Poisoning

“ When a person dies from the effect of poisoning, it is simply because the system was unable to eliminate the offending substance and was exhausted in the effort. There is a tolerance of some substances which frequently results in chronic disease, and again it is shown in what is called the cumulative effect or acute disease.
“Those who would hold that a substance is at one time a medicament, and at another time a poison, have much trouble in drawing the line between the beneficial and the poisonous effect. ”

“ Steep the sweet fern in boiling water an hour, and apply to rash.
Poisoning—Treatment and Antidotes.
Send for doctor, but work immediately.
If you do not know what caused the poisoning, make patient vomit as soon as possible by giving 1 tsp. mustard in a cup of warm water, or 1 tsp. salt in a cup of warm water, or 2 tsp. ipecac. Repeat if necessary.
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After vomiting, give white of egg stirred in water; milk; or boiled starch. Give hot coffee as stimulant.
There are three divisions of poisons:
(a) Those that affect the nervous system; as opium, aconite, alcohol.
(b) Those that irritate ”

“ In the first place, in cases where a defence is attempted by a charge of imputation of poisoning it may be necessary to determine by an accurate account of the symptoms, or by the morbid appearances, or by both together, whether the poison was introduced into the body before or after death. For it is said, that attempts have been made to impute crime by introducing poison into the stomach or anus of a dead body ”

“ CHAPTER II. DIAGNOSIS OF POISONING—DUTIES OF THE PRACTITIONER. The chief characteristics of poisoning mentioned by authors of repute are, that the symptoms commence suddenly after taking any substance or fluid into the stomach, the individual being in a state of health; that they increase steadily, and are uniform in their nature throughout their course; and that they prove rapidly fatal. There are many exceptions to these rules. Thus if the stomach be loaded the appearance of the symptoms will often be delayed some few hours. ”

“ Remissions are most likely to [Pg 236] occur in slow poisoning with the metallic irritants, from fear of detection or cunning on the part of the poisoner to imitate the progress of disease. In nervous affections, all the symptoms must be taken into consideration, and these will be found to differ from those of any known poison. ”

“ For its possible occurrence is the only obstacle in the way of a decision in favour of poisoning, from symptoms and morbid appearances only, in certain cases by no means uncommon, which are characterised by signs of violent irritation during life, early death, and unequivocal marks of great irritation in the dead body, namely, bright redness, ulcers, and black, granular, warty extravasation. ”

“ Bunglers that you are, don't use arsenic or any mineral poison; they leave traces; you will be found out. Use vegetable poisons; poison your fathers, poison your mothers, poison all your families, and their inheritance will be yours—fear nothing; you will go unpunished! You have committed murder by poisoning, it is true ”

“ Slow Poisoning.—Slow poisoning has been caused accidentally by arsenical wall-paper, in the manufacture of arsenical pigments, by the admixture of small quantities of arsenic with salt or other condiments, and repeated small doses have been used for criminally producing a fatal illness intended to simulate disease from natural causes. ”

“ When a medical man is called to a case during life, where poisoning is suspected, he ought as soon as possible to follow the instructions laid down for securing articles in which poison may have been administered. ”

“ The criminal destruction of life by poison has been practised from ancient times. Very little was known of toxicology in those days, and even the symptoms often passed unrecognised or were attributed to natural causes, and the poisoners' fiendish work was frequently undiscovered and rendered easy. In the early Christian era, poisoning, indeed, became quite a profession, and convenient individuals could be hired with little difficulty to administer a deadly dose to an enemy or rival. ”

“ But a more common form than either of the preceding is one, similar to the chronic form of poisoning with the mineral acids, in which constant vomiting of food and drink, incessant discharge of fluid, sanguinolent stools, difficulty of swallowing, burning pain from the mouth to the anus, and rapid emaciation, continue for weeks or even months before the patient’s strength is exhausted; and where death is evidently owing to starvation, the alimentary canal being no longer capable of assimilating food. ”

