Hydrocyanic Acid and Potassium Cyanide.-Fresh air, an emetic, or the stomach tube; potassium permanganate; stimulate; give diluted ammonia water or chlorine water; cold effusions; atropine, gr. 10, subcutaneously.

Carbolic Acid and Creosote.-Give Epsom salts, strong alcohol, dilute sulphuric acid, glycerine and oil; atropine subcutaneously, gr. 1; emetics, apomorphine, gr. to, the stomach tube if necessary; white of egg; amyl nitrite; stimulants; artificial heat; castor oil.

Alkalies, Ammonia, Soda, Potash, Lye, Chlorate of Potassium.-Give vinegar, lemon juice, orange juice, or other acids; fixed oils; bland liquids; secure rest; relieve pain; stimulate if necessary. Chlorate of potassium acts upon the heart and kidneys.

Arsenic, Paris Green, Scheele's Green, Fowler's Solution, Rat Poison.Emetic or stomach tube; give hydrated oxide of iron (made by adding to a solution of the perchloride of iron, or the sulphate of iron, an excess of sodium carbonate (washing soda) or carbonate of potassium or magnesia, and filtering through a cloth); castor oil; secure rest; stimulate. Chronic arsenicism develops renal changes and paralysis.

Mercury, Corrosive Sublimate, Antimony, Tartar Emetic.-Emetics; lavage; give some infusion containing tannic acid; raw eggs and milk; bland liquids; castor oil; stimulate.

Copper Salts, Chronic Copper Poisoning among Artisans.-Albumen (milk, raw eggs); stomach tube; emetics; bland liquids. Symptoms of chronic copper poisoning: dyspepsia, anæmia, nervousness. In some of the manufacturing districts in Germany men work only three months a year in the glazing department by law.

Lead Salts. Emetics or stomach tube; give Epsom salts or dilute sulphuric acid; milk, raw eggs, and water; relieve gastrointestinal pain; potassium iodide to help eliminate the drug. In chronic lead poisoning, there are blue gums, lead colic, constipation, and extensor paralysis.

Phosphorus, Matches, Rat Poison.-Provoke vomiting by repeated 5 gr. doses of sulphate of copper, the antidote; potassium permanganate solution, to per cent; give a saline purgative, but no oils nor fats. In chronic phosphorus poisoning, stomatitis and periostitis result.

Nitrate of Silver (Lunar Caustic).-Give strong salt and water; provoke vomiting; repeat many times, as it is antidote and emetic.

Iodine. Emetics or stomach tube; starch and water; bland fluids; stimulate and relieve pain.

Opium, Morphine, Laudanum, Paregoric, Etc.--Emetic; stomach tube; potassium permanganate by the mouth or subcutaneously; ammonia; hot strong coffee per rectum; atropine subcutaneously; oxygen; keep awake; artificial respiration; lingual traction; amyl nitrite inhalation; interrupted current; use catheter and give rectal irrigation with warm saline solution. Chloral Hydrate, Paraldehyde.-Emetic or stomach tube; artificial heat; massage; stimulate; strychnine; amyl nitrite; artificial respiration.

Nux Vomica, Strychnine, Picrotoxin.-Emetic or stomach tube, apomorphine, gr. 4; animal charcoal or tannic acid; bromides and chloral; amyl nitrite; chloroform anæsthesia for convulsions; curare; artificial respiration.

ANTIDOTES FOR POISONS

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Aconite, Veratrum Viride.-Emetic or stomach tube; stimulate; apply heat; atropine; artificial respiration.

Hemlock, Toadstool.-Provoke vomiting and give a purge; tannic or gallic acid; stimulate well; keep up the breathing.

Belladonna (Deadly Nightshade), Atropine, Hyoscyamus or Hyoscyamine, Duboisia or Duboisine, Stramonium or Daturine (Jimson, or Jamestown, Weed), Tobacco.-Emetic or stomach tube; stimulate; enema of hot coffee; artificial heat; morphine; pilocarpine; physostigmine; artificial respiration.

Alcohol, Wood Alcohol.-Stomach tube or emetic; ammonia and water; faradism; cold douche; cold applied to the heart.

Poisonous Gases, Carbonic Acid Gas, Sulphureted Hydrogen, Illuminating Gas.-Fresh air; oxygen; artificial respiration; amyl nitrite or nitroglycerine; stimulation.

Chronic Sewer Gas Poisoning.-Although workers in sewers are remarkably free from disease, it is generally believed that a prolonged exposure to noxious gas and the powerful odors from foul water may cause in acute types nausea, vomiting, colic, and fever, followed perhaps by collapse or coma. In more chronic forms there may apparently result a low form of fever with or without chills.

