18.- Chlorodyne.
Contains Muriate of Morphine (about 22 gr. to the ounce).
SYMPTOMS AND TREATMENT.- Same as for Opium.
19.- Curare.
Also called Woorara and Urari. Arrow-poison. Paralyzes motor nerves, and causes death by arresting breathing.
TREATMENT.- Artificial respiration. Stimulants. The surface of the wound should be thoroughly and repeatedly washed. If the case is seen in time, a ligature should be tied above the wound when possible.
20.- Alcohol (Alcohol).
It is important to be able to detect poisoning by large potations of Alcohol from poisoning by Opium, and from Apoplexy, as the immediate treatment differs in each case. (See Section on “Opium” for symptoms of Apoplexy.) The odour of the breath, and the history and circumstances of an unconscious patient, may point to drunkenness as the cause; if these be absent, the presumption is that it is not a case of intoxication. It should always be remembered that a drunken person may have suffered an injury and sustained concussion of the brain; or a drunken debauch may coincide with a haemorrhage from some vessel within the cranium.
SYMPTOMS.- Growing insensibility, tactile, mental, and moral; which may increase rapidly and result in come; or may increase slowly, and then become suddenly absolute; face flushed; pupils dilated (in poisoning by Opium, the face is generally pale and the pupils contracted).
TREATMENT.- Narcotic poisoning from large doses of Alcohol or spirits-of-wine requires the use of the stomach-pump, cold effusion over the face and head, and warmth to the cardiac region and the stomach; the circulation in the extremities should also be promoted. When exposure to cold and drunkenness have produced combined effects, those of cold should be first counteracted. If bad cases are neglected, they may prove fatal. Should the patient appear to be dying from Paralysis of the respiratory muscles, artificial respiration should be resorted to (see Secale 224).
One of the chief symptoms of poisoning by Alcohol is Delirium Tremens.
DELIRIUM TREMENS.- Thy physical action of Alcohol, whether taken in large, or in frequently-repeated small, doses, induces profound changes; the general nutrition of the body suffers, and if the habit be long persisted in, an incurable cachexia results. The multiform evils which the use of Alcohol produces are so great that it may be truly stated, that if Alcohol had never been known, a vast amount of sin and crime, and a yet larger proportion of the poverty and misery now in the world, would never have existed.
SYMPTOMS OF DELIRIUM TREMENS.- The disease may only appear after a long course of alcoholic stimulation, or it may be suddenly developed after a protracted debauch. The earliest symptom is one of great mental and physical depression. The patient fancies the is haunted by spectres, and is afraid to be alone. A state of excitement and delirium follows, in which he becomes the victim of various painful delusions, chiefly having reference to his business, which he thinks is irretrievably ruined, or to his friends, whom he believes to be plotting against him. Haunted by spectral illusions and imaginary horrors, he desires to get up, and often makes violent, efforts to escape form foes and danger. Sleep almost wholly forsakes him; he becomes restless, trembles, and is frequently endeavouring to change his posture; he declares that rats, mice, beetles, etc., are about his bed, that strangers are in the room, or that listeners are at the door or concealed behind the curtains. The patient is, however, easily subdued, and induced to remain quiet for a time. His eyes are restless, and the conjunctivae red and injected; the face is usually pale, but sometimes flushed and wild-looking; the skin is commonly moist or clammy; the pulse weak and compressible, the action of the heart is often violent, and the tongue foul, with entire loss of appetite. The natural tendency of the disorder is to terminate in a critical sleep, as the end of some fifty to seventy hours after the commencement of the delirium.
