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CURATIVE MEDICINE.

PART XV.

POISONS AND THEIR ANTIDOTES.

How Poisons Enter the System.—Under the head of poisons, it is intended to include all those substances which exercise pernicious, as distinguished from medicinal, effects upon the human body, tending to disturb its action or organization injuriously, and if not remedied to possibly cause death. Such substances may be swallowed, or taken in by the breath, absorbed through the skin, or the thinner and more delicate mucous membranes, or implanted by bites, stings, or other punctured wounds.

Symptoms of Poison.—In many cases persons are aware almost immediately after the act that they have swallowed a poison; but in many others, also, no suspicion is entertained at first. In a general way, it may be stated that it is reasonable to surmise a person has swallowed some poisonous substance, if, shortly after taking food or drink, he is seized with violent pain in the stomach, with vomiting and purging, especially if convulsions or paralysis are present, or if the individual suffer from marked giddiness or delirium, or should there be a great tendency to sleep. The first thing to do is to send for the nearest reputable physician, and any neglect of this involves a heavy responsibility if the illness prove mortal, as it is certainly very possible that it will do.

Never lose a Moment.—In the meantime not a moment should be lost. There are three rules which should always guide an effort to remedy the effects of poison, no matter what it may be: First, to get rid of the poison; second, to stop its effects; and, third, to remedy the evil it has done. In carrying out the principles thus inculcated, whatever is readiest is best; for the poorest remedy given at the moment, is better than the most appropriate, administered an hour later.

Effect of Some Poisons.—A considerable number of poisons are what might be called self-evacuating; that is, having been swallowed, they set up vomiting and purging, and are thereby eliminated. In such cases, all that is needful is to aid the self-evacuating process, especially to assist the vomiting, and so, perhaps, get rid of the poison altogether. If vomiting, however, has not occurred, or has not been profuse, the first thing is to bring it on immediately.

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The Mustard Emetic.—The three handy emetics are, usually, mustard, common or kitchen salt, and lukewarm water. If we have a choice, mustard should be used in poisoning where the noxious substance has had a sedative influence, and it is less applicable to those cases where an irritant effect has been produced.

Mustard Dose.—The dose of mustard is a tablespoonful, stirred up in a pint of warm, not hot, water, and, after drinking it, the patient should swallow as much warm water as his stomach will hold, both to dilute the poison and to promote the action of the mustard. After a few minutes, if no signs of vomiting appear, the back of the throat ought to be tickled with a feather, or roll of paper, which will often hasten the emetic effect. When the stomach has emptied itself, it is well to repeat the process, so as to give it a good washing out.

Salt Water Dose.—Should there be no mustard at hand, salt water, mixed in the proportion of a small handful to a pint of lukewarm fluid, and followed by copious draughts of the warm fluid, as before suggested, and tickling the throat if needful, will generally answer the purpose. It is a good plan to send at once to the nearest drug store for some wine of ipecacuanha, to be administered in tablespoonful doses every ten minutes, should the ordinary home remedies fail in their customary energetic effect.

Need of an Antidote.—In some instances, this treatment is all that is required, but frequently the simple plan of getting rid of the poison will not suffice. Its effects must be neutralized or remedied, or, in other words, some antidote is needed. No one antidote is suited to all emergencies. The antidote is required to be adapted to the poison, and therefore an effort should be made, instantly after the emetic is given, to find out what kind of a noxious substance has been swallowed, and the proper remedy should be administered in accordance with the following suggestions.

Object of an Antidote.—The object of most antidotes is to render the active poison an inert substance, after which treatment may be instituted with a view to remedy the mischief which it has previously done. Antidotes, therefore, are generally chemical agents, which attack or combine with the poison in such a way as to render it insoluble, and so inert. But some are medicines, the virtues of which are apparently opposed to the active qualities of the poison, constituting what may be correctly called counter-poisons.

Milk and Eggs.—If we are totally ignorant of the kind of poison which has been swallowed, as may occasionally happen, the treatment

(Continued on page pg0711)

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Alphabetical Table of Principal Poisons With Antidotes For Immediate Use.

A case of poisoning is the mightiest of emergencies—one of life or death. Every minute counts. One must know what to fly to on the instant. Here the poisons are arranged alphabetically so as to be found in a second, and followed by their quickest and most effective antidotes at hand in the home.

 

POISONS.      ANTIDOTES.

 

ABSINTHE.—Give an active emetic; then flaxseed tea freely; stimulate.

ACETATE OF LEAD.—Same as SUGAR OF LEAD.

ACETIC ACID.—Same as CITRIC ACID.

ALCOHOL.—Treat by emetics, hartshorn and external warmth. See page 1339.

ALKALI, VOLATILE.—Drink freely of water with vinegar or lemon juice in it.

AMMONIA.—Lemon juice, diluted vinegar or acetic acid.

ANTIMONIAL WINE.—Give warm water freely to encourage vomiting.

ANTIMONY.—Same as TARTAR EMETIC.

AQUA FORTIS.—Magnesia or soap dissolved in water, every two minutes.

ARSENIC.—Give prompt emetic of mustard and salt—tablespoonful of each. Follow with sweet oil, butter or milk.

BED-BUG POISON.—Give milk or white of eggs in large quantities.

BELLADONNA.—Active emetic; stimulate.

BITTER ALMONDS—Same as PEACH KERNELS.

BLUE VITRIOL.—Same as SULPHURIC ACID.

CANTHARIDES.—Evacuate stomach; give mild drinks.

CARBOLIC ACID.—Give flour and water, or other glutinous drinks.

CARBONATE OF SODA.—Prompt emetic; soap or mucilaginous drinks.

CAUSTIC POTASH.—Drink freely of water with vinegar or lemon juice in it.

CAUSTIC SODA—Drink freely of water with vinegar or lemon juice in it.

CHEESE.—Same as MILK.

 

POISONS.      ANTIDOTES.

 

CHLORAL HYDRATE.—Cold water on head and face; artificial respiration; galvanic battery.

CHLORIDE OF LIME—Give acids; evacuate bowels; stimulate.

CHLOROFORM.—Emetic of tablespoonful of mustard in warm water. Follow with stimulating treatment.

CITRIC ACID.—Chalk or magnesia water; flaxseed tea; lime water.

COAL GAS.—See GAS.

COBALT.—Prompt emetic; soap or mucilaginous drinks.

COPPERAS.—Prompt emetic; soap or mucilaginous drinks.

CORROSIVE SUBLIMATE.—Milk or white of eggs, freely.

CREOSOTE.—Starch or flour mixed with water; or white of eggs and milk; or evacuate stomach with an emetic.

DIGITALIS.—Evacuate; lie prone; stimulate.

ERGOT.—Evacuate; give purgatives; stimulate.

ETHER.—See CHLOROFORM.

FISH.—Emetic, followed by saline purgatives and alkaline drinks; or promptly evacuate stomach and bowels, and then stimulate.

