Treatise on Poisons by Sir Robert Christison

order to produce it, a greater quantity of spirits must be swallowed pure and at once, than is usually taken by those among whom poisoning in the second degree chiefly occurs. When swallowed in large quantity, as by persons who have taken foolish wagers on their prowess in drinking, there is seldom much preliminary excitement; coma approaches in a few minutes and soon becomes profound, as in apoplexy. The face is then sometimes livid, more generally ghastly pale; the breathing stertorous, and of a spirituous odour; the pupils sometimes much contracted, more commonly dilated and insensible; and if relief is not speedily procured, death takes place,—generally in a few hours, and sometimes immediately. According to Mr. Bedingfield, who witnessed many cases of poisoning with rum at Liverpool, which always follow the arrival of the West India vessels, the patient will recover if the iris remains contractile; but if it is dilated and motionless on the approach of a light, recovery is very improbable.[2519] A case is briefly alluded to by Orfila of a soldier, who drank eight pints of brandy for a wager, and died instantly.[2520] A case of the same kind is quoted by Professor Marx.[2521] Another, which happened in the person of a London cabman, is noticed in a French Journal. The man, for a bribe of five shillings, drank at a draught a whole bottle of gin; and in a few minutes he dropped down dead.[2522] Similar accidents occur not infrequently in this country; but I have not met with any fully described by authors. A case of the less rapid variety of the present form occurred at the Infirmary here in 1820. A man stole a bottle of whiskey; and, being in danger of detection, took what he thought the surest way of concealing it, by drinking it all. He died in four hours with symptoms of pure coma. Convulsions are not common in such cases. I have seen a remarkable example, however, in which the coma was accompanied with constant alternating _opisthotonos_ and _emprosthotonos_. The subject was a boy who had been induced to drink raw whisky by an acquaintance, and had been two hours insensible before I saw him. The stomach-pump, which was immediately applied, brought away a large quantity of fluid with a strong spirituous odour; and he recovered his senses in fifteen minutes, but remained very drowsy for the rest of the day. Such are the forms of poisoning with spirits usually admitted by authors. But it also appears to act sometimes as an irritant. After its ordinary narcotic action passes off, another set of symptoms occasionally appear, which indicate inflammation of the alimentary canal. Cases of this kind are exceedingly rare; yet they have been met with, as the following extract shows. “A young man at Paris had been drinking brandy immoderately for several successive days, when at length he was attacked with shivering, nausea, feverishness, pain in the stomach, vomiting of everything he swallowed except cold water, thirst, and at last hiccup, delirium, jaundice, and convulsions; and death took place on the ninth day. On examining the body the stomach was found gangrenous over the whole villous coat; the colon too was much inflamed; and all the small intestines were red.”[2523] A case of great complexity, but probably of the same nature, has been related by Opitz in Pyl’s Memoirs. The subject was a woman liable to epilepsy, and addicted to excessive drinking. After one of her drinking-bouts she was seized with vomiting and severe pain of the bowels, afterwards with delirium, then with convulsions, and she died in twenty-four hours after the first attack. The stomach and intestines were greatly inflamed, a table-spoonful of blood was effused into the ventricles of the brain, and the left lung was purulent.[2524] Besides the immediately fatal effects of spirituous liquors now described, there is still another variety of poisoning more common than any yet mentioned, and constituting a peculiar disease. People who fall into the unhappy vice of habitual intoxication, after remaining in a state of drunkenness for several days together, are often attacked with a singular maniacal affection, which is accompanied with tremors, particularly of the hands, and after enduring for several days, ends at last in coma. When the delirium is not so violent, the disease by proper treatment may be cured. But frequently, after the delirium and tremor have continued mildly for some time, they increase, and the delirium becomes furious, or coma rapidly supervenes; in either of which cases the disorder commonly proves fatal in two or three days more. This disease, which is now familiar to the physician, is called _delirium tremens_. It is supposed by some to depend on inflammation of the membranes of the brain, followed by effusion. Other diseases, besides _delirium tremens_, are also