598 IMPORTANT POISONS AND THEIR TREATMENT 



In. summer we should make it a rule to ascertain that an infusion, of digi- 

 talis has not decomposed; but, besides this, digitalis in too large a dose, or in 

 too large a dose in a special case, may cause symptoms undesirable to both the 

 patient and the physician. Among these we may mention vomiting, gastric 

 oppression, marked diminution of the pulse frequency, slight muscular trem- 

 bling, symptoms of depression, irregular pulse, cold sweats, severe urticaria- 

 like exanthems. In the severest cases death occurs in. collapse. 



Mild cases run a favorable course in a few days without treatment, or by 

 simply stopping the administration of digitalis. The severe and most extreme 

 cases require active treatment. The stomach and intestines must be emptied, 

 caflEein and theobromin given, and serpentaria virginica may be employed as 

 an antidote. If the signs of cardiac debility are threatening, strychnin and 

 atropin are to be subcutaneously injected. 



I may remark that severe forms of digitalis poisoning are rarely observed 

 by the physician. 



Of poisonings with bitters and indifferent agents, only aloin toxicosis need 

 be mentioned. 



Employed in small doses (0.2-1.0 gram) aloes cause copious diarrheic 

 discharges. Very large doses give rise to gastritis, enteritis, and nephritis. 

 Treatment consists in the administration of opiates and mucilaginous drinks. 

 The best way to prevent poisoning of this kind is for the physician to refrain 

 from prescribing aloin in too large doses. 



A word in regard to arnican, the active constituent of the tincture of 

 arnica, from arnica montana. It was formerly medicinally employed, but is 

 no longer used. Its property of markedly irritating the skin, and, upon inter- 

 nal use, of producing stomatitis, gastritis and enteritis, has robbed it of its 

 usefulness, and I only mention it at this place to warn the physician against 

 its employment. 



We must now refer to a long series of vegetable and animal poisons. 



These are related partially to poisonous albumin bodies, such as toxalbu- 

 mins, phytalbumoses, etc., as, for example, in some poisonous toad-stools, in 

 snake poison, in spider poison. They are partly related also to bodies previ- 

 ously unknown which, sooner or later, will be assigned to one of the previously 

 described groups. 



From the great number of poisonings by these agents I shall briefly men- 

 tion a few which are of special interest to the physician. 



First we shall consider poisoning from ergot (secale cornutum), the per- 

 manent mycelium of claviceps purpurea. The views of physicians are not yet 

 in accord as to the poisonous principle of this drug. According to Kobert, 

 sphacelinic acid, cornutin, according to Jacobi, sphacelotoxin is the toxic prin- 

 ciple. Poisoning, as a rule, simultaneously affects groups of persons who have 

 eaten food prepared with flour contaminated with ergot. The toxicosis may 

 run an acute or a chronic course. 



Acute ergot poisoning runs its course with vomiting and abdominal pain, 

 pain in the epigastrium, the chest and extremities. There are various nervous 

 symptoms: above all, paresthesia and tonic contractures of the extremities, 

 as well as ataxia, epileptiform attacks, and severe psychical disturbances. 