FOWLER'S SOLUTION.—Prompt emetic of mustard and salt— tablespoonful of each. Follow with sweet oil, butter or milk.

GAS.—Remove patient to air, use artificial respiration, apply heat to extremities; send for doctor.

HAIR OF CATERPILLAR.—Apply cloths saturated with camphor. Don't rub.

HONEY, POISONOUS.—Black coffee, smell of camphor, and rub with same.

ICE CREAM.—Same as MILK.

IODINE..—Starch, flour, or arrowroot, mixed with water.

NOTE—In most cases of poisoning vomiting should be excited at once. The common emetics are mustard, a tablespoonful to a pint of warm water; salt, a small handful to a pint of warm water; warm water itself, in copious draughts. Salt and mustard mixed, a tablespoonful of each to a pint of warm water, make a quick and powerful emetic. Should an emetic prove tardy, tickling the throat with a feather will help to promote vomiting.

 

 

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POISONS.     ANTIDOTES.

 

IVY, POISON.—Same as SUMACH. See page 1394.

JIMSON WEED.—Prompt emetic of mustard and salt—tablespoonful of each to pint of warm water, then stimulate with coffee or brandy.

LAUDANUM.—Strong coffee, followed by ground mustard or grease in warm water to produce vomiting; keep in motion.

LEAD WATER.—Milk or white of eggs in large quantities.

LEAD, WHITE, RED, LITHARGE.—Prompt mustard or salt emetic, then castor oil; heat to bowels.

LIME.—Vinegar or lemon juice, then starch water.

LUNAR CAUSTIC.—A strong brine of salt; then milk and sweet or castor oil.

LYE.—Give vinegar or oil.

MAD-DOG BITE.—Tie band tightly around limb above wound; cut out and cauterize wound; apply antiseptic dressing; give purgative and warm drinks; send to Pasteur Institute.

MATCHES—See PHOSPHORUS.

MEATS, PUTREFIED.—Emetic, followed with vinegar or lemon juice.

MERCURY.—White of eggs freely; afterwards evacuate; mild drinks.

MILK.—Cleanse stomach and bowels; apply heat; stimulate.

MORPHINE.—Strong coffee, followed by ground mustard or grease in warm water to produce vomiting; keep in motion.

MURIATIC ACID.—Magnesia, or soap dissolved in water, every two minutes.

MUSHROOMS.—Same as TOADSTOOLS.

NICOTINE—Same as TOBACCO.

NIGHTSHADE.—Same as BELLADONNA.

NITRATE OF SILVER.—Give common salt in water, freely.

NITRE.—An emetic, then drinks of barley water, followed with castor oil.

NITRIC ACID.—Same as AQUA FORTIS.

NUX VOMICA.—Same as STRYCHNIA.

OAK, POISON.—Same as SUMACH. See page 1394.

OIL OF VITRIOL.—Same as SULPHURIC ACID.

OPIUM.—Same as LAUDANUM.

OXALIC ACID.—Magnesia or soap dissolved in water, every two minutes.

PARIS GREEN.—Same as ARSENIC.

PEACH KERNELS.—Spirits of hartshorn, strong coffee; cold applications.

PHOSPHORUS.—Excite vomiting, then give milk and magnesia, followed by tea of flaxseed or slippery elm.

PINK ROOT.—Coffee without milk, smell of camphor.

 

POISONS.      ANTIDOTES.

 

POKE ROOT AND BERRY.—Evacuate stomach and bowels; stimulate.

POTASH.—See CAUSTIC POTASH.

POTASSA, BICARBONATE.—Magnesia or soap dissolved in water, every two minutes.

PRUSSIC ACID.—Coffee in plenty and quickly; smell spirits of ammonia, camphor or vinegar, pour water on head and back. Death generally ensues so quickly that there is no time for emetics.

RAT PASTE.—Quick emetic of salt and mustard, then flaxseed tea freely.

RED PRECIPITATE.—Milk or white of eggs in large quantities.

SALTPETRE—Milk or white of eggs in large quantities.

SNAKE BITES, POISON.—Tie band around limb above bite; suck out venom with mouth; cauterize wound; give strong stimulants.

SODA.—See CAUSTIC SODA.

SPANISH FLY.—Same as CANTHARIDES.

STINGS.—Apply salt water, or sweet oil, or fresh mould. Always take out the sting of a bee.

STRYCHNIA.—Emetic of mustard in warm water.

SUGAR OF LEAD—Milk or white of eggs in large quantities.

SULPHATE OR CHLORIDE OF ZINC.—Solution of soda, milk, white of eggs.

SULPHURIC ACID.—Prompt use of magnesia, soap, chalk or lime-water. Afterwards mucilage water or milk.

SUMACH.—Apply to parts a paste of equal parts of starch and glycerine. See page 1394.

TANSY.—Evacuate stomach; stimulate; artificial respiration.

TARTAR EMETIC.—Drink warm water freely to encourage vomiting.

TARTARIC ACID.—Soap water, lime water, magnesia or chalk.

TIN.—White of eggs and milk, or sugar water.

TOADSTOOLS.—Evacuate stomach and bowels; give Epsom salts; stimulate.

TOBACCO.—Encourage vomiting with salt and mustard water, then stimulate with spirits of ammonia, or whiskey and water.

TURPENTINE.—Fresh air, flaxseed or slippery elm tea.

VERDIGRIS.—Same as COPPERAS.

VERMILION.—Milk or white of eggs in large quantities.

WHITE PRECIPITATE.—Prompt emetic of mustard and salt— tablespoonful of each. Follow with sweet oil, butter or milk.

WHITE VITRIOL.—Same as SULPHATE OF ZINC.

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is first to provoke vomiting, as already advised, and after the stomach is completely emptied, to give a moderate quantity of some bland liquid, such as milk, eggs beaten up with milk, or sweet oil.

Wine and Brandy.—If the patient feels cold, and the skin is cool and clammy, a little wine or brandy well diluted may be administered; and if he seems drowsy, narcotic poisoning is to be suspected, so that strong coffee, and belladonna under the direction of a physician, should be employed.

Hot Water and Mustard.—If the prostration is very great, stimulants freely, heat to the skin by hot-water bags or bottles, and mustard plasters to the abdomen, are to be resorted to.

When the poison taken into the stomach is known, and prompt attempts have been made to eject it by vomiting, then administer its antidote.

Elimination by Vomiting.—Theoretically the administration of the chemical antidote is the only requisite, the vomiting, with its accompanying discomfort and depression, being uncalled for; but it is safer to eliminate the poison or what part of it can be removed by vomiting, and so take as few chances as possible upon the quality and efficacy of the drug used as an antidote. Chemical results obtained in the laboratory are not always confirmed when the same combinations are attempted within the human system.

