Chapter XV: What to Do When Poisoned

The vast majority of cases of poisoning occur in children, and are, almost without exception, due to carelessness of their elders, and therefore preventable.

As soon as it is recognized that anyone has swallowed a poison of any kind, a competent physician should be summoned with the utmost haste, and in the meantime much may be done, in most cases, to minimize the effects of the substance taken. The patient should at once be urged to drink as much water as is possible, in order that the poison may be diluted, and every effort should be made to induce vomiting; this may often be brought about as soon as the stomach is full of water, by tickling the throat with the finger, or with any other object that can be readily introduced through the mouth. As quickly as possible, some warm water should be secured, to a quart of which either a teaspoon of salt or mustard should be added, and the patient urged to drink until the stomach is thoroughly distended; following this, particularly where aided by tickling the throat, vomiting may be generally induced, with the effect, of course, of expelling a greater or less proportion of the poison from the stomach. If it be known that the poison is an _acid_, ordinary cooking soda should be added to the water that the patient drinks, as in this way all acid substances are at once neutralized.

If the patient has taken an _alkaline_ poison, he should immediately be given diluted vinegar, or water into which the juice of lemons or oranges has been squeezed; such harmless acids neutralize poisonous alkaloids just as harmless alkalies antidote poisonous acids.

_Arsenic poisoning_ usually results from the accidental swallowing of rat-poison or some insecticide, as Paris green, or else some sort of green dye, many of which contain salts of arsenic in some form. An emetic should be at once given, to be followed by the whites of several eggs dissolved in a small amount of water; sweet milk may also be administered with benefit.

Accidental poisoning by _phosphorus_, results usually from children eating the heads of matches, and it is rarely the case that enough of the substance is taken to produce serious results. The poison, however, is a deadly one if taken in sufficient quantity, and where it is found that substances containing it have been swallowed the most energetic measures should at once be resorted to. Warm water containing mustard or some other emetic should at once be given, and this should be followed by whites of eggs and sweet milk. It is well also to try to get rid of any of the phosphorus that might remain in the stomach by giving the patient some saline purgative like Epsom salts.

Where _carbolic acid_ has been taken, the fact can be readily determined by noting the characteristic smell of this substance on the patient's breath, and by observing that the mouth and throat present a more or less whitish appearance. The treatment to be of any avail, should be of the most energetic character. The patient should at once drink largely of water, and vomiting should be induced as quickly as possible. Either milk or the white of an egg should then be given. Ordinary quick-lime, or even plaster from the walls of the house, may be stirred up in water and administered to the sufferer, as both have a distinct value in antidoting the effects of this poison. Burns of the skin with carbolic acid are rarely followed by serious consequences. As soon as the accident occurs the part should be thoroughly washed with water, and if at hand a little alcohol may be rubbed over the part; the affected tissues return to a normal condition in the course of a short time in the vast majority of cases.

_Strychnine poisoning_ is comparatively rare, except when this substance is given with suicidal or murderous intent. Water should be given, immediately followed by an emetic. A mass of crystals of permanganate of potash as big as a pea may be administered in a glass of water, if this substance be at hand. After the poison has been absorbed nothing is usually of any avail if the amount was originally sufficient to produce death.

One of the commonest forms of poisoning is from _opium_ in the form of morphine, paregoric or laudanum. When this happens the stomach should be washed out by water frequently, even where the drug was administered hypodermatically. This is best accomplished by causing vomiting by warm water to which a small amount of mustard has been added. The patient should be given strong coffee or tea at frequent intervals, and artificial respiration should be practiced. Where it is possible to obtain it, permanganate of potash in a watery solution should be given, enough of the chemical being used to make the water a deep purple color; this may be frequently repeated, as the substance is not poisonous in ordinary doses, and destroys morphine and other alkaloids of opium very rapidly.

