Aids To Forensic Medicine And Toxicology Part 17

_Post-Mortem Appearances._--The blood is bright red in colour, due to the interaction of carbonic oxide with haemoglobin. A rosy hue of the skin-surface and viscera is often noticed. Bright red patches of colour are found over the surface of the body. The spectrum of the blood is characteristic.

_Treatment._--Ammonia to the nostrils, inhalation of oxygen, cold douche in moderation, artificial respiration, transfusion of blood.

=Coal Gas.=--Coal gas contains light carburetted hydrogen or marsh gas, olefiant gas, ammonia, sulphuretted hydrogen, carbonic acid, carbonic oxide, free hydrogen, and nitrogen. Coal gas has an offensive odour, burns with a yellowish-white flame, yielding water and carbonic acid.

Cases of poisoning often due to escape of gas into the room.

_Symptoms._--Headache and giddiness, foaming at mouth, vomiting, convulsions, tetanic spasms, stertorous breathing, dilated pupil. The breath smells of gas; there is profound stupor; the patient, if alive, exhales gas from the lungs when removed into a fresh room or into the air. Smell of gas in the room and in patient's breath.

_Post-Mortem Appearances._--Pallor of skin and internal tissues; florid colour of neck, back, and muscles, if much CO present in the coal gas; fluid florid blood; infiltration of lungs.

_Treatment._--Fresh air, artificial respiration, cold affusion, diffusible stimulants; inhalation of oxygen freely.

=Sulphuretted Hydrogen= is characterized by its odour, like that of rotten eggs. It is extremely poisonous.

_Symptoms._--Giddiness, pain and oppression in stomach, nausea, loss of power; delirium, teta.n.u.s, and convulsions.

_Post-Mortem Appearances._--Fluid and black blood (sulph-haemoglobin), smell of H_{2}S on opening the body; loss of contractility of muscles, rapid putrefaction.

_Treatment._--Fresh air, stimulants, inhalation of chlorine.

_Tests._--Acetate of lead throws down a brown or black precipitate according to the quant.i.ty of the gas.

=Sewer Gas.=--Cesspool emanations usually consist of a mixture of sulphuretted hydrogen, sulphide of ammonium, and nitrogen; but sometimes it is only deoxidized air with an excess of carbonic acid gas.

_Symptoms._--If poison concentrated, death may ensue at once; if gas diluted, or exposure only short, insensibility, lividity, hurried respiration, weak pulse, dilated pupils, elevation of temperature to 104, tonic convulsions not unlike those of teta.n.u.s.

_Treatment._--Fresh air, oxygen, with artificial respiration.

Stimulants, hypodermic of strychnine, and alternate hot and cold douche.

=Irritant Gases= are--(1) Nitrous acid gas; (2) sulphurous acid gas; (3) hydrochloric acid gas; (4) chlorine; (5) bromine; (6) ammonia. They have the common property of causing irritation and inflammation of the eyes, throat, and air-pa.s.sages, and may cause spasm of the glottis, bronchitis, and pneumonia.

=Sulphurous Acid Gas.=--One of the products of combustion of common coal.

=Hydrochloric Acid Gas.=--Irrespirable when concentrated, and very irritating when diluted. Very destructive to vegetable life.

=Chlorine.=--Used in bleaching, and as a disinfectant. Greenish-yellow colour, suffocating odour. In poisoning, inhalation of sulphuretted hydrogen gives relief.

XXVIII.--VEGETABLE IRRITANTS

The chief vegetable purgatives are aloes, colocynth, gamboge, jalap, scammony, seeds of castor-oil plant, croton-oil, elaterium, the h.e.l.lebores, and colchic.u.m. All these have, either alone or combined, proved fatal. The active principle in aloes is aloin; of jalap, jalapin; of white h.e.l.lebore, veratria; and of colchic.u.m, colchicin. Morrison's pills contain aloes and colocynth; aloes is also the chief ingredient in Holloway's pills.

_Symptoms._--Vomiting, purging, tenesmus, etc., followed by cold sweats, collapse, or convulsions.

_Post-Mortem Appearances._--Inflammation of alimentary ca.n.a.l; ulceration, softening, and submucous effusion of dark blood.

_Treatment._--Diluents, opium, stimulants, abdominal fomentations, etc.

Certain of these irritant poisons exert a marked influence on the central nervous system, as the following:

=Laburnum= (_Cytisis Laburnum_).--All parts of the plant are poisonous; the seeds, which are contained in pods, are often eaten by children.

Contains the alkaloid _cytisine_, which is also contained in arnica. It has a bitter taste, and is powerfully toxic. Symptoms are purging, vomiting, restlessness, followed by drowsiness, insensibility, and convulsive twitchings. Death due to respiratory paralysis. Most of the cases are in children. Treatment consists of stomach-pump or emetics, stimulants freely, artificial respiration, warmth and friction to the surface of the body.

