The Four Kinds of Poisons and their Antidotes - The Treatment of Patients

Cases of poisoning may be recognised by certain well-defined symptoms occurring soon after the act of eating or drinking. A doctor's qualification includes the knowledge of antidotes for every kind of poison, and accordingly his services must be requisitioned; and, at the same time, he should be informed, as accurately as possible, of the particular kind of poison he has to treat, that he may bring with him its proper antidote.

While awaiting the arrival of the doctor, no time must be lost to prevent the further action of the poison in the system, and this can first be done by diluting it so as to make it feeble in its effect. The dilution may be brought about by giving a copious draught of a bland, demulcent drink,which will also ease the pain and allay irritation. The homely remedies which are most likely to be at hand are milk, beaten egg, oil from tinned sardines (unless, indeed, sardines are suspected as the cause of ptomaine poisoning), olive oil, cod-liver oil, flour and water, weak tea, warm water, barley water, thin gruel, linseed tea, or a small dose of castor oil.

The next thing is to decide upon which kind of poison has been taken. The lips and tongue of the patient must be examined, and if they are marked so as to appear seared, the white markings show that a corrosive poison has been taken, and special treatment is required.

1. Corrosive poisons are strong acids and alkalis, such as vitriol, spirits of salt, aquafortis, carbolic acid, and oxalic acid among acids; and caustic soda, potash, and lime among alkalis.

The symptoms of corrosive poisoning are intense burning pain from mouth to stomach, the inside of the mouth appears blistered or covered with loosely-hanging white skin, the voice is hoarse, and the pulse feeble, and there is retching, and vomiting of food matter containing whitish flakes or shreds, which turn black.

In such a case an antidote should be given promptly. Fortunately, acids and alkalis neutralise each other, so that alkaline poisons can be neutralised by doses of weak acid,"such as vinegar, or lemon-juice and water, in the proportion of two tablespoonfuls to the half pint. Acid poisons can be neutralised by the administration of an alkali, such as a tablespoonful of magnesia, bicarbonate of soda, or common whiting in half a pint of water, or by ordinary lime water. In oxalic acid poisoning, potash, soda, and ammonia must be avoided, and magnesia, whiting, or lime water only used.

On no account must an emetic be given, for with cases of corrosive poisoning there is always the risk that the stomach in pressing against the diaphragm may rupture its weakened walls, and so set up peritonitis.

2. Non-corrosive poisons are best treated by the administration of an emetic to excite vomiting, which is less painful and more effective if the poison has been diluted with a demulcent drink such as those already mentioned.

The most convenient emetics are: (a) Tickling the back of the throat with a feather, which can be done without risk of choking an unconscious patient who is not in a fit condition to swallow a liquid emetic such as: (6) A tablespoonful of salt in half a pint of lukewarm water.

(c) A teaspoonful of mustard in half a pint of warm water.

(d) A tablespoonful of ipecacuanha wine.

(e) Thirty grains of sulphate of zinc in a tea-cupful of warm water.

The non-corrosive poisons are divided into three classes, each of which calls for special treatment, as well as the general treatment just described.

1. The narcotic poisons are those which induce torpor, which gradually becomes deeper, until insensibility merges into death. Such poisons include chloroform, ether, the many preparations of opium, known respectively as laudanum chlorodine, paregoric, syrup of poppies, morphia lozenges, Godfrey's cordial, infant soothing syrup, pain-killer, and many cough specifics. Symptoms of narcotic poisoning may be recognised by insensibility, a cold and clammy skin, a feeble and. slow pulse, a dark line along the middle of the tongue, and by the contraction of the pupils of the eyes to a pin's point.

The chief aim must be to get rid of the poison by vomiting, and then to fight against the increasing stupor. Strong coffee should be given to the patient, who should be made to walk up and down, supported by one or two helpers, while another helper occasionally dashes cold water in his face, or flicks his chest and face with a wet towel. Slapping the bare soles of the feet with a slipper is of service when the patient is unable to be walked about the room, and if the breathing threatens to stop, artificial respiration must be resorted to (see page 871). If medical aid is not forthcoming, and the patient is deeply insensible, an attempt should be made to wash out the stomach. Take a clean piece of rubber gas tubing, and pass one end as far as possible down the gullet, fit a funnel in the other end, hold the tubing upward, and pour warm water gently in until it is full to overflowing. Lower the free end of the tube, and the stomach will be emptied by syphon action.

2. The irritant poisons are of a metallic nature, and include arsenic, phosphorus, tartar emetic, sugar of lead, corrosive sublimate, and sulphate of copper.

The effect of such poisons may be recognised by a metallic taste in the mouth, a running at eyes and nose, pain in the pit of the stomach, vomiting, and violent purging.

Treat such cases according to the general directions, but avoid the administration of oil in a case of phosphorus poisoning. Attend specially to keeping up the patient's strength with stimulating beverages when vomiting has ceased.

3.' The excitants give rise to mental excitement followed by delirium or convulsions. The most common poisons of the class are belladonna with its alkaloid atropine, henbane and its extracts, woody nightshade, poisonous fungi, laburnum seeds, prussic acid contained in laurel leaves and almond essences, and strychnine, which may be recognised by its effect on the sufferer's back, which is bent inwards.

If the patient is not strongly convulsed administer an emetic, otherwise dash cold water over the face, and keep him in a dark room.

4. Alcoholic poisoning. - This form of poisoning has its chief danger in the form of collapse owing to the great loss of heat. Follow the general treatment for poisoning, but promote vomiting without attempting to dilute the poison, keep the patient covered, and when consciousness returns administer a hot drink.