_It should never be forgotten that infants and children are poisoned by comparatively very small doses of opium, and consequently nothing containing any derivative of this substance should be given them except on the advice of a competent doctor._

Many soothing syrups advertised for the relief of the minor ailments of children contain opium, and there can be no doubt that many deaths have occurred as a consequence of taking such nostrums.

_Mushroom poisoning_ in this country is relatively rare, but there are quite a number of popular notions on this subject that are totally incorrect, chief among which is the idea that there is a difference between mushrooms and toad-stools, the former being generally regarded as edible, and the latter poisonous. As a matter of fact, those conversant with this subject make no distinction between the two, using the terms toad-stool and mushroom as interchangeable. It is likewise a common error to suppose that we possess any tests by which the poisonous toad-stools can be told from those that are wholesome. Although a skilled student of the subject can almost at a glance determine which are poisonous and which are not, it is hazardous in the extreme to consume those selected by one who is inexperienced. As a matter of fact, for all practicable purposes, there is only one species that is generally eaten,--the _Agaricus campestris_, or meadow mushroom. This grows for the most part in open fields, and in many parts of the world may be gathered in great number throughout the warmer seasons immediately following rains. This mushroom has also the great advantage that it is the only one of the edible species that can be cultivated.

Just as we have only one common mushroom that is ordinarily eaten, there is only one common species of these plants that is highly dangerous,--the _Amanita phalloides_, which contains one of the most deadly poisons known--and one for which we possess no adequate antidote. This mushroom is very common, being frequently seen along the roadside, and at the edges of fields; it also grows in forests, and is occasionally encountered in treeless areas.

It presents a rather attractive appearance, being rather large, and
having a glistening white cap with a long stem, around which there
may always be seen a distinct collar; on carefully removing the
soil from around its roots, it will be seen that its stem is
surrounded just below the surface of the earth by a sheath-like
structure, the so-called "death-cup," which, together with the
peculiarities already mentioned, clearly stamp this mushroom as
being one of the most deadly of all known natural objects. In
addition to the rather inviting appearance of this toad-stool, its
flavor is agreeable, thus in every way insidiously inviting, it
would seem, the unwary to their doom. Less common than the species
just considered is another closely related fungus known as the
_Amanita muscarius_, or fly-agaric; this handsome mushroom presents
the same peculiarities of structure exhibited by the _Amanita
phalloides_, but differs from it in the fact that the tip of its
cap is scaly, and is of a reddish-yellow color. The fly-agaric is
quite as poisonous as its more common relative, and is equally to
be shunned. The reader should be warned that even handling either
of the fungi just considered may result in poisonous
symptoms--probably as a consequence of multitudes of the tiny
spores of the plants being carried into the nose and mouth by the
air.

Some hours after eating the _Amanitas_, the patient is taken with vomiting, diarrhoea, cramps, and extreme prostration; in children, convulsions may occur. Most unfortunately evidences of this poisoning do not usually develop until some hours after eating it. As a consequence, a considerable amount of the poison has usually been absorbed into the body before the victim is aware that anything is wrong, and it, therefore, becomes impossible, as a rule, to greatly help matters by attempting to remove the offending material from the stomach by emetics. Notwithstanding this it would be proper to administer warm water, into which a small amount of mustard had been stirred, in order to assist nature by washing out of the stomach whatever portions of the fungus might remain. When exhaustion begins to appear, it should be combated with doses of aromatic spirits of ammonia, and by the external application of heat. As it is believed that atropine possesses some antidotal powers to the poison of the _Amanitas_, this substance should be injected hypodermatically in the usual dose as quickly as possible, and an experienced physician should be called at once.

