lum peltatum (May-apple, a common North American plant, also called mandrake), a resinous body (Resina Podophylli, U. S. P.) the chief active principle of which seems to be a glucosid, podophyllotoxin.' The resin, commonly called podophyllin, is obtained by extracting the roots with alcohol and pouring the liquid into acidulated water, when the resin is precipitated. Fatal poisoning has resulted from the eating of the fruit of the May-apple, and the milk of cows feeding upon the plant has caused severe symptoms of poisoning in children. Severe conjunctivitis may occur in workmen who powder the roots or the resin.2

3

In a fatal case of poisoning by podophyllin reported by Dudley 3 the course was as follows: A woman took about 5 grains (0.32 gm.) of the resinoid podophyllin, instead of mandrake. Vomiting and purging began shortly after the drug was taken and continued for several hours. The extremities were cold; cold perspiration stood on the face; pulse 60, weak and thready; respirations sighing, and patient spoke with difficulty. The patient's condition rapidly improved, and she got up, but was soon compelled to lie down again. The primary symptoms of depression returned, her mind showed aberration, but there was no purging or vomiting. Twenty-four hours after the poison was taken patient was comatose; temperature 100° F., pulse 100, and respiration 38 to the minute. The urine was "smoky" and contained albumin and blood-cells. Patient died in a condition of coma about thirty-one hours after the drug was taken. The woman's husband took a similar dose and showed the same primary symptoms; these were followed by a depressed condition for two or three weeks and finally recovery. From these and similar cases the fatal dose may be placed at from five to ten grains (0.32 to 0.65 gm.), although recovery followed the latter dose when administered to a strong woman, and a child twenty-two months old recovered from 4 grains (0.26 gm.).

Detection.-Both podophyllin and podophyllotoxin may be removed from an acid aqueous fluid, as in an examination for alkaloids, by shaking with chloroform. Both substances are colored dark yellowish green by Mandelin's reagent.

Gamboge (Cambogia, U. S. P.) is a gum-resin obtained from Garcinia Hanburii. It has occasionally caused death from its use as a purgative and as an abortifacient; about 1 dram (3.9 gm.) has proved fatal. Gamboge is used as a pigment, and children are said to have been poisoned by moistening their lips with brushes that had been used in the pigment.

Elaterium is a substance deposited by the juice of Ecballium elaterium, or squirting cucumber. Elaterium is of such uncertain strength that it is no longer recognized by the U. S. P., but the active principle, elaterin, a neutral body, is official under the name of Elaterinum. The latter is an extremely active purgative, the medicinal

1 Podwyssotzki, Arch. f. exp. Puth. u. Pharm., 1881, vol. xiii., p. 29; Kürsten, Amer. Jour. Pharm., 1891, p. 485. Webster, Medical Record, vol. xii., p. 357. Dudley, Medical Record, 1890, vol. xxxvii., p. 409. Prentiss, Phila. Med. Times, 1882, vol. xii., p. 520.

dose of which is from to of a grain (0.001 to 0.007 gm.). A few deaths have resulted from elaterium.

The fatal dose is placed at 7 or 8 grains (0.455 or 0.52 gm.), although an ill and feeble lady of seventy seems to have died from the purging caused by of a grain (0.026 gm.).1

Detection. The postmortem isolation of elaterin is not attended with certainty. The material under examination is extracted with hot alcohol, and the residue obtained after evaporation of the alcohol is boiled out with water, dried thoroughly, and extracted with ligroin, by which the poison is dissolved. Elaterin yields a carmin-red color on treatment with concentrated sulphuric acid that contains a trace of carbolic acid.

Treatment. The treatment of cases of poisoning by the above purgatives is essentially the same as that mentioned under croton oil ; the poison should be removed from the stomach by the stomach-tube or by emetics and demulcent drinks, and opiates should be administered. Great care should be taken with the diet, which should be as nonirritant as possible. Cardiac and respiratory stimulants may be necessary in conditions of collapse.

Postmortem Appearances. -The only postmortem appearance commonly found is inflammation of the alimentary tract; sometimes there is ulceration of the entire gastro-intestinal canal. The peritoneum, liver, spleen, kidneys, and bladder have also been found inflamed.

RHUS TOXICODENDRON. Several species of rhus, various members of which are popularly known as poison-ivy, poison-oak, swamp sumac, etc., give rise to frequent cases of poisoning. Speaking of poison-ivy, Chesnut says: "No plant of the United States is more popularly recognized as harmful to man than this ; as its victims far outnumber those of

FIG. 67.-Poison ivy (Rhus radicans): a, Spray showing aërial rootlets and leaves; b, fruit.

2

all other plants combined, it has come to be regarded as the poisonous plant of America."

The active principle of these plants has been shown by Pfaff to be

1 Amer. Jour. Pharm., 1868, p. 373.

2 Chesnut, Principal Poisonous Plants of the United States, 1898, p. 36.

3

Pfaff, Jour. Erper. Med., 1897, vol. ii., p. 181.

a non-volatile oil, toxicodendrol; this oil occurs in all parts of the plant and is extremely active, of a milligram (4 of a grain) being sufficient to produce distinct effects when applied to the skin of some persons.

400

Poisoning usually results from direct contact with the plant, although this is not necessary; contact with articles that have touched or with people who have handled the plant is sufficient. The pollen, moreover, contains the oil, as do also the microscopic hairs which are so abundant over the plant; these are responsible in many cases for "poisoning from a distance."