slowly induced by the habitual and excessive use of spirituous liquors; but in general the habit of intoxication acts in inducing these diseases only as a predisposing cause. A particular variety of tuberculated liver probably arises from the habitual use of spirits without the co-operation of other causes. That variety of disease of the kidney, which was first brought under the notice of the profession by Dr. Bright,[2525] is also obviously often connected with the habit of drinking spirits. The following have been enumerated among the diseases where the same habit acts powerfully as a predisposing cause—indurated pancreas,—indurated mesenteric glands,—scirrhous pylorus,—catarrh of the bladder,—inflammation, suppuration and induration of the kidneys,—incontinence of urine,—aneurism of the heart and great vessels,—apoplexy of the lungs,—varicose veins,—mania,—epilepsy,—tendency to gangrene of wounds,—spontaneous combustion.[2526] _Of the Morbid Appearances._—Some doubts exist as to the morbid appearances in the bodies of those poisoned by spirituous liquors. In animals killed by alcohol, Orfila says he found the villous coat of the stomach constantly of a cherry-red odour. I have several times remarked the same appearance. When the stomach was empty before the alcohol was introduced, I have always found the prominent part of its rugæ of a deep cherry-red tint, the margin of the patches being more florid, and evidently consisting of a minute network of vessels. In man these signs of irritation have not been always observed. In the patient who died in the Infirmary here, the stomach was quite natural to appearance. Dr. Ogston notices injection of the small intestines and thickening of the mucous membrane of the stomach and intestines as common appearances in the cases he has examined; but he seems to consider these the effects not of the last fatal dose, but of the habit of frequent excessive drinking.[2527] The blood in the heart and great vessels is commonly fluid and very dark, and the lungs are sometimes more or less gorged with the same fluid. The state of the brain differs much according to the mode of death. Sometimes great congestion and even actual extravasation of blood are found in the heads of persons who have died of excessive continuous drinking,—the excitement of such a debauch being apt, as already mentioned, to induce apoplexy in a predisposed habit. Accordingly extravasation was found by Professor Bernt of Vienna in no less than four cases of the kind, two of which happened in the persons of young men not above twenty-two years of age;[2528] and Dr. Cooke quotes another in his work on nervous diseases.[2529] I have myself met with another remarkable instance. A female out-pensioner of Trinity Hospital here, who was much addicted to drinking, and for fourteen days after the New-year of 1830 had been very little in her sober senses, soon after arriving at home one evening much intoxicated, fell down comatose, and died in ten or twelve hours. An enormous extravasation of clotted blood was found in the ventricles, producing extensive laceration of the right middle and anterior lobes of the brain.—In such cases it is natural to suppose that a predisposition to apoplexy must concur with the intoxication; otherwise it is not easy to see why death from extravasation is not more frequently produced by excessive drinking. Extravasation is not apt to occur in the cases of rapid death brought on by a very large quantity swallowed at once. The circulation, indeed, is during life in a state quite the reverse of excitement; and accordingly the brain and its membranes are found quite healthy. They were particularly so in the man who died in the hospital here. It is right to mention, however, that one of Bernt’s cases, although the symptoms and other particulars are not mentioned, possibly belongs to the present variety, as the man swallowed for a wager a quart of brandy at a draught.[2530] According to Dr. Ogston, who has given the best account of the appearances within the head in the ordinary cases of this kind, there is usually serous effusion under the arachnoid membrane, occasionally minute injection of vessels, commonly more or less general gorging of the larger veins, and especially effusion of serosity to the amount of two or even four ounces in the ventricles.[2531] When delirium tremens proves fatal, effusion is commonly found among the membranes of the brain; and occasionally to a great extent. In one instance, which proved fatal in two or three days, I have seen minute vascularity of the membranes, with effusion of fibrin, and without effusion of serosity; but such cases are rare. There is also, according to Andral, very extensive softening of the mucous coat of the stomach.