Classification of Poisons.—To facilitate the study of the subject some system of management should be adopted. No classifications of poisons is entirely satisfactory, and the following is offered as probably as good as any other for public use:

1. Gases and volatile substances.

2. Metals.

3. Minerals and metallic salts.

4. Corrosive poisons, acids and alkalies.

5. Vegetable poisons, in form of drugs.

6. Vegetable poisons in natural state.

7. Bacterial and food poisons.

8. Animal secretions.

GASES AND VOLATILE SUBSTANCES.

Illuminating Gas.—In the process of manufacture of illuminating gas from coal but little, if any, injury is done the workmen, owing to the distillation of its more deadly constituents in retorts.

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In its distribution its escape from imperfect pipe connections and collection in trenches, sewers and houses occasionally causes poisonings and explosions. Illuminating gas known as water-gas is much more deadly and much more dangerous on account of its presence being less easily detected by smell.

On animal organism both forms act as a narcotic and depressant of the nervous system; uniting with that portion of the blood normally taking up the oxygen and displacing the oxygen.

Symptoms.—These depends upon amount of poison absorbed. When poisoning occurs gradually there is discomfort, sense of fullness of blood-vessels, headache, dizziness, hot skin, weakness. There may be nausea, vomiting and convulsions. Coma occurs, which, in some cases of recovery, may last for days; it may precede death but a few hours, or it may continue for days before a fatal termination takes place.

Treatment.—Removal of the patient to the open air; the use of artificial respiration, and the application of heat to the extremities are about all that can be done before the arrival of a physican. Artificial respiration hastens the expulsion of the poison and its substitution by oxygen. This result may be effected more promptly by inhalation of commercial oxygen. Nitro-glycerine and amyl nitrite might be used with advantage.

Aniline.—This is made from coal tar, a biproduct in the manufacture of illuminating gas. It is an oily, colorless liquid, but its poisonous effects are chiefly caused by its volatility. The vapor produces headache, dizziness, marked depression, nausea, vomiting. Delirium and convulsions may occur.

Treatment should be same as for illuminating gas poisoning.

Bromine.—This in its commercial form is a red fluid, but to the fumes arising from it when pouring, etc., is to be ascribed nearly all cases of bromine poisoning. Bromine vapor causes irritation of the respiratory organs, cough, spasm of the opening into the larynx and suffocation. It also causes increased flow of tears and saliva and bronchial asthma.

Treatment.—Inhalation of aqueous vapor.

Carbon Bisulphide.—This is a colorless volatile liquid that causes poisoning chiefly by the vapor arising from it. It is used very largely in the manufacture of rubber goods; has a very offensive odor. Acute cases of poisoning do not occur, except where the substance is used for suicidal purposes, when the symptoms are pallor, vomiting, depression, deep, heavy breathing, characteristic odor of breath, feces and urine.

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Carbon Dioxide.—This is the poisonous gas sometimes met with in wells, cisterns, etc. It is the "after damp" of the coal mines. Its deleterious effects and treatment are similar to those of illuminating gas. It will not support flame.

Chlorine.—This is a gas of peculiar odor; is used chiefly as a bleaching agent. The public is familiar with it as a disinfectant in the form of chloride of lime, made by allowing pure slaked lime to take up all the chlorine gas it will absorb. It is a strong irritant to the respiratory tract. Continued exposure to it produces skin eruptions, inflamed eyes, asthma and bronchitis.

Chloroform.—This has been taken as a liquid by accident and intention. In this form its poisonous effects do not occur so soon as when the vapor alone is absorbed.

One teaspoonful has been known to have brought death to a boy of four years. Twelve times this amount killed an adult. Several adults have recovered after swallowing sixteen teaspoonfuls.

Treatment.—1. Empty the stomach by giving a tablespoonful of wine of ipecac, or a tablespoonful of mustard in warm water. Twenty grains of sulphur of zinc or thirty grains of powdered ipecac may be given in warm water for the same purpose. A hypodermic injection of one-tenth grain of hydrochlorate of apomorphine and use of the stomach tube are very effective measures to remove the poison from the stomach.

2. Stimulating treatment must be used extensively, as, for instance, brisk switching, or towel slapping or flicking; hot external applications; injection of hot strong coffee into the rectum, pint at a time; application of mustard plaster to calves and legs and over the heart; hypodermic injections of ether and hot brandy, atropine, strychnia and digitalis; use of the interrupted current by sweeping poles over the surface of the body; placing victim with his head lower than his body that the brain might be supplied with blood with the least possible effort of the heart.

Even though apparently there is no response to treatment efforts at resuscitation should be continued for a comparatively long time, as recoveries have occurred at the end of an hour of continuous effort.

Chloroform.—Chloroform taken into the lungs in form of vapor is supposed to act more promptly than when taken into the stomach as a liquid. In this form there is a wider range between the smallest quantity producing death and the largest amount taken without fatal result. Records show that less than half a teaspoonful mixed with air and administered by a competent person for surgical purposes has caused death, on the other hand a woman suffering with convulsions following childbirth (post-partum eclampsia) has been kept under the influence of chloroform, vapor for seventy hours continuously.

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Symptoms.—The symptoms of poisoning by inhalation of the vapor are similar to those following taking the drug in liquid form into the stomach.

Treatment.—1. The treatment differs only in refraining from any attempts at the production of vomiting or emptying the stomach by use of stomach pump. Equally applicable to both forms of poisoning are the following aids to resuscitation, not previously mentioned: Prompt commencement of artificial respiration. The occasional inhalation of amyl nitrite. The measure advocated in the following quotation might be of some avail.

2. "When the patient seems to be in extremis a couple or more violent blows on the chest quickly given may restore the action of the heart."

3. Electric Treatment.—Regarding the use of the interrupting current as an aid to recovery authorities differ in details of application. One advocates placing one pole of the battery at the pit of the stomach and the other at the region of the larynx, with the idea of stimulating the phrenic nerve, which causes the diaphragm to act and aid respiration. Another authority states this method is dangerous, because nerves (cardiac inhibitory nerves) which tend to slow or stop the action of the heart lie so near the phrenic nerve that it is impossible to stimulate the latter without exciting the former to action, and so defeating instead of promoting recovery; hence the previously mentioned method of sweeping the poles of the battery over the surface of the body.

Chronic Chloroform Poisoning.—Chronic chloroform poisoning is a condition the existence of which would not be readily suspected. It occurs among a class of people who use chloroform constantly, for the same purposes or reasons that the other type of inebriate uses alcohol. Although the path to ruin and death is probably more direct by the chloroform than the alcohol method, yet that the former is occasionally comparatively long is shown by the record of a woman dying at the age of forty-two in a chloroform stupor, who for at least ten years had taken by inhalation a pint of chloroform daily.

Ether is a colorless volatile liquid. It is highly inflammable, and when taken by the mouth imparts a burning taste. It is not so dangerous a drug as chloroform when used by inhalation and probably not when taken in liquid form. Although less apt to cause death it has greater tendency to produce diseases of the respiratory tract than chloroform when taken by inhalation.

