LECTURES ON MEDICAL JURISPRUDENCE,

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  • No. 733.

    LONDON, SATURDAY, SEPTEMBER 16, 1837. [1836-37.

    LECTURESON

    MEDICAL JURISPRUDENCE,NOW IN COURSE OF DELIVERY,

    AT

    UNIVERSITY COLLEGE, LONDON.

    BY PROFESSOR A. T. THOMSON.

    LECTURE XLVIII.

    NUX VOMICA.STRYCHNIA.

    Nux VOMICA.Igasaurate of strychnia inarnica montuaaa. Treatment of poisoningwith nux-vomica and strychnia. M. Donralsproposed antidotes. Circumstance of thestomach which increases the activity ojstrychnia, - CAMPHOR. Poisoning there-with, and treatment.

    SEDATIVE POISONS:- Their generalcharacters. PRUSSIC ACID. Poisoning-therewith. Recovery. Mode and rapidityof action.OIL OF BITTER ALMONDS. Poi-soning therewith. Volatile oil expressedfrom them.LAURO-CERASUS. Its botani-cal characters. Laurelwater. Poisoningthei-eu,ith in food, and otherwise. Chemi-cal tests for, and post-mortem appearancesin, poisoning with these sedatives. Case ofthe murder of Sir T. Boughton. Evidenceof Dr. Rattray and John Hunter on thetrial. Treatment qf poisoning with thesesedatives.GENTLEMEN :-1 am disposed to think that

    arnica montana contains igasaurate of strych-nia, because not only does the infusion ofthe petals, when tested with ammoniacalsulphate of copper, afford a green tint, butthe symptoms of poisoning by it closelyresemble those of poisoning by nux vomica.

    In treating cases of poisoning by nuxvomica, or by strychnia, the contents of thestomach may be advantageously evacuatedat any period of the attack ; and the sto-mach-pump is preferable, in this instance,to emetics. Much dilution is required onaccount of the very close adhesion of the

    powder of nux vomica to the coats of thestomach. Dr. CHRISTISON says, that, "ifthe person be not attacked with spasm intwo hours, he will generally be safe."M. DoNNE has proposed to employ chlo-

    rine, bromine, and iodine, as antidotes forpoisoning by strychnia; and, consequently,for that by nux vomica ; because he hasfound that compounds of these substances,and strychnia, are not poisonous. Twograins of the iodide, or the bromide, or thechloride of strychnia, produced no poison-ous effects on a dog; and a dog which hadtaken one grain of strychnia, and two grainsof veratria, when tincture of iodine wasadministered, in less than ten minutes after-wards, was not injured ; but when a greaterdelay took place in the administration ofthe antidote, it was useless. This, of itself,is, in my opinion, a great objection to thesealleged antidotes, as the symptoms of theinfluence of the poison are not displayed,even in dogs, till twelve or fifteen minuteshave elapsed after taking strychnia; and,at any time before these have appeared, theevacuation of the stomach by a brisk emeticwill secure the safety of the person. Evenafter the symptoms of poisoning have firstdisplayed themselves, the evacuation of thestomach lessens greatly the danger of thepatient. I am also doubtful whether thehydrochloric acid in the stomach wouldnot greatly interfere with the formation ofthese iodides in that viscus. The subjectrequires farther investigation.

    All acids should be carefully avoided, asthe compounds formed between them andstrychnia, or brucia, are more poisonous,owing to their greater solubility than thestrychnia or the brucia alone ; indeed, theactivity of strychnia, either as a poison oras a remedy, very much depends on thequantity of acid present in the stomach atthe time of its administration. It is chieflyowing to this circumstance that we find in-dividuals to whom strychnia is administer-ed as a remedy in paralysis, so differ-ently affected by it. DEVERGIE says that hehas given it to the extent of seven grains aday to some individuals without any dele-terious effect; yet it is well known thatsome individuals suffer from doses of even

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    the twelfth of a grain. In one case in theNorth London Hospital, the influence of theacetate of strychnia, in doses of the tenthof a grain, was so severe upon the respira-tory function, that I was forced to discon tinue the use of the remedy. The applica-tion of the actual cautery on the loins, whichwas substituted for the strychnia, very soonrelieved the symptoms caused by the drug ;and, in cases of overdosing by strychnia, Ihave seen cupping on the loins prove highlybeneficial,

    In the collapse which supervenes, brandy,opium, and camphor may be freely admi-nistered; but I have never seen any re.covery take place after collapse has ap-peared.

    CAMPHOR.

    I have put down cmnplwl as the last ofthe narcotico-acrid poisons; but it is one notvery likely to display its influence on man,unless under peculiar circumstances, orwhere it has been made the subject of expe-riment, as it was by Dr. ALEXANDER uponhimself.

