WHAT TO DO WHEN POISONED

The vast majority of cases of poisoning occur in children, and are,
almost without exception, due to carelessness of their elders, and
therefore preventable.

As soon as it is recognized that anyone has swallowed a poison of any
kind, a competent physician should be summoned with the utmost haste, and
in the meantime much may be done, in most cases, to minimize the effects
of the substance taken. The patient should at once be urged to drink as
much water as is possible, in order that the poison may be diluted, and
every effort should be made to induce vomiting; this may often be brought
about as soon as the stomach is full of water, by tickling the throat
with the finger, or with any other object that can be readily introduced
through the mouth. As quickly as possible, some warm water should be
secured, to a quart of which either a teaspoon of salt or mustard should
be added, and the patient urged to drink until the stomach is thoroughly
distended; following this, particularly where aided by tickling the
throat, vomiting may be generally induced, with the effect, of course, of
expelling a greater or less proportion of the poison from the stomach. If
it be known that the poison is an _acid_, ordinary cooking soda should be
added to the water that the patient drinks, as in this way all acid
substances are at once neutralized.

If the patient has taken an _alkaline_ poison, he should immediately be
given diluted vinegar, or water into which the juice of lemons or oranges
has been squeezed; such harmless acids neutralize poisonous alkaloids
just as harmless alkalies antidote poisonous acids.

_Arsenic poisoning_ usually results from the accidental swallowing of
rat-poison or some insecticide, as Paris green, or else some sort of
green dye, many of which contain salts of arsenic in some form. An emetic
should be at once given, to be followed by the whites of several eggs
dissolved in a small amount of water; sweet milk may also be
administered with benefit.

Accidental poisoning by _phosphorus_, results usually from children
eating the heads of matches, and it is rarely the case that enough of the
substance is taken to produce serious results. The poison, however, is a
deadly one if taken in sufficient quantity, and where it is found that
substances containing it have been swallowed the most energetic measures
should at once be resorted to. Warm water containing mustard or some
other emetic should at once be given, and this should be followed by
whites of eggs and sweet milk. It is well also to try to get rid of any
of the phosphorus that might remain in the stomach by giving the patient
some saline purgative like Epsom salts.

Where _carbolic acid_ has been taken, the fact can be readily determined
by noting the characteristic smell of this substance on the patient's
breath, and by observing that the mouth and throat present a more or less
whitish appearance. The treatment to be of any avail, should be of the
most energetic character. The patient should at once drink largely of
water, and vomiting should be induced as quickly as possible. Either
milk or the white of an egg should then be given. Ordinary quick-lime, or
even plaster from the walls of the house, may be stirred up in water and
administered to the sufferer, as both have a distinct value in antidoting
the effects of this poison. Burns of the skin with carbolic acid are
rarely followed by serious consequences. As soon as the accident occurs
the part should be thoroughly washed with water, and if at hand a little
alcohol may be rubbed over the part; the affected tissues return to a
normal condition in the course of a short time in the vast majority of
cases.

_Strychnine poisoning_ is comparatively rare, except when this substance
is given with suicidal or murderous intent. Water should be given,
immediately followed by an emetic. A mass of crystals of permanganate of
potash as big as a pea may be administered in a glass of water, if this
substance be at hand. After the poison has been absorbed nothing is
usually of any avail if the amount was originally sufficient to produce
death.

One of the commonest forms of poisoning is from _opium_ in the form of
morphine, paregoric or laudanum. When this happens the stomach should be
washed out by water frequently, even where the drug was administered
hypodermatically. This is best accomplished by causing vomiting by warm
water to which a small amount of mustard has been added. The patient
should be given strong coffee or tea at frequent intervals, and
artificial respiration should be practiced. Where it is possible to
obtain it, permanganate of potash in a watery solution should be given,
enough of the chemical being used to make the water a deep purple color;
this may be frequently repeated, as the substance is not poisonous in
ordinary doses, and destroys morphine and other alkaloids of opium very
rapidly.