_Ivy Poisoning from Touch._--One of the two species of _Rhus_, is exceedingly common in all portions of the United States, producing a severe inflammation of the skin when handled, or even in some persons by merely being near the plants or in the smoke of a fire where they are burning. There are two varieties of the _Rhus toxicodendron_, one being the shrub commonly called _poison oak_, and the other a climbing vine generally known by the name of poison ivy. The _Rhus venenata_ grows in swampy localities all over the United States, and is known as poison-sumac, swamp dog-wood, poison-elder, and poison dog-wood. About twenty-four to forty-eight hours after the exposure, the skin begins to itch, and this is shortly followed by an inflammation accompanied by the formation of numerous small blisters, and still later by scaling. It should not be forgotten that the berries and other portions of these plants are poisonous when taken internally, giving rise under such circumstances to vertigo, faintness, dilation of the pupils, trembling, confusion of the senses, and, in some instances, convulsions. Should it be discovered that anyone has been exposed to poisoning by these plants, the skin should be washed as quickly as is possible with alcohol, or some substance like whisky that contains it; where this cannot be obtained, hot water and soap should be liberally applied--the object, in either case, being the removal of as much of the poison as is possible. After the irritation of the skin has begun, the parts may be bathed in a one per cent. solution of carbolic acid, to be repeated every few hours, as the necessities of the case may demand. Lead-water is also frequently used with benefit, lime-water also appears to be of use, but the various powders and salves sold in stores rarely help the patient much. The best thing after all is soap and water as hot as it can be borne; and ordinarily the itching and inflammation will disappear in four or five days, followed by scaling.

VENOMOUS SNAKES AND SNAKE BITES.

Much popular misapprehension exists on the subject of snakes, both as to the results of their bites and the appropriate treatment under such circumstances. It is not generally understood that a very large percentage of our American snakes are entirely harmless--the poisonous ones being decidedly more the exception than the rule.

Within the confines of the United States there exist only two families of venomous serpents. By far the most numerous are three genera of viperine snakes, including the rattlesnakes and moccasins; all of these have a pit-like depression between the nose and eyes, and hence are called _pit-vipers_. In the southern portion of our country there are two species of a colubrine genus closely related to the dreaded cobra of the East, one of them being called the coral-snake or harlequin snake, and the other, which occurs in the southwest, is known as the Sonoran coral-snake.

While there are three genera of vipers in America, two of them are so closely related, and present characteristics that are so similar that the ordinary observer would regard them as being identical, and inasmuch as the character of their poison seems in every way similar, for practical purposes it would seem desirable to include them under one head; in both genera, the species have rattles on the tips of their tails, the more common being the ordinary rattlesnakes (genus _Crotalus_), of which there are twelve species in the United States, and the ground-rattlesnakes (genus _Sistrurus_), of which there are two species.

Closely related to the rattlesnakes are the true moccasins, of which there are two species, one being the cotton-mouth or water-moccasin (_Ancistrodon piscivorus_), and the other the highland moccasin, pilot-snake or copper-head, (_Ancistrodon contortrix_).

The two species of poisonous colubrine serpents already referred to are known respectively as the _Elaps fulvius_, and the _Elaps euryxanthus_, both of which occur in the southern portions of the United States. These snakes are fortunately of a very mild disposition, and rarely attempt to bite, even when handled. That their poison is exceedingly deadly is attested by the fact that out of eight instances where it was known that persons were bitten by them, six died, and they should, therefore, be looked upon as among the most deadly of North American serpents. Mention should be made of the fact that there are at least six harmless reptiles that resemble the coral-snakes very closely, and as a consequence of the former being mistaken for the latter, the assertion has been frequently made by the ignorant that our elapine serpents are harmless.

A short description of the really deadly reptiles encountered in this country that would enable even the novice to distinguish them from those that are harmless would seem not inappropriate here, for where a person is bitten by a snake it becomes at once a matter of vital importance to determine, if possible, its true character. Most non-venomous serpents will viciously bite when cornered, and while they may produce slight wounds, with a small amount of bleeding, such injuries are entirely devoid of danger, and need occasion no fear on the part of the victim. There now follows a brief description of our venomous snakes, by means of which it will be easy for any one to distinguish them from their innocent relatives.

