystals are formed, which, dissolved In oil, blister the skin. Imperfectly investigated. Evidently we have to do with a mixture of sub- stances, of which phrynin is a volatile base. The car- bylamin substances may be distilled off. It is ques- tionable if toxalbumins are present, but this seems to be very likely. In regard to formic acid see page . In addi- tion, there evidently ex- ists an enzyme respon- sible for the main ac- tion , b ut which is chemi- cally absolutely un- known. In addition, undeoan is present, which is volatile. It is questionable whether formic acid is to be found in the urine. THE MOST IMPOETANT ANIMAL-POISONS. 107 SPIDEB-POISON. FISH-POISON. SNAKE-POISON. Lyoosa tarantula, genuine tar- antula ; Trochosa singoriensis, Bussian tarantula ; Oteniza sarmentaria ; Ohiracanthium nutrix; Epeira diadema L., diadem- spider ; Lathrodeotes tredeeimguttatus (Malmign- atte); Lathrodeotes lugubris; (Karakurte) or black spider; Galeodes araneoldes (Solpuge or Phalange). Trachinus draco It., Serranus Scriba. Trachinus -^ipera L., Bynaneeia braohio, Cottus Scorpio, Thalassophryne reti- culata, MurnEena Helena, Scorpaena, Stomia boa, Tetro- don, PugTi, Anguilla, Eel, Con- ger, Fetromyzou, Lamprey, Vipera berns ; Pellas pres- ter, black variety ; Vipera am- modytes; Tipera Eedil; Cro- talus durissimus and horri- dus, rattle-snake; Naja tri- pudlaus; Naja haje; Felamys. The bite of Lathrodeotes has killed a number of human beings' and thousands of do- .mestie animals. Fatal cases have only occurred with any frequency after eat- ing Tetrodon, mainly in Japan. Very frequent in India. The data in regard to mortality in Germany varies between 2.8 and 25 P.O. Bite received -vrhile sleeping, or when marching barefooted over the steppe ; irritating the spiders. In some cases the hands are i nj ured by handling the thorny animals; otherwise internal intoxication after eatine. Always bites, mostly into naked hands or feet. Of the poison of lathrodeotes, enumeration by milligrams suffices if the capillaries are invaded. The fresh blood of 0.6 kgr. eels acted almost fatally; for the other flsh the dose is un- known. According to experiments on animals, the fatal dose is very small, to be expressed only in milligramms. No local action at all with lath- rodeotes, but paralysis of cen- tral-nervous system ard for- midable pains. With all other spiders, inflammation, begin- ning at the bitten point. Partly analogous to the pois- ons of aculeatffi and spiders. The genitals of tetrodon con- tainalocally excitating poison similar to curare. Fresh blood of the eel and lamprey causes vomiting and purging. Varies according to the spe- cies in question. Generally local hsemorrhagie inflamma- tion ensues; dilatation of vessels and central paralysis. The bites of different species produce local changes of vary- ing intensity, generally analo- gous to those discussed with the aeuleatEe. Lathrodeotes causes screaming with the pain, this latter not being local. Paralyses enduring for months. Easy, in case the spider is found ; otherwise very diflcult. Corresponding to the just- mentioned difference* vary- ing action, viz., inflammation of skin, gastro-enteritis, par- alysis, spasms. Neither my- driasis nor general exanthe- ma are symptoms observed in consequence of handling or partaking of the mentioned species. The bitten part swells, be- comes painful and assumes a bluish color. Then the whole extremity swells and is cover- ed with heemorrhages into the skin. Next the trunk is attacked; paralysis, suffoca- tion and death, generally with inflation of abdomen. Only possible if the flsh in question is at hand. The local phenomena and the impressions made by the teeth leave no doubt. For bites of the ordinary spi- ders, just as with the iniuries received by aculeatse; for those of Lathrodeotes, hot baths and internally o_pium. A popular remedy against the bites of all spiders is: spiders crushed in oil. Purely symptomatic. Thorny flsh must not be handled ; new strange flsh should not be eaten. Ligating of the extremity and immobilization. Suck out, cauterize or cut out; potas- sium permanganate; locally, chromic acid; internally, al- cohol, ammonia ; hypoder- mically, strychnin. Washing of stomach. Many fanciful and unique expedients pecu- liar to different localities— all of doubtful value. For the ordinary spiders, in- flammation of skin, same as with aouleatas; for lathrodeo- tes. sometimes extensive co- agulation of vessels. Inflammation of the injured parts of skin. Heemorrhagio gastro - enteritis. The ab- dominal veins surcharged with blood. Bapid putrefaction of the dark- blue -colored corpse. Around the bitten point exu- dation of serum and blood; red-colored, serous extrava- sations into the cavities of the-' body; multiple haamorrhages; mucous coat of intestines impregnated with blood. With lathrodeotes, we have to dealwith a toxalbumin, which loses its activity even when treated with alcohol ; it has no special chemical reactions ; it is found in every part of the body of the spider. With the others we have to do with the secretion of the poison-glands and salivary gland.=, which have never yet been chemical- ly approached. We possess some chemical knowledge only of one poison of Fugu and one of Eel (ich- thyotoxin) ; the locally excita- ting substances and tests for these are entirely unknown. Here we have evidently to do with enzymes. In case of the so-called barbel-cholpra pro- duced by eatine barbel, pto- maines are possibly the cause. We generally have to do with a mixture of toxalbuminp, from which basic complexes are easily split oft. Spedfle reactions are missing. The poison is contained in the gland corresponding to the parotid, which only extends beyond the head with cau.sus rhombeatus and with callo- phis. Evidently the poison of different groups of snakes is not identical. 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Another part will be resorbed, causing coagulations, hsemorrhages and ulcers in the vessels of the intestinal mucous coat. The number of people who have thus fallen sick or died is not insignificant. The pretty colored castor-beans ripening in the garden are particularly attractive for children, who will put them into their mouths. A second group of blood poisons either dissolves the red blood- corpuscles or extracts the coloring matter thereof. A portion of this dissolved coloring matter, non-poisonous in itself, will be retained within the liver, and partly transformed into bile coloring-matter, provided it is small in quantity. But if the amount of dissolved corpuscles is large, a part of the haemoglo- bin will be transformed into met-hsemoglobin, the alkalescence of the blood will be considerably reduced, and within the kidneys a mixture of haemoglobin and met-hasmoglobin will be secreted with the urine. Under these conditions cylinders of haemoglobin and met-haemoglobin are easily formed within the kidneys, which will clog up the convoluted tubes, Henle's loops being mainly affected. It may also happen that a part of the haemoglobin is temporarily deposited in the spleen, the lymphatic glands and the spinal-cord. The stroma of the blood-corpuscles, which had been partly extracted, partly dissolved, not only causes embolism of the capillaries, but it increases the disposition of the blood to form coagula, and clogs the vessels of the intestinal follicles and of the parenchyma of the kidneys by thrombosis. It is of no import- ance whether or not these poisons are, in addition, of specific action upon the nerves. The following table, which contains only vegetable poisons, mainly a number of the so-called sopomVsubstances (Nos. 3 to 11), might easily be enlarged; the common horse-chestnut, for example, contains such a substance. PJiaUin (No. 1.), is a toxalbumin, which is partly resorbed in an active form by the intestinal canal, after par- taking of sufficient quantities of fresh toad-stools ; many fatal cases are on record. Solanin (No. 9.), is located directly underneath the skin of the potato and will be removed with this. On boiling potatoes it is partly dissolved, which explains the fact that occasionally small animals, mainly poultry, fall sick from potato-water. GENERAL TOXICOLOGY. 113 TABLE OP THE MOST IMPOETANT POISONS WHICH DISSOLVE BLOOD- COEPUSCLES. No. NAME OF POISON. PLANT FURNISHING IT FAMILY. ACTION. 1 jehailin. Amanita phalloides Fr. ,and its numerous varieties, e. g., A. mappa, Am. viridis, Am. citrina. Fungi. Some length of time after partaking vom- iting and purging, prostatation, cold per- spiration, delirium, cyanosis. Post-mor- tem appearance like phosphorus. 2 Helvellaic acid. Helvella esculenta Pars., while Moroh- ella esculenta seems to be non-poisonous. A distinct species by the name of HelveUa Buspecta does not exist. Id. After some time, nau- sea, vomiting, icter- us, somnolence. The convoluted urinary tubes filled with hae- moglobin - cylinders; urine contains hsemo- globin, met - haemo- globin, bile pigment. 8 Qnillaic ac- id and sa- potoxin. Quillaja Saponaria. The bark contains both poisons, which are very similar to each other and of glycosidic nature. Rosaceae. Haemoglobinuria, in- flammation of intes- tines, dislocation of kidneys, only after direct introduction into the blood of ani- mals. Internally, ex- citation of the ali- mentary canal. 4 Senegin and poly- galaic acid. Polygala senega, and some American spe- cies closely related to it. The bark of the root is the pois- onous part. Rubiacese. Same as Quillaja. With man, after in- ternal application; expectoration, vomit- ing, diarrhoea. 5 Paridin. Paris quadrifolia. LiliacesB. Vomiting and purg- ing with man and animals. 6 Saporubrin. Saponaria oiificinalis, common soap-wort. Silenacese. Id. 7 Cyclamin. Cyclamen Europse- um, sow-bread. Primulaceae Id. 8 Agrostem - ma - sapo - toxin. Agrostemma gith- ago, Silenacese. Domestic animals have often been killed by it. Resorbed by the intestines. 9 Solanin. Solanum nigrum, black or common night shade. Sol. Lycopersicum, tom- ato;- Sol. tuberosum, potato. aolanaoese. Excitation of alimen- tary tract in man and animals ; giddiness, staggering, weakness of back. 10 Dulcamar ■ in. Solanum dulcamara, bittersweet. Id. Same as with solanin. 11 Melantliin. Nigella sativa, nut- meg flower. Ranuncula- oeee. Excitation of alimen- tary canal. 114 SPECIAL TOXICOLOGY. Some of the saponin-svibstanoes will not be resorbed at all by the intact mucous coat of the stomach and intestines, e. g., quillaic-acid and sapotoxin, while this does not hold true of others. In case of non-resorption, the action upon the blood will of course not take place, however, when internally applied, there will be excitation of the mucous coat of the alimentary canal. In case the drugs are marketed in a powdered state, as, e. g., quillaja-barh, the dust must be kept away from the eyes, as it inflames them violently. A third group of blood poisons fixes the oxygen of oxy- hsemoglobin in an inseparable manner to hsemoglobin, with or without previous solution of blood-corpuscles. Thus, the tissues not being supplied with oxygen, dyspnoea and even suffocation will follow. We call this modification of the color- ing matter of the blood, remarkable for its sepia-brown color, methcemoglobin. In the spectroscope it is characterized by an absorption-baned in the red part. It is of importance for the physician to know that within the corpse the methcemoglobin will disappear after some days, hcemoglobin being reformed, while the oxygen had been used up for bacterial life. This occurs mainly in summer. Consequently, in suspicious cases, the post-mortem should be held at once, else we cannot expect to find any methsemoglobin at all. The decomposition of the coloring matter of the blood by corrosive poisons, always give rise to the formation of methcemoglobin in addition to hcematin. Between those poisons which merely dissolve the blood-cor. puscles and those forming methcemoglobin, stand the bile-acids and arsin, the action of which gives rise to dissolved hcemo- globin at first, and later on to abundant quantities of methcemx)- globin. A useful antidote for all. the poisons forming methcemoglobin is sodium carbonate, or the so-called sodium sesqiii-carbonate. This transforms the brown methcemoglobin into a red modification called alkaline methcemoglobin which latter allows the organism to transform it with comparative ease into oxy-hcemoglobin. The danger arising from a pos- sible solution of red blood-corpuscles is the same with the poisons belonging to this group, as with those of the preced- ing one. In regard to therapy, in case of intoxications caused by the group now under discussion, it must be remembered SPECIAL TOXICOLOGY. 115 that the formation of methcemoglobin will set in more readily, and develop to a greater excess in proportion to the diminished alkalescence of the blood and the tissue-juices. Always attempt, therefore, to increase the alkalescence, never pre- scribing acid beverages. TABLE OP THE MOST IMPORTANT POISONS CAUSING PEIMARY FORMATION OP MET-H^MOGLOBIN. NO. NAME. ACTION, ETC. 1 Chlorates. Potassium chlorate, in particular, has killed many people. A few grammes are sufficient, as in cases of fever, dyspnoea and of partaking of acid lemonade {e.g. ,of HCl or HaPOi) Icterus, met-hsemoglobinuria, somnolency, ursemia, anemia. The post-mortem will show the blood to be of chocolate-brown color ; the kidneys filled with met-hssmoglobin-cylinders. 3 Pyrogallol or pyro- gallic acid. The mere application of salves of from 5 to 10 p.c. rubbed over the whole body, suffices to cause headache, chills, vomiting, purging, cyanosis, somnolency and met-hsemoglobin- uria. Post-mortem same as above . 