posed by tincture of ferric chloride, but if well diluted first changes only into ferric salicylate.

Solutions of quinine salts, with those of the alkaline acetates, or with Basham's mixture, precipitate the sparingly soluble quinine acetate. Morphine solutions give the phenol reaction if mixed with tincture of ferric chloride.

Spirit of nitrous ether liberates iodine from solutions of iodides, and decomposes antipyrine solutions, forming a green nitroderivative. It precipitates mucilage of acacia, but if it be well diluted with water it can usually be added last in a prescription without precipitating. Tannin preparations decompose it. Tincture of guaiac is stated by Potter to be pharmaceutically incompatible with it, although they are often prescribed together.

Stronger acids (mainly inorganic) set free the weaker acids (mainly organic) or, brought in contact with alcohol or alcoholic solutions, they form ethers.

Tincture of ferric chloride gelatinizes mucilage of acacia.

CHAPTER VI

TOXICOLOGY

TOXICOLOGY is the science which treats of poisons, their recognition, effects, and antidotes.

Poison. Any substance which, in relatively small quantities, can injure the health or destroy life.

Poisonous action may be either local or remote.

The local action consists in the destruction of tissues at the point of contact.

Remote action is due to the poison being absorbed and taken into the circulation. It may reach the circulation by way of the mouth, lungs, rectum, or vagina, by absorption through the skin or exposed mucous membranes, or it may be introduced underneath the skin and directly into the circulation, hypodermically, by bites and stings of poisonous creatures, or through wounds.

The local effects consist mainly of two kinds: corrosion and irritation.

Corrosion, or the destruction of tissues, is caused by such agents as strong acids, alkalies, etc. See Corrosives.

Irritation is produced by diluted corrosives and by specific drugs, and varies from simple redness to ulceration and gangrene. See Irritants.

The remote action of poisons affects the nervous system, frequently producing very pronounced and characteristic symptoms. Thus, certain of them, like physostigma, produce marked contraction of the pupil of the eye (myosis), while others, like the solanaceous alkaloids, atropine, etc., produce a marked dilation of the pupil of the eye (mydriasis). Aconite produces a characteristic tingling sensation at the back of the mouth. Strychnine produces a characteristic stimulation of the spinal muscles, bending the person backward (opisthotonos), etc.

According to the most characteristic and prominent symptoms, poisons may be divided into three general classes:

1. Poisons which act very rapidly. Acids, hydrocyanic and oxalic; bromine; carbon dioxide; carbon monoxide; chlorine; cyanides; nicotine, strychnine, and strong mineral acids.

2. Poisons known as corrosives and irritants:

(a) Corrosives cause local destruction of tissues, nausea and vomiting, and death usually by shock.

Acids, chromic, hydrochloric, nitric, nitrohydrochloric, sulphuric, etc.; ammonia-water, barium salts, caustic potash, caustic soda, concentrated lye, phenol, potassium chlorate, potassium nitrate, quicklime, etc.

(b) Irritants cause pain, nausea, vomiting, and purging.

Cantharides, carbolic acid, castor beans, chlorine and compounds of antimony, arsenic, bismuth, copper, chromium, iron, lead, tin, zinc, ptomaines, croton oil, gelsemium, iodine, mushrooms, phosphorus, savin, veratrum, etc.

3. Poisons affecting the nervous system.

(a) Narcotics produce insensibility as the chief symptom, frequently preceded by more or less cerebral excitement. Alcohol, chloral, chloroform, ether, opium, etc.

(b) Deliriants produce delirium as a prominent symptom. Belladonna, camphor, cannabis, cocaine, hyoscyamus, mushrooms, solanine, stramonium, etc.

(c) Convulsives.-While convulsions may be produced by many poisons, the following produce very violent muscular paroxysms: Brucine, ignatia, narcotine, nux vomica, picrotoxin, strychnine, etc.

(d) Multiple Disturbers.-They produce complex nervous disturbances. Examples: Aconite, conium, curare, digitalis, lobelia, nicotine, physostigma, tobacco, etc.