TREATMENT.-Remedy the drainage pipes or remove to sanitary sur

roundings.

Poison Ivy.-Edematous erythema may spread over the entire body. Give a brisk cathartic. Apply lime water, lead water, or some simple ointment.

Ptomaine Poisoning, Poisoning from Meat, Pork, Sausage, Head Cheese, Beef, Veal, Mutton, or Fish.-From tainted or diseased meat, we observe vomiting, pain, and diarrhoea; it may simulate cholera; there may be wakefulness, delirium, headache, and changes in the pupils; the skin may show roseola, wheals, or urticaria; high fever or normal temperature; pulse accelerated or slow; thoracic oppression; patients may be prostrated; tendency to relapse; death may occur.

TREATMENT.-Symptomatic; make the patient drink warm water and induce vomiting; enemata, stimulants, baths.

Poisoning from Mussels.-Profound nervous symptoms, slight gastrointestinal disturbances; numbness, coldness, no fever, dilated pupils, rapid pulse; death may come in a few hours.

TREATMENT as for ptomaine poisoning.

Oysters and Lobsters Which Are Not Fresh.-Gastrointestinal poisoning, faintness, prostration, perhaps fever.

TREATMENT, that of ptomaine poisoning.

Poisoning from Milk, Ice Cream, Cheese, Etc.-Poisoning from milk is spoken of in the section on Pædiatrics (Cholera Infantum).

The various milk products, cheese, custard, ice cream, etc., may be very poisonous from ptomaines, and cause severe gastrointestinal symptoms. The TREATMENT is the same as given above.

Grain Poisoning

Ergotism.-Meal may be contaminated with the ergot fungus, and its prolonged use will cause poisoning. There are two forms of intoxication. One begins with anesthesia, tingling, and pains, in the toes and fingers usually, with spasmodic movements of the muscles, and a gradual stasis of the blood, terminating in gangrene. The other form shows nervous symptoms; the patient often complains from ten to fourteen days of headache and tingling sensations, possibly with slight fever and cramps in the muscles with contractures develop. The arms are flexed and the legs and toes are extended. These cramps come in spasms and may last from a few hours to many days. Relapses are frequent. Eclampsia develops in the most severe cases. Death may occur in a convulsion. Delirium may occur at first, and in chronic poisoning melancholia or dementia may result. Posterior spinal sclerosis may result from chronic poisoning with ergot.

Lathyrism (lupinosia) is a poisoning produced by using meal made from a grain popularly known as chick pea. It causes a spastic paraplegia involving the legs, which may proceed to complete paraplegia. India, Italy, and Algiers are the countries in which it has been noticed.

Pellagra (maidismus), a diseased condition found extensively in parts of Italy, France, and Spain, is supposed to be caused by using maize which has fermented or is diseased. At first there are indefinite symptoms, debility, pains in the back, sleeplessness, digestive disturbances, and sometimes diarrhoea. The pellagral erythema appears in the spring, and is followed by desiccation and exfoliation of the epidermis, which becomes very dry. Sometimes there is a suppurative process underneath the crusts. With these skin conditions there are digestive disturbances, salivation, dyspepsia, and diarrhoea, which may be hæmorrhagic. In the milder cases, after a few months recovery gradually takes place.

In the severe and chronic forms we observe backache, headache, spasms, paralysis, and mental disturbances. The paralysis affects the legs and may lead to paraplegia. Melancholia or suicidal mania may occur after several attacks, and there may result a profound cachexia.

TREATMENT. The maize should be properly inspected and preserved. The patient should be removed from the infected district, and have a change of diet. Elimination and stimulation are indicated.

Various Poisons-Insect and Snake Bites

Pigments used in jellies and candies have produced poisoning. Pigments in stockings and underwear may produce local eczema and constitutional symptoms. Early recognition is important. The treatment is symptomatic.

Preservatives, such as salicylic acid, boric acid, and formalin, have been used in foods in such large amounts as to cause intoxication.

Lead and tin, used in canning fruits, vegetables, etc., have also caused poisoning.

Flies have been known to carry infection to food which has communicated the disease to the person eating it. Tuberculosis, cholera, and typhoid

fever have been contracted by eating food infected with the germs of these diseases.

The treatment is self-evident when the nature of the poison is known. Snake Bites. In this country there are few snakes, except the rattlesnake, the bites of which are poisonous. The poison of this snake, as well as that of others, does not affect one if swallowed, provided there are no abrasions in the mouth, but if it enters the circulation it is very poisonous. We observe dyspnoea, cramps, bloody diarrhoea, hæmorrhage from the nose and lungs, asphyxia, paresis, and paralysis, which may be fatal by affecting respiration and circulation.

Immediately after the bite, if the wound is sucked by the human mouth, much of the poison can be removed. We may apply the actual cautery, make deep incisions, and apply a 5 per cent solution of carbolic acid, but this is useless, unless done immediately.

Internally, alcohol in large amounts is very effectual. The person bitten can tolerate an immense amount, and we can only determine when to stop its administration by the appearance of the symptoms of alcohol intoxication. Antitoxine for snake bites (antivenine) will be available in the near future.

Insect Bites. -PEDICULI.-The Pediculus capitis, or head louse, the Pediculus corporis, or body louse, and the Pediculus pubis, or crab louse, may cause by their bites small hæmorrhagic spots or an urticaria. In cases of long standing induration and pigmentation may be produced from the bites and from scratching.

Treatment. For the head louse, when the condition is bad, it is best to cut the hair short, as it is very difficult to destroy the nits. Repeated washings in coal oil or turpentine or carbolic acid, 1 to 50, are usually sufficient.

For the body louse, the clothing should be baked or steamed in an oven or sterilized for several hours. The itching of the skin can be allayed by a warm bath containing 4 or 5 oz. of bicarbonate of sodium. A lotion of carbolic acid, about .02 per cent with 2 oz. of glycerine, is helpful.

The PUBIC LOUSE may be destroyed with ordinary blue ointment or white precipitate ointment. The parts should be thoroughly washed two or three times a day with soft soap and water.

BED BUGS may cause in some people very great distress from the local poisoning. Bichloride of mercury, kerosene, or sulphur fumigation usually destroys them in the cracks of beds or walls, where they secrete themselves. They probably can carry an infection from one person to another.

MYIASIS. This term is given to wounds or scars in which the larvæ of certain flies develop, making it "living." It is not common in temperate climates. The invasion is rare, unless a region is previously diseased. We find them in the nose, ears, conjunctivæ, vagina (after delivery), etc. They can be removed by forceps or by thorough cleansing and antiseptic applications.

The STING OF BEES, WASPS, HORNETS, and SPIDERS is followed by acute pain and considerable local swelling.

Treatment.-Cold lead water should be applied locally. An incision. into the swollen tissues is occasionally necessary to relieve tension.

DRUG HABITS

Morphine, cocaine, and chloral, all anodynes and used at first to relieve pain, are the most common drugs to which people become addicted.

The treatment of the morphine habit is to gradually withdraw the drug, and it is always best to do this in a trustworthy institution with reliable attendants, so that the patient is never alone. As aids, we should give good food and plenty of it, and build up the general health. Coffee and alcohol in small amounts as stimulants may be helpful. As counteracting drugs, dionin, subcutaneously or by mouth, in doses double that of the morphine, may be tried. Codeine is also helpful, but the bromides are of

FIG. 225.-EMERGENCY POISONING CASE.

little use. In collapse we may need alcohol and sometimes more morphine. Hydrotherapeutics is helpful.

The cocaine habit is very difficult to overcome, and its victims are most pitiful. It is best to take the patient to an institution and withdraw the drug. It is probably best to do it gradually. Great excitement follows its discontinuance, and even paranoia. Alcohol and morphine are sometimes indicated during the treatment.

Chloral may produce serious symptoms in those addicted to it. It may cause dyspnoea and even death by bronchial effusion. Eruptions on the skin are common and there is a tendency to skin eruptions upon the slightest provocation. It is said also to cause in chronic cases petechiæ, ecchymoses, and ulcerations. General edema, profound weakness, and heart failure may result.

TREATMENT.-Withdrawal of the drug.

An emergency poisoning case should form part of the armamentarium of the physician. Dr. J. W. Wainright, of New York, has suggested such a case with the following contents:

One stomach tube, one tongue forceps, one mouth gag, one 2-oz. glass syringe, one hypodermic syringe. It also contains five 2-oz. bottles of magnesium sulphate, of zinc sulphate in 20-grain powders, powdered mustard, calcined magnesia, and chloroform. The 1-oz. vials contain amyl nitrite, alcohol, iron dialyzed, acetic acid, oil of turpentine, and aromatic spirit of ammonia. The -oz. vials contain powdered ipecac, powdered opium, potassium bromide, chloral hydrate, and potassium permanganate. The hypodermic tablets are of strychnine sulphate, morphine sulphate, pilocarpine muriate, apomorphine, hydrochlorate, nitroglycerine, digitalis, and atropine sulphate.