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Symptoms of Ether Poisoning.—The symptoms and treatment of poisoning by ether are similar to those of chloroform, except the use of ether hypodermically as a stimulant should not be permitted.

When in poisoning by ether the face becomes cyanotic, flushed, the failure to breathe properly is not due to weakness of the heart but to respiratory trouble, and the head should not be placed lower than the body. When the poisonous effects are carried beyond the cyanotic stage pallor succeeds the same as in chloroform poisoning and indicates lowering the head below the body in the same way as the latter drug.

Treatment.—Traction upon the tongue, simulating normal respiration in frequency, duration, regularity and evenness is a method of causing recovery that is equally applicable to both ether and chloroform poisoning.

Amyl Nitrite.—This is a product of the chemical combination of amylic alcohol and nitric and nitrous acids. It is a clear volatile liquid having an aromatic penetrating odor. For administration by the public it is prepared in small glass receptacles called pearls, resembling some forms of capsules, and containing from three to five drops. The pearl is broken in a handkerchief and the contents inhaled.

Symptoms of Amyl Poisoning.—An excessive amount causes alarming prostration, very rapid and tumultuous beating of the heart, difficult respiration, bursting sensation in the head and roaring in the ears. Recovery is said to have occurred after taking one-third of an ounce. With the exception of prussic acid amyl nitrate is the quickest of all nervous depressants.

Treatment.—Artificial respiration. Hypodermic injection of strychnia and atropine. Give digitalis and whiskey. Apply heat in form of hot water in bottles or rubber bags if required.

Ammonia.—See Corrosive Poisons.

Nitro-benzine.—This is a yellow liquid formed in the manufacture of anilene by adding nitric acid to benzine. It has the odor of bitter almonds and has been used to perfume soaps. It is a subtle, dangerous poison both as a liquid and vapor.

Symptoms.—Inhalation of a poisonous amount is followed by appearances of slow intoxication except the mind remains clear until a period of insensibility is reached. Insensibility may occur with great suddenness, may be delayed for several hours and may continue for several hours before death occurs.

There is an odor of bitter almonds upon the breath.

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Treatment.—If the liquid has been taken empty the stomach with a pump or by emetics. If the poison has been inhaled, or taken into the stomach apply heat. Use strychnia and general stimulating treatment.

Turpentine and white lead instead of white lead and oil are largely used for painting interiors, and so forth. It is claimed by the painter and the physician, and denied by the employer, that the use of turpentine in confined places, such as between decks, causes watery discharges from the nose, a feeling of fullness or stuffiness in the head, difficult urination and bloody urine.

Treatment.—Recovery follows exposure to the fresh air and use of mild bland drinks such as tea made from slippery elm or flaxseed. There is no record of the occurrence of any fatalities. Taken into the stomach in excessive amounts turpentine produces the same symptoms of strangury and bloody urine caused by inhalation of its vapors. In addition it may cause inflammation of the kidneys, stomach and intestines.

Iodine in its process of manufacture and manipulation volatilizes at ordinary temperature. In its liberation from seaweed it gives off fumes in the same way as chlorine and bromine in their process of extraction. Its vapors cause the same effects as those of chlorine and bromine. For poisoning resulting from its use in drug form, see Minerals, Metallic Salts.

Prussic Acid.—This colorless, transparent, inflammable, volatile liquid is perhaps the most rapid and deadly of poisons. Taken in sufficient quantity it has been claimed to have caused almost instant death.

Symptoms.—These vary with the quantity of poison taken. When not sufficient to be promptly fatal there may be open, staring eyes, fixed jaws, pallor of cyanosis, depending upon whether the cardiac or respiratory functions are the more affected, convulsions, vomiting, unconscious discharge of feces, urine and semen. The odor of bitter almonds is noticeable upon the breath and upon post-mortem examination, but rapidly disappears.

Treatment.—This is, of course, confined to those cases that afford time for action and may be outlined as use of stomach pumps, artificial respiration, oxygen inhalation, cold applications to head and spine, electricity, ammonia by inhalation or intravenously.

Sulphurous Acid.—This is a strong solution of sulphurous oxide gas. Its poisonous effects are directed chiefly against the respiratory tract.

Remedies.—The remedies are fresh air, artificial respiration and stimulants.

Nitrous Oxide.—This is known also as nitrogen monoxide, and laughing gas is used chiefly as a brief anesthetic in dentistry. It is capable of producing alarming symptoms and even death by respiratory paralysis.

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Recovery is to be attempted by fresh air, rhythmic traction upon the tongue, artificial respiration.

METALS, MINERALS, METALLIC SALTS.

Antimony.—This is found both as a metal and a mineral. The preparations of the metal best known to the public, and from the abuse of which poisoning is liable to occur, are tartar emetic, oxide of antimony, sulphureted antimony, wine of antimony and compound syrup of squills, known as Coxe's lime syrup.

Symptoms of Poisoning.—Marked depression characterizes poisoning by this substance. Violent purging and vomiting occur. The bowel discharges are characteristic and known as rice water stools; that is upon standing in a glass a separation can be noticed into two layers; an upper watery and clear, and a lower white and flocculent.

Treatment.—Evacuate the stomach by means of a stomach pump. Give tannic acid freely to form the insoluble and inactive tannate of antimony. The general precautions taken in all cases of depression are to be observed. Maintain the prone position, not raising the head to vomit, nor the body for defecation. Apply heat and use stimulating treatment, whiskey, strychnia and digitalis hypodermically. Give opium to allay pain, but counteracting its tendency to after depression by strychnia.

Arsenic.—This is a brittle crystalline metal of steel-gray color. Its freshly broken surface is very brilliant. It is found in its native state in the rocks of many different localities. It is also a constituent of cobalt, copper, nickel and tin ores.

Symptoms of Poisoning.—Rarely the course is one of rapid succession of severe pain, prostration and death. Frequently the period between ingestion and fatal ending is of five or six days' duration, including a time when there is an absence of marked symptoms and an apparent beginning of recovery. There is a burning sensation in the mouth and esophagus. The stomach and bowels are strongly irritated. There is violent purging and vomiting with great pain over the entire abdominal region. The pain is of cramp-like character, and sometimes extends to the calves of the legs or legs in general. The bowel evacuations are bloody "rice water" in character, and contain stringy mucus, supposed to be mucous membrane stripped from the bowels.

Treatment.—The acknowledged effective preparation to counteract arsenic when taken into the stomach is hydrated oxide of iron with magnesia, and is made as follows: Solution of tersulphate of iron, one thousand parts; magnesia, one hundred and fifty parts; water, a sufficient quantity. Mix the solution of tersulphate of iron with twice its weight of water, and keep the mixture in a well-stoppered bottle. Rub the magnesia and water to thin and smooth mixture; transfer this to a bottle capable of holding thirty-two fluid ounces, and fill it up with water. When the preparation is wanted for use mix the two liquids by adding the magnesia mixture gradually to the iron solution, and shake them together until a homogeneous mass results.