    Dr. EDWARDS has recorded a case inwhich ss. of camphor was given in theform of enema. The person soon felt thetaste of the drug ; and, oil going down stairs,he seemed so light that he appeared to him-self to skim along the floor almost withouttoucbing it. He staggered, became pale,felt chilly, and experienced a sensation ofnumbness of the scalp. He recovered aftertaking a glass of wine; but for twenty-four hours the odour of the camphor wasexhaled with his breath. ORFILA*, who re-lates this case of Dr. EDWARDS, made severalexperiments on dogs, which fully demon-strated the poisonous influence of camphoron these animals. From these experiments,and from a case related by HOFFMAN of aman who took ij. of camphor dissolved inoil, the irritant influence of camphor is de-monstrated.The symptoms of poisoning by camphor

    are, in the first instance, a vertiginous feel-ing, accompanied with confusion of ideas,and an indistinctness of vision; a loss ofconsciousness succeeds, with convulsions,foaming at the mouth, and maniacal phrensy.

    In treating cases of this kind, the sto-mach should be evacuated as rapidly aspossible, and cordials afterwards freelyadministered.

    SEDATIVE POISONS.Sedative poisons are usually ranked with

    narcotic poisons, but the difference of theeffects produced by their influence uponthe system, is too obvious not to point outthe necessity of separating them, and form-ing a distinct class, or sedative poisons.

    Sedatives, when administered in doses

    * Toxicologie Generate, ii., 400.

    suflicient to prove poisonous, cause no pre:vious symptoms of excitement : their de-pressing power is immediately felt, andoften, in a few seconds, death, without anymorbid symptoms, is the result. That thisis the consequence of a direct sedative in-fluence on the nervous energy is undoubted;and the fact that convulsions sometimesdisplay themselves, when the dose is notsufficient to cause instantaneous death, is noargument against the opinion, since (lefee-tive stimulus of the brain produces convul-

    sions as decidedly as over excitement ofthat organ; a fact strikingly illustrated inprofuse haemorrhages and over-bloodletting,The influence of sedative poisons is ex-

    erted chiefly on the nerves of sensation;and this is often displayed locally. RoBt-

    QUET continued for some time to hold hisfingel- on the mouth of a bottle containingsome strong hydrocyanic acid, whilst hewas conversing with a friend ; it becamenumbed, and continued so for thirty hours,yet he felt no other inconvenience from thecircumstance.The sedative poisons differ in other re-

    spects from the narcotic ; thus post-mortemexaminations display no characters of in-flammatory action having existed in the mti-cous membrane, or in the brain, or in thespinal chord; indeed no changes appear ineither the stomach or the lungs, nor in anyof the nervous organs.The cause of death, in every instance,

    seems to he an immediate and direct ex-haustion of nervous excitability.

    HYDROCYANIC ACID.

    The first of the sedative poisons is hydlo-cyanic acid, either alone or in substances inwhich it abounds; namely-the oil of bitteralmonds, the distilled water of bitter al-monds, the distilled water of the prunuslauro-cerasus, and noyau.

    Hydrocyanic acid has too frequentlybeen employed as an instrument of deathby the suicide ; occasionally, also, it hasbeen used by the murderer.

    In treating of poisoning by this acid, Ido not intend to make any reference to theanhydrous acid ; for, although it is themost virulent of poisons, yet, owing to thedifficulty of keeping it, the possibility ofits becoming a poisonous agent is very rare:it is the diluted acid, such as is usuallyemployed as a medicinal agent, which de-mands our attention.Many instances pf its employment as an

    instrument of suicide are on record. HurE-LAND relates the case of a thief who swat-lowed f,j. of the medicinal acid, equal to 40minims of the anhydrous: he staggered, anddied in less than five minutes. A medicalman, with whom I was intimately acquaint-ed, determined to destroy himself. Aftermaking his will, and arranging all his affairs,he purchased an ounce of hydrocyanic acid,

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    at Gardens, the Chemist, in Oxford-street;and walked as far as the end of Argyle-street. Having called a hackney-coach fromthe stand, whilst it was turning round heopened the phial and drank its contents. Healmost immediately staggered, was forced tosupport himself by holding by the post, andhad scarcely power with the assistance ofthe cad, to enter the coach, and order it togo to Sloane-street: on arriving there, theunfortunate gentleman was found, seated inthe corner of the coach, completely dead.An instructive case of poisoning by this