_It should never be forgotten that infants and children are poisoned by
comparatively very small doses of opium, and consequently nothing
containing any derivative of this substance should be given them except
on the advice of a competent doctor._

Many soothing syrups advertised for the relief of the minor ailments of
children contain opium, and there can be no doubt that many deaths have
occurred as a consequence of taking such nostrums.

_Mushroom poisoning_ in this country is relatively rare, but there are
quite a number of popular notions on this subject that are totally
incorrect, chief among which is the idea that there is a difference
between mushrooms and toad-stools, the former being generally regarded as
edible, and the latter poisonous. As a matter of fact, those conversant
with this subject make no distinction between the two, using the terms
toad-stool and mushroom as interchangeable. It is likewise a common error
to suppose that we possess any tests by which the poisonous toad-stools
can be told from those that are wholesome. Although a skilled student of
the subject can almost at a glance determine which are poisonous and
which are not, it is hazardous in the extreme to consume those selected
by one who is inexperienced. As a matter of fact, for all practicable
purposes, there is only one species that is generally eaten,--the
_Agaricus campestris_, or meadow mushroom. This grows for the most part
in open fields, and in many parts of the world may be gathered in great
number throughout the warmer seasons immediately following rains. This
mushroom has also the great advantage that it is the only one of the
edible species that can be cultivated.

Just as we have only one common mushroom that is ordinarily eaten, there
is only one common species of these plants that is highly dangerous,--the
_Amanita phalloides_, which contains one of the most deadly poisons
known--and one for which we possess no adequate antidote. This mushroom
is very common, being frequently seen along the roadside, and at the
edges of fields; it also grows in forests, and is occasionally
encountered in treeless areas.

     It presents a rather attractive appearance, being rather large, and
     having a glistening white cap with a long stem, around which there
     may always be seen a distinct collar; on carefully removing the
     soil from around its roots, it will be seen that its stem is
     surrounded just below the surface of the earth by a sheath-like
     structure, the so-called "death-cup," which, together with the
     peculiarities already mentioned, clearly stamp this mushroom as
     being one of the most deadly of all known natural objects. In
     addition to the rather inviting appearance of this toad-stool, its
     flavor is agreeable, thus in every way insidiously inviting, it
     would seem, the unwary to their doom. Less common than the species
     just considered is another closely related fungus known as the
     _Amanita muscarius_, or fly-agaric; this handsome mushroom presents
     the same peculiarities of structure exhibited by the _Amanita
     phalloides_, but differs from it in the fact that the tip of its
     cap is scaly, and is of a reddish-yellow color. The fly-agaric is
     quite as poisonous as its more common relative, and is equally to
     be shunned. The reader should be warned that even handling either
     of the fungi just considered may result in poisonous
     symptoms--probably as a consequence of multitudes of the tiny
     spores of the plants being carried into the nose and mouth by the
     air.

Some hours after eating the _Amanitas_, the patient is taken with
vomiting, diarrhoea, cramps, and extreme prostration; in children,
convulsions may occur. Most unfortunately evidences of this poisoning do
not usually develop until some hours after eating it. As a consequence, a
considerable amount of the poison has usually been absorbed into the body
before the victim is aware that anything is wrong, and it, therefore,
becomes impossible, as a rule, to greatly help matters by attempting to
remove the offending material from the stomach by emetics.
Notwithstanding this it would be proper to administer warm water, into
which a small amount of mustard had been stirred, in order to assist
nature by washing out of the stomach whatever portions of the fungus
might remain. When exhaustion begins to appear, it should be combated
with doses of aromatic spirits of ammonia, and by the external
application of heat. As it is believed that atropine possesses some
antidotal powers to the poison of the _Amanitas_, this substance should
be injected hypodermatically in the usual dose as quickly as possible,
and an experienced physician should be called at once.

