XVII.

Toxicological Effects of Arsenic.

By C. JUDSON HILL, M. D.

Frances Gage, alias Evans, a servant girl, aged sixteen years, purchased, February 6, one ounce of arsenic powder, with the intent to destroy her life.

At about seven P. M., she took the first dose, dry, while on her way. home from the apothecary's. Soon after reaching home she repeated the dose; again, during the night, she took the third dose; and still another, the fourth, in the morning; taking, in all, about two drachms.

In about an hour after taking the first dose she experienced a sensation of faintness, burning and nausea; after the second dose, vomited several times, and then fell asleep and slept until near midnight. On awaking, took the third dose, and shortly after, began to experience a good deal of pain, burning, etc., in the oesophagus and stomach, with constant nausea and vomiting for several hours, when the symptoms mitigated; and she took another nap and slept until morning. At the usual hour arose and dressed herself, took the fourth dose and proceeded to prepare breakfast for the family, although suffering severely from the terrible distress in the stomach. accompanied with occasional vomiting and purging. She endured the suffering with extreme fortitude until noon, when the lady with whom she lived, noticed something more than usual in her actions and appearance and inquired the cause, when the girl burst into tears, and said she had taken arsenic. She then gave the lady two half-ounce vials, containing arsenic, one of which was about half full. She said she had taken all that was gone from the one vial. The lady immediately referred to Gunn's Practice of Medicine, which recommended the administration of warm milk and white of eggs; which she gave, with some temporary relief. The lady then sent for me. I arrived about two o'clock, and, learning the case, which presented all the symptoms of arsenic poisoning, I immediately sent for some hydrated peroxide of iron; which was given in table-spoonful doses, every five or ten minutes, and after each spell of vomiting,

the

until one pint was taken, when her symptoms somewhat improved, and the iron was given at longer intervals. The patient also drank copiously of flaxseed tea, milk, and white of eggs. Gave also at intervals of an hour, carbonate of magnesia in milk, in order to procure expulsion of that portion of the poison which might have passed into the intestines. The latter not acting, I ordered two ounces of castor oil, which was soon followed by a copious evacuation of a dark brown substance. I then left the patient for the night, giving instructions to keep up the use of the iron and mucilaginous drinks at regular intervals.

February 8, nine A. M.-Saw patient again; found her improved and quite cheerful; had rested some during the night; vomiting still continued, but at longer intervals; complained of a severe headache, with dizziness, which compelled her to lie down; was very uneasy, and desired to change her position often; the pain in the throat and stomach was still severe at times, and seemed to alternate between the stomach and head; complained of great thirst, but drank very little at a time; had a severe burning pain in the region of the heart, accompanied with a tumultuous action of that organ. It seemed to her, as she described it, that her heart was being turned inside out, and as though everything was being spilled out of it. The pulse remained quick and small, almost imperceptible, as it was the night previous; no desire for food; constant desire to urinate; urine hot and dark colored; skin hot, and face flushed, accompanied with occasional vomiting and shuddering; when the paroxysms of pain and nausea came on, the patient obtained relief only by sitting up and bending forward, pressing upon the stomach with the hands; as soon as vomiting occurred, relief was experienced. Continued treatment of the night before.

Five P. M.-Saw the patient again; was still improving; had vomited three or four times since my last visit; stomach felt much better; no pain or nausea, but a constant thirst and severe headache; gave the iron at still longer intervals, but ordered the milk, eggs, and flaxseed tea continued at short intervals, and gave another dose of oil, and left her for the night.

February 9, nine A. M.-Found the patient sitting up; felt better than the day before, except the headache and pain about the heart; stomach did not distress her at all; no nausea or vomiting; had partaken of some milk gruel; bowels moved freely and gave some relief to the head; could not sit up long at a time, as it caused the

head to swim; pulse better, but still rapid; ordered beef-tea, milk, and white of eggs, and gave water to drink.

February 10.-Found the patient about the same as the day before; had not vomited, nor experienced any nausea, nor any pain in the stomach; coughed some, and said there was a feeling of soreness at the pit of the stomach when coughing; slight tenderness of the mouth and throat, with tongue coated dark brown, but moist; considerable thirst and desire for food; there was also considerable vertigo on attempting to sit up. Continued treatment.