_True Rattlesnakes._--There are twelve species of these reptiles in the United States, all of which, with but two exceptions, live west of the Mississippi. They vary very greatly in color, but the common eastern forms generally have alternate transverse yellow and brownish-black marks over their bodies. All possess rattles. The body of the snake is thick in proportion to its length, and the head, which is more or less diamond-shaped, is much larger than, and is quite distinct from the neck. The pupils of the eye are elliptical--a peculiarity which the pit-vipers alone possess of all the North American snakes. Between the eye and nose there is a comparatively deep depression or pit which gives to this group of snakes their name. There are two large, exceedingly sharp fangs in the front of the mouth, in the position of a dog's canine teeth, that are folded up against the roof of the mouth when the snake is in repose;--being brought forward in a position for stabbing as the serpent strikes. The scales on the under surface of the body back of the anus do not divide along the middle line into two rows, as in harmless snakes.

_Ground Rattlesnakes._--There are two species of the pygmy or ground-rattlesnakes. They attain to a length of only about twenty inches, and present the general characteristics of the true rattlesnakes, with the exception that the rattle is small, consisting of but one single button at the end of the tail. These serpents are exceedingly vicious, and usually bite without warning. Contrary to the general opinion, however, the wounds they inflict are rarely, or never, followed by serious consequences in man. One species is southern. The other occurs from Ohio to Nebraska, where it is called massasauga.

_Cotton-Mouth Moccasin._--The largest specimens of the cotton-mouth moccasin attain to a length of about six feet. The full grown reptile is of a dingy brownish-black color, but the young are pinkish, with coppery bands running transversely across the body. With the exception that this reptile has no rattles, it answers in its general peculiarities to the description already given of its near relatives the rattlesnakes. The cotton-mouth moccasin is semi-aquatic, being found around the edges of streams and other bodies of water.

_The Copper-head, or Highland Moccasin._--This serpent is found from Florida and Illinois to southern Massachusetts; also in parts of Texas. The largest specimens have a length of about three feet. They resemble the cotton-mouth moccasin in their general peculiarities, being, however, somewhat lighter in color. The head has a coppery tinge, from which the snake gets its name, while the body is of a brownish color, with transverse Y-shaped bands of reddish-brown. Its favorite habitat is rocky hill-sides and the banks of mountain water-courses.

_Coral-snakes._--The two coral-snakes resemble each other very closely, and are long slender serpents, whose heads are quite small, and scarcely differentiated from their bodies. The pupils are round, and the head has no pits. They possess two short permanently erect fangs, which are by no means so well developed as those of the viperine reptiles--though perhaps capable of inflicting more deadly wounds than any of the latter,--with the possible exception of the diamond-back rattlesnake of the extreme southern portion of the country. Their coloration is exceedingly beautiful, and when properly interpreted, entirely characteristic. From the head to the tail their skins exhibit alternate rings, or encircling bands of black, red and yellow--each band of the two former colors being bordered by yellow; _in other words there are as many yellow stripes as there are both black and red together._ Stress is laid upon the characteristics just mentioned, for the reason that half a dozen species of harmless serpents that greatly resemble them may, without exception, be differentiated from the true coral-snakes by the fact that there are as many _black bands as both red and yellow_. Where a snake has been killed, it is of course quite easy to determine whether or not it is venomous by a search for the fangs, which are never present in the non-poisonous reptiles. Fortunately, the coral-snakes are only found in the extreme southern portion of the United States, live under ground for the most part, and are rarely encountered.