=Yew= (_Taxus baccata_) contains the alkaloid _taxine_. The symptoms are convulsions, insensibility, coma, dilated pupils, pallor, laboured breathing, collapse. Death may occur suddenly. Treatment as above.

Post-mortem appearances not characteristic, but fragments of leaves or berries may be found in the stomach and intestines.

=Arum= (_Arum Maculatum_).--This plant, commonly known as 'lords and ladies,' is common in the woods, and the berries may be eaten by children. It gives rise to symptoms of irritant poisoning, vomiting, purging, dilated pupils, convulsions, followed by insensibility, coma, and death.

Many plants have an intensely irritating action on the skin, and when absorbed act as active poisons.

=Rhus toxicodendron= is the poison oak or poison ivy. Poisoning by this plant is rare in England, though not uncommon in the United States. Mere contact with the leaves or branches will in many people set up an acute dermat.i.tis, with much oedema and hyperaemia of the skin. The inflammation spreads rapidly, and there is formation of blebs with much itching.

There is often great const.i.tutional disturbance, nausea, vomiting, diarrhoea, and pains in the abdomen. The effects may last a week, and the skin may desquamate.

=Primula obconica= is another plant which, when handled, gives rise to an acute dermat.i.tis of an erysipelatous character. The face swells, and large blisters form on the cheeks and chin.

XXIX.--OPIUM AND MORPHINE

=Opium.=--The insp.i.s.sated juice of the unripe capsules of the _Papaver somniferum_. As a poison it is generally taken in the form of the tincture (laudanum), which contains 1 grain opium in 15 minims. Opium is found in almost all so-called 'soothing syrups' for children, and in G.o.dfrey's cordial, Dalby's carminative, and Collis Browne's chlorodyne.

Laudanum contains 1 per cent. morphine, and it, along with all other preparations (_e.g._, paregoric) which contain 1 or more per cent.

morphine, are included in Part I. of the Schedule of Poisons, and come under the Dangerous Drugs Regulations.

The most important active principles of opium are the alkaloids morphine and codeine.

_Symptoms_ usually commence in from twenty to thirty minutes: Giddiness, drowsiness and stupor, followed by insensibility. Patient seems asleep; may be roused by loud noise, but quickly relapses. Breathing slow and stertorous, pulse weak, countenance livid. As coma increases, pulse becomes slower and fuller. The pupils are contracted, even to a pin's point; they are insensible to the action of light. In deep, natural sleep the eyes are turned upwards and the pupils contracted. Bowels confined, skin cold and livid or bathed in sweat. Temperature subnormal.

Nausea and vomiting are sometimes present. Remissions are not infrequent, the patient appearing about to recover and then relapsing.

Haemorrhage into the pons may give rise to contracted pupils. Young children and infants are specially susceptible to the poison.

_Diagnosis_ is not always easy, and one has to differentiate poisoning from _cerebral apoplexy_. In the latter one can seldom rouse the patient, the pupils are often unequal, and hemiplegia is present. In _compression of the brain_, fracture of the skull may be present, subconjunctival haemorrhages may be seen, the pupils are unequal and dilated, and the paralysis increases. In _uraemic or diabetic coma_ the urine must be examined.

The habitual use of opium is not uncommon, and opium-eaters are able to take enormous quant.i.ties of the drug. The opium-eater may be known by his attenuated body, withered yellow countenance, stooping posture, and gla.s.sy, sunken eyes.

_Post-Mortem Appearances._--Not characteristic. Turgescence of cerebral vessels. There may be effusion under arachnoid, into ventricles, at base of the brain, and around the cord. Rarely extravasation of blood.

Stomach and intestines usually healthy. Lungs gorged, skin livid.

_Fatal Period._--Usually nine to twelve hours; but in many cases, if life is prolonged for eight hours, recovery takes place.

_Fatal Dose._--Four grains of opium is the smallest fatal dose in an adult, or one drachm of laudanum; children are proportionately much more susceptible to the action of opium than adults.

_Treatment._--Stomach-tube, emetics, strong coffee or tea, ammonia to nostrils. Give 10 grains of permanganate of pota.s.sium in a pint of water acidulated with sulphuric acid, and repeat the dose every half hour.

Belladonna by mouth, or atropine hypodermically. Patient must be kept roused by dashing cold water over him, flagellating with a wet towel, walking about, etc. In conditions of collapse, however, this treatment must not be continued, but everything should be done to preserve the strength. Treatment must be continued as long as life remains.

_Method of Extraction from the Stomach._--Opium itself cannot be directly detected, but we test for morphine and meconic acid. These may be separated from organic mixtures thus: Boil the organic matter with distilled water, spirit, and acetic acid; filter, and to the fluid pa.s.sed through add acetate of lead till precipitate ceases. Filter.