manager of the brewery was informed of the man's state, and on learning the mistake made (which had ere this been discovered by the patient), administered a mustard emetic, which, to use the manager's own words, " acted to no material extent," the patient was then sent to hospital. On arrival at the hospital, at 11-15 A.M., the man was seen by Assistant Apothecary J. R. Dolby, who observing his collapsed state, gave an ounce of brandy and applied a sinapism over the heart, and sent for me. At this time the patient complained of heat and tingling in the mouth and stomach, and a sense of impending dissolution. There was complete loss of muscular power with coldness of the extremities. The heart's actionwas feeble and intermittent, no impulsecould bedetected on placing the hand over it, and stethescopic examination revealed five or six contractions in a minute, the second sound being almost absent ; one feeble beat of the radial pulse could be felt per minute. The forehead was bathed in a cold clammy perspiration, pupils normal, and intellect quite clear, respirations slow and gasping. From the symptoms presented, aconite poisoning was diagnosed. Another emetic of mustard was administered, hot bottles applied to the extremities, and sinapisms to the calves, together with frictions with hot flannel to the spine, but as death appeared imminent, it became evident that other and more active measures should be adopted without loss With this object, reference of time in the hope of saving life. was made by Mr. Dolby to an edition of Dr. Fothergill's essay on the "Antagonism of Therapeutic Agents," where a case was cited of aconite poisoning, which had been cured by hypodermic injection of tinct. digitalis, minims twenty. Tinct. digitalis was therefore immediately injected into the areolar tissue below the left sterno clavicular articulation at 11-20 A.M. 11-23.?Radial pulse felt feebly and intermittently, four times in a minute, heart's contraction eight per minute. The patient was seen by Surgeon-Major Bennett in Medical Charge, Station Hospital, at 11-30, and minims fifteen, tinct. digitalis injected at
u-35-
.
,
11-45.?Pulse felt at wrist about twelve times in a minute, very feeble and intermittent, the slightest pressure arresting it. The patient now vomited freely, after the fauces were tickled with a feather, and was able to draw his legs up in bed, but had to be supported over the edge to vomit into a vessel alongside ; bowels moved involuntarily. 12-20 noon.?Heart's action again failing, pulse less frequent at wrist and almost imperceptible. Ordered a stimulating draught with brandy gss. Ammon. carbon, grs. x, and Tinct. digitalis gi ; galvanism to cardiac region ; and frictions with hot flannels to spine continued. 12-40.?Pluse has improved considerably, can be felt twentyMuscular five times in a minute, though still very weak. power returning, feels more cheerful, and states the tingling in his mouth is less, respirations more regular. heart's action feeble, though 1 p.m.?Extremities warmer, more rhythmical, pulse at wrist still weak and intermittent. 1-20 p.m.?Repeat stimulating draught with twenty minims of tinct. digitalis. wrist 30, stronger and more regular. 1-40 P.M.?Pulse at 2 p.m.?Repeat stimulating draught with twenty minims tinct. digitalis. 2-20 P.M.?Respirations natural, pulse 40, regular, passed urine voluntarily, can now sit up in bed, and feels hungry. p.m.? Repeat stimulating draught without tinct. 2-40 digitalis. 3-20 p.m.?Pulse 60, feeble, though regular. 4 p.m.?Circulation quite re-established, pulse 78, full and regular, ate some milk and bread, and was able to get out of NOTES OF A CASE OF ACONITE POISONING, Treated at Kasauli. By Apothecary Station
James Forsyth, Hospital, Kasattli.
A strong middle aged pahari was brought to the station hospital on the nth November, having taken a dose of some poisonous drug in mistake for medicine which he had been taking for gonorrhoea. The poison was swallowed between 7 and 8 a.m., and half-an-hour afterwards the man partook of some chappatees with ghee, he then went to his work at the brewery, and while there, a sense of tingling with heat in the mouth, and region of the stomach came on, followed almost immediately by vertigo and loss of muscular power. The
bed to do so. After this the
patient
did
morning, expressing gratitude
and returned home next for his narrow escape from
well,
death. Remarks.?The nature of the poison could not be ascertained It had been given to him by a hakeem, from the patient. who told him it was the root of a jungle plant good for fever ; about forty-eight grains or the weight of half a pice was taken. The food partaken of shortly after, will probably explain the delay in the first appearance of toxic symptoms over two hours, soon after which the first emetic was administered, and stomach partially evacuated ; but sufficient of the poison was assimilated to act so powerfully upon the centres of circulation and respiration as to have caused a fatal termination, but for the antagonistic action of the digitalis , to which the patient's recovery must, I think, be mainly attributed, although doubtless the
,
324
v
THE INDIAN MEDICAL GAZETTE.