[2532] In an instance mentioned in Rust’s Journal, besides effusion into the cerebral membranes, there was found an enormous accumulation of fat in all the cavities, a conversion of the muscular substance into fat, and a nauseous sweet smell from the whole body.[2533] In all cases of rapid poisoning with spirituous liquors some of the poison will be found in the stomach. For when the case is one of pure narcotic poisoning, unaided by the effects of blows, exposure to cold, or the like, and the person dies in a few hours, the poison cannot be all absorbed before death.—Although the spirituous liquors used in Britain have all very powerful odours, the inspector in a case of importance ought not to confine himself to this test alone. He must subject the suspected matter to distillation; and then remove the water from what distils over by repeated agitation with dry carbonate of potass, till he procures the alcohol of the spirit in such a state of purity as to be inflammable. Alcohol may also be in some circumstances detected in the tissues and secretions of the body. A spirituous odour has been remarked not infrequently in various parts, and especially in the brain. Dr. Cooke mentions a case in which the fluid in the ventricles of the brain had the smell and taste of gin, the liquor which had been taken;[2534] Dr. Ogston adverts to an instance, in which after death by drowning during intoxication, he found in the ventricles nearly four ounces of fluid, having a strong odour of whisky;[2535] in the case which occurred in the hospital here the odour of whisky was said to have been perceived in the pericardium; and in a man who died of long-continued intoxication from immoderate drinking Dr. Wolffe found that the surface, and still more the ventricles, of the brain had a strong smell of brandy, although the contents of the stomach had not.[2536] The presumption afforded by such facts as these, in favour of the absorption of alcohol and the possibility of detecting it throughout the animal system, has been turned to certainty by the late experimental researches of Dr. Percy; who found that in animals poisoned with alcoholic fluids, as well as in the case of a man who died during the night after drinking a bottle of rum, alcohol could be detected, generally in the urine, and also in the brain, by cautious distillation, and removing the water from the distilled fluid by means of dry carbonate of potass.[2537] Dr. Percy gave me an opportunity of verifying his results with the brain of the man; and I had no difficulty in obtaining from a few ounces of brain a sufficiency of spirit to exhibit its combustion on asbestus repeatedly. It is hardly necessary to add, that when the individual has survived the taking of the poison a considerable length of time, an odour of spirits will not be perceived either in the stomach or elsewhere. In the out-pensioner of Trinity Hospital, for example, who survived about twelve hours, no spirituous odour could any where be perceived. In such cases the poison disappears during life by absorption.—A question may even be entertained, whether the odour may not sometimes be imperceptible at the inspection of the body, although the poison was really present immediately after death. It is probable that, as in the instance of hydrocyanic acid, the alcohol, on account of its volatility or fluidity, will evaporate or percolate away in a few days. In this manner only can be explained the occasional absence of the odour in persons who have been killed in the early stage of drunkenness. I could not perceive any odour of whisky in the stomach of the woman Campbell, who was murdered by the notorious resurrectionist Burke, although she had drunk spirits to intoxication half an hour before her death. The body was not examined till thirty-eight hours after.[2538] It must be observed, however, that alcohol may exist in the contents of the stomach and be detected by chemical analysis, although it is not indicated by its odour. I have twice had occasion to observe this, where the bodies were disinterred some time after death. From all that has been said, there ought seldom to be much difficulty in recognizing a case of poisoning with spirituous liquors. But, before quitting the subject, a form of it must be noticed which may be extremely difficult to distinguish. It was formerly remarked that the eatable mushrooms have been sometimes poisoned with substances possessing effects on the system analogous to those caused by the deleterious fungi. In the same manner spirituous liquors may be poisoned with narcotics allied to them in action. Thus, in former parts of this work, it has been stated that a young man was killed during a debauch in consequence of his companions having mingled opium with his wine; that many persons have been poisoned and some killed by fermented liquors drugged in the same manner; that murder has been accomplished by poisoning wine with nightshade; and that several fatal accidents have occurred in consequence of liqueurs having been too strongly impregnated with hydrocyanic acid, to give them a ratafia flavour. Cases of this nature may be embarrassing. In general, they may be made out by attending strictly to the symptoms, the quantity of liquor taken, and the contents of the stomach. But, it must be admitted, that if a murderer, who chooses such a method, should season his guest’s drink judiciously, and ply him well with it, a medical jurist might be puzzled to determine whether the liquor was to blame in point of quality or quantity. _Of the Treatment._—The treatment of poisoning with alcoholic fluids does not differ essentially from that of poisoning with opium. In the former, as in the latter, the chief objects must be to remove the poison from the stomach, and to rouse the patient from his state of stupor; but in poisoning with alcoholic fluids it is also frequently necessary to treat a secondary stage of reaction by local and even general antiphlogistic measures. As to the primary object, the removal of the poison from the stomach, it appears that in the present form of poisoning emetics are more seldom effectual than in the case of other narcotics, and that the stomach-pump should be promptly resorted to. It is remarkable that the operation of clearing out the stomach is likewise often a sufficient stimulus to dispel stupor immediately and even permanently. I have seen almost complete consciousness permanently restored with the discharge of the alcoholic fluid; and the same remark has been made by others. Where the senses are not thus restored, one of the most effectual stimulants, according to the practice of the police-office of this city, is the injection of water into the ears. Great advantage has been derived, as in poisoning with opium, from the cold affusion applied to the head. Dr. Ogston, who has appended to his paper formerly quoted a very useful summary of the treatment of poisoning with spirits, has found this a safe and effectual remedy where the heat of the head was unnaturally great and that of the body not too low.[2539] Cases have been published where it proved successful although the pulse was gone at the wrist, the breathing scarcely perceptible, and the temperature of the whole body greatly reduced.[2540] It is doubtless a powerful remedy: but where the general temperature of the surface is much lowered, I conceive it should be restricted to the head and neck, and conjoined with the application of warmth to the body. Dr. Ogston objects to the general use of blood-letting in cases of poisoning with spirits, as being often apt to be followed by sudden sinking. Where other remedies are judiciously used, it is probably seldom called for; and the purpose it is intended to serve, namely, the relief of cerebral congestion and determination, is better fulfilled by the local employment of cold, and local blood-letting. Ammonia and its acetate have been found useful as internal stimulants where the stupor is deep. The treatment of the secondary affections adverted to above does not require specific mention. _Of Poisoning with Sulphuric and Nitric Ether._ Sulphuric ether and nitric ether are poisons of the same nature with alcohol. But the effects produced by them when taken in considerable doses are not very well known. Orfila found that half an ounce of sulphuric ether introduced into the stomach of a dog and secured there by a ligature on the gullet, excited efforts to vomit, in ten minutes inability to stand, and in six minutes more, insensibility. In fifteen minutes more the animal revived a little, but soon became again comatose; and it died in three hours after the commencement of the experiment. The villous coat of the stomach was reddish-black, the other coats of a lively red colour.[2541] The effects of the ethers on man have not been accurately ascertained. From some observations published in the Journal of Science, sulphuric ether appears to act energetically even in small doses. In moderate quantity it produces a strong sense of irritation in the throat, a feeling of fulness in the head, and other symptoms like those excited by nitrous-oxide gas. A gentleman, in consequence of inhaling it too long, was attacked with intermitting lethargy for thirty-six hours, depression of spirits and lowness of pulse.[2542] When long and habitually used, as by persons afflicted with asthma, its dose must be gradually increased; and it appears that considerable quantities may then be taken for a great length of time without material injury. I have been informed of an instance of an asthmatic gentleman about sixty years of age who consumed sixteen ounces every eight or ten days, and had been in the habit of doing so for many years. Yet, with the exception of his asthma, he enjoyed tolerable health. An interesting case has been published which proves that nitric ether in vapour is a dangerous poison when too freely and too long inhaled. A druggist’s maid-servant was found one morning dead in bed, and death had evidently arisen from the air of her apartment having been accidentally loaded with vapour of nitric ether, from the breaking of a three-gallon jar of the _spiritus etheris nitrici_. She was found lying on her side, with her arms folded across the chest, the countenance and posture composed, and the whole appearance like a person in deep sleep. The stomach was red internally, and the lungs were gorged.