_Treatment of Snake-Bite._--As soon as a person has been bitten by a poisonous serpent, a tight bandage, or ligature of any kind, should be applied above the wound if the injury has been received on any of the extremities,--which is fortunately the case in the vast majority of instances. The part bitten should be at once exposed, and search made for the point of entrance of the fangs. It should be particularly noted as to whether there are one or two wounds, as it is true in about one-half of the cases that only one fang enters the flesh,--in which case, of course, the probabilities of serious consequences resulting are largely diminished. With a pocket-knife or other sharp instrument the wound should be enlarged, and, if possible, someone should be persuaded to suck the wound; this should not be done by one with decayed teeth, as under such circumstances the poison might be absorbed and produce unpleasant consequences. A doctor should be summoned as quickly as is possible, but it must be confessed that in the present state of knowledge, unless he should happen to possess--which he probably will not--some antitoxin for the particular snake doing the damage, his services will likely be of no great value.

It has been asserted by some that very large doses of strychnine
are directly antidotal to snake venom, but more recent experience
does not tend to confirm this view; still there is no harm in
making the trial, and if the services of someone capable of giving
the injections can be secured, the treatment is certainly worth the
trial. The immediate injection into the tissues around the wound of
a one-per-cent. watery solution of chromic acid or potassium
permanganate is thought to be of value by destroying the poison,
but in order to be efficient it must be administered within a short
time after the bite has been received. Should the patient's
condition become serious, and the breathing finally stop,
artificial respiration may be resorted to. As soon as the remedies
suggested have been tried, it is time for us to go back to the
ligature, which cannot be suffered to remain around the limb
indefinitely, as by cutting off the blood-supply it will sooner or
later produce death of the tissues. From time to time we should
slowly loosen the bandage, thus allowing a little of the poison to
pass into the body, and at the same time permit the entrance of a
small quantity of blood into the tissues of the limb beyond the
ligature; the bandage should of course be tightened at the end of a
half a minute, and it should be alternately loosened and tightened
every half hour until the patient is considered to be out of
danger.

The reader cannot fail to have observed that nothing has been said concerning the use of alcohol in the treatment of snake-bite, and the matter is only here referred to for the purpose of condemning it as being unsound in theory and bad in practice.

The idea that this drug is of value in snake bite doubtless
originally arose from the fact that those bitten by poisonous
serpents were depressed, and, as in the past alcohol was considered
the best of all stimulants, it is not surprising that its use was
generally considered to be essential. As we now know, however, that
alcohol is a depressant rather than a stimulant, and as numerous
experiments carried out on animals have clearly shown that it does
harm in snake bite rather than good, there is every reason why we
should cease to endanger the lives of those already poisoned by
adding to the trouble by using this drug. There is but little doubt
that many more persons have been killed by the alcoholic treatment
for snake bites than have died from the effects of snake venom.
Inasmuch as there is a deep-rooted superstition among most people
that alcohol is the panacea for snake bite--and such notions die
hard--it may be well to say that all of the authenticated cases of
this character that have occurred in this country have recently
been collected, with the result that it was shown that only about
one man in ten dies who is bitten by a venomous serpent, and it is,
therefore, quite easy to understand why alcohol has maintained its
reputation as being an antidote in such cases--the chances being
nine to one in the victim's favor without any treatment whatever.

As soon as the patient's needs are attended to, it is well to find if the snake that inflicted the wound was killed, and an examination of it should at once be made as by determining the size and character of the reptile an accurate forecast to the probable results may be made. In many instances it will be found that the snake was not venomous, it having made only a few scratches which are of no more consequence than the prick of a brier. If it be found that the serpent inflicting the wound belongs to one of the groups already referred to, the probabilities of a serious result will depend upon the size and character of the snake, and also to a considerable degree on whether one or both fangs entered the victim's body. A full grown diamond-back rattlesnake, which may attain the extreme length of eight feet, is perhaps the most dangerous of all the American poisonous reptiles, though a fully grown coral-snake may be regarded as almost, if not quite as, deadly. Next to these a large sized cotton-mouth moccasin is perhaps most to be dreaded, to be followed, depending upon their size, by the other varieties of rattlesnakes, the copperheads, and finally the ground-rattler. The larger the serpent inflicting the wound the greater is the result to be dreaded; naturally it also follows that the larger the individual bitten the less the danger.