CASES FROM PRACTICE. NOTES ON FOUR CASES OF POISONING BY CIILORODYNE, TREATED AT THE MEDICAL COLLEGE HOSPITAL, CALCUTTA, DURING 1867. By S. C.
Officiating
2nd Assistant
Mackenzie, M.D., Surgeon, Presidency General Hospital.
The following cases occurred during my tenure of office as House Surgeon to the Medical College Hospital, Calcutta. I think the publication of my notes may not prove uninteresting to the readers of the Indian Medical Gazette, as such cases have hitherto been of rare occurrence, and none have been reported in this country. CASE
I.
E. G., aged thirty-three, a Eurasian female, was admitted on the 4th June, 1867, at 7. a. m. During the early part of the morning she had quarrelled with her husband for having gone into the country the previous day against her wish, and, while in a fit of rage, she drank an ounce of chlorodyne which was kept in the house. When admitted into hospital, she was perfectly comatose; her breathing was stertorous, and pupils contracted. The stomach was emptied by the stomach pump, and strong coffee and other stimulants were freely administered. As she could not he roused, galvanism was resorted to, and applied to her body, and mustard to her extremities. These remedies, however, proved of no avail. She gradually sank, and died at 2-30 p. si. The autopsy was made by the Police Surgeon nineteen hours after death. The vessels of the brain were found to be much congested, and both cavities of the heart full of dark blood of the color and consistence of black currant jelly. CASE
II.
L. C-, aged nineteen, a Eurasian female, was brought by her* friends to the hospital at 9 o'clock on the morning of the 5th September, 18G7. The persons who accompanied her stated that, some short time before, her step-mother had found fault with her, which had preyed so much' on her mind, that she resolved to commit suicide, and to effect that purpose she had swallowed the contents of a bottle of chlorodyne supposed to contain one ounce. When admitted, she was quite sensible, but drowsy and stupid, her pupils were considerably contracted, and were not affected by light. Ait emetic was immediately administered, by which the stomach was emptied of a large quantity of semi-digested food impregnated with the odour of ether. Strong coffee was then given, and she was made to walk for about thirteen hours, when the narcotic symptoms passed off, and she was allowed to rest. Two days after, namely, on the 7th September, she was discharged cured. CASE III.
J. M., a police constable, aged fifty, but much older in appearwas adance, and much emaciated, apparently through disease, mitted into hospital, quite insensible, at 9. p. sr., on the 13th September, 1867, with stertorous breathing, a cold clammy skin, and pupils contracted to the size of a pin's point. All endeavours to rouse him proved fruitless ; he gradually sank, and died four hours after admission. The autopsy on his body was made eighteen hours after death, when it was found that the vessels of the brain were congested, the heart full of dark blood, the whole intestinal canal much inflamed, with a few ulcers in the ileum. Eroin the story told by his relatives, it appears that he had been suffering from dysentery for some time, and had been in hospital; but losing patience, he had taken his discharge, and had returned home the day before, namely, on the 12th September. The following morning, however, he felt worse, and went, as advised by a friend, to a chemist's shop, and procured He began to take it in small an ounce phial of chlorodyne. doses ; but finding it relieved the pain he was suffering from, he continued to take it until, by the afternoon, ho had finished the ounce. He was found by his wife, late that evening, insensible, and was brought to the Medical College Hospital. CASE IV.
F. G. W., aged sixty-three, once a tea cently out of employ, was admitted into
planter, but more hospital, at 11. a.
re-
si.,
THE INDIAN MEDICAL GAZETTE.
180
the 8th November, 1867, with all the symptoms of narcotic poisoning. History.?He had been drinking very hard for four or five days previously, and while in a state of delirium tremens, took seven drachms of chlorodyne. Treatment.?An emetic of sulphate of zinc on admission, and frequent doses of strong coffee during the day. Being sensible, he was made, but not without much difficulty, to walk about for twelve hours. The narcotic symptoms then passed off,
on
and he was allowed to rest. He was relieved of all narcotic symptoms by the 10th November. He was not, however, discharged from hospital till the 10th December, as it was discovered he had internal hemorrhoids, and had to be treated for them. B EM AUKS.
Poisoning by chlorodyne is of only been able to trace one case, of the Lancet, Vol. I., 18G8.
occurrence, that I have which is reported at page 210
so rare
Of the four above-mentioned cases, it will be seen that two, cases I and II, were attempts at suicide. In case III the act of poisoning was wholly unintentional, and in case IV purely accidental, the act of a frenzied man. The symptoms in all the cases were those of simple narcotic poisoning, and were benefited by the treatment usually adooted in such cases ; and on reference to cases II and' IV, it win be seen that the treatment was successful. In cases I and III the patients, when admitted, were in a dying state. I incline to the opinion, however, that if the patient, in case I had been admitted a little sooner, her life would probably have been saved, as she was healthy, and would have been equal to several hour's walking exercise. In case III the patient appeared so emaciated from previous disease, as to be quite unequal to the fatigue of exercise. The use of chlorodyne appears to have very largely increased, of late years, in this country ; and in view to guard against acts of suicide and accidents, it would be as well, perhaps, if chemists were to exercise a greater degree of caution in dispensing the most useful, and much-used, but to some extent dangerous medicine.
namely,
[June 1,
1868.
