Treatise on Poisons by Sir Robert Christison

OF POISONING WITH CAMPHOR, COCCULUS INDICUS, ETC. The third group of the narcotico-acrids resemble strychnia in their action so far, that they occasion in large doses convulsions of the tetanic kind. But they differ considerably by producing at the same time impaired sensibility or sopor. They are camphor, Cocculus indicus, its active principle picrotoxin, the Coriara myrtifolia, the Upas antiar, a Java poison, and perhaps also the yew-tree. _Of Poisoning with Camphor._ Camphor dissolved in oil soon causes in dogs paroxysms of tetanic spasm. At first the senses are entire in the intervals; but by degrees they become duller, till at length a state of deep sopor is established, with noisy laborious breathing, and expiration of camphorous fumes; and in this state the animal soon perishes. A solution of twenty grains in olive oil will kill a dog in less than ten minutes when injected into the jugular vein. When camphor is given to dogs in fragments, it does not excite convulsions, but kills them more slowly by inducing inflammation of the alimentary canal. These are the results of numerous experiments by Orfila.[2370] They are confirmed by others performed more lately by Scudery of Messina; but this experimentalist likewise remarked, that the convulsions were attended with a singular kind of delirium, which made the animals run up and down without apparent cause, as if they were maniacal. He also found the urinary organs generally affected, and for the most part with strangury.[2371] Lebküchner discovered camphor in the blood of animals poisoned with it.[2372] _Symptoms in Man._—The symptoms caused by camphor in man may not have been observed; but so far as they have been witnessed, they establish its claim to be considered a narcotic and acrid poison. Its effects appear to be singularly uncertain: at least they are very discrepant; and the reason for this is not apparent. Its narcotic effects are well exemplified in an account given by Mr. Alexander from personal experience, and by Dr. Edwards of Paris, as they occurred in a patient of his who received a camphor clyster. Mr. Alexander, in the course of his experiments on his own person with various drugs, was nearly killed by this poison, and has left the best account yet published of its effects in dangerous doses on man. After having found, by a previous experiment, that a scruple did not cause any particular symptom, he swallowed in one dose two scruples mixed with syrup of roses. In the course of twenty minutes he became languid and listless, and in an hour giddy, confused, and forgetful. All objects quivered before his eyes, and a tumult of undigested ideas floated through his mind. At length he lost all consciousness, during which he was attacked with strong convulsive fits and maniacal frenzy. These alarming symptoms were dispelled, on Dr. Monro, who had been sent for, accidentally discovering the subject of his patient’s experimental researches, and administering an emetic. But a variety of singular mental affections continued for some time after. The emetic brought away almost the whole camphor which had been swallowed three hours before.[2373] In Dr. Edwards’s patient, the symptoms were excited by an injection containing half a drachm of camphor. In a few minutes he felt a camphrous taste, which was followed by indescribable uneasiness. On then going down stairs for assistance, he was astonished to feel his body so light, that he seemed to himself to skim along the floor almost without touching it. He afterwards began to stagger, his face became pale, he felt chilly, and was attacked with a sense of numbness in the scalp. On then taking a glass of wine, which he asked for, he became gradually better; but for some time his mind was singularly affected. He felt anxious, without thinking himself in danger; he shed tears, but could not tell why; they flowed in fact involuntarily. For twenty-four hours his breath exhaled a camphrous odour.[2374] Hoffmann has related a case analogous to those of Alexander and Edwards. The dose was two scruples taken in oil; the symptoms vertigo, chilliness, anxiety, delirium, and somnolency.[2375] These cases would seem to indicate very considerable activity; yet there can be little doubt that even larger doses have been at times taken with much less effect. Thus, from an account given by Dr. Eickhorn of New Orleans, of its operation on himself, when incautiously swallowed to the amount of two drachms in frequent small doses within three hours, it would appear that the only result was great heat, palpitation, hurried pulse, and pleasant intoxication, then moisture of the skin, next profound sleep for some hours, attended with excessive sweating, and finally no ultimate ill consequence except great debility.[2376] I am assured by a correspondent, Dr. Jennison of Cambridge, U. S., that a medical friend of his has given 90 grains of camphor four times a day in phrenitis, with safety and advantage. Professor Wendt of Breslau has related an instance, which proves the irritant action of camphor on man, and likewise the uncertainty of the dose required to act deleteriously. In the case of Mr. Alexander, two scruples would in all probability have proved fatal, had they not been discharged in time by vomiting. In the case now to be noticed, 160 grains were taken in a state of solution in alcohol, and were not vomited; yet the individual recovered. He was a drunkard, who took four ounces of camphorated spirit, prescribed for him as an embrocation. Soon afterwards he was attacked with fever, burning heat of the skin, anxiety, burning pain in the stomach, giddiness, flushed face, dimness of sight, sparks before the eyes, and some delirium. He soon got well under the use of almond oil and vinegar, but did not vomit.