February 11.-Patient much the same; bowels had moved; the discharge having the appearance of mucous shreds, indicating some disorganization of the mucous membrane of the alimentary canal; complained of considerable weakness, especially of the back. Prescribed ipecacuanha and china.

February 12th.-No soreness or tenderness of the mouth or throat; tongue coated with a white fur, and moist; not much thirst; said that she would feel as well as usual, were it not for a burning pain in her back; worse on sitting up; she could not sit long at a time; some vertigo and debility remaining; gave china.

February 13th.-Symptoms about the same as the day before; pulse one hundred and four; small and weak; has a strong desire for food, and ate quite a hearty meal; some tenderness of the stomach, noticed only while coughing; pain in the back about the same; gave nux vom. and china.

February 14th.-Improving; only symptom complained of was the pain in the back, across the kidneys, with a desire to urinate frequently; pulse one hundred; small and weak; continued treat

ment.

February 15th.-Found the patient dressed, and about the house; pain in the back much better; otherwise as well as usual; continued same treatment.

February 17th.-Still improving; walked out yesterday several times; feels quite well; discharged the case.

The above cases is valuable in medical jurisprudence, from the fact, that so far as can be ascertained, none has been reported as recovered, where so long an interval between the taking of the first dose of poison, and the administration of the antidote has occurred. The poison was taken some eighteen hours before medical aid was obtained. The symptoms were urgent, but the case yielded promptly to the proper antidotal treatment.

XVIII.

Toxicological Effects of Morphine and Laudanum.

By STILLMAN SPOONER, M. D.

H. C., aged forty, of irregular and intemperate habits, May 1st, purchased two ounces of laudanum and six grains of morphine; walked two miles to his home in the country, and at seven P. M. put the morphine and laudanum into a bowl containing about half a pint of milk, and drank the whole at a dose; then went up stairs, deliberately undressed and retired.

The family, on ascertaining that he had taken laudanum (the vial being labeled), immediately sent for me. I saw him at nine o'clock, two hours subsequently. He was yet conscious. I ordered ground mustard, with the intention of causing the patient to vomit, which he utterly refused to take, and within twenty minutes, became perfectly comatose, followed by stertorous breathing; pulse fifty, soft and full; respiration from six to eight; skin soft and warm, and no physical violence would rouse him in the least. I deemed it useless to use a stomach pump, after profound coma had come on, especially after so large a dose had been taken. I once saw a patient die within three hours after taking a smaller dose. I therefore, waited about that length of time, and the patient still breathed. The pulse was now ninety, small and soft; skin moist and warm. now dissolved nux vom., third dilution, in half a tumbler of water, and put a tea spoonful of the solution in his mouth, as he lay with it open, which he swallowed.

I

After waiting fifteen minutes, I gave another tea spoonful of the solution, then spoke to him with a loud voice, and shook him violently.

After twenty-five minutes from taking the first dose the patient exhibited signs of consciousness. At the end of thirty minutes called me by name, and soon became perfectly conscious, and refused to take any more medicine. Supposing, however, he would not relapse, I left him, with orders to take the nux every half hour. About an hour after I went home, he became again profoundly comatose. Violent efforts were now made by the attendants to rouse him, but

in vain. They then put the medicine in his mouth every five minutes, and continued their physical efforts. Within about half an hour he again became conscious, and again refused to take the remedy, and within an hour relapsed into a more profound stupor, if possible, than the others. The symptoms became more aggravated; a cold, clammy sweat came out on the body; large drops stood on his bald head, and the attendants thought the pulse almost gone. The nux was again given as before, with like result. As the patient again became conscious he was very thirsty, and called for water. The attendants were now shrewd enough to put the nux into the water that he drank, and the same physical efforts continued to keep him awake. The patient did not relapse. I saw him the following morning at nine o'clock, when he was wakeful, without any symptoms indicating a tendency to relapse. Violent vomiting came on during the day, but within a few days was well, and went about his work.

Every symptom indicated that a large and apparently fatal dose of opium had been taken. The sudden and repeated improvements after taking the nux was as strong an indication that the medicine was the cause of the improvement as there ever is in any prescription ever made by any physician.

As the truthfulness or accuracy of the above report has been questioned, I will here say that every word here asserted can be proved by the testimony of several intelligent and respectable witnesses.