PATHOLOGICAL CAUSE.- The delirious affection is caused by the direct action, of Alcohol (* “I dare say you are all impressed with the general belief that delirium tremens depends mainly on abstracting stimulants from a person largely addicted to them. I will not say that it never depends on that; but what is more certain is, that it is much more likely to ensue when a person who is largely addicted to the use of stimulants leaves off food. So long as a man keeps up both the eating and the drinking, he is in little risk of delirium tremens. Either when he suddenly leaves off eating and takes to drinking, or when he gradually diminishes his food and increases his drink, he is in the greatest danger of that disease. So that we come to this-which may seem paradoxical and immoral too-that a man who both eats and drinks too much is in less danger than a man who commits only one of those excesses. The double fault is less mischievous than the single; the eating counteracts the harm that would ensue from the drinking. If we look about in society we may see this very plainly. There are still many persons habitually engaged in too great eating and drinking, doing both to excess; and they are in danger of breaking down in various defects of digestion and the consequent disturbances, but they are in no danger of delirium tremens. The people who are in that danger, and show the evil effects of drinking in the most marked form, are they who drink largely and eat little.” -Sir James Paget, F.R.S. upon the nervous system, and is not the result of the sudden withdrawal of the accustomed stimulant. The experience derived from hospital practice, and from prison discipline, abundantly proves that a person who indulges very freely in stimulants may suddenly abandon them without any risk. Indeed, as with other poisons, the great danger to be feared arises from their continued employment.
TREATMENT.- The immediate cause of danger is exhaustion; hence the importance of supporting the strength by nutrition, digestible diet, in a fluid form, beef-tea, soups, yolk-of-eggs, warm milk, cocoa, etc., in small quantities frequently repeated. “The stimulus of such a spice as cayenne pepper, given in soup, on the atonic stomach, will have a favourable influence on absorption” (Aitken). A cup of coffee is sometimes useful to still the nervous excitement. It is important, at the same time, to eliminate the poison from the system; and this is sometimes pest effected by hot or cold baths, and especially by the wet- pack. A tumbler of cold water given on entering the bath materially increases its efficacy. The action of the skin should be also promoted by friction. The patient should remain in a quiet, darkened room, and everything be done to induce sleep, and obviate mental irritation. Skillful nursing is of great importance. If nourishment is not administered, and sleep does not succeed, the patient may sink from exhaustion.
The following remedies are useful at different stages of the disease according to the symptoms present:- Belladonna, Stramonium, Hyoscyamus, Opi IX, Nux V. “Stramonium in pure tincture, and IX dilution, I have found successful in three very bad cases of Delirium Tremens” (Dr. Dalzell). “The most generally useful remedy in well-marked Delirium Tremens, is Belladonna O gtt. if, every two hours. Sleep and a quiet night, with marked improvement next day, I have almost always found to ensue” (Dr. D.D. Brown). Where the delusion of poisoning is prominent, Hyoscyamus 3.
21.- Chloroform, Ether (Chloroform, AEtherum).
If during the inhalation of Chloroform, especially at the commencement, the vapour be not well diluted with atmospheric air, dangerous symptoms may arise. as syncope or respiratory failure or both at the same time.
TREATMENT.- Promptitude is all-important. Immediate exposure of the patient to currents of fresh air, and cold affusion, the tongue being drawn forward to open the wind pipe. The head should be lowered, if the face be pale; raised, if turgid. The chest, cheeks, and extremities should be flapped with a wet towel to stimulate the peripheral nerves. If not quickly successful, artificial respiration should be performed. It this be commenced whilst the pulse is perceptible it is nearly always successful; even if the heart be too feeble for its impulse to be felt in the pulse at the wrist, it is often sufficient to restore its failing energies. Inhalation of Nitrite of Amyl. Galvanism sometimes succeeds in restoring respiration. The introduction of a piece of ice into the rectum is generally by a deep breath, and the gradual restoration of natural breathing. If Chloroform have been swallowed, the stomach-pump is necessary; and afterwards Ammonia should be given, or ten minims of Liq. Ammoniae, diluted with forty minims of water, may be injected into a vein of the arm.
The treatment of Ether poisoning is the same.
In the bronchitis which frequently follows Ether anaesthesia, Belladonna is the best remedy.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."