[2543] The editor of the journal, where this case is related, says he is acquainted with a similar instance where a young man became completely insensible from breathing air loaded with sulphuric ether, remained apoplectic for some hours, and would undoubtedly have perished had he not been discovered and removed in time. _Of Poisoning with the Oleaginous products of Combustion._ The physiological effects of these substances have not yet been extensively investigated. It has been already mentioned, that the empyreumatic oils of tobacco and other narcotic vegetables are active poisons; and that the emanations from candle snuffings and imperfectly consumed tallow probably owe their injurious properties to a peculiar oil. Many empyreumatic oils are known, and some are used in medicine, which act powerfully on the animal system as stimulants and antispasmodics. Among these may be enumerated naphtha, oil of galbanum, oil of guiaiac, oil of amber, oil of wax, and Dippel’s oil. The last in particular, which is the rectified empyreumatic oil of hartshorn, but is prepared also from blood and various animal matters,[2544] has been a good deal used of late on the continent for medical purposes, and has even been resorted to as a poison for the purpose of self-destruction. The only one of these substances whose physiological properties have been examined with particular care, is the empyreumatic oil procured by the destructive distillation of lard. When freed of adhering acid by rectification from quicklime, this oil is limpid and very volatile, has an insupportable smell, and when diffused in the air, irritates the eyes and nostrils, and even excites giddiness. Buchner found it to possess simple narcotic properties. When a mouse was confined under a jar, into which a little of its vapour was introduced, it suddenly tried to escape, immediately fell down exhausted, and, although soon afterwards removed into the open air, expired in about fifteen minutes, without convulsions. It is much less powerful when introduced into the stomach, yet is still a dangerous poison through that channel; for five drops projected into the throat of a chaffinch very nearly proved fatal; and the only symptoms were excessive exhaustion, slow respiration, and insensibility.[2545] Similar effects have been occasionally observed in man. The late Professor Chaussier has related a case of poisoning in the human subject from the _oil of Dippel_, or rectified empyreumatic oil of hartshorn. It is merely mentioned, however, that the individual, on taking a spoonful by mistake, died immediately; and that no morbid appearance could be discovered in the dead body.[2546] Another case has been more recently related, where the poison was the impure oil of commerce, from which the oil of Dippel is prepared by rectification. The subject was a woman, who took it intentionally in the dose of an ounce and a half. The symptoms induced could not be ascertained; but it appeared, that she had been attacked with vomiting, and, finding the action of the poison either less speedy, or less supportable than she expected, had thrown herself into a well and been drowned. The appearances in the body clearly showed that in this instance the poison had not acted as a pure narcotic. The whole body exhaled the peculiar fetid odour of the oil. The palate, tongue, throat, and gullet, were white and shrivelled. The stomach had outwardly a diffuse rose tint, crossed by gorged black veins, which here and there had burst and formed patches of extravasation. The contents of the stomach consisted of remains of food, a good deal of the oil, some water, and likewise some extravasated blood. Its villous coat was thick, covered with red points, corrugated into prominent rugæ, but not eroded. The intestines also presented signs of irritation, but in an inferior degree.[2547] Dr. Kurtze, a German author, mentions that the impure oil [Oleum Animale Fœtidum] was given with malicious intention in repeated doses to an infant eighteen days old, whom he attended, and that it caused crying and vomiting; and he quotes Froriep’s Notizen, for the case of a woman of thirty, who swallowed nearly two ounces, and, after repeated attacks of vomiting, threw herself into a well and was drowned.[2548] These facts seem to establish sufficiently the propriety of arranging the empyreumatic oils among the narcotico-acrids. _Oil of turpentine_ possesses somewhat similar properties; but is much less active. It was found by Professor Schubarth, that two drachms of this oil administered to a dog produced immediate staggering, cries, tetanus, failure of the pulse and breathing, and death in three minutes; and in the dead body he remarked flaccidity of the heart, gorging of the lungs, and redness of the stomach.[2549] It is likewise well known to be a powerful poison for vermin, such as lice, fleas, and worms.—On man its effects are capricious. It is frequently used along with other laxatives against obstinate constipation of the bowels, and either in the same manner or alone as a remedy for intestinal worms. For these purposes it has been at times administered in very large doses, for example in the quantity of two, three, or four ounces, without any other effect than brisk purging. But on the other hand it has sometimes, in much inferior doses, induced violent hypercatharsis, or acted severely on the urinary organs, producing strangury and bloody micturition, or affected the brain, producing a state like intoxication, followed by trance for many hours.[2550] I am not aware that it has ever proved fatal. _Oil of tar_, a composite substance obtained by the distillation of wood-tar, is another pyrogenous fluid of poisonous properties. Messrs. Slight of Portsmouth have related the case of a seaman, who, after taking nearly four ounces by mistake for spirits, was attacked with frequent vomiting of a matter having a strong odour of tar, attended with excessive pain in the bowels and loins. Nothing was done for his relief till about seven hours afterwards, when he was freely bled and purged, with immediate relief; and next morning he was so better as to be able to resume his work. The urine had a strong tarry odour, and for some time he suffered from heat in passing it.[2551] A case occurred in the London Hospital, in which the symptoms were very different. A lad of eighteen, while intoxicated, took two or three draughts of oil of tar, although aware of its being poisonous. Not long afterwards he became insensible, and had laborious, rattling respiration, coldness of the extremities, suffusion of the conjunctiva, contraction of the pupils, and an exceedingly feeble pulse. The stomach-pump brought away a liquid with an overpowering smell of tar. Stimulants, external as well as internal, venesection, and turpentine clysters were of little avail; the insensibility continued, with only a short and imperfect interval; and he died about twenty-four hours after swallowing the poison. The pulmonary mucous membrane was highly injected, the lungs gorged with blood and of a tarry odour, the stomach and intestines natural, except that the whole _valvulæ conniventes_ were yellow,—the brain and its membranes also natural.[2552] It is mentioned in the paper of Messrs. Slight that a gentleman at Brighton died in consequence of a druggist using oil of tar by mistake for something else in making up a prescription. _Creasote_ is another pyrogenous substance possessing considerable activity as a poison. It is now extensively used in small doses as a medicine for a variety of purposes. It has been made the subject of physiological experiment by various inquirers, and especially by Dr. Cormach; who found that doses of twenty-five or forty drops caused death in a few seconds when injected into the jugular vein of a dog, by arresting the heart’s action, and without visibly altering the condition of the blood; that a quantity somewhat larger caused only sopor and spasmodic twitches of the muscles, if injected into the carotid artery, and without proving fatal; that thirty drops introduced into the stomach of a rabbit excited convulsions, acute cries, and death in one minute, apparently from arrestment of the action of the heart; and that the same dose given to a dog brought on salivation, giddiness, tetanic spasm, a feeble, fluttering, almost imperceptible pulse, and general insensibility, with dilated immovable pupils; but recovery took place under the employment of blood-letting.[2553]—The effects of too large a medicinal dose in man are pain in the stomach and vomiting, and also, according to Dr. Elliotson, giddiness, headache, and stupor.[2554] Dr. Pereira alludes to a case, mentioned in the Times newspaper, of death caused in 36 hours by two drachms taken at once; and in this instance acute pain in the abdomen was a prominent symptom.[2555] I presume this is the same case which is mentioned in the Edinburgh Medical and Surgical Journal as having occurred at Liverpool.[2556]—The results of Dr. Cormack’s experiments on animals lead to the conclusion, that in poisoning with creasote, this substance may always be detected in the body, if it has not been removed by artificial means a considerable time before death.