“ In very rapid cases of poisoning, when a very large quantity of poison has entered the circulation at once, instead of the gradual extinction of function of the cerebro-spinal centres, the poison appears to act almost immediately by stopping the action of the respiratory centre. ”

“ Under certain conditions it is possible that degenerative changes are initiated or accelerated in the kidneys or blood vessels by the acute poisoning which is manifested for a short time in even the milder cases. In yet greater degree these changes may follow those insidious forms of food poisoning due to the frequent ingestion of small quantities of mineral or organic poisons, which in each dose may cause little or no measurable physiological change, but whose cumulative effect may be vicious. ”

“ It has been enumerated nevertheless among the general characters of poisoning, because, although its presence can hardly ever add any weight to the evidence in favour of death by poison, its absence may sometimes afford even positive proof in favour of natural death. That is, changes of a certain kind occurring in the symptoms during their progress may be incompatible with the known effects of a particular poison or of all poisons, and capable of being accounted for only on the supposition of natural disease having been at least the ultimate cause of death. ”

“ Hence, although it is impossible to distinguish the effects of narcotics from this disease by the appearances in the body after death, yet, when the general evidence of poisoning is strong, and none of the medical circumstances are at variance with the supposition of narcotic poisoning, the evidence of poisoning, as judged of by the jury from the whole facts, medical and general, will be commonly sufficient,—so far as regards the possibility of death from simple apoplexy. ”

“ The mania for secret poisoning seems to have seized on all classes from the highest to the lowest, and no one who made an enemy was safe. Porta, in his work published in 1589, gives some account of the poisons used at the time, and seems to have made a study of the subject. ”

“ Poisoning, whether from accident or otherwise, should always be provided for, and it will be well to be supplied with a few antidotes. Some poisons are best ejected by vomiting—draughts of salt or mustard and warm water, half a wine-glassful of ipecacuanha wine, or a glassful of warm water with twenty or thirty grains of sulphate of zinc. ”

“ The symptoms in the first variety are very like what occur in the ordinary cases of poisoning with arsenic,—namely, vomiting, especially when any thing is swallowed, violent pain in the pit of the stomach, as well as over the whole belly, and profuse diarrhœa. ”

“ Animals (or insects or bees) may feed on substances that cause their flesh or products to be poisonous to man. Meat poisoning. Eating sausage or pork pie or headcheese has caused poisoning. Poisoning from impure milk, shell fish, pellagra, from using altered maize, etc.
[INTOXICANTS AND SUN STROKES 375] Symptoms.—Acute inflammation of stomach and bowels, with great prostration, ending in collapse. In shell fish poisoning, there are numbness, weakness, dilated pupils, rapid and feeble pulse, temperature under the normal and collapse. ”

“ In one or two cases the individual has suddenly, without any premonitory symptoms, fallen down convulsed, and died almost immediately. In one or two instances again, the effects have rather been those of irritant poisoning, namely, inflammation of the mouth and throat, spasms of the muscles 661of the throat, vomiting, and excessive weakness and faintness, without any convulsions or insensibility.—It appears then that this plant is a true narcotico-acrid poison. ”

“ The Renaissance knew of strange manners of poisoning,--poisoning by a helmet and a lighted torch, by an embroidered glove and a jewelled fan, by a gilded pomander and by an amber chain. Dorian Gray had been poisoned by a book. ”

“ Of all other methods employed by poisoners, the administration of the lethal dose through the medium of food or drink seems ever to have been the favourite. The poisoned wine or cake recurs with a somewhat monotonous frequency in the history of the poisoner, from the earliest times down to the present day. Women especially seem to have been attracted by this mode of poisoning, a fact probably due to their control and direction of domestic matters, which rendered the introduction of a poisonous substance into food or drink an easy matter. ”

“ Of the minerals, arsenic, antimony, mercury, gold, silver, copper, and lead were used by the Greeks; the antidote recommended15 in case of poisoning being hot oil, and other methods to induce vomiting and prevent the poison being absorbed into the system. ”

“ Poisons. A poison is a substance which, if taken into the system in sufficient amounts, will cause serious trouble or death. For convenience poisons may be divided into two classes, irritants and narcotics.
The effects of irritant poisons are evident immediately after being taken. They burn and corrode the skin or membrane or other parts with which they come in contact. There are burning pains in the mouth, throat, stomach, and abdomen, with nausea and vomiting. A certain amount of faintness and shock is also present.
With narcotic poisoning, the symptoms come on more slowly. ”

“ Accidents from poisoning are of such frequent occurrence, that every one should be able to administer the more common antidotes, until the services of a physician can be obtained. As many poisons bear a close resemblance to articles in common use, no dangerous substance should be brought into the household without having the word poison plainly written or printed on the label ”

“ Allowing his patient therefore apparently credit for the truth of his suspicions, the medical attendant should request him to give a full history of existing symptoms, of 86their origin and progress, of their relation in point of time to various meals, and of the mode and vehicle in which the supposed poison was administered. No unprofessional person can possibly go through such a narrative, without stating many circumstances which are wholly irreconcilable with the idea of poisoning generally, and still more of the administration of a particular poison. ”

“ In other instances the body probably decays in the usual manner. For example, in Rust’s Magazin is related the case of a child who died in six hours of poisoning with arsenic, and in whose body, fourteen days after death, the integuments were found considerably advanced in putrefaction, and the liver and kidneys beginning to soften. ”

“ Toxic poison cases; from acute and chronic diseases, such as typhoid fever, tuberculosis, rheumatism, syphilis, malaria, nephritis; or chronic lead poisoning, mercury, arsenic, and copper poisoning.
Symptoms.—There is pallor, dizziness, headache, palpitation and dyspnoea, difficult breathing on exertion; there is weakness, tendency to fainting, poor appetite, dyspepsia and constipation. The red blood cells are diminished, also the haemoglobin. Death may occur from a single hemorrhage. ”

“ One of the first and most important matters in dealing with any form of poisoning is to obtain knowledge of the actual symptoms both clinically and physiologically, as well as pathologically, of the effects of any drug, and to determine if the symptoms so produced in an experimental animal conform to the symptoms as seen in man. ”

“ The AAPCC also reports that more than one thousand deaths due to poisoning take place in the United States every year. Poisoning most frequently involves medicines and typical household chemicals, including cleaning supplies and personal care products. ”

“ In poisoning with arsenic or corrosive sublimate it is no unusual thing to meet with redness or ulceration of the throat, great disease in the stomach, vascularity of the small intestines, ulcers in the great intestines, and excoriation of the anus.—When the poison is an active corrosive much more extensive ravages are sometimes caused, particularly in the stomach. After poisoning by the mineral acids, for example, the whole mucous membrane of the stomach is at times found wanting ”

“ The symptoms of poisoning may be known for the most part from those of some diseases, which they are very like, from the fact of their coming on immediately after eating or drinking something; whereas those of disease come on, in most cases at least, by degrees, and with warnings. In most cases where poison is known, or suspected, to have been taken, the first thing to be done is to empty the stomach, well and immediately, by means of mustard mixed in warm water, or plain warm salt-and-water, or, better, this draught, which we call No. ”

“ Vomiting and purging. (3) Absorption and elimination. (4) Decomposition—phosphorus, chloral hydrate, chloroform. (5) Smallness of the dose.
(For directions for conducting a post-mortem examination in cases of poisoning, see page 61.)
4. Evidence from Experiments on Animals.—The evidence derived from experiments on animals with the contents of the stomach and vomited matters must not be too implicitly trusted, as these may give rise to vomiting and other symptoms when no poison is present. All animals are not alike affected with man by the same poisons ”