3 Chrysarobin. After extreme applications, as in skin affec- tions, the same phenomena as with pyrogallol; in addition, a brownish-red coloration of the skin ; conjunctivitis and swelling of the lym- phatic glands . The urine contains met-hsemo- globin and chrysophanic acid. 4 Hydrazin, phenyl- hydrazin and pyro- din (hydracetin). Chills, vomiting and purging, formation of met-haemoglobin, but after small doses the urine will not have a brown color. 5 Salts of hyroxylamin. Same as with hydrazin. 6 Nitrobenzene or es- sence of mirbane. More than 150 people have so far been recorded poisoned by it. The breath has an odor sug- gestive of bitter almonds ; profound cyanosis ; vomiting; dyspnoea; maxillary spasms; chills; delirium ; mydriasis ; convulsions ; blood of brown color. 7 Nitroglycerol. Inflammation of alimentary canal ; dizziness, dyspnoea, cyanosis, delirium. The poison ia readily absorbed by the skin. 116 SPECIAL TOXICOLOGY. NO. NAME. ACTION, ETC. 8 Amylnitrite, ethyl- nitrite, butylnltrite, isobutylnitrite. Entering most rapidly into the blood in case of inhalations, or if taken internally. Very pronounced dilatation of blood-vessels, and consequent lowering of the blood-pressure and unconsciousness. Blood brownish and of an odor suggestive of apples. 9 Sodium nitrite. Acts as does amylnitrite, but slower and of more persistent duration. Internally applied, inflammation of the gastro-intestinal tract. 10 Dinitronaphthol, Martius-yellow ; po- tassium di - nitro- cresol, saffron -sur- rogate. Both dyes act upon the intestinal tract similar to sodium nitrite, at the same time giving to it a yellow color. The nervous system wi 1 at first be excited, then paralyzed. But little met-hsemoglobin formed. 11 Picric acid and its salts. Excitation of the gastro-intesbinal canal, which is colored yellow^. Intense picrin — icterus ;. urine colored red by Picraminic acid. Picrin- urticaria; delirium, spasms. At the post- mortem all organs are found to be yellow. But little met-hsemoglobin formed. 13 Anilin, toluidin, antl- febrin, exalgin. When inhaled or taken internally, anilin-oil wiU produce deepest cyanosis, caused not only by met-hEemoglobin-formation, but also by the production of anilin-black within the blood. Lowered temperature, chills ; dilated pupils ' coma ; convulsions. Urine of brownish-black color. Antidote is Glauber's salt (?). Washing of organism. 13 Carbondisulfid. After inhalation or when taken internally, headache ; disturbances of vision ; dizziness ; vomiting ; coma. With animals, convulsions in addition. But little hsBmoglobin in the- blood. In chronic cases, psychoses with exci- tation and following depression. A fourth group of blood poisons is represented by prits- sic acid, carbon monoxid and hydrogen sulfid, in so far as tlier& exist combinations of these with the coloring matter of the blood. But only with carbon monoxid is the formation of such a compound called carbon monoxid-hcemoglobin, the main cause of death. With hydrogen sulfid, the formation of sulf-met-hcem- oglobin begins only after the action of the poison upoiL the nerves has proved fatal. With hydrocyanic acid, thera SPECIAL TOXICOLOGY. 117 are even three compounds existing, one with hsemoglobin, viz., Jiydro-cyan-hcemogloUii ; one with met-hsemoglobin, viz., hydro' ■cyan-met-hcemoghbin, and one with hsematin, viz., cyan-hcematiii^ which latter exists only in alkaline solution. With this acid, the poisonous qualities are not discerned in its action upon the ■coloring matter of the blood, but they consist in inhibiting the interchange of oxygen with the protoplasm of the body-tissuea and with the red blood-cells. In contrast to the brown color of met-hsemoglobin, its compound with hydrogen cyanid is of a, beautiful reddish hue, and this fact is utilized as proof of tha presence of both met-hsemoglobin and prussic acid. ^ ■^ g ^ '^ a t?l s s a. o" l- a. p^. s o ig «5 Co s § 1^ Cft "S^ & i^ Oi Co =«S S l«y •ts 3 t§ s. 00 n t-> k CO a- H" I-" to s^ 3- s ^ 3 ^ §J 118 SPECIAL TOXICOLOGY. ■c oE^ „" gi^ §•" I t4 a)'>H cs <3> [»■ ^-.^ > — 'C © s tin 2 (JQ c3 Ho ■OS ® . < ■goM a o c3 a*^ ^^'^ ri on ^ o OS'S ® 5 S 0.2 a a t-o£;a S .9'^ j.a a § s ^f-g ■ . ■S'O " aj rt too -ato.2 (D I -»^ a ^i3 f^ I I r aa»9 Oatsa ■Bo .aSf 2±! mtsa ^ t>i o a*-' a-a'S'^'^ Q a rtca ■u ° t^*^ a l^g-sf So-S S3,rt s^ Ih "^ Kl^ a^^-Sdga'gisS2go.2 i3°. 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O^ ©CD S - 03 £3 fl a 2 "i ™io - 'o o O O CO © w^^jd CO © O Lh rt M- a «^ °'°'S. © rt cn'S-S^ ■ m © cS © ■a^SSa^°tC-aa:z;ag.a ■|.2i? a a o-S a a a.-g §0 § | S^ s O e3 © c3.S 2 c8 ^ '-'K ^ g a-K CO a>.*M ^tH.'^^-a^ a a So 2 csr.OrfSo^o^'O.Soa ^©"^ g-S©Sa§' 5©§S©a^g ir^ © aja © a o a' d'oS 2 8©-3 maM" ma,is^ 2Sg« Oa"M ca "^ oj-i; CO a 2 OS S « o3 © N a g-aS q3a£^ d^a gso 1-s| .2r2 •s-s— - *S Jh 2 d -ht r] 03 fl O O nco > n s- 1 Hi ft SPECIAL TOXICOLOGY. 119 ^a J t< © J © Sg.S'3 ■^ o 11,-goin •3"*^ ti'^ S-H--0 ,&sa>, PhJ CO CQ O^ o S I CJ ffl ' "J) *^ 53 OTd o sSa 0-" °op,g2a§^M ■«fl3 S'S "S.S oHnaSa °g 2S2«=Q ^"gS 43 co,S5.g -.3.0^^ s3:Z°.aSJS.og om'OcnB^ 0-1 a. 2 u o^^ to m*« S ^ tm s§g5^-ag-a| ca a^^ o c g-S b o "2 .S H So oSSmoocd © 03 co.icoMaJ'g O r^ CJ "H 9 S tag cots ---^ l^u .-aa o .S^^al-a agal^a 3 a a « -.a '^ oS bSa 9+J CO gS.3S.2gg o'S °§.S Qo ® ea'y ^ ,«w xj J3 " ca « o * g I ""^ © gl«l""©l>.o _ cow a-" ra a m MH x^S fe °-S a - a-° ag-a-ii^-g H o oi'T; .», c3.t> art rt c rtJ3 'S'2aJS-©o.S°S .* Sa5-'gM3|'g-g^'0.3 I f^ cj (^ .-. rt ™-^ _ ur:i w ■sa2 0M>.35agS„a'-p o r-j 3 O-S ^'::i d) M ©.3 o ■S d-^ fci © o « o>n^ 3 * I0 a.Q.Q t» aj5 o ot3*..S © - P3& V Hra^*;3 3 to CO "o MO ass ca "ocopmS-geaij ca2ab.g"caa P^ 3^0 Kj ra *^ O CQ 3 g S go MC.Q Sa^Sa =3a ca a >?© a^ u co aS'^p'SsS.rt 2'='5g'S^i| -^-a^gfea-^; 00 O h- C1.3 r ©sp^ag-il ^ HhH.pH^ ""^ "TI g Q CB -H ©53 © P= ^ a 3^ ^■SO tag © P S P "-ja^ S »! o 3^.2 3 s ^ « ". S°^£||§« =^1 g III III gS| ^ 120 SPECIAL TOXICOLOGY. C. Substances which may Prove Fatal without Causing any gross Anatomical Changes. It would be a mistake to suppose that the following poisons never cause anatomical changes at all; we only assert that the pertaining fatal results, so far as observed in man, were generally brought about without presenting such marked pathological disturbances as might themselves have been regarded as the direct cause of death. It is obvious that we may at will arrange the experiments on animals in such a manner that any one of those substances will cause anatomical changes. L — POISONS OF THE CEEEBEO-SPINAL SYSTEM. The number of poisons belonging to this class is extraor- dinarily large, restricting consideration thereof to the more important ones only. At the outset we are tempted to classify them, according to the respective parts of the cerebro-spinal system immediately affected, into poisons of the cerebral cortex, the basal parts of the cerebrum, the cerebellum, the medulla oblongata, the spinal cord and the peripheral nerves. But such an arrangement would be extremely artificial, because most poisons, according to the dosage, attack different parts of the nervous system. Of the following two tables, the first (pages 122-125) records the vegetable poisons, while the second (pages 126-127) briefly enumerates the artificially prepared toxic substances. Following these are presented in three more tables, special data, referring to some vegetable poison-groups which are of particular practical interest. We repeat, that, concerning all poisons applied per os, speedy evacuation of the stomach being most obviously necessary, we have, therefore, not in any of the tables, made particular mention of this measure under the heading of "therapy." The Indian-arrow-poison, curare, is not mentioned, since it has never actually caused poisoning in Germany, and its most important action has been already sufficiently stated. (Page 58). We learn from table, page 122, and seq.', that cytisin and coniin will, under certain conditions, produce _ paralysis, suggestive of curare, of the peripheral terminations of the motor-nerves. The coniin liydrohrowid has even been recommended as a substitute for curare in the treat- ment of tetanus. Unfortunately, the preparations of this salt offered by the trade are so lacking in uniformity, that we can- not endorse this recommendation. The curare of commerce SPECIAL TOXICOLOGY. 121 continues to depreciate in quality and it has been suggested to use as a substitute the active base contained therein, viz., curarin. And yet the marketed preparation of the latter, Bcehm-mebck's curarinum purissimum leaves room for improvement. Curare consists essentially of the aqueous extract of certain kinds of strychnos. We would therefore' expect to see strychnin produce in frogs an action suggestive of curare, at least when an overdose is administered. The active substances of the boraginacece, as, e. g., anchusa, heliotropium, echium, cynoglossum, Symphytum, lithospermum and myosotis are alkaloids, which are said to produce at first excitation of the central-nervous system, followed by paralysis suggestive of curare. But they have never yet caused intoxi- cation in man. We have already mentioned (on page 107) the fugin of the tetrodon-^shes, acting similar to curare. Also the mytilite, living in stagnating water, develops a poison similar in action to curare, it is called mytilotoxin. The aconi- tum septentrionale growing in high latitudes, contains several alkaloids, of which one, called sepientrionalin, possesses in addition to other actions, one decidedly suggestive of curare. The leaves of celastrus edulis or catha edulis {celastracece), indigenous to southern countries, contain a base possessed of an action similar to cocain, and which constitutes the active principle of the Arabic Kath. The American condurando hark, which is furnished by gonolobus condurango {asclepiadacece) contains a series of glycosids which are embraced by the one name, condurangin. They produce violent spasmodic attacks of purely cerebral origin, and are to be enumerated with the substances on page 130 and 131. It is remarkable that these spasms seem to have never been observed as occurring in man. All poisons causing violent spasms may, by means of these, secondarily produce a severe disturbance of metabolism, (exchange of material). Under normal conditions, and under the influence of muscle-activity, carbohydrates are burned up to form carbon dioxid and water; but in case of violent spasms, particularly if simultaneously there is insufficient supply of oxygen, this combustion ceases at the stage of lactic acid-formation; the latter acidifies the blood, thus causing further disturbances. The temperature of the body is by no means always increased in case of spasms, as it was formerly believed; frequently it is even lowered. 122 TABLE OF THE MOST IMPOETANT PLANTS No. PLAMT. EAMILX. POISON CONTAINED IN IT. 1 Papaver somuiferiim. The state- ment that Escholzia califorDia. belonging to the same family, contains morphin, is not true. Papilionao, The dried j nice of the unripe capsules furnishes Opium, containing; 10-16 p.c. morphin, 1.5-4.0 p.e. narcotin, l.o p.e. thebain, 1.0 p.c. papaverin, 0.3 p.c, codein, narcein, laudanin, protopin, xanthalin, meconio aoid, etc. ■I Cannabis satlva, var. Indioa, In- dian hemp. Cannabac. Several alkaloids, a glycosid eanna- bin, a resin oannabinon. an ethereal oil, etc. In my own laboratory only one active substance, cannabindon. was found. 3 Lactuea virosa. Compos. Traces of a nameless base, and traces of hyosoyamin. 4 Lolium temulentum. Gram. Temulin. 6 Erythroxylon coca, and other species. Erythroxyl. Coeain, cynnamyl-eoeain. isatropyl- ooeaiii, benzoyl-pseudo-trnpeiu or tropa-eocain, etc. The leaves and coeain hydrochlorid are in use. 6 Coffea arabioa. Eubiao. Coffein, coffeol or coffeon. The latter is formed only on roasting. 7 Hterculia acuminata. Stereuliac. Coffein, colanin. 8 PauUlnia sorbilis. Sapindac. Coffein. 9 Thea chinensis. Camelliao. Coffein, theophyllin, tea-oil. 10 Ilez paraguayensia. Ilicin. Coffein. 11 Ilex oassine. Ilicin. Coffein. 12 Atropa belladonna, deadly-night- shade. Solanac. Atropin, hyoscyamin, belladonnin. 13 Datura stramonium, thorn-apple. Solanac. Atropin, hyoscyamin, daturin. li Hyoscyamus niger, black -hen- bane. iSoiauac. Seopolamin, hyoscyamin, atropamin. 15 Soopolia atropoides. Bolanao. Soopolamin, hyoscyamin. 16 Nicotiana tabaoum, N. rustioa, N. macrophylla. Solanac. Nicotin. 17 Pilocarpus pennatifolius. Kutae. Pilocarpin, pilooarpidin. etc. Id Lobelia niootianselolia, etc. Lobeliac. Lobelin. la Lupinua albus, L, luteus, L. an- gustifolius. Papilionac. Lupinin, lupinidin, lupanin, etc. 20 Oonium maculatum,spotted-hem- look. UmbelliJ. Coniin, methyl-eoniin, couhydrin. pseudo-oonhydrin, etc. 21 Cieuta virosa, -water-hemlock. Umbellil. (Jicutoxin. 22 Menispermum oocculus L. or ana- mirta oocculus W. and A. Menisperm. li'iorotoxin. CONTAINING CEKEBKO-SPINAL POISONS. 