Narcotic Poisoning.—Giddiness, headache, drowsiness, and considerable difficulty in keeping awake. Paralysis of the muscles, convulsions, ending in profound coma and death. The symptoms of narcotic poisoning begin not later than an hour, or at most two hours, after the poison is taken, except in the case of poisonous fungi and spurred rye, when a day or two may elapse. The symptoms of narcotic poisoning advance gradually. The person may, in most cases, be roused from the deepest lethargy. The pupil in opium poisoning is, as a rule, contracted. Recovery seldom occurs after twelve hours; in most cases, death takes place in six or eight hours—the shortest time being three hours.

Apoplexy.—In some cases apoplexy is preceded by warning symptoms—headache and giddiness. As a rule apoplexy is a disease of old age, and of stout, plethoric people. If the symptoms do not come on for some hours after food or drink has been taken, this disease is to be suspected; but it may occur at or immediately after a meal, too soon to be the result of the action of narcotics—ten to thirty minutes always elapsing before these poisons act. Apoplexy generally comes on suddenly, coma at once present. It is seldom possible to rouse the person when the sopor of apoplexy is fully developed. The pupils in apoplexy are usually unequal or dilated; but should the effusion of blood take place into the pons Varolii, the pupils may be contracted, hence closely simulating opium poisoning. Apoplexy may last for days, or death may occur in an hour.

Epilepsy.—Loss of consciousness and presence of convulsions mark this disease; and in these it resembles poisoning by prussic acid. Epilepsy is in most cases a chronic disease. Warnings—aura epileptica—are often present. The fit begins violently and abruptly. The paroxysm generally lasts for some time, and death rarely occurs during the first attack.

Table showing Points of Difference in the Action of
Corrosive and Irritant Poisons

GENERAL TREATMENT OF CASES
OF POISONING

The principal modes of procedure are as follows:

1. To remove the poison from the digestive tract, or neutralise it or render it insoluble by the administration of suitable antidotes.

2. To overcome the effects of that which has been absorbed.

3. To promote its elimination.

4. To alleviate dangerous symptoms, and endeavour to keep the patient alive until the effects of the poison have passed off.

To forcibly empty the stomach, emetics may be administered or other means used to induce vomiting, or the stomach pump or tube may be employed.

Suitable emetics are sulphate of zinc in thirty-grain doses dissolved in warm water, a dessert-spoonful of mustard in half a pint of warm water, ipecacuanha wine in tablespoonful doses, copious draughts of hot water. Tartar emetic and sulphate of copper should be avoided, except in cases of phosphorus poisoning, when the latter may be used. The hypodermic injection of ⅒ grain of apomorphine is a very useful emetic, especially in cases of narcotic poisoning. Irritation of the fauces with the finger or a feather promotes vomiting, and may be useful in the absence of an emetic.

The stomach tube or pump is most useful in that it is under the control of the operator and enables him to thoroughly wash out the stomach. After passing the tube, previously lubricated with vaseline or glycerine, through the œsophagus down to the stomach, a pint of warm water should be first injected before withdrawing any of the contents. By alternate injection of water and its withdrawal, the stomach may be efficiently cleansed, and at the same time solutions of suitable antidotes may be passed into it. It must be remembered that neither the stomach pump, syphon tube, nor emetics, are to be used in cases of poisoning with corrosives, with the exception of carbolic acid. The tube should be used with great caution in cases of irritant poisoning.

Antidotes are remedies which counteract the effects of poisons. They act mechanically, e.g. flour and water, chalk mixture; chemically, as magnesia and chalk in mineral acid poisoning, alkaline sulphates in lead and barium poisoning; and physiologically, as antagonists, such as morphine and atropine, atropine and physostigmine, strychnine and chloral hydrate.

To counteract the effects of the portion of the poison absorbed, special treatment is necessary: purges and diuretics may be called for; artificial respiration may be necessary; cardiac depressants require cardiac stimulants; the cold douche as a restorative and external warmth are desirable in certain cases. Sedatives may be administered to alleviate convulsive seizures. Tracheotomy may be required in cases with laryngeal complications; and pain, exhaustion, excessive vomiting or purging are to be treated by appropriate remedies.

EXAMINATION OF THE CONTENTS OF THE
STOMACH, VISCERA, ETC., FOR POISON

The number and condition of the vessels received should be noted and copies made of any affixed labels.

The appearance, smell, colour, and reaction to test paper of the contents should be noted, and their weights and volumes determined. All jars, wrappers, labels, and seals should be preserved for future reference.

The stomach contents should be carefully examined in reference to their nature, colour, and smell, and the presence or absence of any abnormal constituents. The mucous membrane of the stomach should be examined with the naked eye and by the aid of a lens, the surface washed with distilled water, and the washings added to the contents.

There is often some clue as to the nature of the poison afforded, and the investigation should be made for it first; the presence or absence of other poisons, however, must be determined. If there be no clue, then a systematic examination must be carried out. The poison must be looked for not only in the contents of the stomach, but in the viscera as well; it must be remembered that poison may be introduced into the stomach after death.

Volatile poisons, such as alcohol, chloroform, prussic acid, may be separated by distillation after acidulation with tartaric acid. Arsenic is best separated by drying the organic material, and distilling after adding strong hydrochloric acid.

Other metallic poisons may be tested for, with or without destruction of organic matter. To destroy the organic matter, the moist method is the one in general use: After reducing the contents of the stomach or the viscus to a pulp, they are mixed with distilled water to the consistency of thin gruel, and placed in a flask with some crystals of potassium chlorate—half an ounce to each pound of the liquid. Pure hydrochloric acid is added, and the flask gently heated on a water bath, a mixture of chlorine and oxides of chlorine is given off and gradually breaks up the organic matter, converting at the same time any mineral poison present into the chloride. This procedure is followed until the material becomes quite limpid, more chlorate or hydrochloric acid may be added if necessary. It is then transferred to an evaporating dish and heated on the water bath until the smell of chlorine disappears. It is then filtered while hot, to allow chloride if present to pass through; a stream of sulphur dioxide is passed through the filtrate when cold, to reduce any metals present to a lower state of oxidation. Silver chloride will not pass through the filter in this process, so it has to be dealt with in a special manner.

In making a systematic analysis, volatile poisons must be tested for first, then ascertain the presence or absence of alkaloids, after which the inorganic poisons must be dealt with.