In case of poisoning, action must be prompt if the life of the person is to be saved.

The first rule is, "Never wait for a remedy, however perfect, if an imperfect one is at hand." That is best which is readiest, the grand rule being to lose no time.

In case of poisoning a physician should be summoned at once. The general modes of treatment to be administered may be stated as follows:

1. Get rid of the poison.

2. Stop its action.

3. Remedy the mischief done.

4. Fight against the tendency to death.

1. To get rid of the poison, if it has been swallowed, is the. first thing to be done. To this end one may employ the stomachpump, stomach-tube, or emetics.

It is not advisable to use the stomach-pump for the removal of corrosive poisons because of the danger of perforating the stomach wall with it. Vomiting is frequently one of the first symptoms of poisoning, and in such cases nature may be assisted by administering copious draughts of lukewarm water (35° to 40° C.). Of the emetics, zinc sulphate is perhaps the most valuable, since its action is more prompt and its effects less depressing than other emetics, save, perhaps, mustard. Zinc sulphate may be administered in 1-gm. (15-gr.) doses. Mustard, ranking in efficiency with zinc sulphate, is more commonly found in the average household. It may be administered in from 1 to 2 teaspoonfuls in a teacupful of warm water, frequently repeated. Tincture of ipecac, 15 to 30 mils in a wineglassful of water, may also be used.

In the absence of these, common salt may prove efficaceous in the proportion of a handful in a pint of lukewarm water. Vomiting may also be produced by tickling the fauces with the finger or a feather, or by the free administration of warm water alone.

When the poison has been applied locally, as in snake bite, the circulation should, if possible, be cut off by applying a ligature as near as possible to the wound and between it and the heart. The wound may then be enlarged with a knife and freely cleansed with water or solution of potassium permanganate; sucking by the mouth may be employed and without danger to the operator, since snake venom is harmless unless introduced directly into the circulation.

Dog bites (if rabies is suspected) should be cauterized with strong nitric acid (the excess of acid to be neutralized with sodium bicarbonate as soon as it has penetrated to all parts of the wound) and the patient placed in the hands of a physician.

2. To stop the action of the poison in case it cannot be readily and immediately removed.

In this case an antidote is ordinarily administered.

An antidote may be defined as any drug which counteracts the effects of a poison. Usually they are classified as Chemical Antidotes and Physiologic Antidotes or Antagonists.

A chemical antidote is one which enters into chemical combination with the poison. This union may result in modifying its properties, as acid and alkali, or may render it insoluble and hence incapable of entering the circulation, or its poisonous molecule may be destroyed, usually by oxidation.

A physiologic antidote is one whose action on the system is directly antagonistic to that of the poison. They are frequently counterpoisons, such as physostigmine and atropine; aconite and digitalis, etc.

As antidotes are not general in character, they will be given in their proper place in the list of poisons and antidotes.

3 and 4 may be considered together, and have for their object the alleviation of the symptoms as they arise. This generally constitutes the "after-treatment," and a physician is usually at hand. Such treatments as can be predicted will be given in their proper place in the list of poisons and their antidotes.

LIST OF POISONS AND ANTIDOTES

ACETANILIDE-Antipyrine.-L. D., 1 gm. Place patient in a recumbent position, loosen clothing about the upper part of the body, allow plenty of fresh air. Respiratory stimulants (aromatic spirit of ammonia, strychnine), circulatory stimulants (atropine and belladonna); external heat, artificial respiration, oxygen inhalations if cyanosis is excessive.

ACID, CARBOLIC.-See Phenol.

ACID, HYDROCYANIC.-F. P. very short, ten to fifteen minutes; L. D., 1 mil. Place in a recumbent position, allow plenty of fresh air, empty stomach with pump, mustard, or zinc sulphate. Keep body warm. Chemical antidotes, cobalt nitrate and ferrous salts, followed by potassium carbonate solution. Cautious inhalation of ammonia; cold affusions to the spine. If breathing ceases, use artificial respiration.