12a BEMABKS. DBTEOTION. The green plant contains only morphiu and nareotin, pre- formed. Meconio acid, as well as the strongly odorous sub- stance in opium, are Inactive. Meeonic acid turns blood-red with ferric chlorid. According to Dragendorff, benzene extracts meconin from an acid solu- tion, while amylio alcohol dissolves meconio acid. From an alkaline solution benzene will extract codein, nareotin and thebain; and chloroform, as well as amylie alcohol, nareein and morphin. Morphin turns dark-blu e with ferric chlorid in strictly neutral solution ; with Proehde's reagent violet,gr6en. blueish-green and yellow. The tips of the branches of the female plant, as well as the resinous masses ezudated by these, represent hasheesh. We cannot speak of detection by chemical means, since this- plant has scarcely been examined. But the leaves may easily be determined pharmacognostically. The cannablndon which I found acts in a reducing manner and causes hallucinations. Acts as a narcotic and my- driatic. - The base passes from alkaline solution into amylie alcohol on agitation. The plant is easily recognized pharmacognosti- cally; generally, however, the condensed juice (laotucarlum) Is used. Acts as a narcotic and my- driatic. Ether, as well as chloroform, will abstract it on agitation,from alkaline solution. The leaves are taken as a food. The leaves of all species con- tain cocain, but only the mentioned one contains an abundant amount of it. Petroleum-ether on agitation with an alkaline solution will take it up. Amylalcoholie KOH turns cocain, evaporated with. HNO3 violet, on warming. lodin-water renders its solution in sulfuric acid at first reddish -violet, afterwards kermes-red. The roasted beans, which fur- nish the coffee, contain 0.6 to ip.c. eoffein. The seeds are the active part. Guarana-paste is furnished by the crushed seeds. Ooffein allows abstraction from alkaline solutions by means of ohlorofoform. Boil the residue of evaporation, consisting of characteristic crystal-needles, with concentrated nitrio acid, and after cautious evaporation to dryness, add am- monia. We then obtain the identic purple reaction, which, for uric acid, we call the murexid-reaotion. Traces of KOH The leaves represent the Chinese-tea; they contain about 3.6 p.c. eoffein. The leaves, containing 0.8 p.c. eoffein, furnish the mat^, or Paraguay-tea. solution change the purple to violet. Within the organism, the cocain is not destroyed, but secreted with the urine. The Apalache-tea is furnished by the leaves, containing 0.3 p.c. eoffein. All parts of the plant are poisonous, in particular the berries and the root. Atropin.hyoscyamin and scopolamin behave chemically very similarly. They may be obtained by agitation of their alka- line solutions with benzene, chloroform or ether. lodin in AU parts are poisonous, e.g., the seeds and leaves. diluted liQuids. They turn first violet, then cherry-red. when evaporated with nitrio acid and afterwards touched with alooholic-KOH. With an alcoholic sublimate-soljition they turn at first yellow, then brick-red. They produce th© odor of the slee-blossoms when warmed with cone. HaSO* J and following addition of H2O. All parts are poisonous, in particular the seeds. All parts are poisonous. The treated leaves represent tobacco, and contain 0.5 to 8.0 p.c. nicotin. Prom ammoniacal solutions nicotin is abstracted on agitation, with petroleum-ether. It may be distilled off from alkaline solutions. It furnishes ruby-red crystals when mixed with. a solution of iodin in ether. Chlorin gas will turn it blood- red. The fragments of tobacco-leaves show peculiar glandu- lar hair. The leaves, folia-jaborandi, are ofloinal. Both bases go from alkaline solution into benzene. They turn green with H2SO4 -1- potassium bichromate. The herb is used medicinally. Lobelin is obtained from alkaline solutions by agitation with petroleum-ether or ether. The extract of the herb is turned violet with Proehde's reagent. The herb and the seeds are poisonous. The bases are partly volatile and similar to eonlin, partly solid and extractable by ether. The herb and the almost ripe seeds are quite poisonous. Coniin is to be abstracted by agitation of alkaline solutions. with ether, chloroform, petroleum-ether, etc. It behaves to- wards reagents similarly to nicotin, but Its aaueous solution becomes turbid on boiling. The rhizoma in particular is very poisonous. Oicutoxin passes upon agitation Into ether. Besides, tha rhizoma contain.^ umbelliferon, of beautiful fluorescence. The seeds, known as cooculus, or flsher's-berrles, are the poisonous part. They were formerly used for the purpose of stifling flsh. The extracts from the organism, purified by means of neutral plumbic acetate and freed from lead, yield picrntoxin to amy- lie alcohol or chloroform. It will reduce alkaline cuprio sul- fate solution. Evaporated with cone. HNOa. then touched with cone. HaS04 and finally upon addition of NaOH solution^ it turns brick-red. With H2SO4 alone, a saffron-yellow appears- 124 TABLE OF THE MOST IMPOETANT PLANTS No. PLANT. FAMILY. POISON CONTAINED IN IT. 23 Artemisia maritima, wormwood. Compos. Santonin. 24 Artemisia absinthium. Compos. The bitter principle absintLin, and the ethereal absinth-oil. a6 Laurus Camphora.' Laurao. Camphor, 26 Mentlia piperita, peppermint. Labiat. Menthol, menthen, etc. 27 Tanaoetum vulgare. common tansy. Compos. Tauacet camphor, etc. 28 Cinchona family ol many species ; we mention: C. sueoirubra, C. ledgeriaua. C. officinalis, C. cali- saya, and 0, lancifolia. Bubiao. Quinin. auinidin or conauinin, cin- ehonin, cinohonidin, etc. Qninatan- nic acid, auinovin or auinlc acid. 29 Physostigma venenosum. Papilionae. Physostigmin or eserin. 30 Yeratrum sabadilla. Melanthao, sive Colchlcao Veratrin, Veratridin, oevadlUin. saba- dillin, etc. 31 Veratrum album (white hellebore or Indian polce), V. viride, V. nigrum. Melanthao, sive Colohicac Veratroldiu, jervin, protoveratriu, etc. 32 Colohieum autumnale. Melanthao, sive Colchloac Oolehicin, oolohieein. 33 Aconitum napellus, true monks- hood or officinal aconite. Ranunoulac. Aconitin, isaconitiu, etc. 3J: Delphinium staphisagria, lark- spur. Eanunculac. Delphinin, delphisin, etc. 36 Strychnos nux vomica. Loganlao. Strychnin, brucin. 36 Aspidlum fllix mas, shield-fern. Filic. ■ Filixic acid. 37 Cytisus laburnum, goldenchair or bean-tref oU-tree ; and other spe- oies. Papilionae. Cytisln. 3S Ulex europesus. Papilionae. Ulexin, identical with oytlsin. 3V) Andromeda polltolia. Siphonandr. The bitter principle, audromedo- 40 Cassandra calyculata,leather leaf. biphonandr. toxin, possessing an action sug- gestive of aconitin. 41 Rhododendron ferrugineum and hirsutum, rose-bay. Khodorac. The glyeosid arbutin and the bitter principle erioolin. 42 Equisetum palustre and limosum. Eauisetao. Still unknown alkaloids. 43 Cetraria vulpina, or evernia vul- pina. Lichenes. The beautifully yellow vulpinio acid. CONTAINING CEEEBEO-SPINAL POISONS. 125. DETECTION. Semen oinae is a popular ver- mifuge. From acid solutions upon agitation with benzene and eliloro- torm, santonin is taken up. Within the organism it is trans- formed into santogenin, and another substance whicli turns- a yellowish-red upon addition of an alkali. On protracted partaking of spirits of absinth, appear- ances of paralysis and of ex- citation of the central-nervous system obtain. Absinthol, contained in the ethereal oil, appears in the urine, as absyntnol-glyouronic acid of reducing action. All parts of the tree contain camphor. See page 42. for detection. The urine will contain diverse reducing campho-glycuronic acids. The leaves furnish an ethereal oil. For detection see page 42. The urine will contain menthoi- glycuronlo acids, which reduce copper solution. The leaves supply an ethereal oil. For detection see page 4a. curonic acids. The urine contains possibly gly- The bark contaius the alka- loids. They appear in the urine, peculiarly transformed. The cinchonamin contained in some barks serves as a re- agent for nitric acid. The auinln bases pass from alkaline solutions into chloro- form, (luiniu itself into benzene and petroleum-ether besides., Upon addition of chlorin-water and ammonia to the solution of a Quinin salt, green flakes are precipitated, soluble withi emerald-green color in an excess of ammonia. Upon addition, of anacicithe tint turns sky-blue, then violet and flery-red. Quinin sulfate is of strong fluorescence ; Its alcoholic solutionr gives, with iodin-tincture, crystals of herapathite of greenish lustre. The beans. Calabar beans, are the poisonous part. From alkaline solution physostigmin passes over into : ben- zene, ether, amylio alcohol and chloroform. Evaporated together with NHs, it will dissolve with blue color in alcohoU turning red with acids and exhibiting fluorescence. The seeds are supposed to act medicinally; salves orvinegar prepared by means of them may cause poisoning even on external application. The whole plant is poisonous. Veratrin passes even from acid solution into benzene, chloro- form an* amylio alcohol ; and from alkaline solution into- petroleum-ether, benzene, chloroform, amylic alcohol. A. beautiful red color is produced on warming with cone. HCl- It willgivaas well the reaction with HNOa, as mentioned for- atropin. With cono. HaSO* and sugar, it turns yellow, dark- green, blue, violet. With Froehde's reagent it assumes first. the yellow color of gamboge, afterwards it turns cherry-red. It is isolated in the same way as veratrin ; it behaves in the- same manner with HzSOt; HOI on boiling turns it cherry- red. Bulbs and ripe seeds are poisonous. Wiihin the organ- ism oxydi-oolohicin is formed. Prom acid solution colohicin as well as oxydi-colchioin are- taken up by chloroform and amylic alcohol. Erdmann's re- agent turns them blue, and upon addition of caustic alkali- solution a brick-red color obtains; fuming ENOs produces- violet to indigo-blue. The root mainly is poisonous. Petroleum-ether, benzene and chloroform abstract aconitin from alkaline solutions. Color reactions are wanting. The seeds are the poisonous part. Delphinin and delphinoidin are soluble in ether as well as in chloroform. The seeds, bachelor buttons, are the drug. Strychnin passes from alkaline liquids into chloroform and benzene. The chromate with cono. HzS04 turns blue, violet,. and cherry-red. Mandolin's reagent turns it first violet-blue then vermillion-red. The rhizoma is the poisonous part. The acid passes from acid solution into ether. All parts are poisonous, e.g., the seeds, the bark, etc. The herb Is poisonous in cer- tain months. The alkaloid passes from alkaline solution into chloroform. The entire plants are poison- ous. The Esth's use it as a universal medicine. The poison is soluble in alcohol, amylio alcohol, chloroform^ ether, benzene. Diluted mineral acids turn it red on evap- oration. Almost all other species con- tain andromedotoxln. Arbutin yields on deeompositiim quinol, to be abstracted from acid solution by acetic ester. With ferric ohlorid it furnishes-. crystals of greenish lustre. In cattle it will produce par- alysis of the rear extremities and death with spasms. This intoxication is diagnosed in man by the production of' very severe hsBmoglobinuria, the explanation of which re- main.i hidden from me. Chemical detection is wanting. The acid and Its salts produce spasms and paralysis. According to Neuberg, vulplnlc acid does not reappear in the» urine ; pulvlnio acid, however, related to it, reappears. 126 TABLE OP THE MOST XMPOETANT ABTIFIOIAIXY No. NAME OF SUBSTANCE. rOEMULA. ACIION. 1 Chloroform or tri- ohlor-methane. CHCla. See page 42 and page 128. In oontradistinctlon to ether, chloroform can not be used as an excitant. 2 Ether or sulfuric ether, stronger ether. OaHeOCzHB. It acts on inhalation as chloroform. On hypo- dermic injection, the formation of gas readily obtains, as well as coagulation in the blood vessels, and degeneration of nerves in direct contact. 8 Aether bromatus, ethyl-bromid. CsHsBr. Narcotic for narcoses of short duration. After larger doses, speedy cyanosis and collapse; With people addicted to drink, appearances of excitation. i Aether ohloratus, ethyl-ohlorid. C2HBCI. Modern local ansesthetio, very similar in its re- mote actions to ethyl-bromid. 6 Bromoform, tri- brom-methane. CHBrs. Internally of narcotic action. In large doses it produces a state of inebriation, sleep, collapse, total ansesthesia. Only one case on record. 6 Amylene or pen- tal. CbHio. Acts on inhalation, as does chloroform. State of jovial excitation, then profound narcosis. Ba,d after-effects observed: dizziness, trembling, paralysis of tongue, Eaphania. (Krlebeln. ) 7 Amylene hydrate, or tertiary amylio alcohol. (OH3)2.C2H6.C.OH. Acts like paraldehyde as a hypnotic. Even 27 gms. have been endured, but caused total' in- sensibility, mydriasis and somnolency lasting for days. The pulse is not retarded. 8 Laughing gas or nitrous oxid. N2O. It paralyses, on inhalation, at ilrst the sensation of pain, then consciousness, spinal marrow, medulla obi., and finally the heart. Since it will not be decomposed by the organism, it caupes cyanosis it oxygen had not been admixed. 9 Marsh gas or me- thane. CH4. Of feeble narcotic action, the qiuantlties con- tained in the intestine are without influence. 10 Ethylene. C2H4. Of weak narcotic action. 11 Nitrogen. N. Acts similar to laughing gas, but paralyses the sensation of pain later than this one. Death with spasms of suffocation. 12 Carbon dloxid(car- bonio acid mis- nomer). 002. Of local excitatlng action upon mucous mem- branes, and of remote paralyzing action upon brain and spinal cord. 13 Alcohol or ethyl- aloohol. C2H6OH. See page 129. The cheap kinds are always im- purifled with fusel (propylic-. butylio- and amy- lic-alcohol)furfurol, aldehyde, etc., all of which are still more poisonous than C2HBOH. li Chloral hydrate or tri - chlor - alde- hyde hydrate. CCI3.COH.H2O. See page 128. Chloral-form-amid, chloralose. paraldehyde, acetal, somnal, are of similar action. Antidotes applied are picrotoxin and strychnin. IB Sulfonal, or di- ethyl - sulfou - di- methyl-methane. (CH3)2C(S02C2H5)2. Strong narcotic; however, 100 gms. have been endured, after causing twitohlngs, collapse of temperature, and protracted sleep for five days. HEematoporphyrin may appear in the urine. Therapy : washing of the organism, picrotoxin, strychnin. 16 Trional. CH3.C2H6.C.CS02C2 Hb)2. In every respect similar to the preceding. n Benzene and pe- troleum-ether. CeHe, benzene; pe- troleum-ether con- sists of: CeHn and C7H16. Both may produce, on inhalation or when taken internally, narcosis, twitchings, cyanosis, my- driasis. Even chronic poisoning obtains. 18 Antitebrinoraoet- anilid. C6H5.NH.CHaC0. As with anilin, a strong blue coloration of the body, dyspnoea, weakness of heart. 28 gms. have been endured. Exalgin acts in a similar man- ner. Washing of the organism. 19 Antipyrin or di- methyl - phenyl - pyrazolon. C11H12N2O. Cyanosis, dyspnoea, chills, collapse, spasms, ex- anthema. Three fatal cases on record. Tolu- pyrin acts in a milder way. 20 Apomorphin. Cl7Hl7N02. Most powerful emetic, causing excitation on animals incapable of vomiting. For man, a high degree of feebleness maintains, as well as dysp- noea and dizziness. PREPAEED CEEEBRO-SPINAL POISONS. 127 CHEMICAL PEOPEKTIES ; DETECTION. On narcotizing in presence o( the light of a flame, it burns to carbonyl ohlorid or phosgen <00Cl2). which is endowed with an exeitatlng action upon mucous linings of its own, besides having the poisonous properties of CO. Within the organism, the greater part of chloroform will not be burned, but exhaled as such. Easily volatile and combustible. Danger of Are. It is exhaled to the greater amount. Urine does not act reducing as in case of chloroform. A mixture of 1 pt. ether and 3 pts. chloroform, Splritus Aetherus or Hoffman's drops. Is a popular remedy in Germany. The commercial ether often contains hydrogen peroxid, it air and light had access. Concerning detection. see page 42. Colorless liquid, sensitive to light and strongly refractive. Partly burned within the organism to form bromids. Breath has an odor suggestive of garlic ; the same obtains for the organs. Detection as on page 12, Easily oondensible gas ; danger of Are ; partly burned within the organism to form chlorids. Breath and organs of ethereal odor. Detection as with ether. Colorless liauid. suggestive of chloroform.'sensitive to light, of speeiflo odor, which is par- ticipated to the breath and the organs. In the urine partly in form of bromid. Detection as with chloroform. Colorless ethereal liauid of specific odor, conveyed to the breath and the organs. Easily inflammable, very volatile. Separation as on page 42. In the only fatal ease on record the detection was not attempted. Boils at + lOS^G ; therefore on distillation it passes over much later than common alcohol, boiling at + 78''4C. It is of disagreeable odor; forms valerianic acid when heated with potas- sic chromate and H2S0t. To be obtained from mixtures by agitation with petroleum-ether or ether. In case of man, it is not found in the nriue. Compressible gas, appearing in the trade in the liquefled state and without detrimental impurities. When personally prepared it contains easily admixtures of nitric oxid, which in contact with air is transformed into nitrogen tri- and per-oxids, which violently attack the mucous linings and decompose the blood, forming met-hEemoglobin. Forms in swamps, mines, sewers, and in the putrefactive processes in the intestine. It is odorless, colorless and inflammable. Contained to the amount of 6 p.o. in illuminating gas from coal. Inflammable and of a some- what sweet odor. Normally contained in the atmosphere to the amount of 79 p.o. : together with COz, in the expirated air ; odorless. Formed in the processes of: combustion, putrefaction, decay. Best mode of determining It. by means of barium hydrate, with which it forms barium carbonate, insoluble in water. The rectifled distillate smells of alcohol, burns, forms acetic acid with spongy platinum and yields crystals of iodoform when treated with KOH and iodin. Diluted alcohol is transformed into chloroform when treated with bleaching powder. [Ca(OCl)Cl.] For separation, see page 43. Uro-chloralio-acid is laevo-rotary. while the free glycuronic acid obtained from it by splitting with mineral acids, is dextro-rotary. Both will reduce Fehling's solution. Chloral hydrate or chloroform, when treated with resoroinol and an excess of KOH, give rise to a red coloration ; in case of an excess or resoroinol, a vellowish-green fluorescence obtains. The organs are extracted with alcohol, the residue of evaporation treated with boiling water, concentrated and taken up with ether. Powdered sulfonal, when treated with char- coal powder, will yield the odor of mercaptan. The formation of hsematoporphyrin is all the more easy the less excess of alkali Is at the disposal of the system. Detection as for sulfonal. Here, also, hasmato-porphyrinuria may follow. For detection, see page 42. A part of the benzene reappears in the urine as sulfuric acid- phenol-ester ; another part will be exhaled. Petroleum acts similarly to petroleum-ether ; detection on page 42. No inet-hEemoglobin in the urine, but an ample amount of free and coupled antifebrln. To be obtained by agitation with chloroform and ether. When treated with dry zinc chlorid, a moss-green fluorescence obtains. Obtained by agitation with chloroform from acid or alkaline solution. Ferric ohlorid turns the aqiueous solution reddish-brown ; nitrous acid turns it green. Easily decomposable base. Petroleum-ether will abstract from the ammoniacal solution a raspberry-red product of decomposition. Ferric ohlorid turns apomorpbin the color of amethyst, auric ohlorid a purple-red. 128 TABLE OF INTOXICATIONS BY CHLOBOFORM, CHLOBOFOEM. CHLOEAL HYDEATB. iETIO. Generally inhalations for the proauotiou oi narcosis ; rarely internally. Mostly medicinal eases, caused by over- doses. Stat. More than iOO fatal oases on record; however, there is only one ease of death to from 3000 to 6000 administrations. More than 100 fatal cases on record, but since the maximal dose has been reduced new cases rarelv obtain. Dos. LET. Internally. 60, even 99, sms. have been endured : In ease of inhalations, 50 to lOO ems. have been withstood, while pecu- liarly susceptible persons have been killed by 10 gms. People with a weak heart, poiatores, may be killed by 5 gms. In individual cases. 1 gm. proved toxic. Act. A protoplasmic .poison, killing the pro- toplasm of the ganglion cells, at first those of the brain, then dissolving blood corpuscles and degenerating all tissues. Protoplasm poisoned. In the first place, paralysis of the walls of all the vessels, then action of the heart and brain weak- ened simultaneously ; later on the kid- neys, mainly, degenerate. oYMPT. Locally, excitation at point of applica- tion. After resorption, we have first exr citation, then paralysis of the cortex of the brain, then of the other parts of the brain, the spinal cord, and the elongated marrow. The pupils are first contracted, then dilated. The muscles become per- fectly limp ; all reflexes close ; in ease of long lasting narcosis, numberless red blood-corpuscles perish and produce Icterus. In case of chronic administra- tion, a certain adaptation takes place, and there is emaciation, anaemia, icterus, and weakening of the heart's action. Local excitation at place of application, vomiting. After resorption, irresistible desire to sleep ; great reduction of blood- pressure and dilatation of the vessels, mainly of the skin ; later on, respiration becomes very slow and stertorous, skin cyanotic and cold. In chronic chloralism, disturbances of digestion, swelling of mucous lining of mouth, weakness of muscles, emaciation, diarrhosa, delirium, marasm. In case of sudden deprivation, appearances of abstinenoy, but not to such a high degree as with morphio- maues. EXTT. In acute cases, death normally by par- alysis of the muscles of respiration; in cases of invalids or of awkward adminis- tration, by untimely stoppage of the heart's action. In chronic cases, the cause of death is generally the cessation of the heart's action. Death ensues in healthy animals, and, in case of acute action, by paralysis of the muscles of respiration; with man; gen- erally by sudden ceasing of the heart's action. In chronic cases, the cause of death is. exclusively, stoppage of the heart, generally occurring without pro- drome. DiAGN. The specific odor leaves no doubt. The blood may be odorless, since the red blood-corpuscles enclose the chloroform. The pupils, which are not contracted, exclude morphin, and the absence of any odor of the breath excludes chloroform. Thek. Stop administration at once, artificial respiration, electric excitation of nervi phrenici. Ether injections of little value. Prophylactically much can be done: Closely investigate patient, before anaes- thesia for heart diseases, for diseases of the vessels and lungs ; allow plenty of air to be inhaled with the vapor, and use the purest chloroform, free from chlorin, phosgen-gas, arsenic. Insist on having constant supervision of pulse, respira- tion and pupils. In case of chronic poisoning, prevent access to the poison. Artificial respiration In a warm bed; washing of stomach. Hypodermically, picrotoxin or strychnin ; washing of or- ganism with sugar-salt solution is indi- cated. Prophylactically. people with de- generated heart should not take it, and people with sound heart only doses below 3.0 gms , and never to be continued for months. In most eases chloralose may be substituted for chloral hydrate, which, former is less poisonous. P.-Mtm. In case of narcosis of short duration, nothing Is found necessarily ; sometimes a few bubbles of air in the blood on ac- count of the forced artificial respiration. In chronic cases, icterus, fatty degenera- tion of the heart, liver, kidneys, and muscles of skeleton; general ansmia. In acute poisoning, all cavities of the body have the odor of chloroform. The blood contains unchanged chloroform, and the urine, besides a little chloroform, a reducing substance, and a substance similar to oystin. Chloroform itself, how- ever, win reduce Fehling's solution. Local phenomena of excitation of mucous lining of mouth and throat. Mucous lining of stomach degenerated and hse- morrhagio. The urinary canals show fine grains of fatty degeneration. The blood contains no chloroform ; the urine contains large Quantities of tri-ohlor- ethyl-glycuronie acid, which will Reduce cuprio sulfate like sugar, but which turns the plane of polarized light to the left. The free glycuronic acid, however, split off by warming with mineral acids, is- dextro-rotary. CHLORAL HYDRATE, ALCOHOL, MORPHIN AND OPIUM. 129 Suicide, abuse, practical jokes. MOBPHIN AND OPIUM. Suicide, murder, medicinal poisoning, mor- phomania; frectuent with physicians and nurses. By far the most frequent of all intoxications is the chronic alcoholism produced by a long series of acute poisonings. 60.0 to 180.0 gms. cause acute cases, according to constitutional susceptibility, adaptation and surrounding temperature. For chronic poisoning, the doses are very variable. Next to alcohol, the most freauent intoxica- tion, at least in England. The habit of smok- ing opium Is increasing. Locally, alcohol has a dehydrating and coagu- lating action upon albumin, thus causing in- flammation. Remotely, its first action upon the brain is that of excitation, and then of paralysis. Children under five years will be strongly poisoned by from o.oi to 0.03 gms. ; adults will die after 0.4 gms., provided they are not accustomed to the drug; morphomaniacs stand several gms. daily. In case of acute poisoning, common intoxica- tion ; loses control of the motor nerves of loco- motion and cannot walk steadily or at all; want of sensation, reddening of the face, ster- torous breathing, vomiting, involuntary stool; pulse hardly noticeable ; sticky skin, cyanotic; Temperature and blood-pressure greatly re- duced. (Katzenjammer.) In chronic poison- ing, catarrhal inflammation of the mucous lining of the throat, mouth, oesophagus and stomach. The liver at first Is infiltrated with fat and enlarged, then cirrhotic ; the vessels show fatty and atneromatic degeneration, kid- neys degenerated. Decrease otvisual faculties and of Intelligence; tremor; skin furunculous; the resistance of the body greatly reduced ; in case of sudden discontinuation, delirium tre- mens and collapse. (Quartal-Saufen.) The oat, horse and cow show cerebral excita- tion ; man is narcotized. The peristalsis of the intestine is stopped, and the respiration paralyzed. In chronic poisoning, the morphin acts as an indispensable stimulant. In acute poisoning, desire to sleep, stupefac- tion, want of sensation, Cheyne-Stokes' res- piration, strongest retardation of pulse. To the excitation of the brain corresponds the widening of the pupils, where with narcosis there is contraction of the pupils to the high- est degree. Red exanthema of the skin ; there may also occur increase of the secretion of mucus and saliva. In chronic cases, insom- nia and want of appetite; at times constipa- tion, at others bloody diarrhoea ; pupils per- .sistently contracted ; the skin, leathery and hardened, shows numerous abcesses; fre- auent vomiting; diminution of potency and of energy; habit of lying; carelessness in re- gard to family and occupation ; intermittent attacks ; tremor ; hallucinations. In acute poisoning, either a gradual change to a healthy sleep and recovery, or coma, oedema of lungs, and paralysis of muscles of respira- tion. Jn chronic poisoning, progressive par- alyses, the same as with Insane people, or sui- cide in a delirious spell, or death by intercur- rent diseases, especially pneumonia, or drop- sy. or cancer of the stomach or oesophagus.' In acute poisoning, deepest coma and strong- est retardation; oedema of lungs, spasmodic twitching of legs, and bloody diarrhoea may occur. In chronic cases, marasm and com- plete apathy. In case of deprivation of mor- phin, terrible excitement, followed by fatal collapse. In acute cases, the odor Is sufficient for diag- nosis. In chronic cases, along with the odor, palpation of the liver and inspection of the throat and face. In acute cases, when there is congestion of the brain, bleeding, washing of the organism, cold eonyjresses on the head, ammonia, black coffee. In case of collapse of temperature, warm-bottles, mustard-plasters, artificial res- piration and passive movements; in chronic eases, treatment in asylums and surveillance for years. Do not discontinue Its use too sud- denly. The appetite is stimulated by bitter substances. Baths. Excision and cauterization of the red acne. In case of delirium, do not give chloral hydrate but scopolamin. Prophy- lactically, support the temperance movement, and give warning, even In the sohoolsi, against alcoholic beverages. (Schnapps.) In acute oases, the contracted pupils, retard- ation of pulse, and narcosis are sufficient. In chronic oases, morphin is to be chemically proven in the vomit and stool. In case of acute poisoning, hypexsemiaof the brain and even apoplexy ; eochymosis and in- flammation of the mucous lining of the intes- tines ; oedema of lungs ; all cavities of the body smell of alcohol. In chronic cases there Is first fatty degeneration of the liver, then cirrhosis of the liver; fatty degeneration of the intima of all arteries, arteriosclerosis, pharyngitis, laryngitis, oesophagitis, gastritis, chronic ne- phritis. Stomach shows ulcers and carcino- matous changes of the mucous membrane. The fat of all organs shows a remarkable amount of water. In acute cases, same as with alcohol ; hypo- dermic injection of atropin in maximal doses has repeatedlygiven good results. The most important measure is washing of the stomach, even after hypodermic injection. Potassium permanganate internally and hypodermioally in exceedingly dilute aqueous solution ; one gram to a tumblerful of water. One grain potassium permanganate will annihilate one grain of morphin(Wm. Moor). TTseful. provid- ed the morphin has not entered the blood. In chronic cases, we can think only of improve- ment in an asylum. Gradual and cautious deprivation with most careful surveillance. In ease of collapse, single doses of codein, cocain, spartein. Prophylactically: every young physician should vow never to take it himself; never allow a patient to use the syringe himself ; prescribe only the minimum quantity in one prescription. In case of acute poisoning by opium, its specific odor may be noticed in the intestines and cavities of the body. In acute oases of morphin-poisoning there maybe no finding at all ; however, we find, as a rule, an Increase of blood In the meninges and accumulation of eerebro- spinal liquid in the cavities of the brain ; there is congestion of the lungs and extreme quantities of urine In the bladder, which contains oxydi-morphin and morphin. In chronic oases, It is said that we may find, besides marasm, degeneration of the pos- terior columns of the spinal cord. The mueous lining of the intestines is ulcerated 130 TABLE OF INTOXICATIONS BY ^TIO. Stat. Dos. Let. Act. Sympt. Exit.- DlAGN. Thee. P.-Mtm. CICUTOXIN. Mistaking the water- hemlock, cicuta vir- osa, for edible um- bels, e.g., for celery. About 40 cases, with 45 p.c. mortality. Unknown. Excitation of Noth- nagel's tetanic cen- tre in the elongated marrow, as well as of the centres of the vasomotors, respira- tion, and of the va- gus of the heart. Nausea, vomiting, colics, increased heart - action, stag- gering, unconscious- ness, terrible epilep- tiform spasms,grind- ing of the teeth; pu- pils widened, pulse hard and slow; dys- pnoea, salivation. Death by paralysis of the previously ir- ritated centres. The vomit contains particles of the plant. Chloroforming, chlo- ral hydrate; artifi- cial respiration, Finding may be en- tirely negative. Or, we find eoohymoses, e.g., underneath the pleura, and irritation of the mucous coat of stomach. The abdo- men has at times been found much in- flated. No poison can be chemically detect- ed in the urine. PICEOTOXIN. Partaking of beer containing ploro- toxin, of cocoulus in- dicus, of flsh poison- ed by it. Growing less fre- quent nowadays. 3.4 gms. of seeds. The action is between that of cicutoxin and of strychnin. The picrotoxinin con- tained in picrotoxin acts in yet stronger manner. Nausea, vomiting, diarrhoea, numbness , trembling, convul- si5ns — even tetanus; salivation, dyspnoea, perspiration, deliri- um; on man, mydri- asis; flsh will be stunned. Paralysis of limbs, retardation of pulse. Death caused by par- alysis of respiratory apparatus. The vomit is of very bitter taste. Same as for cicutox- in. Prohibit the use of the seeds. Generally nothing characteristic. Hy- persemia of brain and lungs; salivary glands swollen ; heart flaccid ; the unchan g- ed poison detectable in the urine. Addi- tion of KOH does not change the color of the urine. DIGI- TAL! KESIN Eem'ks. Comp. p. 122, No. 31. Comp. p. 133, No. 33. C. p,137, TOXI- RE8IN o o m Tl Pi (>1 ?. J^ o T) o OJ .Si s J2 a % 01 .a g .^ s SANTONIN. Excessive doses of santonin or of worm- wood powder in cases of ascarides. Poisoning of fre- quent occurrence ; mortality low. Unknown. Action strongly sug- gestive of picrotoxin, but the cortex of the brain is not involved. The drug contains, besides the poison, a poisonous ethereal oil. Purple vision, xan- thopsia, aphasia, hal- lucinations; further, as picrotoxin. For animals, icterus and hsematuria. Violent diarrhoea may occur. Death by brain -par- alysis. Paresis of lower extremities. Xanthopsia assures the diagnosis. For urine, see below. Same as for picro- toxin. The medicine should not be sold by peddlers. Finding may be ne- gative. Hyperaemia of the brain, ecchy- moses; icterus, poly- cholia; the urine con- tains albumin, a chro- mogen and a com- pound of mono- and di-oxy-santonin. On putrefaction or upon addition of KOH, the urine turns scarlet- red. Comp. p. 134, No. 23. THE MOST IMPORTANT TETANICS. 131 ACONiriN. COLCHICIN. VEEATEIN. Murder, medicinal poison- ing, accident, mistaking the plant. Medicinal poisoning, mis- taking the plant, whose leaves and flowers develop at different periods. Unskilled handling of the seeds as a destroyer of lice; medicinal poisoning; mis- taking the plant. Poisoning not frequent; mortality large. Infrequent poisoning; mor- tality about 50 p.c. Poisoning rare; mortality low. A few mUligramms. About 0.06 grms. Unknown; probably same as colchicin. Local irritation; in addi- tion: first irritation, then paralysis of the central- nervous system. Corres- pondingly, first irritation of the vagus of the heart, then paralysis of the same. Local irritation; ascending paralysis (after short dura- tion of excitation) of spinal cord and medulla oblon- gata. Muscular action as in case of veratrin. Local irritation of the ter- minations of the sensory, motor, and secretory nerves, as well as of the brain and spinal cord. Peculiar mus- cular action on the frog — veratrin rigidity. See p. Burning in mouth, saliva- tion, vomiting and purg- ing, dizziness, formication, mydriasis, retardation of pulse, dyspnoea, spasmodic paroxysms. A part of the poison is voided in an un- changed state by the sa- liva. Burning in mouth, saliva- tion, haematic vomiting and purging, dizziness, de- lirium, slight convulsions, irregular pulse, great de- bility. Goats wUl secrete the poison in an active form, partially with the milk. Burning in mouth, saliva- tion, vomiting and purging, raving mania, spasms, re- tardation of pulse, dyspnoea, great debility, lowering of temperature. The action upon the muscles, so pro- nounced in the frog, ia absent in man. Eetardation of pulse chan- ged into acceleration of the same; paralyzed respira- tion. Death with gastro-enter- itis and collapse. In case of recovery, chronic dys- entry. Death with collapse by- paralyzed respiration, after the pulse had become ac- celerated. "Widening of pupils simul- taneously with retardation of pulse and burning in mouth. Detection of the plant in the vomit ; anamnesis in regard to medicines. Detection of the plant in the vomit; anamnesis as to medicines. Artificial respiration, for the spasms induce nar- cosis. Mucilaginous potions, op- ium; warm compresses on the abdomen. Scopolamin hypodermical- ly; narcotics to stop excita- tion; abundant warm tea; calcium chlorid. Finding possibly negative. SwQUing and pointed eo- chymoses in the intestinal canal and under the serous membranes . In the urine the unchanged alkaloid ; also in blood, liver, kidney. On attempting to regain it, it decomposes easily. The then produced splitting- products are hardly poison- ous. Finding in man, so far ne- gative; for the animal, hae- morrhagic gastro-enteritis, parenchymatous nephritis, degeneration of liver, hy- peraemia of the articular surfaces of the joints and of the marrow of the bones. Oxy - di - colchicin detect- able in the organism. The colchicein accompanying the colchicin in the plant and in the cadaver, is inert. Finding in man so far al- ways negative; in the ani- mal, gastro-enteritis may be found. "We have further observed hyperaemia of the brain and its membranes, and of the lungs and kid- neys. The substance is very soon traceable in the urine. The accompanying alka- loids, such as veratridin, ce- vadillin, sabadillin, pass over into the urine. Comp. p. 134, No. 33. Comp. p. 124, No. 32. Comp. p. 124, No. 30. 132 TABLE OF INTOXICATIONS BY physostigmin. STRYCHNIN. ^TIO. Partaking of Calabar-beans through ignorance ; medicinal poisoning ; mistaking external for internal medicine. Murder; medicinal poisoning; par- taking of fox- or rat-poison; beer containing strychnin; confusion. Stat. Now a rare intoxication; fatal cases scarce. More than 60 cases known; mor- tality 35 p c. Dos. LET. Unknown. In medicine bottles the physostigmin is soon rendered less active. 4 mgr. for children; 30 to 100 mgr. for adxilts. Act. Local action almost absent; central excitation of the brain and peri- pheral excitation of the muscles of the iris, vessels and salivary glands. Local action entirely absent. Ex- citation of the spinal cord, medulla oblongata and brain. Accumuula- tive action on repetition. Sympt. Salivation, vomiting and purging, colics, abortion, retardation of pulse, incrccise of blood-pressure, maniacal attacks, spasms, contraction of pu- pils, dyspnoea. Myosis will follow promptly upon dropping of mineral doses. Increased excitability of reflexes, drawing in limbs, rigidity of neck, stiffness, trismus, tetanus, opistho- tonos; periodic increase of blood- pressure, retardation of pulse; sud- den frights, fear, protrusion of eyeballs. Exit. Death with spasms by paralysis of respiratory organs. Rigidity of muscles does not obtain during the interval between spasms. Death with spasms by stoppage of respiration and marked decrease of blood-pressure. DlAGN, Spasms and raving mania, with markedly contracted pupils. Terrified from slightest cause ; rigidity of neck and increased re- fiex sensibility. Theh. Scopolamin hypodermically. Arti- ficial respiration, Chloral hydrate, chloroform; wash- of organism, artificial respiration, curarization. P.-Mtm. Finding in man may be negative; or we find slight irritation of the gastro-enteritic mucous membrane. For animals, gastro-enteritis. In urine, saliva, bile, the poison is con- tained in form of an insoluble modi- fication. Such an one also occurs preformed in the drug along with physostigmin. Pronounced rigidity of corpse, fre- quently in position of tetanic con- traction. Hypersemia and extra- vasation into spinal cord and brain. Lungs surcharged Tsrith blood; heart but little filled ; urine contains albumin, lactic acid, strychnin, and sugar; liver and central-nervous apparatus rich in strychnin. Eemabks. See page 134, No. 29. See page 134, No. 35. THE MOST IMPORTANT TETANICS. 133 (JVTISIN. CONIIN. Accidental partaking of seeds, flowers, leaves or bark of the diflferent species, which in Europe are nursed in gardens and parks. Cytisus. Murder; suicide; medicinal poisoning; confounding the plant witli parsley, chervil, parsnip; use of conium plasters. 131 cases, with 3 p,c. mortality. So far, about 20 fatal cases. Unknown, but not large. 0.15 grms. of the pure alkaloid. Local action absent. Excitation of brain, medulla oblongata, and spinal cord, with following paralysis. On application of large doses, paralysis of the terminations of motor-nerves, suggestive of curare. Local corrosion. Excitation of the motor- centres in brain and spinal cord, with often very rapidly-following paralysis. In frogs, paralysis, similar to the action of curare, of the terminations of motor- nerves. This, however, may depend on accompanying bases. Nausea, vomiting, salivation, excitation, convulsions, tetanic spasms. Blood-pres- sure strongly increased. Colics, tumultu- ous beating of heart, diarrhoea, cyanosis. Herbivorae tolerate much more than car- nivorae. (Goats pro kg. 86 times more than cats.) Burning in mouth, soreness in throat, salivation, dizziness, nausea, vomiting, mydriasis, feebleness of legs, spasms of muscles of calves, convulsions, delirium, dyspnoea. Animals will tolerate, inter- nally, very large doses. Action upon the heart suggestive of nicotin. As a rule, everything is voided by vomit- ing. On hypodermic injection, death by stoppage of respiration. Death by paralysis of respiration, with or without spasms. The data of literature are contradictory. The vomit contains parts of the plant; the urine very soon contains cytisin. The specific odor in the vomit of the base and parts of the plant. In the stage of spasms give narcotics; much liquid ; artificial respiration in case of paralysis of organs of respiration. Artificial respiration; washing of organ- ism. In case of spasms, apply narcotics. Finding negative, as a rule. Sporadic- ally, injection of the gastro-intestinal canal and oedema of the brain have been found. Accumulation of poison in cen- tral-nervous system not proven. In goats the poison passes unchanged and partly into the milk, which thus is rendered poisonous for man. Now and then irritation of the mucous coat of the intestines, even hsemorrhages. Hypersemic meninges; sometimes cedema of the lungs. All cavities of the body are pervaded by the odor of coniin. Blood is said to coagulate with diflSculty. Confusing of coniin with cadaverin (corpse-conlin) easily possible. See page 124, No. 37. See page 132, No. 20 134 TABLE OF POISONING BY ATEOPIN' ATEOPIN. NICOTIK. ^TIO. Medicinal poisoning; ignorance in regard to plants in question; mis- take. Abuse of tobacco; use of tobacco as injection per rectum; partaking by children. Stat. Rather frequent; mortality 11.6 p.c. Chronic poisoning very frequent, slight acute ones also; severe ones rare. Dos. LET. 130 mgrs. for adults; 95 mgrs. for children. Not more than 0.06 gi-ms. for nicotin; 0.8 grms. of snuff, inter- nally. Act. Paralysis of secretion of all glands proper, of visual accommodation, of inhibitory nerves of heart, of the motor-elements of the intestines, and of the muscles of the vessels. Irrita- tion of the cortex of brain and in- creased reflex excitability of spinal cord. Hyoscyamin causes spasms of accommodation. Local irritation at place of applica- tion. The same organs, paralyzed by atropin, are at first excited and then paralyzed; this also obtains for brain and spinal cord. Death is caused by paralysis of the respira- tory centre. In regard to the pupils, see page 73 ; 1, b. Btmpt. Dryness in mouth and throat, hoarseness, diiBculty of swallowing, reddening of face, acceleration of pulse, dry, hot skin, disturbances of vision, mydriasis; dizziness, deli- rium, raving mania; scarlet exan- thema. Death with general paraly- sis. In warm - blooded animals, twitehings; in the frog, the so-called late tetanus. Concerning the pupil, see page 73. Burning sensation in mouth, sali- vation, vomiting and purging - pulse first slow, then arrhythmic j perspiration, myosis, visual disturb- ance. Dizziness, dazed state, dys- pnoea, abortion, convulsions. In chronic cases, catarrh of pharynx, larynx and middle ear; violent beating of heart, limitation of field of vision, scotomy, weakness of memory, dizziness, gastralgia; ar- teriosclerosis; psychoses. Thee. Injections of pilocarpin; washing of organism ; dropping physostigmin into the eye. Ice-cap. Morphin acts splendidly in a symptomatic sense. Prohibition of smoking and of re- maining in places filled with to- bacco smoke, in chronic cases. In acute cases, washing of organism; atropin at the stage of excitation. P.-Mtm. But little is positive. Mydriasis; meninges overcharged with blood. In case of partaking of berries of deadly nightshade, stomach is of dark-blue color; in case of datura, extravasation and inflammation of gastro-intestinal mucous coat. The urine contains unchanged atropin; it is found in the brain and liver of the cadaver. Tobacco odor of all organs; inflam- mation of mucous linings of throat and stomach (in case of internal application); intestine contracted j contains some hsematic mucous. Heart flabby. Meninges hyper- semic. Urine contains unchanged nicotin. Pupils not necessarily chaTiged. Remarks. See page 133, No. 13. See page 133, No. 16. NICOTIN, PILOCARPIN AND COOAIN. 135 PILOCARPIN. Almost exclusively medicinal poisoning and mistakes are to be considered. COCAIN. Medicinal poisoning; abuse of the alka- loid, as well as of the leaves. Slight poisoning frequent; even fatal ones on record. Since 1884 eleven fatal cases and more than 200 grave intoxications. Somewhat larger than for nicotin. the Jaborandi-leaves incalculable. For 1,0 grms., internally or hypodermically, acts fatally. Local irritation absent. Those organs paralyzed by atropin will be at first ex- cited and then paralyzed; but the excita- tion lasts longer than with nicotin. Death with cedema of lungs. Concerning the pupils, see page 73; l,to. As a food, pilo- carpin need not be considered. The eth- ereal oil contained in jaborandi-leaves acts as a diuretic. Central and peripheral action. First ex- citation, then paralysis of the cerebrum. Subdued sensibility of terminations of sensitive nerves. Paralysis of vagus of heart. Mydriasis, depending upon irri- tation of the peripheral terminations of the nerves of dilating muscles of pupils. In case of chronic intoxication, psychical degeneration. Salivation, perspiration, coryza, nausea, vomiting and purging; pulse at first slow, then arrythmic; myosis, lachrymation, spasms of accommodation; abortion; stinging in urethra, and tenesmus with vesical pain; attacks of yawning, head- ache, dizziness, rattling sound in trachea. In chronic cases, inflammation of per- spiratory- and salivary-glands. Unknown whether persistent visual disturbances obtain as with nicotin. Dryness of throat, with burning and furry feeling; trouble in swallowing; nausea, vomiting, pain in abdomen; ac- celerated pulse and beating of heart; mydriasis; protrusion of eyeballs; Cheyne- Stokes' breathing. Gayness, state of in- ebriation, then melancholy. Precordial terror, sensation of swooning. Cyanosis, collapse, amaurosis; paresthsesia; twitch- ing, convulsions, tetanus; paralyses. In chronic cases the state is very suggestive of moi'phinism. For decrepit individuals pilocarpin should be altogether avoided. Never use pilocar- pin without having atropin at hand; this will at once check the intoxication. Sinapisms on heart and stomach; ammo- nium carbonate; washing of organism. In case of spasmp, narcotics. Artificial respiration. In case of chronic cocainism, remove patient to a lunatic asylum. Dissections of human subjects are scarce- ly on record. Organs inodorous. In gastro-intestinal canal injections of muc- ous membranes and liquid contents. De- cided cedema of lungs. Hyperaemic men- inges. Changes of pupils do not of neces- sity obtain. The urine contains unchang- ed pilocarpin; after partaking of jabor- andi-leaves, also pilocarpidin. Hypersemia of brain, liver, spleen and kidneys. For animals, vacuolary degen- eration of the liver-cells has been foimd, with accompanying fatty degeneration and necrosis. In chronic cases a high degree of emaciation. Widening of the pupil of the cadaver, in case of acute poisoning, need not of necessity persist. Urine contains unchanged cocain. See page 122, No. 17. See page 132, No. 5. 136 SPECIAL TOXICOLOGY. XL — CAEDIAC-POISONS. Nothing would be more erroneous tlian to suppose that the poisons thus far mentioned exert no influence upon the heart. Such action is present even to a high degree, in a paralyzing sense, following the use of hydrocyanic acid, phosphorus, arsenic, antimony, carbon monoxid, alcohol, chloral hydrate ; and it is quite a peculiar one in the case of atropin, pilocarjnn, nicotin and coniin. This has already been stated explicitly on pp. 62-65 and 134-135. We here add that atropin and hyoscyamin prim- arily paralyze the inhibitory ganglionic centers of the heart and thus will cause acceleration of the pulse in warm-blooded animals ; small doses of scopolamin (Jiyoscin) in man, do not paralyze the mentioned ganglions, but feebly excitate them. A review of all poisons influencing the pulse, would properly belong here, but for the sake of brevity the above reference may suffice. In the following table we mention only those poisons whose action upon the heart is predominant and directly instrumental in bringing about the fatal issue. The proto- types of such are digitalin and muscarin, the action of which is described in detail in table, page 137. Digitalin is by no means the only substance upon which the poisonous action of the foxglove {digitalis) depends ; in addition to this, the plant contains two other substances of identical action, viz., digitoxin and digitalein. The latter is readily soluble in water and alcohol, while the two former dissolve well only in boiling alcohol. By putrefaction, or other decomposition, all three substances furnish two active products of splitting, viz., digitali- resin and toxiresin, both of which are without action upon the heart. They are mentioned on pp. 130-131. The digitaliresin may be further split when non-poisonous digitaligenin is formed. It is not known if toxiresin allows of further splitting. Badly dried digitalis-lea\es or infusions decomposed by bacterial life may cause the decomposition of the three mentioned heart-poisons, and in using such medicines, violent spasms may obtain. Digitonin and its products of decomposition, digitogenin and paradigitogenin, etc., belong to the sapo»im-group,fpagell2)and scarcely act when digitalis in given internally. But in the decoction of the leaves they hold in suspension the active substances which are insoluble in water. Amanita muscaria contains muscdrin and amanitin (or sinkalin or cholin), but the latter is of no import in case of poisoning by the mushroom; the amanita-atropin, which is frequently present, modifies the intensity of its manifestation. SPECIAL TOXICOLOGY. 137 TABLE OF THE TWO MOST IMPORTANT HEAKT-POISONS. DIGITAIilN. MUSCAEIN. JEtio. Medicinal poisoning ; partaking of the leaves, flowers or seeds of the red fox- glove (digitalis), or of the officinal pre- parations. Partaking of amanita muscaria (false orange), green, dried, uncooked or cooked. Stat. Slight intoxications witnessed by al- most every physician, grave ones rare. In Russia and Siberia not rare in man (food ) and cattle. Dos. LET Unknown, but very small. Unknown, but very small. Act. Local irritation of mucous membranes and of the subcutaneous connective tissue. After resorption, irritation of the vagus-centre and of the peripheral apparatus of the heart- vagus and the vessels. The excitation of the vagus and heart-muscles is later on changed into paralysis. Action upon the frog heart, see page 65. BaClz is of similar action. No local action. After resorption, the amanita of high latitudes causes a cer- tain inebriation conjointly with excita-' tion. The pure muscarin irritates all peripheral apparatus which are para- lyzed by atropin. Compare page 134. The musculature of the heart and vessels is not at all infiuenced. Action upon the frog-heart, see page 63. Stmpt. Nausea, vomiting, pressure in the re- gion of the stomach, pains by colic, diarrhoea; cardiopalmus ; pulse wiry, diminished to 40; hammering sensation of carotids; pain in forehead, dizziness, buzzing in ears, darkening of field of vision; anuria ; abscesses after subcu- taneous injection; pupils generally dilated. Concerning the action of the products of-decomposition of digitalin- substances, see pages 130 and 136. Nausea, salivation, perspiration, rum- bling in abdomen, vomiting and purg- ing. After faiitial acceleration of pulse, retardation, even below 40; pulse soft, intermitting. Pain in forehead, dizzi- ness, visual disturbances, contracted pupils, spasms of accommodation, lachrymation ; desire to urinate, sali- vation; abortion. The accompanying alkaloid reduces the strength of all symptoms. Exit. Pulse becomes arrhythmic, greatly ac- celerated, small; fainting speUs; face remarkably pale. Heart stops, and death in coma with or without spasms. Stools become hgematic. Thickening of blood" as in the case of cholera. Rattling in trachea, oedema of lungs. Pulse becomes steadily slower, finally is imperceptible, but is never wiry. DiAGN. The pulse, at first very strong and very slow, later on becomes directly the opposite. Fragments of the mushroom in the vomit; pulse very slow until death, but soft ; increase of all secretions. Thek. There is no antidote existing. Treat symptomatically. Atropin will only remove the retardation of pulse. Atropin, hypodermioally, will at once remove the danger of life and almost all symptoms. In spite of this, wash- ing of the stomach is necessary. P.-Mtm. The finding may be negative. Accord- ing to experiments on animals, sub- endo-cardTial haemorrhages into the left ventricle should not be rare. Heart ceasing to beat in systole only occurs (for animals) after excessive doses. The gastro-intestinal canal may show appearances of irritation. Aside from the oedema of the lungs, which cannot be considered, but little characteristic; the finding may be a negative one. The heart is remarkably flabby; both sides flUed. The intestine contains a reddish liquid ; the mucous membrane of the intestine may be partly hsemorrhagic. The blood very much thickened. Degeneration of the organs (?). Detect, So far it has been impossible to find even a trace of the active substances of digitalis either in the organs or in the urine. It remains very question- able whether digitalin may be obtain- ed from the contents of the intestines according to DragendorfE's method. The proof has to be restricted, there- fore, in most cases, to digitoniu, which is contained in digitalis besides digi- talin, and which belongs to the sapon- in-substances mentioned on page 113. For instance, we can obtain it by agi- tation with amylic alcohol, and it will turn a beautiful red with cone. HCl or HaSO*. The pharmacognostio proof of fragments of leaves of fox-glove insures the diagnosis. Also the phy- siological proof Is decisive. Up to date the proof has never been rendered. Furthermore, even if we should be able to detect it, such proof would not be conclusive, since there exists a cadaver-muscarin. Compare pages 38, 48 and 49. The physiological proof ensures the diagnosis, and should be conducted in such a manner as to free the isolated alkaloid from the amanita-atropin, which is soluble in ether. A special reaction for muscarin is wanting; it might reappear un- changed in the urine; this has long been known to be true of the inebriat- ing substance of the northern amanita. The pharmacognostio proof of frag- ments of amanita will also insure the diagnosis. Among the products of decomposition of muscarm, we find tri-methyl-anin. 138 TABLE OF THE MOST IMPOKTANT No. NAME OF PLANTS. FAMILY. POISONS. 1 Digitalis purpurea, ferruginea, ambigua, parviflora, grandi- flora, aurea, nervosa, gigantea, eriostaohys, glandulosa and Fontanesii, fox-glove. Scrophulariac . Digitalin, digitalein, digitoxin. The first two are glycosids, the latter a bitter principle. 3 Helleborus niger, f oetidus and viridis. Ranunculac. Helleborein, glyoosid. 3 Coronilla s^corpioides, juncea, montana, pentaphylla and varia. Papilionao. Coronillin, alkaloid. 4 Adonis vernalis, aestivalis, autumnalis, flanMnea,cupiana, amurensis. Ranunculac. Adonidin, glycosid. 5 Convallaria, majalis, lily of the valley. Liliac. Convallamarin, glycosid. 6 Polygonatum multiflorum and ofiBcinale, Solomon's seal. Liliac. Possibly convallamarin. 7 Nerium Oleander. Apocynao. Oleandrin and neriin, glyco- sids. 8 Nerium odorum. Apocynac. Neriodorin and neriodorein, glycosids. 9 Apocynum canabinum, com- mon Indian hemp. Apooynac. Apocynin and apocynein; only the latter is a glycosid. 10 Soilla maritima or Urginea scilla, squill. Liliac. Scillain and Scillitoxin, glyco- sids. 11 Strophanthus, many species. Apooynac. Strophantin or methyl-ouabin,. and ouabain, glycosids. 13 Cactus grandiflora. Cactese. Cactin, glycosid (?). 13 Tulipa gesneriana. Liliac. Tulipin, alkaloid. 14 Agaricus muscarius or Aman- ita musoaria, false orange (mushroom). Hymenomyo. Muscarin, alkaloid. 15 Agaricus pantherinus or Am- anita pantherina. Hymenomyc. Muscarin, alkaloid. 16 Boletus luridus. Hymenomyc. Muscarin, alkaloid. 17 Boletus satanas. Hymenomyc. Very likely muscarin. 18 Areca catechu, areca-palm. Palmee. Arecolin and other alkaloids. PLANTS CONTAINING HEART-POISONS. 139 ACTION ; CHEMICAL BEHAVIOR. Considerable difference in the toxic quantity exists between the different species. Dig-ferruginea acts strongest. The active substance, in all species, is contained mostly in the seeds ; next the leaves ; even the roots are not inert. Mainly the root, and the leaves near the root, contain the poison. The last-named species in particular contains, besides, a glycosid possessed of action upon the heart, viz. , helleborin. Cone. HjSO^ turns this a beautiful bright red. The seeds mainly contain the poison, which is very bitter. It forms crystalline salts, soluble in water. All parts of the plant contain the poison, the herb mainly. It is easily soluble in ether-alcohol. It disappears in the organism. Also convaUarin in addition, contained in the entire plant ; soluble in water and alcohol, insoluble in ether. Beautiful purple coloration with cone. HaSOi. It is probable that neriin and oleandrin are identical. Oleandrin is soluble in chloroform. The leaves contain the poison. According to Schmiedeberg, identical with oleandrin and neriin. Common as an ornamental plant in England. The poison is contained in the leaves. Similar to neriin and oleandrin. The plant is indigenous to America, and popularly used. Possesses all virtues of digitalin, but causes stronger irritation as a vomitive. Soluble, with red color, in cone. HCl. Mostly contained in the bulb. Now officinal in form of Tinct. Stropanthi, prepared from the seeds. Acts like digitalin. The beautiful flowers of this popular ornamental plant are the poisonous part. It is not assured whether this poison belongs to the digitalin-group or not. The false orange is occasionally gathered and eaten instead of the non-poisonous Amanita osesarea, the orange (mushroom). Frequent in Europe and Asia. This mushroom is of frequent occurrence in German pine- and leaf -forests. This mushroom grows particvilarly on shell-limestone, and it is very poisonous. Arecolin is nearly related in its action to muscarin. APPENDIX. A ReTiew of Toxicologically Interesting Products of Metabolism (Exchange of Material). We have mentioned on pages 13 and 38, that certain products of metabolism are of decided toxicological interest, particularly those consequent to micro-organisms and appear- ing in certain diseases and in corpses. For the most meritori- ous labors concerning our knowledge of these substances, we are indebted to Feanoesco Selmi, L. Beiegee, and later ou, Griffith. The following data, even though imperfect, will serve to give an insight into these substances. The albumin is the source of most of the poisonous products of metabolism. Albumin itself may undergo poisonous change (toxalbumius, enzymes), or, by decomposition, it may admit of the generation of numberless poisonous products ; such products of decom- position belong to the groups of alkaloids, amido-acids, acids, etc. They generate partly in the intestinal canal and partly in the other organs most varyingly. Albuminous esculents, even before they are taken into the body, may give rise to the formation of poisons. I. — Concerning Esculents Undergoing Toxic Change. I. — ANIMAL ESCULENTS. Poisoning by sausage is also called allantiasis (from aXXaQ,aWdvtoC, = sausage), or botulism (from botulus =- sau- sage). The first one to describe it more exactly M'as Justinus Keenee. It is identical with a certain form of fish-poisoning. Poisoning by meat has not infrequently been compared and confounded with typhus and intestinal sepsis. It has occurred principally, and in wholesale fashion, at popular festivals (Volksfeste, Vogelschiessen, etc.), and we cannot say that it is on the decrease. Similar cases of cheese-poisoning appeared during the last decade, mainly in North-America. The poison involved in this case, tyrotoxin, derives its name from rvpoQ = cheese. 140 APPENDIX. 141 o to M o H 03 a M o Q ->1 1^ OS 5 n o CO O O S^ f,-^ fe'S g'3 i ■a„e_ -J 3 " ^^ S ^ 9 S o AoX -5t^ o ce ^ a ® l||g«.2 §•? 0+^ Prt ^i.S m © ^•a-a 9 s S S';^ o 2feO §«£ m IP M UU d'^S ^51 So o o d ^ © dTi d bo m ©fl d ^r^.y d§« .sao S P (Q TO •. 0^.9 o 43 -g .ass =8.3 ■2 « s © =* g.2S^:S ■°" >=o-| o SsJ g f:af^ o ? a5^g-s.s ID I _; I» 00 1 rH " i --H to M oj+s ID y m m c8-j:3 m O © d ©;;3 © ™ .fl-^ d o d .. > 52 2 °'S«i'"-*= §©&g°'S § ©a"iSS3iJM^ p," ©©©9 ^'3-g G ij ©H 600+3 ^ So o o ^ 03 .Ss«. ID O ^i+= 1=4 CQ CQ © 01} df OU i»©oS£d Sa.d-^©^g 3 . f< be© '5 s© iS-S ^ •d5t»a'«©idS a^5-3.2igog 5,S9KfedsB3 a s g^^-s^ in a >. lisSteoMSS 1"'-' m [>n3 o j°2 .£a CcodPSi 00 d t8 •- >.t3 O Ph 5-^ -=!> "^ © c ,< S © O Ph 5dd 9 fl w ©'S 9 .•o-ro 111 j^g rf » 2 ©»o| .a d,d P- ■S P.CS © od ©*!* . "■si _i o " gg'g' 0+3 =H ^■d ° "dd .d o © a-s as§ 5o'3 ^5g £°g?+i S 2od S^,d§<«S ^"i:ig ^©^■gg-^ .i*J -p ad (B «.:2.s oSS» Sag. © h © bd © ©' So!? g©l3 ^ to c3 9 SJ © ;5 (B WW jr . H © I«ili'.t oga«2o'd© -Ills oil ©t3 o d © 15 P'Da' "^■S ■* fltd "SI* o-°?dg.Sl»© d ga-ijo+id 9 :'ado'^g>,i>.© CO d ■* © ^ ^7f Lj *^ flJ U « ?|»&^|s^d ij Co " Q,'^ d _d y in f.&5 ;if§ »£a^ §a^o STjad so © °3dl 02^© . ^ » 43g o-d © " © S,So© £§■30' !M 2 © © d £D © =3 13 © d M rs ■tj >. S H g tS © o g P; ■Sd-i .g 3 >, © 5 o o sHlld rt O .to d^ " Oja © 4^S.d'adg, ■g Oc53 do" |o«*"-s ©13 C3 OfQ C e3 h p.fe © s !!5 m n o • -'''0 2 ig^g © M JS eg © CO o bo© (R --©.9 .d © © _ © l>.o g s © O d © .gg&* ll^a f:i F-i+3 H l45gS a §■" gl tH a °^ MS ,9© I5 ^^ •S.S15 m © & ffi Pi d'B^. aa© (1h.! © I I I o ' o:r-jj3 eS4J O d'^^os -S ©XJ © bobll'^ S p > '^.B a P. ,d^S*^ © g o o to ■" g K ©2 © * a d "+3 »^ " s s s © " a "(v.S 60, 3 fl<*-S ©9 as*!'-' hiS-s « ^ © © a- fed .dja " 1. © d o+^fLj5 © O d.Pi ° ©EH t* P3 i©^^tS |g§'3'3.§.g s.0.d © bDf^ g ©^ fl d d-g ELioaJsoa 142 SPECIAL TOXICOLOGY. n. — VEGETABLE ESCULENTS. It is obvious that from improper preparation and preser- vation of any of the many different vegetable substances, organic poisons may develop. Flour, e. g., which had been kept in a moist condition, has been found polluted by ptomaines. In Dorpat, in 1893, intensely bitter, but relatively non-poisonous substances, formed in many hundreds of pounds of flour destined for the use of soldiers. We have mentioned on page llOthat poisons may form in imperfectly dried Indian- corn. Edible mushrooms, which had rotted before drying, or which had been insufficiently dried, may form poisons of most daugerous action, the most important of which is neurin, behaving like muscarin. On the other hand, e. g., helvella escuhnta, mentioned on page 113 loses its poisonous proper- ties on drying, but if it now rots, new poisonous properties of another nature are acquired. The vegetable fats become rancid on preservation, viz., they split by hydrolysis into glycerol and free fatty acids. The vegetable carbohydrates, in particular the different kinds of sugar are readily changed into acids. The vegetable albumins decompose less readily than those pertaining to animals, because they as a rule, contain less water. But in a moistened condition, they are easily decomposed by putrefaction, and by mold-formation. II. — The Most Important Chemical Groups of Products of Metabolism. For the purpose of giving the physician some idea of the multitude of substances belonging to this class, we affix the following table (pages 143-147), making particular mention that this enumeration is not exhaustive. Here are some of the derivations of the strange names appearing in this table : Cadavsrin, from cadaver = corpse ; asparagin, from aspar- agus ; vernin, from ver = spring ; mercaptan, from mercurium captans = readily seizing the mercury ; gadinin, from gadus = cod-fish ; susotoxin, from sus = pig ; saprin, from GanpoZ = putrid ; mydalein, mydatoxin and mydin, from /^vSdoo = to putrefy ; scatol, from ffxaroZ = excrements ; leucin, from TievKoQ = white ; creatin, from npeaZ = flesh ; xanthin, from ^avSroZ = yellow ; lysatin, from Xvsiv = to dissolve ; adenin, from aStjv = gland ; pyridin and pyrotoxin, from rrvp = fire, fever-heat ; pyocyanin, from ttvov = pus, and uvavoQ = blue ; ichthyotoxin, from ijS-iiC = fish ; spasmotoxin, from GnaGfidZ = spasm ; phlogosin, from cpXoywaiZ = conflagration, heat, inflammation. APPENDIX. 143 TABLE OF THE MOST IMPOETANT PRODUCTS OF METABOLISM. No. NAME. POEMULA. ORIGIN, ACTION, &C. GEOUP. 1 2 3 4 Formic acid. Acetic acid. Propionic acid. Butyric acid. C2H4O2 CsHeO. C4H8O2 ■ Described on page 83. Non-poisonous in form of their neutral salts. i The following members are ) omitted ; see page 79. I. Group of the fatty acids. 5 6 Lactic acid, or oxy- propionic acid. y3-0xy-butyric acid. CsHsOs CiHbOs The lactic acid of fermenta- tion and the sarco-lactic acid are involved. They lessen the alkalescence of the blood. Occurs in the blood of diabetic persons and causes the dia- betic coma. II. Group of the oxy-acids 7 8 Oxalic acid. Succinic acid. C,H.04 C.H,04 Described on page 83. Its for- mation in the organism causes oxaluria. Forms in fermentation; see page 79. III. Group of the oxalic acid series. 9 10 11 12 13 Amido-acetic acid, or glycocoU. Amido - propionic acid, or alanin. ^- Amido - iso - butyl - acetic acid, or leu- cin. Amido-carbonio acid, or carbaminic acid. Amido-succinio acid, or asparaginic acid. CjH3.NH..O, C3H5.NH2.O. CeHn.NHs.Oj CO.NHj.OH C4H5O4.NH. Forms, e.g., in putrefaction of glue. It plays a part in the formation of hippuric acid. See p. 11, It is non-poisonous. Linkedto aromatic complexes, itis contained in the albumin- moleeule.and is non-poisonous Forms in digestion and in put- refaction of albumin and glue ; many kinds of leucin exist, partly dextro - rotary, partly laevo-rotary, having a tenden- cy to crystaUize readily; non- poisonous. Stepping-stone to urea; com- pare page 88 (Lime). Forms in the intestinal canal on splitting of albumin. IVa. Group the ami do- acids. 14 15 Carbaminic acid-am- id, or carbamid, or urea. Asparaginic acid-am- id, or asparagin. CO.(NHs)j C4H40s.(NH.). Normal final product of nitro- gen in albumin digestion. One of the most important products of metabolism in plants, e.g., peas, beans, as- paragus. IVb. Group of the amido- acid- amids. 16 17 18 19 20 21 22 Methylamin. Ethylamin, Prop^ylamin. Butylamin. Amylamin and Iso- amylamin. Hexylamin. Glycosamin. CH3NH2 C.H.NH. CsHiNH, C4H9NH, aHn.NH, CeHisNH, CeHn.NH^.Oo In herring brine and in (putrid) corpses. In putrid yeast and in putrid corpses. In putrid gelatine and in putrid corpses. In cod liver oil. In cod liver oil and in putrid yeast. In cod liver oil and in putrid yeast. Product of splitting of and of chondrosin. 0* All of these are polson- p; ous,corrosive,ana cause B spasms like ammoma. V. Group of the primary amines or amido- bases. 144 APPENDIX. No. NAME. FORMULA. ORIGIN, ACTION, ETC. GROUP. 33 34 Di-methylamin. Di-ethylamin. (CH3)2.NH (C.H.),.NH ) In putrid flsh and in putrid [ human corpses. They cause ) spasms and are corrosives. VI. Group of the secondary amines or imido- bases. bo 26 Tri-methylamin. Tri-ethylamin. (CHs)3.N (CH^s.N In herring-brine, in cultures of the coma bacillus, in putrid cheese, etc., causes spasms. In putrid corpses alongside of tri - methylamin. Causes spasms. VII. Group of the tertiary amines or imin- bases. 37 38 39 30 Ethylidene-diamin. Tetra-methylene-dia- min or Putrescin. Penta - methylene - diamin or Uadaverin, Hexa-methylene-dia- min. CH3.CH.