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The Stomach Pump.—This antidote will not produce the desired result if the arsenic is not in solution, consequently the stomach pump takes a position of primary importance in attempts at recovery. Following the evacuation of the stomach should be the application of external heat and the administration of stimulating drugs; morphia if necessary to quiet pain. Water to flush the entire system.

Calcium.—This is a very abundant element in nature, occurring as limestone, marble, chalk, and so forth. Calcium chloride is perhaps the only drug derivative that might prove dangerous to the public. In excess this drug is a strong gastro-intestinal irritant, and poisonous effects should be treated by vegetable acids and demulcent drinks. Calcium chloride is not chloride of lime. For the latter see Lime.

Chlorine occurs in combination with sodium, potassium, magnesium and calcium. It is in its liberation that it proves itself dangerous to life on account of its poisonous vapor. (See Gases and Volatile Substances.)

Chromium.—The preparations of this mineral, most familiar to the public, are chromic acid, bichromate of potassium and chromate of lead. All the chromium preparations are irritants to the stomach and bowels and can cause death when taken internally. To counteract, use the stomach pump and give demulcent drinks. Administer stimulants under the skin and apply heat. Give lime-water or other weak alkalies if chromic acid has been taken.

Copper.—The salts of copper taken into the stomach in excess are powerful irritants to the stomach and bowels, giving the following symptoms: Copperish taste, intense pain in stomach, vomiting, purging, convulsions. Death may follow.

Treatment.—Give the chemical antidote, yellow prussiate of potassium, mild drinks, such as sweet oil, milk, white of eggs. Soaps and alkalies are said to be antidotal. The stomach should be emptied of the compounds formed either by emesis or stomach pump. Stimulating treatment and opium to relieve pain should be given.

Gold.—The pharmaceutical preparations of gold are decidedly poisonous, the chloride more so than corrosive sublimate, it is claimed. They are corrosive in their action, with symptoms similar to copper and other gastro-intestinal irritant poisons.

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Treatment.—For treatment, evacuate stomach; stimulate. Sulphate of iron is said to be a chemical antidote.

Iodine.—This is a non-metallic substance, having a metallic lustre. It volatilizes at a low temperature and gives off a crimson-purple vapor. For poisoning by this drug, see Gases and Volatile Substances.

Iodoform.—This is a yellowish powder, with a strong and objectionable odor. It is used principally in the treatment of surgical wounds, and has caused local and systemic poisoning when so applied.

Symptoms of Poisoning.—Fatal results have been rare, but when occurring the symptoms were local rash, headache, vomiting, delirium, convulsions, coma. The kidneys may be affected and retention of urine or bloody urine occur.

Treatment.—Cause sweating by the hot pack and give diuretics to relieve the kidneys. Bicarbonate of sodium is said to be useful in promoting the elimination of the iodine constituent of the drug. Stimulate.

Iron.—The only salt of iron likely to do harm by its unguarded use by the public is the subsulphate or Monsel's salt, a solution of which known as Monsel's solution is used to stop hemorrhage.

Antidote.—The antidote is common soap. Monsel's solution should be applied and not taken inwardly.

Lead.—Perhaps no other metal has such diversity of uses in the arts and manufactures. It might be more accurate to say no other metal furnishes such an array in number and variety of instances of poisoning. As a rule industrial lead poisoning is a slow, chronic process, and does not call for the prompt attention required by the ingestion of excessive amounts of lead-burdened drugs.

Sugar of lead.—Acetate of lead, known to the public as sugar of lead, is the preparation of lead most frequently prescribed by medical practitioners.

Symptoms of Poisoning.—Indications of poisoning are pain in the region of the stomach and vomiting of a white, curdy material, resulting from the chemical combination of the hydrochloric acid of the gastric juice with the lead. Inflammation of the stomach occurs sometimes with constipation, sometimes diarrhoea, with black discharges, caused by the formation of sulphide of lead in the bowels.

Treatment.—Epsom and Glauber salts are preferred as chemical antidotes for their effective action chemically and for their purgative influence. Other antidotes are alkaline carbonates, soap and salt. Use stomach pump or emetics to insure evacuation of stomach contents. Apply heat and give stimulants. Use opium to relieve pain.

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Lime.—Chloride of lime, used as a disinfectant and germicide, is slaked lime to which has been added 35 per cent. of chlorine. Its poisonous properties depend upon the chlorine gas it contains, for which see Chlorine, under Gases and Volatile Substances. If lime is taken into the stomach it causes great thirst, abdominal pain and constipation.

Antidotes.—To counteract give vegetable acids and demulcent drinks, Evacuate stomach; stimulate.

Mercury.—This is a silvery, white, heavy fluid metal, obtained chiefly from cinnabar, a sulphide of the metal. In the mining of the ore and in the many industrial uses made of the pure metal, its compounds and combinations, chronic poisoning occurs. Acute poisoning is more frequently due to the injudicious use of drugs containing some preparation of the metal.

Symptoms of Poisoning.—In severe cases these are metallic taste, burning sensation in the throat and stomach, vomiting, bloody stools, convulsions, coma.

Antidote.—The antidote is white of egg; additional treatment same as given in case of other corrosive poisons; evacuation; bland drinks; stimulants. Potassium iodide to aid in elimination. Opium to relieve pain.

Paris Green.—Symptoms of poisoning and treatment same as in arsenic.

Phosphorus is a non-metallic element, discovered in 1669 by Brandt, who obtained it from urine. In 1769 it was found in bones, the chief source of supply at present.

Symptoms of Poisoning.—In acute poisoning symptoms do not appear for several hours. Pain in the esophagus, stomach and bowels may be accompanied by purging or constipation. Discharged matters have characteristic odor and luminosity in the dark. The second or third day there may be a cessation of vomiting or of such symptoms for several hours, followed by a jaundice, pain, vomiting, delirium, convulsions, coma.

Antidotes.—Hare suggests peroxide of hydrogen and permanganate of potassium as antidotes. Sulphate of zinc is recommended for the same purpose. To the victim rescued from even acute poisoning is held out the gloomy prospect of an early death through fatty degeneration of vital organs.

Silver.—The salts of this metal that are most apt to cause poisoning are cyanide and nitrate. The cyanide is dangerous on account of its liberation of hydrocyanic acid when strongly heated. The nitrate if frequently used as a caustic, and when taken into the stomach produces marked gastric and intestinal inflammatory symptoms.

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Symptoms of Poisoning.—The lips are first white from the caustic action of the drug, then become black. The vomited matter and the discharges from the bowels turn black upon exposure to the air. Convulsions, coma, paralysis, death may follow.

Treatment.—The chemical antidote is common salt. Soap and alkalies are supposed to annul the poisonous tendencies or to prevent the action of the poison upon the mucous membrane of the alimentary canal.

Tartar Emetic.—See Antimony.