and other remedies assisted towards this result. Dr. Tanner in his memoranda on poisons, states, that 0f the English aconite root has caused death, but that the Indian plant, Aconitum feroxy which is indigenous in the Sub-Alpine Himalayas, is a more active and dangerous drug. Sufficient was therefore taken in the present case to have killed the patient. It is to be regretted that in the anxiety of the moment, caused by the patient's critical state, the temperature as registered by the thermometer, was overlooked, I am indebted to Mr. Dolby for the notes on this case.
brandy, ammonia, rapidly favourable
gj(
[December,
188:
u-35-
.
,
11-45.?Pulse felt at wrist about twelve times in a minute, very feeble and intermittent, the slightest pressure arresting it. The patient now vomited freely, after the fauces were tickled with a feather, and was able to draw his legs up in bed, but had to be supported over the edge to vomit into a vessel alongside ; bowels moved involuntarily. 12-20 noon.?Heart's action again failing, pulse less frequent at wrist and almost imperceptible. Ordered a stimulating draught with brandy gss. Ammon. carbon, grs. x, and Tinct. digitalis gi ; galvanism to cardiac region ; and frictions with hot flannels to spine continued. 12-40.?Pluse has improved considerably, can be felt twentyMuscular five times in a minute, though still very weak. power returning, feels more cheerful, and states the tingling in his mouth is less, respirations more regular. heart's action feeble, though 1 p.m.?Extremities warmer, more rhythmical, pulse at wrist still weak and intermittent. 1-20 p.m.?Repeat stimulating draught with twenty minims of tinct. digitalis. wrist 30, stronger and more regular. 1-40 P.M.?Pulse at 2 p.m.?Repeat stimulating draught with twenty minims tinct. digitalis. 2-20 P.M.?Respirations natural, pulse 40, regular, passed urine voluntarily, can now sit up in bed, and feels hungry. p.m.? Repeat stimulating draught without tinct. 2-40 digitalis. 3-20 p.m.?Pulse 60, feeble, though regular. 4 p.m.?Circulation quite re-established, pulse 78, full and regular, ate some milk and bread, and was able to get out of NOTES OF A CASE OF ACONITE POISONING, Treated at Kasauli. By Apothecary Station
James Forsyth, Hospital, Kasattli.
A strong middle aged pahari was brought to the station hospital on the nth November, having taken a dose of some poisonous drug in mistake for medicine which he had been taking for gonorrhoea. The poison was swallowed between 7 and 8 a.m., and half-an-hour afterwards the man partook of some chappatees with ghee, he then went to his work at the brewery, and while there, a sense of tingling with heat in the mouth, and region of the stomach came on, followed almost immediately by vertigo and loss of muscular power. The
bed to do so. After this the
patient
did
morning, expressing gratitude
and returned home next for his narrow escape from
well,
death. Remarks.?The nature of the poison could not be ascertained It had been given to him by a hakeem, from the patient. who told him it was the root of a jungle plant good for fever ; about forty-eight grains or the weight of half a pice was taken. The food partaken of shortly after, will probably explain the delay in the first appearance of toxic symptoms over two hours, soon after which the first emetic was administered, and stomach partially evacuated ; but sufficient of the poison was assimilated to act so powerfully upon the centres of circulation and respiration as to have caused a fatal termination, but for the antagonistic action of the digitalis , to which the patient's recovery must, I think, be mainly attributed, although doubtless the
,
324
v
THE INDIAN MEDICAL GAZETTE.
and other remedies assisted towards this result. Dr. Tanner in his memoranda on poisons, states, that 0f the English aconite root has caused death, but that the Indian plant, Aconitum feroxy which is indigenous in the Sub-Alpine Himalayas, is a more active and dangerous drug. Sufficient was therefore taken in the present case to have killed the patient. It is to be regretted that in the anxiety of the moment, caused by the patient's critical state, the temperature as registered by the thermometer, was overlooked, I am indebted to Mr. Dolby for the notes on this case.
brandy, ammonia, rapidly favourable
gj(
[December,
188:
