Page:EB1911 - Volume 21.djvu/927

Rh attempts have been made to classify them scientifically, but with no signal success, and perhaps the best system is that which groups the various poisons according to the more obvious symptoms which they produce. Our knowledge of the more intimate action of poisons is still too imperfect to admit of any useful classification according to the manner in which they specifically affect the vital organs. Poisons may in the manner indicated be classified as (1) Corrosives, (2) Irritants, (3) Neurotics, and (4) Gaseous Poisons.

1. Corrosives

The typical member of this class is corrosive sublimate, the soluble chloride of mercury. In it are included also the concentrated mineral acids (sulphuric, nitric and hydrochloric); oxalic acid, the alkalies (potash, soda, and ammonia) and their carbonates; acid, alkaline, and corrosive salts of the metals (such as bisulphate of potash, alum, butter of antimony and nitrate of silver); also carbolic acid.

The symptoms produced by the mineral acids and the alkalies are almost altogether referable to local action; but some corrosive poisons, such as carbolic acid, produce, besides a local action, remote and specific constitutional effects. The symptoms of corrosive poisoning are marked and unmistakable, except in infants. Immediately on swallowing the corrosive substance, an acid, caustic or metallic burning sensation is experienced in the mouth, fauces, gullet and region of the stomach, and this speedily extends over the whole belly; as a rule vomiting speedily follows. In the case of the mineral acids, and in oxalic acid poisoning, the vomit is so acid that if it falls upon a marble or concrete floor effervescence ensues. No relief follows the evacuation of the stomach. The ejected matters contain blood, and even fragments of the corroded walls of the alimentary canal. The belly becomes distended with gas and horribly tender. High fever prevails. The mouth is found to be corroded. Death usually ensues within a few hours; or, if the patient survives, he or she may perish miserably, months after the poison was taken, through starvation consequent upon the gradual contraction of the gullet, brought about by its corrosion and subsequent healing.

The treatment of corrosive poisoning consists in very gently emptying and washing out the stomach by means of a soft siphon tube. The stomach-pump cannot be used with safety in consequence of the weakening of the walls of the stomach by corrosion. Demulcents and opiates may be subsequently administered. After death from corrosive poisoning the walls of the stomach are found corroded and even perforated.

1. Corrosive Sublimate.—Here all the signs and symptoms of corrosive poisoning are produced in their severest form. A grain or two of this poison may prove fatal. Fortunately there is an efficient antidote in white of egg, the albumen of which, if administered at once, renders the salt insoluble. The eggs should be divested of their yolks, beaten up with water, and given promptly, repeatedly, and abundantly, followed by emetics. Poisoning by corrosive sublimate may be followed by the specific toxic effects of mercury, such as salivation and tremor.

Workers in mercury, such as water-gilders, looking-glass makers, and the makers of barometers and thermometers, are apt to suffer from a peculiar form of shaking palsy, known as “the trembles,” or mercurial tremor. This disease affects most frequently those who are exposed to mercurial fumes. The victim is affected with tremors when an endeavour is made to exert the muscles, so that he is unable, for instance, to convey a glass of water to the lips steadily, and when he walks he breaks into a dancing trot. The treatment consists in removal from the mercurial atmosphere, baths, fresh air, and the administration of iron and other tonics.

2. Mineral Acids.—These are oil of vitriol or sulphuric acid, aqua fortis or nitric acid, and spirit of salt or hydrochloric (muriatic) acid. These, when taken in a concentrated form, produce well-marked symptoms of corrosion. When they are diluted, the symptoms are those of an irritant poison. Nitric acid stains the mouth and skin of a yellow colour. The treatment consists in the administration of the alkalies or other carbonates, chalk, whiting, or even uncoloured plaster scraped off the walls or ceiling, with the view of neutralizing the acid.

3. Oxalic acid is a vegetable acid. When taken in the state of concentrated solution it acts as a corrosive, but when diluted as an irritant. But it also exerts a specific effect, killing the patient by cardiac syncope not infrequently within a few minutes. When a person after taking a crystalline substance, tasting strongly acid, dies within 15 or 30 minutes, after the manifestation of great weakness, small pulse and failure of the heart's power, poisoning by oxalic acid is almost certain The treatment consists in promptly administering an emetic, followed by chalk, whiting, or any substance containing carbonate of calcium. The alkaline carbonates are valueless, for the alkaline oxalates are almost as poisonous as oxalic acid itself.

4. The Alkalis.—Caustic potash and caustic soda produce symptoms resembling those of the mineral acids, except that purging is a usual accompaniment.

5. Carbolic acid when taken in the form of a concentrated liquid acts as a corrosive, causing whitening and shrinking of all the animal membranes with which it comes in contact. The patient, however, becomes speedily comatose, the poison acting profoundly upon the great nervous centres. A curious phenomenon—black or dark green urine—is commonly observed after the administration of this poison. Saccharated lime-water, diluted and drunk freely. and a solution of sulphate of soda are perhaps the most useful remedies.

2. Irritant Poisons.

Irritant poisons are of two classes—metallic irritants and vegetable and animal irritants, these latter being for convenience grouped together. Perhaps none of the irritants act purely as such, the irritant symptoms being usually accompanied by well-marked effects upon the nervous system. An irritant is a substance which causes inflammation of the part to which it is applied—usually the alimentary canal. Arsenic is by far the most important of the metallic irritants. Other irritants are the moderately diluted acids, many metallic salts, such as those of antimony, lea, copper, zinc and chromium. Elaterium, gamboge, aloes, colocynth and croton oil are good examples of vegetable irritants; and cantharides of animal irritants. Animal and vegetable food when decomposed, or infested with certain organisms known as bacteria, may produce violent irritant symptoms. The symptoms produced by irritant poisons are usually more slow in their development than where a corrosive has been administered. Usually, after an interval, greater or less according to the specific nature of the irritant swallowed, a burning pain is felt in the mouth, throat and gullet, with a sense of constriction of the parts, and followed by burning pain in the region of the stomach. This is increased, and not alleviated, by pressure, a mark which serves to distinguish the attack from one of ordinary colic. Nausea, vomiting and thirst ensue, speedily followed by distension of the whole abdomen, which is exceedingly tender to the touch. Ordinarily the vomiting is followed by profuse diarrhoea. Should the poison not be speedily eliminated in the vomited and faecal matters, inflammatory fever sets in, followed by collapse; and death may ensue in a few hours. There is danger of confounding irritant poisoning with some forms of natural disease, such as gastritis and gastric ulcer, colic, peritonitis, cholera and rupture of the intestines.

1. Arsenic is a specific irritant poison. Almost all the compounds of this metal are poisonous. The term "arsenic" is, however, most commonly applied, not to the metal itself, but to its lower oxide, arsenious oxide, which is also known as white arsenic. By whatever channel arsenic is introduced into the system, it invariably affects specifically the stomach and intestines, causing congestion or inflammation. The common sources of arsenical poisoning are the taking of white arsenic, which causes acute poisoning, and the inhalation of dust from arsenical wall-papers and textile fabrics, whereby a chronic form of poisoning is induced.

The symptoms and treatment of arsenical poisoning are described under (q.v.).

Arsenic-eating, or the ability of some persons to take relatively large doses of arsenic habitually, is a well-established fact. The cause of this singular immunity from the ordinary results of arsenic is unknown.

2. Lead.—The salts of lead, more especially the acetate (sugar of lead), are irritant poisons of no very great activity; and, though occasionally death ensues, recovery is the rule. Chrome yellow, or lead chromate, is a powerful irritant poison. All chromates are, indeed, irritant poisons. (See .)

3. Copper.—The soluble salts of copper, such as blue vitriol (the sulphate) and verdigris (subcarbonate and subacetate), are emetic and) irritant salts. Their emetic effects usually, but not invariably, secure their prompt rejection by the stomach. Occasionally fatal effects have resulted from their administration. Copper becomes accidentally mixed with articles of dietary in a variety of modes. It is also used for improving the colour of preserved fruits and vegetables. Its deleterious properties when thus used in minute quantities have been both asserted and denied. There is, however, a large body of evidence in favour of the at all events occasional poisonous effects of minute quantities of copper.

4. Zinc salts and barium salts, except the quite insoluble barium sulphate, are irritant poisons; and barium compounds act also upon the central nervous system.

5. Chromates, e.g. bichromate of potash, are violent irritants. Chrome yellow, or lead chromate, has already been mentioned.

6. Phosphorus.—Of the two chief forms of the elements—the yellow or ordinary and the red or amorphous—the former only is poisonous. Rarely there is met with a chronic form of poisoning among workers in the material, arising from the inhalation of phosphorus vapours. Its special characteristic is a peculiar necrosis or death of the bony structure of the lower jaw. Acute phosphorus poisoning is more common. Phosphorus is used for tipping matches, and is also the basis of several vermin destroyers. (See and .)

7. Vegetable Irritants.—These produce drastic purgative effects. Frequently the nature of the illness may be ascertained by the discovery of portions of the vegetable substance—recognizable by the microscope—in the matters ejected by the patient.