1

The most common form of rhus poisoning is that caused by the con

FIG. 68. Snow on the mountain (Euphorbia marginata): a, Whole plant; b, seed capsule.

tact of the plant or of its juice with the skin, and consists in a severe inflammation and a vesicular eruption. There are violent itching, redness, swelling, vesication, and, finally, desquamation. In a case quoted by White, deep ulcers formed which led to death in three weeks. If the poison reaches the face, the swelling may be so great as almost entirely to obliterate the features; the patient may be unable to open the eyes for several days. The period at which the first symptoms appear after 1 Schwalbe, Münch. med. Wochenschr., 1902, vol. xlix., p. 1616. 2 Dermatitis venenata, p. 43.

exposure varies greatly; they usually begin within four or five days, but may appear in less than a day or be delayed for a week or even longer. The lesions of herpes zoster have been mistaken for those of ivy poisoning.

Poison ivy recently figured in a lawsuit in New York; a judgment for $3500 was rendered against the directors of a cemetery in a case of poisoning due to poison ivy which had been allowed to grow within the grounds. The plaintiff was ill for eighteen months.

Of the numerous remedies employed in treating rhus poisoning, the

a

FIG. 69.-Caper spurge (Euphorbia lathyris): a, Upper half of plant; b, seed capsule.

best is probably an alcoholic solution of lead acetate; the alcohol brings the poison into solution, and the lead forms an insoluble compound with it. Vaselin and other ointments are contraindicated, for the toxicodendrol is soluble in fatty substances and their use simply aids in spreading the poison.

Moorman reports a case of poisoning of children supposed to have resulted from the eating of the berries of poison ivy; there were symptoms of local irritation and also evidences of effects upon the nervous 1 Trial Term of Supreme Court, Brooklyn, May 6, 1897; see Chesnut, op. cit., p. 9. 2 Moorman, Amer. Jour. Med. Sci., 1866, p. 560.

system, as shown by drowsiness, stupor, and mild delirium. A case1 is also reported in which an infusion of the root was taken instead of sassafras tea; there was a rash resembling that of measles, with intolerable itching, suffusion of the eyes, and pain in the throat and stomach. In experiments upon rabbits Pfaff found that the internal administration of toxicodendrol caused nephritis; perhaps the few deaths attributed to poison-ivy were due to this action upon the kidneys.

Detection. To an alcoholic infusion of the material under examination is added an alcoholic solution of lead acetate, and the precipitated lead compound of toxicodendrol is suspended in water and decomposed with ammonium sulphid. After filtering off the lead sulphid the active principle is shaken out with ether. As there are no chemical tests known by which toxicodendron may be identified, the residue obtained after evaporating the ether should be dissolved in olive oil and applied to the skin. The characteristic eruption thus produced may serve, under the most favorable conditions, for the detection of T000000 gram (64000 gr.) of the poison.3

A number of other plants, either native to the United States or introduced, are known to produce skin eruptions more or less similar to those caused by rhus; among these may be mentioned various varieties of buttercups and crowfoot (Ranunculi), various species of Euphorbia, especially Euphorbia corollata, which was formerly official, and E. marginata or "snow on the mountains" (Fig. 68), and E. lathyris (Fig. 69), Primula obconica,' rue (Ruta graveolens), Daphne mezereum, and arnica. Several cases of poisoning have also been recently reported from handling various species of Cypripedium (lady's-slipper, moccasin flower); the effects were very similar to those caused by rhus.

TANSY.

8

Tansy (Tanacetum, U. S. P.), the leaves and tops of Tanacetum vulgare, a common plant in the United States, contains a volatile oil. Tansy is used extensively by the laity as an abortifacient, usually without suecess, and a number of deaths have occurred from this practice; it is also used occasionally as an anthelmintic.

9

The symptoms are similar to those caused by other volatile oils (see Oil of Turpentine, Savin, etc.); convulsions are common.

Stokes, Med. and Surg. Reporter, 1867, vol. xvii., p. 373.

2 Pfaff, Jour. Exper. Med., vol. ii., p. 187. See White, Dermatitis venenata, 1887.

3

Pfaff, ibid., vol. ii.,

p. 192.

5 See Olive, Bull. Torrey Bot. Club, 1895, vol. xxii., p. 393.

See Jackson, Med. Rec., 1897, vol. li., p. 636; Schenck, Bot. Gaz., 1890, vol. xv., 277. Poisoning also results from the eating of honey derived from the flowers of E. marginata; the chief symptoms are vomiting and purging.

p.

See Bull. Pharm., 1898, vol. xii., p. 80; Cooper, Brit. Med. Jour., 1899, vol. i., 1543; Dreyers, Münch. med. Wochenschr., 1902, vol. xlix., p. 574. A large number of cases are cited in the last article.

See Chesnut, Principal Poisonous Plants of the United States, p. 19; Northwestern Lancet, 1898, vol. xviii., p. 382; Bull. Torrey Bot. Club, 1875, vol. vi., p. 115; Jessup, Bot. Gaz., 1893, vol. xviii., p. 142.

9

Belt, Medical Record, 1889, vol. xxxvi., p. 342: Jewett, Boston Med. and Surg, Jour., 1880, vol. cii., p. 237; Dalton, Amer. Jour. Med. Sci., 1852, vol. xxiii., p. 136.