Tin.—In the separation of tin from its ores poisoning is a rare occurrence, except from the deleterious substances combined with the tin. Pharmaceutically it is of little or no value, consequently it is not likely to fall into the hands of the public for perverted use. Of the chloride, three-quarters of a grain injected into the veins of a dog caused death. Fifteen grains introduced into the stomach caused vomiting and gastric irritation. Effective treatment would be evacuation, magnesia, mucilaginous drinks.

Zinc.—All the salts of zinc which can be absorbed in excess have a strongly depressing, even paralyzing, action upon the heart and all voluntary muscles, and may cause death by this means. Convulsions, coma and death is the brief statement of another bond of effects following zinc poisoning.

Treatment.—Empty the stomach. Give milk mixed with sugar and white of egg to form insoluble albuminate of zinc. Sodium or potassium carbonate, tannic or gallic acid have also been recommended as antidotes. Overcome depression by stimulants, strychnia, digitalis, and so forth. Apply heat, give morphia for pain.

CORROSIVE POISONS.

Acetic Acid.—Acetic acid of the pharmacopeia is very mildly caustic. Taken internally it may prove very dangerous. Recovery has followed the injection of three ounces, followed by collapse and asphyxia from closure of the glottis. Suffocation was prevented by tracheotomy. Gastroenteritis is liable to result.

Antidotes.—The chemical antidotes are lime-water and soap-water, milk and other bland drinks should be given. The stomach pump should be applied. Heat and stimulating treatment may be required.

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Carbolic Acid.—This, in its pure state, is a white substance, appearing as needle-like crystals. It is very deliquescent and, with the addition of 10 per cent. of water or glycerine, becomes liquid; in this form it is usually dispensed.

Symptoms of Poisoning.—In large doses it has produced death in two or three minutes.. In smaller doses it causes gastro-enteritis, marked by extreme pallor, cold sweats, stupor, coma, subnormal temperature, dark urine or suppression of renal secretion, very much contracted pupils. The drug has produced poisonous effects by absorption from surgical dressings.

Treatment.—Give soluble sulphates, Epsom or Glauber salts as the chemical antidote. A well-known authority says the lapse of several hours does not counter-indicate the use of the chemical antidotes as they follow the acid into the blood-vessels and tissues to unite with it. The stomach pump, heat, hypodermic stimulation, bland drinks should follow the use of the soluble sulphates. The use of oil as an emollient drink is prohibited owing to the belief that it aids the absorption of carbonic acid.

Hydrochloric Acid is not so destructive in its action as nitric or sulphuric acids. When swallowed the tissues are superficially destroyed, but rarely does deep erosion or perforation occur. It causes great thirst and restlessness, burning skin, agonizing stomach pain. Chemical antidotes are magnesia, soap or any dilute alkali. Supportive treatment may be required.

Nitric Acid.—In industrial occupations the inhalation of the fumes arising from this acid has repeatedly produced death. Its irritative action upon the larynx may cause spasm of the glottis severe enough to end fatally by asphyxia. Taking it into the lungs has been followed by pulmonary edema and death. As a liquid in excess its action upon the alimentary canal is extremely corrosive, and where death does not follow promptly the following symptoms may appear:

Symptoms.—Burning of the mouth, esophagus, stomach and intestines; intense pain, distention of stomach and intestines, frequent erectations[sic], emesis, extremely fetid odor of exhalations and vomit, great thirst, cold extremities, anxiety, collapse. The stain upon the clothing and lips is yellow in color and is resembled by the stains of iodine and bromide. Discolorations made by the latter two drugs can be removed by caustic potash, but nitric acid stains are increased in brightness by the same application.

Treatment.—The treatment is the same as for other corrosive acid poisons, alkaline solutions, magnesia, soap, chalk, oils, demulcent drinks, heat and stimulation. Opium to allay pain. Recovery is rare and usually followed by early demise from destructive effects, such as constriction of esophagus or bowels or loss of function in digestive organs.

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Oxalic Acid.—Accidental poisoning has occurred by taking oxalic acid in mistake for epsom salts. The sour taste is very different from the taste of epsom salts.

Symptoms vary with the quantity taken. Taylor says the minimum fatal dose is one drachm. Death has occurred as early as ten minutes after taking the poison in excess. With large amounts the early indications are those of a corrosive poison, pain in esophagus and stomach, retching and bloody vomit. They may be followed by great depression and death without a struggle.

Treatment.—The antidotes are lime-water, magnesia, chalk; plaster from the wall has been suggested in emergency. These should be given promptly to form insoluble oxalates of magnesium or calcium. The oxalates of ammonium and potassium are soluble, poisonous and require the same antidotes as oxalic acid.

Sulphuric Acid.—This is the most corrosive and the most extensively used of mineral poisons, having the same poisonous symptoms as the other strong corrosive acids. The tissue discoloration due to its action is black. Death may be caused by laryngeal obstruction through violent inflammatory effects; by collapse due to perforation of the stomach or by shock due to extensive destruction of tissues. If recovery occurs the injured tissue sloughs off and subsequent contracture or loss of function may cause death later on.

Treatment consists in the prompt use of magnesia, soap, chalk, lime-water as antidotes. After neutralization of the acid give mucilaginous drinks, milk or other bland drinks. The deep and extensive tissue destruction render the use of emetics and stomach pump dangerous. The strong muscular effort accompanying emesis and the manipulation of the pump both tend to result in perforation. Counteraction of depression by heat and hypodermic administrations is, of course, strongly indicated.

Tartaric Acid, more irritant, but less expensive than citric acid, is sometimes used instead of the latter in making a substitute for lemonade. In large quantities it is a gastrointestinal poison and has caused fatal results.

Antidotes.—Give soap-water, lime-water, magnesia, chalk as antidotes. Use the stomach pump or emetics; administer stimulants; apply heat.

Ammonia.—This is a transparent, colorless gas, having an acrid taste and an exceedingly pungent smell. It is alkaline in reaction. The best publicly-known preparation containing this gas is aqua ammoniae or water of ammonia, a solution of 10 per cent. by weight of the gas in water. Death has been caused by inhalation of the gas, by ingestion of the liquid and by the muriate and carbonate. Fatal results have followed after the lapse of four minutes through spasm of the glottis. The same ending may occur after comparatively long periods as with other corrosive poisons, causing stricture or prolonged prostration.

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Symptoms.—These are pain, burning sensation from mouth to stomach, vomiting of bloody mucus. Cardiac and respiratory efforts are greatly stimulated, but soon equally depressed. Lachrymation, sneezing and cough are marked. Ammonia differs from the other alkalies in affecting the nervous system, while the others are destructive in local effects only.

Treatment.—As an antidote, lemon juice and dilute vinegar or acetic acid may be given. Bland drinks and vigorous efforts to counteract prostration should follow. Opium may be required to allay pain and reduce nervous symptoms.

Soda.—This is the hydrate of sodium, known commonly as caustic soda. When fluid it is moulded and placed upon the market in the shape of small sticks or cylinders not quite as large as an ordinary lead pencil.

Symptoms of Poisoning.—It is corrosive in its action, causing, when taken, pain throughout the alimentary tract and destroying, by softening, all tissues with which it comes in contact. Vomiting occurs. The softened and destroyed tissues slough, sometimes in mass, and inflammatory conditions follow.

Treatment.—Give weak acids, oils, demulcents, and use stimulating treatment.

Potash.—This is the hydrate of potassium, commonly called caustic potash. It is more corrosive than caustic soda. Poisonous symptoms and treatment are the same. (See Soda.)

VEGETABLE POISONS (in form of drugs).

Limited space and the great number of substances included under this heading compel the briefest notice of symptoms and treatment where poisoning has occurred by accident or overdoses.

Acetanilid, a white powder; common constituent of advertised headache powders. Causes cyanosis, prostration, heart failure. Use strong stimulants, external heat.

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Acid, Boric, in large amount produces nausea, vomiting, collapse, cardiac failure. Treatment is to evacuate stomach, stimulate.

Acid, Salicylic, in large amount causes deafness, delirium, defective breathing, respiratory failure. Treatment is by strychnia and other stimulants.

Aconite, a dangerous drug; small amount may prove fatal.

Symptoms of Poisoning.—Tingling of mouth and throat becoming general, pallor, anxiety, slow pulse, weak respiration, great muscular weakness, heart failure.

Treatment.—Keep victim on flat of back, with head below body. External heat, hypodermic injections of ether, alcohol, digitalis, strychnia in large doses, atropine, artificial respiration if required.

Alcohol.—Frequent cases of acute alcoholic poisoning occur among children.

Symptoms.—Giddiness, drunken gait and manner, flushed face, may be pale, stupor, coma, sometimes death long after apparent recovery.

Treatment.—Digitalis, strychnia hypodermically, external heat, artificial respiration, prone position, with head lower than body.

Antipyrine.—This causes erythema or other skin disturbances, tingling sensations, depression. Treatment is same as aconite poisoning.

Apomorphine causes prompt and severe vomiting, depression, cardiac failure. Use hypodermic stimulation, external heat as antidotes.

Absinthe causes insensibility, convulsions, involuntary evacuations, possibly death. Evacuate stomach, give demulcent drinks, stimulate.

Aspidium or Male Fern.—Used to destroy tape worm. Overdose might cause gastro-enteritis, collapse, death. Evacuate, stimulate.

Atropine, Belladonna, Hematropine cause flushed face, general redness of skin, great dryness of mouth and throat, dilated pupils, prostration. For treatment insist upon prone position, evacuate stomach if seen early, stimulate, use artificial respiration if necessary.

Bloodroot.—See Sanguinaria.

Camphor.—In large doses produces roaring in the ears, delirium, convulsions, possibly gastro-intestinal symptoms. To treat, evacuate, stimulate.

Cantharides.—Produces vomiting, bloody stools, priapism, strangury, convulsions, coma, respiratory paralysis. For treatment, evacuate, give morphia for pain, bland drinks, stimulate.

Colchicum.—Symptoms of gastro-enteritis, great pain, fatal depression. For treatment, evacuate, give tannic acid, stimulate, morphia for pain.

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Conium.—Muscular depression, paralysis of respiratory muscles Evacuate, give tannic acid, atropine, stimulate.

Digitalis.—Produces headache, slow full pulse becoming irregular; great prominence of the eye-ball, pearly color of sclerotic coat, vomiting. Death is caused probably by cardiac spasm.

Treatment.—Give tannic acid as a chemical and aconite as a physiological antidote. Evacuate, enforce prone position, stimulate. Prone position should be maintained for days after apparent recovery, as death has immediately followed erect posture after digitalis poisoning of a day or two previous.

Elaterin and Elaterium in excess cause gastroenteritis. Use stomach pump, heat, stimulant, opium.

Ergot.—Enormous doses are required to cause fatal results. Symptoms are tingling sensations, vomiting, muscular spasm, great coldness of the surface. Evacuate, give purgatives, stimulate, enforce prone position.

Fusel Oil causes muscular rigidity, respiratory failure. Evacuate, stimulate, use artificial respiration.

Gamboge causes gastro-enteritis. Evacuate with pump, stimulate, apply heat, give demulcent drinks.

Gelsemium causes great depression, falling or drooping of the eyelids, double vision, respiratory failure. Evacuate, stimulate hypodermically with atropine, strychnine, ether, digitalis, apply heat, use artificial respiration.

Hemlock.—See Conium.

Henbane.—See Hyosciamus.

Hyosciamus causes giddiness, incoherence of speech, loss of power to swallow, partial loss of voice, difficulty in respiration, delirium. For treatment, evacuate, stimulate.

Jaborandi.—Profuse sweating, salivation, vomiting, diarrhoea, ocular irregularities. Give atropine as antidote, evacuate, stimulate.

Laudanum.—See Opium.

Lobelia causes vomiting, sometimes purging, great depression, respiratory failure. Give tannic acid, stimulate, apply heat, use artificial respiration.

Morphine.—See Opium.

Nicotine.—See Tobacco.

Nitro-Glycerine causes severe headache, rapid, irregular cardiac action, collapse. Give atropine, digitalis, strychnine. Maintain recumbent position.

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Nux Vomica.—See Strychnia.

Opium causes mild excitement or contentment, followed quickly by sleepiness, stupor. Cyanotic face, contracted pupils, gradually decreased frequency of breathing, respiratory failure. For treatment evacuate stomach with pump; give strong coffee by mouth or rectum; use flagellation or the battery to keep patient awake; keeping victim in motion by walking is also useful for the purpose, but may exhaust him. Give hypodermic injection of strychnine; apply heat; use artificial respiration.

Pinkroot.—See Spigelia.

Bloodroot, Sanguinaria, causes salivation, vomiting, purging, convulsions, respiratory failure. For treatment evacuate, stimulate.

Spanish Fly.—See Cantharides.

Spigelia causes dilatation of the pupils, prominence or protrusion of the eyeballs, internal strabismus, retching, increasing muscular weakness, depressed respiration, coma, death.

Treatment.—Evacuate; stimulate; use heat and artificial respiration.

Squills produce gastro-enteritis, bloody urine, strangury, convulsions, death.

Treatment.—Evacuate; stimulate; give demulcent drinks.

Strychnine.—Symptoms may begin gradually or be pronounced from beginning. If they come on slowly, there is stiffness of jaw and neck; slight, then strong muscular contractions, with body bent backward and resting on head and feet. Intervals of relaxation succeeded by tonic convulsions; death from exhaustion, or more frequently by asphyxia due to spasm of muscles of respiration.

Treatment.—Give tannic acid. Evacuate stomach, administer bromides and chloral. Amyl nitrite may lessen the spasm. If drugs cannot be given by mouth on account of convulsions, prevent same by chloroform, and at same time give bromides and chloral per rectum. If periods of relaxation are too brief to permit of chloroform securing control, give amyl nitrite hypodermically.

