446 POISONS I THEIR EFFECTS AND DETECTION. [§ 553 . 
(as, for example, in the persistent use of a digitalis medicine) may pro¬ 
duce their first toxic effects even at the end of many days ; but when a 
single large dose is taken, the symptoms are rarely delayed more than 
three hours. They may commence, indeed, in half an hour, but have 
been known to be retarded for more than twenty-four hours, and the 
longer periods may be expected if digitalis is given in hard, not easily 
soluble pills. There is commonly a feeling of general malaise, and then 
violent retching and vomiting. The pulse at first may be accelerated, 
but it soon is remarkably slowed—it sinks commonly down to 50, to 
40, and has even been known as low as 25. To these symptoms, refer¬ 
able to the heart and to the digestive tract, are added nervous troubles ; 
there are noises in the ears, and disturbances of vision. In a case re¬ 
lated by Taylor, a red coal fire seemed to the patient to be of a blue 
colour ; in another, related by Lersch, 1 there was blindness for eighteen 
hours, and for some time a confusion in the discrimination in colours ; 
quiet delirium has also been noticed. As the case proceeds, the gastric 
symptoms also increase in severity ; the tongue, Christison, in one case, 
noticed to be enormously swollen, and the breath foetid. Diarrhoea is 
commonly present, although also sometimes absent. The action of the 
kidneys is suppressed. Hiccough and convulsions close the scene. 
In the cumulative form, the symptoms may suddenly burst out, and 
the person pass into death in a fainting-fit without any warning. As a 
rare effect, hemiplegia may be mentioned. 
This brief resume of the symptoms may be further illustrated by the 
following typical cases :—A recruit, aged 22, desiring to escape from 
military service, went to a so-called “ Freimacher ,” who gave him 100 
pills, of which he was to take eight in two doses daily. Eleven days 
after the use of the pills, he became ill, and was received into hospital, 
where he suddenly died after three weeks’ treatment. His malady was 
at first ascribed to gastric catarrh ; for he suffered from loss of appetite, 
nausea, and constipation. He complained of pain in the head and 
giddiness. His breath smelled badly, and the region of the stomach 
was painful on pressure. The pulse was slow (56), the temperature of 
the body normal. Towards the end, the pulse sank to 52 ; he suffered 
from vomiting, noise in the ears, troubles of vision, great weakness, and, 
later, hiccough and swelling in the neck. The mere act of standing up 
in order to show his throat caused him to faint ; on the same day on 
which this occurrence took place, he suddenly died on the way to the 
nightstool. Thirteen of the pills were found in the patient’s clothes, 
and from a chemical and microscopical examination it was found that 
they contained digitalis leaf in fine powder. The quantity which the 
unfortunate man took in the four weeks was estimated at 13-7 grms. 
( = about 211 grains). 
1 Rhen. West. Corr. Bl., 15, 1848 ; Husemann in Maschka’s Handbuch. 