(NH0. NHj.(CH2)4.NHj NH,.(CH2)5.NH, NH,.(CH,).NH, Product of putrefaction of corpses. In putrid corpses, and condi- tionallyin the excrements and urine of living persons. In putrid corpses, putrid flsh, cultures of proteus- and chol- era-bacilli. The free base is corrosive, the salts are non- poisonous. With the two preceding ones. In the urine in cystinuria; non-poisonous in form of its salts. vm. Group of the di- amines. 31 83 33 34 35 36 Cholin. Betain or Oxy-neu- rin or Lycin. Mydatoxin. Neurin or Vinyl-cho- lin. Neuridin. Cadaver-muscarin. CsH^.NO, CsHisNOa CsH.sNO, CsHuNO CsH.^N, CaH.^NOs In bile, chicken's egg. sprouts of germinating plants, barks and: seeds etc. of many plants. Forms in the putrefying corpse from protagon and lecithin. Non-poisonous. In matrimony-vine (lyoium) and many other plants in poisonous mussles (mytilus edulis) etc. Non-poisonous. Obtained from very putrid corpses ; acts similarly to mus- carin and kills with spasms. It is found in corpses on the fifth or sixth day, as well as in putrid helvalla and acts like museailn. One of the most frequent pro- ducts of putrefaction. Non- poisonous. Similar to. or perhaps identi- cal with the amanita-muscar- iu. Compare page 137. IX. Cholin group. On fur- ther de- composi- tion, tri- methyl- amin is formed. 37 38 39 40 Guanidin. Methyl-guanidin. Methyl-guanidin ace- tic acid or Creatin or Methyl-glycocyamin. Propyl glycocya- min. CH5N3 CH4.N3.CHa CsHeiNsO^.CHa CsHeNaOj.CaH, One of the splitting-products of albumen, in germs of vetch or tare (viola). Causes epilep- sy by irritating the cortex of the brain. See page 60. In putrid flesh; acts as the preceding one. Contained in muscles, nerves, blood, testicles, etc., of living persons and acts stimulating- ly. Creatin is oreatinin minus one molecule of water. In the urine in case of Quinsy, very poisonous. X. Guanidin group. APPENDIX. 145 No. NAME. FORMULA. ORIGIN, ACTION, ETC. GROUP. 41 43 43 Glycocyamidin. Lysatin. Arginin. C3H5N3O CaHisNsOa C.HmN,0. In the urine in ease of measles as well as in pure cultiires of whooping-cough bacilli. Isomerio.or identical with pro- pyl-Klyool-oyamin ; prepared artificially from casein. Ly- satinin is lysatin minus one molecule of water. Normal constituent of sprout- ing plants. Action unknown. X. Guanidin group. 44 45 46 47 48 49 50 51 53 Adenyl-imin or Ade- nin. Adenyloxid or Hy- poxanthin. Adenyldioxid or Xan- thin. Methyl-adenyl- diox- id or Heteroxanthin. Dimethyl - adenyl-di- oxid. Trimethyl - adenyl - dioxid or CofiEein. Adenyl - trioxid or Uric acid. Adenyl-imin-oxid or Guaniu. Vernin. Episarcin. C6H,N4.NH. CsH.NiO C5H4N4O, CsHsCHsNiO, C6H..(CH3)aN40, C5H.(CH3)3N40j C3H4N4O3 C5H4N4NH.O Ci.H^oNsOs (C4HeNsO)x Normal constituent of thymus, lymphatic glands, pancreas, etc., but also of tea-leaves. Action unknown. In the sprouts of maple.plane- tree (platanus), lupine.etc, but also in spleen, pancreas, liver, muscle, marrow, blood and urine of normal animals. Am- ount increased in leucEemia and acute yellow a,trophy ol liver. In pancreas, brain, liver, spleen , thymus and urine. It sometimes forms calculi. Pound in urine, etc., besides xanthin. Three isomers exist : paraxan- thin of urine, theopnyllin of tea-leaves, and theobromin of cocoa-beans. In coffee it acts in an irritating manner, like the other xanth- in-substanoes. See page 122. Is the cause of gout, arthritis urioa and nephritis urica. The latter also occurs in case of saturnism. See page 98. In liver, pancreas, guano, ex- crements of spiders, and in the skin of various reptiles and fish. In hogs it causes the so- called guanin-gout. In pumpkin-seeds, vetches, red clover, in olavioeps purpu- rea (ergot). On boiling with HCl, guanin forms. According to Bat.ke, in nor- mal urine. XI, Adenin. group. 53 54 55 Pyridiu. Methyl - pyridin or Picolin. Dimethyl-pyridin or Lutidin. CsHsN CeH,N C6H4.CH3.N CHgN— C5H3.(CH3)3N Nucleus of many alkaloids. Forms on destructive distilla- tion of organic, nitrogenized substances. Acts, like the whole series, in a manner sug- gestive of niootin. One gulp killed a workman. In tobacco - smoke, causing part of its toxic actions. So far it is of no pharmacolo- gical interest. Pound in bone- tar and in Dippel's oil. Pois- onous. XII. Pyridin group- 146 APPENDIX. No. NAME. FORMULA. OEIGIN, ACTION, ETC. GROUP. 56 CoUidin. GeHi.N Forms in putrefaction of gela- tine (base of Nenoki) and in putrefaction of sea-polypus. Poisonous. 57 Parvolin. C»Hi3N Found in putrefaction of flesh XII. (base of Gautieb and Etabd). Poisonous. Pyridin 58 Coridin. CioHibN In the putrefaction of various animal substances (base of group. GuABESCHi and Mosso). Poi- sonous. 59 Hydro-coridin. C,„Hi,N Product of metabolism of bacterium Allll. 60 Quinolin. CHvN Nucleus of many alkaloids.in coal-tar. Protoplasmic poison; kills after a short time of irri- tation, by paralysis of respira- tory-centre. XIII. 61 Methyl - chinolin or Lepidin. CsHe.CHs.N Found e. g., in bone-oil and in, coal-tar. Poisonous. Quinolin. 63 Dimethyl-chinolin or Cryptidin. CoHs. (CH3).N Found besides Lepidin. e. g„ in bone-oil. poisonous. Cairin and thallin are derivatives of this group. group. 63 Hydroxyl-benzene or Phenol. CeH^.OH Discussed on page 83, under the name of carbolic acid, forms as a product of putre- faction in the normal intes- tinal bacterium - digestion and reappears in the urine as sulfuric acid - phenol - ester. Compare page 10. -64 Methyl - phenol or Cresol. CsH4.OH3.OH Mainly one of the three possi- ble isomeric oresols, para-cre- sol, is invariably found among the products of the process of intestinal putrefaction. It ap- pears In the urine as sulfuric acid para-cresol ester. The oresols are less poisonous than phenol. 65 Di-hydroxyl-benzene CeH.COH), Of the three isomeric di-hy- droxyl benzenes, mainly the ortho-compound, catechol, is always formed in the intestine. XiV. Group of and reappears in human urine as mono- and di-sulturic acid the ester. The meta-eompound. resorcinol, is freely used as a aromatic medicine. The para - com- series. pound, ciuinol, forms in the or- ganism in oonsecjuence of par- taking of arbutin or of bear- berry-leaves (Fol. Uv» Ursl). 66 Phenyl-acetic acid. CsHs.CHs.COOH Forms in putrefaction of albu- min, poisonous. 67 Para-oxyphenyl-ace- C6H4.OH.CH2 Forms in putrefaction of albu- tic-acid. COOH min and passes in an unchang- ed state into the urine. Pois- onous. 68 Phenyl - propionic - C6H5.C2Ci4. Forms on putrefaction and re- acid or Hydro - cin- COOH appears in the urine as hip- puric acid. Poisonous. namio acid. 69 Phenyl - amido - pro- C6H5.C2H3.NH,. Splitting-product of albumin. pionic acid orPhenyl- alanin. COOH but it is further decomposed in the organism. Poisonous. APPENDIX. U7 No. NAME. FORMULA. ORIGIN, ACTION, ETC. GROUP. 70 71 72 73 Oxy - phenyl - alanin or Tyrosin. Methyl - tyrosin or Andirin. Indol. Methyl-indol or Sca- tol. CHi.OH.CHa. NHj.COOH CsHio.CHs.NOs CsHtN CeH..CH3N One of the most ordinary pro- ducts of putrefaction of albu- min. In the normal organism it is further oxidized (burned), but not so in the case of phos- phorus-poisoning and aleap- tonuria. But slightly poison- ous. It is also found in the tuber of staohys tublf era. It is found in the genuine geof - froya-bark (as surinamin or geoffroyin ).in ratanhy-extraet (as ratanhin), and in the resin of pereira speotabilia ( as an ge- lin). But slightly poisonous. Forms in the intestine in put- refaction of albumin, and re- appears in the urine as a salt of indicau or sulfuric acid in- doxyl ester. Many patho- genous bacteria will produce it even outside of the intestine. It is contained in the wood of celtis (haokberry or nettle- tree). Poisonous. Forms in the intestine in put- refaction of albumin and re- appears in the urine as a salt of sulfuric aoid-scatoxyl-ester. Scatol is also formed on dis- tillation of strychnin with lime. Poisonous. XIV. Group of the aromatic series. 74 75 76 77 78 Hydrogen Sulfid. Methyl-mercaptane . Amido-ethyl- sulf on- ic-acid or Taurin. Potassium sulfo cy- anate or Pot. thyocy- anate or Pot.rhodan- ate. Dithio - diamido - lac- tic acid or Cystin. HsS CHa.SH CsH4.NHa.SOsOH CNSK CeH^N^S^O, Found in every putrefaction going on with exclusion of air, conseauently in the intes- tine. Poisonous. See page 118. ■Similar to the preceding. Poi- sonous. Forms on putrefaction of taurooholic acid in the intes- tine. Taken internally, it re- appears in urine as a substi- tuted urea. Non-poisonous. Forms on complete decom- position of adenin, and is found in saliva, urine and milk of man and various ani- mals. Even ordinary mold, aspergillus niger will produce it. It accentuates the reilexes and causes spasms. Forms in pancreatic digestion; its increased formation, due to specific bacteria, causes cys- tinuria. It is non-poisonous. XV. Group of the albumin deriva- tives contain- ing sulfur. 79 80 81 83 83 Iso-cyan-methyl, Iso-cyan-ethyl. Iso-cyan-amyl. Iso-cyan-acetic acid. Iso - cyan - propionic acid. CHs.NC CHs.NC CsHn.NC CH^.NC.COOH C2H4.NO.COOH Sparingly contained in toad- poison. Poisonous. Splitting product of the so- called pseudo-lecithin, which is contained in the triton- poison. Poisonous. In the poison of salamandra maoulata. Poisonous. Abundantly contained in toad-poison. Poisonous. In the poison of tritons. Poi- sonous. XVI. Group of the iso-cyan- com- pounds. 148 APPENDIX. No. NAME. FORMULA. ORIGIN, ACTION, ETC. GROUP. 84 85 86 87 89 90 91 93 Tetanotoxin. Tetanin. Saprin. Mydin. Gadinin. Typhotosin. Nameless base. Nameless base. Nameless base. Eczemin. 94 Malleus base (perhaps identic with No. 127) CxBHioNjOe 95 Pneumonia base. CoHsbN^O, 96 Influenza base. CoHsNOi 97 Erysipelin. CnH.sNOa 98 Convulsivin. CsHisNO, 99 Pyaemia base. CsjHisNOj 100 Epilepsy base. Ci.H.eNaO, 101 Anthraxin. CsHeNa 103 Morbilli- or Rubeola- base. CaHsNsO 103 Pyocyanin. C.HuNO, 104 Sardlnin. C„H„NO» 105 Scombrin. CnHssN, 106 Lepierre's base. CieH.^NjOi 107 Asellin. C25H32N4 108 Morrhuin. C„H2,N3 109 110 • Nameless bases. CnHjoN^O, CsHnNOs 111 Pluviatilin. CsHsiNsOs 113 Tetragenin. CsHeNO. CsHnN Ci4H3oN204 C5H14N2 CeHnNO CHitNOs C,Hi,NOs CeHisNO^ . C,Hi,NOj C3H9O2 C7H16NO {Isolated from cultures of the tetanus bacillus, with other substances. Both are poi- sonous. Found in human corpses; non- poisonous. Forms under the influence of typhus bacilli, from the albu- min of blood ; non-poisonous. Isolated from putrid glue and putrid codflsh. Causes ascend- ing paralysis. In typhus - cultures; poison- ous. In tetanus - cultures ; non- poisonous. In putrid flesh ; poisonous. Forms in cadavers; poisonous. In the urine of eczema pa- tients; causes inflammation and fever. Isolated from cultures of bacillus mallei and from the urine of glanders patients; poisonous. In the urine of pneumonic patients; poisonous. In the urine of influenza pa- tients ; kills with high fever. In the urine of erysipelas pa- tients ; causes violent fever. In the urine of whooping- cough patients, as well as in cultures of whooping-cough bacilli. From the urine of a woman suffering from puerperal fever. Found in the urine in epilepsy. Produced from anthrax cul- tures. In the urine of patients suf- fering from measles. Coloring matter of blue pus; non-poisonous. Forms in putrid sardines; causes death with vomiting and purging. In putrid mackerel. In over-ripe cheese. ( In the dark cod-liver oil; the J latter base not inert, but dia- ( phoretic and diuretic. Found in putrid fibrin. Found in putrid flbrln and putrid flesh. Produced on peptone gelatine by bacillus fluviatilis. Produced by Micrococcus te- tragenes, freauent In phthisi- cal sputa; poisonous. 3 ,2 1 o CM a § ,2 o 5 X. APPENDIX. 149 No. 113 114 115 116 117 118 119 130 121 122 123 124 125 136 127 128 139 130 131 132 133 Pellagrocein of Lombroso. Pyrotoxin of Centanni. Sepsin or base of Schmiedebeeg and Bergmann. Ptomatropin or Kerner's base of sausage-poison. Ptomacurarin or base of Harkawy, Peptotoxin of Brieger. Ichthyotoxin of Mosso. Tyrotoxin of Vaughan. Mydalein of Brieger. Spasmotoxin of Brieger. Phlogosin of Leber. Sucholotoxin, sucholoalbumin, suso- toxia. Tuberculin of Koch. Tuberculoidin of Klebs. Morvin of Babes. Choleratoxopepton of Scholl. Toxopepton of Petri. Diphtheria-toxalbumin. Gonococcus-toxalbumin. Tetanus-antitoxin. Diphtheria-antitoxin. ORIGIN, ACTION, etc. Is said to form in putrefaetion of Indian-corn and to cause pella- gra. Is said to cause Inf ectlon-f ever. Obained from putrid yeast. Is said to produce the symptoms of septicaemia. Acting similarly to atropin ; base formed eventually in putrid fish and putrid sausage. Base acting similarly to curare, repeatedly found in putrid corp- Forms when albumin is pepton- ized. Poisonous substance of the blood of eel. Sometimes found in cheese ; very poisonous. Obtained from human corpses, most likely a diamin. From tetanus-cultures; ous. poison- Obtained from cultures of staphy- lococcus aureus ; does not contain nitrogen ; causes inflammation. They form in hog-cholera or hog- pest. Mixture of substances from cul- tures of bacilli of tuberculosis; poisonous. Purified tuberculin. Enzyme formed in bouillon of horseflesh from bacilli of gland- ers; causes fever, nephritis and marasm. Formed, by cholera-splrllll, from living protoplasm with exclusion of oxygen ; causes paralyses and hypersemia of the kidneys and the small Intestine. Formed by the same spirlUl on dead albumin. Produced by the baccilus of diph- theria; very poisonous. Generated from Neisser's coccus ; produces orchitis. Acts as a cure of tetanus-infec- tion. Acts as a remedy In ease of diph- theria. GROUP. S o ID J5 a s 1 1 01 >> s ri 01 3 sfi ■i d