Sulphonal causes sleepiness, stupor, scanty or suppressed urine, unconsciousness, death by respiratory failure. For treatment evacuate, stimulate. Give diuretics; use artificial respiration.

Tansy produces abortive tendencies, convulsion, coma, respiratory failure. For treatment evacuate, stimulate, use artificial respiration.

Tobacco contains an alkaloid, nicotine, that is said to cause death as promptly as hydrocyanic acid. Thirty grains of tobacco or one to two drops of nicotine are sufficient to cause death in less than half hour by the first and in a few minutes by the second.

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Symptoms.—Nausea, vomiting, cold clammy skin, general muscular relaxation, pupils contracted, then dilated, odor of person disagreeable.

Treatment.—Recumbent position; tannic acid; evacuation of stomach, stimulants; heat.

Fungi, toadstools, and so forth, may cause vomiting, purging, convulsions, delirium, stupor, death. Evacuate, give Glauber or Epsom salts, stimulate.

Poison Ivy, Poison Oak, Poison Vine cause irritation of skin, particularly of face, itching, swelling, vesicular eruption. If taken inwardly drowsiness, stupor, delirium, convulsive movements.

Treatment.—Externally use alkaline solutions or dilute subacetate of lead. Rest, low diet, laxatives, opium.

Poke Berry and Root causes nausea, vomiting, purging, cardiac and respiratory depression, convulsions. For treatment evacuate, stimulate.

Sumach.—See Poison Ivy, and so forth.

Toxicodendron.—See Poison Ivy, and so forth.

FOOD AND BACTERIAL POISONS.

Cheese.—See Milk.

Cream Puffs.—See Milk.

Custard.—See Milk.

Fish poisoning may be divided into two classes, physiologic and of bacterial origin. As a means of defense and offense some fish secrete deadly poisons, which they eject through spines in caudal, dorsal or ventral fins; others poison with their bite by bathing the teeth in a poison secreted in the roof of the mouth. Fishermen have been poisoned by catching these fish in the hand and by puncture of the feet when wading in the water. The poison is severe and rapid in action, causing great pain in the cardiac region, sense of suffocation, cold perspiration, delirium, convulsions, coma, death.

Symptoms.—The symptoms of fish poisoning in general are similar to cholera morbus; vomiting, purging, cold perspiration, depression, abdominal pain, collapse. The most dangerous cases are those in which free bowel movements do not occur. For this reason opium should not be given to relieve pain, unless accompanied by a purgative to counteract its constipating effects.

Treatment.—The treatment is evacuation of stomach and bowels. Washing the large bowel is the preferred method of cleaning that portion of the intestines. Apply heat and stimulate.

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Ice Cream.—See Milk.

Meat.—Disease and putrefactive changes are responsible for poisoning following the use of meat as food. It is said that of 112 epidemics of meat poisoning reported in medical literature since 1867, in which 6,000 persons were affected, 103 were due to meat from diseased animals, and only 5 shown to result from putrefactive changes.

Poison from Cow Meat.—The raw and cooked meat of a cow suffering with profuse diarrhoea for two days before being slaughtered, caused poisoning and death through a bacillus it contained.

Poison from Sausage.—In many cases of sausage poisoning the sausage has been eaten uncooked. While cooking will destroy the bacteria; boiling, drying and freezing do not destroy the ptomaines.

Poison from Canned Meats.—Poisoning from canned meats may be due to diseased meat; to putrefactive changes before canning; putrefactive changes after canning and before opening, owing to imperfect closure of can; to putrefactive changes after opening can.

Treatment.—Symptoms and treatment are similar to those of fish poisoning.

Milk.—In addition to the transmission of tuberculosis and other diseases by milk, the article of food is credited with extensive poisoning in bottle fed babies. It is presumed that the majority of serious and fatal diarrhoeas of infants fed upon cow's milk can be traced to bacteria in the milk.

Symptoms.—Bacterial ferments for peptonizing milk are accountable for much of the trouble. The occurrence of these diarrhoeas chiefly in summer is explained by the fact that heat aids materially in and is essential to the growth and multiplication of bacteria. Boiling, unless long continued, does not destroy some forms of microorganisms.

Treatment.—Treatment should be abstention from use of milk, washing stomach and bowels, calomel as required.

Milk Products, such as cheese, custard, cream puffs, ice cream, and so forth, have occasioned many serious and fatal results by ptomaine poisoning. The destructive alkaloid that has been discovered in these cases has been tyrotoxicon, though the investigator, Vaughan, chiefly instrumental in its discovery concludes that it is not the most virulent one, nor the one most frequently occurring in milk ptomaine poisoning. In a number of marked cases of poisoning by impure milk products he has been unable to find tyrotoxicon, but has also failed to detect the real poison. This tyrotoxicon causes vomiting, purging, epigastric pain, great prostration, death.

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Treatment.—This consist in washing stomach and bowels, application of heat, stimulation hypodermically.

Mushrooms.—The close resemblance between some of the poisonous and non-poisonous specimens of mushrooms have led to many fatal cases of poisoning. The two prominent poisons, separated from poisonous mushrooms are muscarine, an alkaloid, and phallin, a tox-albumen. The difference in their properties accounts for the difference in symptoms in fatal cases.

Symptoms.—Aside from the variations in symptoms due to quantity of poison ingested and resisting powers of the victim, are the cardiac depression due to muscarine and the choleraic diarrhoea due to phallin. Phallin is supposed to effect blood changes by the serum, is separated and thrown into the bowels causing watery stools and enteritis. Muscarine is the more prompt in production of symptoms and death, indications appearing in three or more hours, while with phallin twelve hours may elapse. Fatal results may with either be delayed for a week.

Treatment.—Atropine given nearly hourly, hypodermically, in doses of one one-hundredth to one-fiftieth is to be used as the physiologic antidote of muscarine. Tannin may also be given as the antidote for alkaloids in general. Muscarine is said to be soluble in acids, so as to prevent rapid absorption mild alkalies should be given. Bland drinks to allay gastro-intestinal irritation are advised. Give cardiac stimulant, alcohol, ammonia, digitalis by hypodermic injection. Intravenous injection of salt solution in condition of collapse is recommended.

Nutmeg produces stupor, and collapse is said to have occurred as a result of taking into the stomach one and one-half nutmegs.

Treatment.—Evacuate bowels and stimulate.

Vegetable Food.—The prominent articles of diet under this head from which poisonous results occur are maize and rye. A ptomaine is produced in maize as a sequence of premature harvesting, improper care of harvested products, and so forth, that is productive of extensive chronic poisoning in Spain and Italy. The dangerous element in rye is a fungous growth called ergot, that in some European countries causes many cases of chronic poisoning. As grave results following the use of both these substances are reached only after somewhat protracted indulgence their treatment requires no further mention.

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