    acid, where the person recovered, is detailedin the 11 Revue Medicale," for 1825. A phy-siciau at Rennes, who had taken two tea-spoonfuls of the oflicinal hydrocyanic acidwith impunity, swallowed, on the 5th Sep-tember, 1824, at seven oclock in the evening,an equal dose of the acid twice at a veryshort interval. He had taken a hearty diu-ner five hours before. He had scarcely leftthe room where he swallowed the acid,when he felt a confusion of head, but as hehad occasionally experienced the same thingbefore, he did not particularly attend to it. IOn entering his laboratory he fell down likea person who had been struck with lighten-ing, or with apoplexy. He lost all con-sciousness ; his face and neck swelled; thepupils became fixed and dilated ; trismussupervened ; he scarcely breathed ; the ex-tremities were icy cold; a strong odour-of jthe acid issued from his mouth; and the pulsewas nearly imperceptible. In a few minutes,violent convulsions displayed themselves,!and the extremities were horribly distorted. I,These symptoms continued for nearly twohours and a half, at the end of which timehe gradually regained his consciousness;but several days elapsed before he com-pletely recovered.The French Codex, orders a syrup of

    hydrocyanic acid. It was administered in Idrachm doses to seven epileptics in the Bi-ctre, and all of them died, with syt-nptomssimilar to those which I have j list described.

    In whatever manner it is prescribed oradministered, either therapeutically or as aposion, hydrocyanic acid operates directlyon the nervous centres.Experiments on the lower animals de-

    monstrate that it acts most energeticallywhen it is applied to serous membranes,next, when it is taken into the stomach,-thirdty, on the cellular tissue and ulceratedsurfaces,and lastly, on the sound skin.EMMERT, COULLON, KRIMER, and others,

    have drawn opposite conclusions to mine,with regard to its action on the nerves,jn consequence of observing that it doesnot act on cut nerves, nor on expos-ed nerves;nor on the brain, nor the spi-nal chord. They also contend that, be-cause when vessels of a part are tied, beforetQnc4ipg it with this poison, its action ispl,evente,4; and is not prevented by dividing

    nerves;and because it is discovered inblood, it must necessarily operate by absorp-tion.The rapidity of its action,for instance,

    the application of the strong acid to the eyeof a dog, causing instant death, is againstthis idea :-and, in my opinion, it can onlybe explained, by supposing that the poisonacts through the nerves.The effect of a strong dose of hydrocyanic

    acid is death, almost instantaneous, andwithout convulsions. Such large doses maycause death in a few seconds ; but some mi.nutes may elapse.

    In more moderate, but yet poisonous doses,the symptoms are vertigo, nansea, great de-pression of the strength ; the weakness is feltchiefly in the limbs ;-tetanic convulsions ;gradually i tiereasin- insensibility, coi-na, anddeath. In some instances; salivation hassupervened.When it proves fatal, death generally takes

    place in less than fifteen minutes:whenrecovery ensues, the symptoms may go onfor many hours ;-in some instances theyhave extended to twelve hours.

    If a patient survive thirty or forty minutes,he will generally recover. Nevertheless thesymptoms have continued for more than a.day, and yet death has ensued. In man, theperiod depends on the extent of the dose ;but in no case are the fatal ejects so rapidas in the lower animals. I have seen a dog,to whom iv. of the medicinal acid were ad-ministered, die before he could be placed onthe ground, from the lap of the assistantwho held him. Some experiments weremade by Mr. MACAULEY, of Leicester, to de-termine whether an Apothecarys servantwho was poisoned with hydrocyanic acid,could, after taking the dose, before becominginsensible, have time to cork the phial, wrapit up, and adjust the bed clothes. He madethree experiments on dogs : one dog, whotook f3iv., died in four seconds; another,who took the same quantity, died in sevenseconds; and a third, who took f5ivss., diedin three seconds. As far as this evidencewent, the presumption was, that the girl hadeither been poisoned, or that some one hadbeen present to arrange these matters ; forhad convulsions taken place, her positionwould have displayed it. The apprenticeof her master, by whom she was pregnant,was tried for the murder, but he was ac-quitted.

    Such is the influence of this poison onthe animal system.

    Cyanide cf potassiuiii,Which is formed by decomposing ferrocya-nate of potassa, by a long continued redheat, separating the soluble matter, andevaporating to dryness, operates as a poisonin the same manner as hydrocyanic acid.In a solid state this cyqi)j(le is deliquescent,very soluble and has an alkaline reaction.

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    It is inodorous, but has a taste resemblingthat of hydrocyanic acid. Its effects onthe animal economy are exactly the same asthose of hydrocyanic acid. It has been re-commended to be used in the same manneras the hydrocyanic acid ; and requires thesame precautions.

    OIL OF BITTER ALMONDS.

    This is procured by the distillation withwater of the marc remaining after the pres-sure of bitter almonds, in order to extractthe bland oil. It contains two substanceswhich operate differently. One is an azo-tised substance, very poisonous, uncrystal-lisable ; the other, unazotised, and readilycrystallising on exposure to air or oxygengas, which changes it to an acid.The azotised substance exerts a powerful

    action on the animal economy, one drop al-most instantaneously destroying a small bird.On quadrupeds it exerts a less powerful

    action than hydrocyanic acid.ROBIQUET and VILLERME tried its influ-

    enc...