Officiating
2nd Assistant
Mackenzie, M.D., Surgeon, Presidency General Hospital.
The following cases occurred during my tenure of office as House Surgeon to the Medical College Hospital, Calcutta. I think the publication of my notes may not prove uninteresting to the readers of the Indian Medical Gazette, as such cases have hitherto been of rare occurrence, and none have been reported in this country. CASE
I.
E. G., aged thirty-three, a Eurasian female, was admitted on the 4th June, 1867, at 7. a. m. During the early part of the morning she had quarrelled with her husband for having gone into the country the previous day against her wish, and, while in a fit of rage, she drank an ounce of chlorodyne which was kept in the house. When admitted into hospital, she was perfectly comatose; her breathing was stertorous, and pupils contracted. The stomach was emptied by the stomach pump, and strong coffee and other stimulants were freely administered. As she could not he roused, galvanism was resorted to, and applied to her body, and mustard to her extremities. These remedies, however, proved of no avail. She gradually sank, and died at 2-30 p. si. The autopsy was made by the Police Surgeon nineteen hours after death. The vessels of the brain were found to be much congested, and both cavities of the heart full of dark blood of the color and consistence of black currant jelly. CASE
II.
L. C-, aged nineteen, a Eurasian female, was brought by her* friends to the hospital at 9 o'clock on the morning of the 5th September, 18G7. The persons who accompanied her stated that, some short time before, her step-mother had found fault with her, which had preyed so much' on her mind, that she resolved to commit suicide, and to effect that purpose she had swallowed the contents of a bottle of chlorodyne supposed to contain one ounce. When admitted, she was quite sensible, but drowsy and stupid, her pupils were considerably contracted, and were not affected by light. Ait emetic was immediately administered, by which the stomach was emptied of a large quantity of semi-digested food impregnated with the odour of ether. Strong coffee was then given, and she was made to walk for about thirteen hours, when the narcotic symptoms passed off, and she was allowed to rest. Two days after, namely, on the 7th September, she was discharged cured. CASE III.
J. M., a police constable, aged fifty, but much older in appearwas adance, and much emaciated, apparently through disease, mitted into hospital, quite insensible, at 9. p. sr., on the 13th September, 1867, with stertorous breathing, a cold clammy skin, and pupils contracted to the size of a pin's point. All endeavours to rouse him proved fruitless ; he gradually sank, and died four hours after admission. The autopsy on his body was made eighteen hours after death, when it was found that the vessels of the brain were congested, the heart full of dark blood, the whole intestinal canal much inflamed, with a few ulcers in the ileum. Eroin the story told by his relatives, it appears that he had been suffering from dysentery for some time, and had been in hospital; but losing patience, he had taken his discharge, and had returned home the day before, namely, on the 12th September. The following morning, however, he felt worse, and went, as advised by a friend, to a chemist's shop, and procured He began to take it in small an ounce phial of chlorodyne. doses ; but finding it relieved the pain he was suffering from, he continued to take it until, by the afternoon, ho had finished the ounce. He was found by his wife, late that evening, insensible, and was brought to the Medical College Hospital. CASE IV.
F. G. W., aged sixty-three, once a tea cently out of employ, was admitted into
planter, but more hospital, at 11. a.
re-
si.,
THE INDIAN MEDICAL GAZETTE.
180
the 8th November, 1867, with all the symptoms of narcotic poisoning. History.?He had been drinking very hard for four or five days previously, and while in a state of delirium tremens, took seven drachms of chlorodyne. Treatment.?An emetic of sulphate of zinc on admission, and frequent doses of strong coffee during the day. Being sensible, he was made, but not without much difficulty, to walk about for twelve hours. The narcotic symptoms then passed off,
on
and he was allowed to rest. He was relieved of all narcotic symptoms by the 10th November. He was not, however, discharged from hospital till the 10th December, as it was discovered he had internal hemorrhoids, and had to be treated for them. B EM AUKS.
Poisoning by chlorodyne is of only been able to trace one case, of the Lancet, Vol. I., 18G8.
occurrence, that I have which is reported at page 210
so rare
Of the four above-mentioned cases, it will be seen that two, cases I and II, were attempts at suicide. In case III the act of poisoning was wholly unintentional, and in case IV purely accidental, the act of a frenzied man. The symptoms in all the cases were those of simple narcotic poisoning, and were benefited by the treatment usually adooted in such cases ; and on reference to cases II and' IV, it win be seen that the treatment was successful. In cases I and III the patients, when admitted, were in a dying state. I incline to the opinion, however, that if the patient, in case I had been admitted a little sooner, her life would probably have been saved, as she was healthy, and would have been equal to several hour's walking exercise. In case III the patient appeared so emaciated from previous disease, as to be quite unequal to the fatigue of exercise. The use of chlorodyne appears to have very largely increased, of late years, in this country ; and in view to guard against acts of suicide and accidents, it would be as well, perhaps, if chemists were to exercise a greater degree of caution in dispensing the most useful, and much-used, but to some extent dangerous medicine.
namely,
[June 1,
1868.