[2377] _Morbid Appearances._—The morbid appearances caused by camphor have not, so far as I know, been witnessed in man. In dogs examined immediately after death, the heart is no longer contractile, and its left cavities contain arterial blood of a reddish-brown colour. When the poison has been given in fragments, it leaves marks of inflammation in the stomach and intestines. Orfila found these organs much inflamed in such circumstances.[2378] Scudery found the membranes of the brain much injected, and the brain itself sometimes softened; the inner membrane of the stomach either very red, or checkered with black, gangrenous-like spots of the size of millet-seeds; the duodenum in the same state; the ureters, urethra, and spermatic cords inflamed; and every organ in the body, even the brain, impregnated with the odour of camphor.[2379] _Of Poisoning with Cocculus Indicus._ The _Menispermum cocculus_, _Cocculus suberosus_, or _Anamirta cocculus_ of botanists, is a creeping plant which grows in the island of Ceylon, on the Malabar coast, and in other parts of the East Indies. Its fruit, which is the only part of the plant hitherto particularly examined, is like a large, rough, grayish-black pea, and is known in the shops by the name of Cocculus indicus. It has a rough, ligneous pericarp, enclosing a pale grayish-yellow, brittle kernel, of a very strong lasting bitter taste. The medical jurist should make himself well acquainted with its external characters, because, besides being occasionally used in medicine, it is a familiar poison for destroying fish, and has also been extensively used by brewers as a substitute for hops,—an adulteration which is prohibited in Britain by severe statutes. It has been analyzed by M. Boullay of Paris,[2380] who found in it besides other matters, a peculiar principle termed picrotoxin. This principle constitutes, according to Boullay, about a fifth part of the kernel; according to Nees von Esenbeck, only a hundreth part:[2381] and my own experiments agree with the results of the latter. It is moderately soluble in water, and crystallizes readily from a hot acidulous watery solution. It is more soluble in hot alcohol, from which it crystallizes in granular masses. Ten grains of it killed a dog in twenty-five minutes in the second paroxysm of tetanus. The seeds themselves occasion vomiting soon after they are swallowed; so that animals may often swallow them, if not without injury, at all events without danger. But if the gullet be tied, the animal soon begins to stagger; the eye acquires a peculiar haggard expression, which is the sure forerunner of a tetanic paroxysm; and the second, third, or fourth fit commonly proves fatal. Three or four drachms will kill a dog when introduced into the stomach; less will suffice when it is applied to a wound; and still less when it is injected into a vein.[2382] Wepfer has related a good experiment, from which he infers that Cocculus indicus acts by exhausting the irritability of the heart. In the intervals of the fits the pulse could not be felt; and on opening the chest immediately after death, he found the heart motionless and all its cavities distended.[2383] Orfila also sometimes found the heart motionless, and its left cavities filled with reddish-brown blood.[2384] This poison does not seem to possess distinct acrid properties in regard to animals. M. Goupil indeed found that it produced vomiting and purging,[2385] but Orfila could not observe any such effect. According to Goupil it possesses the singular property of communicating to the flesh of animals, more particularly of fish, that have been killed with it, some of the poisonous qualities with which it is itself endowed. The accuracy of this statement may be doubted, the alleged fact being contrary to analogy. Besides, this poison has been used immemorially in the East for taking fish; and it is familiarly used for the same purpose in some parts of France, though prohibited by statute. Chevallier mentions that in a particular parish the inhabitants live half the year on fish caught with this poison; and that a friend of his made trial of fish so caught, without the slightest injury.[2386] _Symptoms in Man._—Although it is well known that malt liquors have often been adulterated with Cocculus indicus for the purpose of economizing hops, cases of poisoning in the human subject are rare, because the quantity required to communicate the due degree of bitterness is small. Professor Bernt has shortly noticed a set of cases, which arose in consequence of an idiot having seasoned soup with it by mistake. Nine people were taken ill with sickness, vomiting, pain in the stomach and bowels; and one died in twelve days.[2387] The symptoms under which this person died are not stated; but the account of the accident sent to Bernt imputed death to the poison,—which is improbable, considering the length of the interval before death. In the same group with camphor and Cocculus indicus Orfila has arranged _Upas antiar_, a Javanese poison. This poison is a very bitter milky juice or extract, which is known in Europe only as an article of curiosity. It has been sometimes confounded with the Upas tieuté. It owes its properties to a neutral principle called antiarin.[2388] From the experiments of MM. Magendie and Delille,[2389] as well as from those of Sir B. Brodie[2390] and of Emmert[2391] it appears to act in the same manner, and to produce the same effects, as camphor and Cocculus indicus. In small doses it acts as an irritant; in large doses it causes convulsions and coma. It is here noticed principally because it is one of the poisons which act violently on the heart. If the body of an animal be examined immediately after death from the Upas antiar, the heart is found to have lost its irritability, and the left ventricle to contain florid blood: Schnell found, that, like many other active poisons, it has no effect when applied to the divided end of a nerve.[2392] The _Coriaria myrtifolia_ is also supposed by some to possess the properties of the present group, and is sufficiently important from its energy, and its occasional injurious effects on man, to claim some notice here. Its toxicological action has been investigated by Professor Mayer of Bonn, who found that it excites in most animals violent fits of tetanus, giving place to apoplectic coma; and that in the dead body the brain is seen gorged with blood, the blood in the heart and great vessels fluid, the heart not irritable immediately after death, and the inner membrane of the stomach yellowish and shrivelled. A drachm of the extract of the juice killed a cat in two hours when swallowed; half a drachm applied to a wound killed another in eighty-five minutes; and six grains in the same way killed a kitten in three hours and a half. A drachm swallowed by a young dog killed it in two hours and a half. Ten grains of the extract of the infusion applied to a wound killed a kitten in six hours; and three grains another in three hours. A buzzard was killed in three-quarters of an hour by half a drachm of the extract of the juice. Frogs are also soon killed by it. Rabbits, it is remarkable, are scarcely affected by this poison, either administered internally, or applied to a wound,—a drachm in the former way, and half as much in the latter, having produced no effect at all. A grain, however, injected into the jugular vein occasioned in about five hours a single convulsive paroxysm, which proved immediately fatal.[2393] Instances of poisoning with this substance have occurred in the human subject,—generally in consequence of its having been taken in various parts of the continent with senna, which it is employed to adulterate. Sauvages has recorded two cases of death occasioned by the berries. In one, a child, death took place within a day under symptoms like epileptic convulsions; and in the other, an adult, who swallowed only fifteen berries, convulsions, coma, and lividity of the face were produced, ending fatally the same evening, though the greater part of the berries were discharged by emetics.[2394] In recent French journals various similar cases are recorded. M. Fée describes five cases, one of them fatal. In this instance, a male adult, death occurred within four hours after he took an infusion of senna adulterated with the coriaria; and the symptoms were violent convulsions, locked-jaw and colic.[2395] M. Roux has noticed a great number of cases in the fullest paper yet published on its effects on man, and gives the details of three which came under his own notice, and of which one proved fatal. In the fatal case, that of a child three years and a half old, who took between eighty and a hundred berries, the symptoms were heat and pricking of the tongue, sparking and rolling of the eyes, loss of voice, locked-jaw, and convulsions recurring in occasional fits of eight or ten minutes in duration. Death ensued in sixteen hours and a half.[2396] Roux refers also among other instances to those of no fewer than ten soldiers, who were attacked at the same time in consequence of eating the berries, and of whom two died. In Roux’s fatal case there was injection of the membranes of the brain, and no other particular appearance; in that mentioned by Fée, there was inflammation of the stomach and bowels; and in one of Sauvages’s cases no morbid appearance at all was discovered. Considering these very pointed proofs of the poisonous qualities of the coriaria, it is not a little singular that doubts have lately arisen whether it is a poison at all. Peschier of Geneva says he has ascertained that tanners, who use it in their trade on account of the powerful astringency of the leaves, also take it internally for gleet, and that he gave a decoction of an ounce to chickens, dogs, and men, without witnessing any ill effect.[2397] _Of Poisoning with Yew._ The leaves and berries of the _Taxus baccata_, or yew, are known to be poisonous; but their effects have not been investigated with care. I have arranged it in the meantime with the present group. M. Grognier, as quoted by Orfila, ascertained that a decoction of eight ounces of berries without seeds had no effect on a dog; that a pound and a half of seeds had no effect on a horse; that three ounces of the juice of the leaves given to a large dog merely caused vomiting; and that a decoction of twelve ounces of leaves, confined in the stomach of a dog by a ligature on the gullet, had also no effect. But two ounces of the juice of the leaves killed a small dog; and Orfila himself ascertained, that thirty-six grains of extract of the leaves, injected into the jugular vein, caused giddiness, stupor, and death.[2398] Accidents have repeatedly happened to children in this country from yew-berries. Mr. Hurt of Mansfield has given the particulars of an interesting case. A child, three years and a half old, two hours after eating the berries, was observed to look ill at dinner, and became affected with lividity and heaviness of the eyes, as if he was about to fall asleep. Vomiting followed, without any pain; and he died before a medical man, who was sent for, could arrive. Four other children, somewhat older, who had eaten the seeds, were made to vomit by emetics, and got well. The dead body of the first child presented many livid spots, redness of the villous coat of the stomach, and gorging of the brain and membranes with blood. A mass of berries, seeds, and potatoes was found in the stomach.[2399]—Dr. Hartmann of Frankfort mentions that a girl, who took a decoction of the leaves to produce abortion, died in consequence, but without having miscarried.[2400]—Dr. Percival has related other cases in his essays.[2401]