_Ivy Poisoning from Touch._--One of the two species of _Rhus_, is
exceedingly common in all portions of the United States, producing a
severe inflammation of the skin when handled, or even in some persons by
merely being near the plants or in the smoke of a fire where they are
burning. There are two varieties of the _Rhus toxicodendron_, one being
the shrub commonly called _poison oak_, and the other a climbing vine
generally known by the name of poison ivy. The _Rhus venenata_ grows in
swampy localities all over the United States, and is known as
poison-sumac, swamp dog-wood, poison-elder, and poison dog-wood. About
twenty-four to forty-eight hours after the exposure, the skin begins to
itch, and this is shortly followed by an inflammation accompanied by the
formation of numerous small blisters, and still later by scaling. It
should not be forgotten that the berries and other portions of these
plants are poisonous when taken internally, giving rise under such
circumstances to vertigo, faintness, dilation of the pupils, trembling,
confusion of the senses, and, in some instances, convulsions. Should it
be discovered that anyone has been exposed to poisoning by these plants,
the skin should be washed as quickly as is possible with alcohol, or some
substance like whisky that contains it; where this cannot be obtained,
hot water and soap should be liberally applied--the object, in either
case, being the removal of as much of the poison as is possible. After
the irritation of the skin has begun, the parts may be bathed in a one
per cent. solution of carbolic acid, to be repeated every few hours, as
the necessities of the case may demand. Lead-water is also frequently
used with benefit, lime-water also appears to be of use, but the various
powders and salves sold in stores rarely help the patient much. The best
thing after all is soap and water as hot as it can be borne; and
ordinarily the itching and inflammation will disappear in four or five
days, followed by scaling.


VENOMOUS SNAKES AND SNAKE BITES.

Much popular misapprehension exists on the subject of snakes, both as to
the results of their bites and the appropriate treatment under such
circumstances. It is not generally understood that a very large
percentage of our American snakes are entirely harmless--the poisonous
ones being decidedly more the exception than the rule.

Within the confines of the United States there exist only two families of
venomous serpents. By far the most numerous are three genera of viperine
snakes, including the rattlesnakes and moccasins; all of these have a
pit-like depression between the nose and eyes, and hence are called
_pit-vipers_. In the southern portion of our country there are two
species of a colubrine genus closely related to the dreaded cobra of the
East, one of them being called the coral-snake or harlequin snake, and
the other, which occurs in the southwest, is known as the Sonoran
coral-snake.

While there are three genera of vipers in America, two of them are so
closely related, and present characteristics that are so similar that the
ordinary observer would regard them as being identical, and inasmuch as
the character of their poison seems in every way similar, for practical
purposes it would seem desirable to include them under one head; in both
genera, the species have rattles on the tips of their tails, the more
common being the ordinary rattlesnakes (genus _Crotalus_), of which there
are twelve species in the United States, and the ground-rattlesnakes
(genus _Sistrurus_), of which there are two species.

Closely related to the rattlesnakes are the true moccasins, of which
there are two species, one being the cotton-mouth or water-moccasin
(_Ancistrodon piscivorus_), and the other the highland moccasin,
pilot-snake or copper-head, (_Ancistrodon contortrix_).

The two species of poisonous colubrine serpents already referred to are
known respectively as the _Elaps fulvius_, and the _Elaps euryxanthus_,
both of which occur in the southern portions of the United States. These
snakes are fortunately of a very mild disposition, and rarely attempt to
bite, even when handled. That their poison is exceedingly deadly is
attested by the fact that out of eight instances where it was known that
persons were bitten by them, six died, and they should, therefore, be
looked upon as among the most deadly of North American serpents. Mention
should be made of the fact that there are at least six harmless reptiles
that resemble the coral-snakes very closely, and as a consequence of the
former being mistaken for the latter, the assertion has been frequently
made by the ignorant that our elapine serpents are harmless.

A short description of the really deadly reptiles encountered in this
country that would enable even the novice to distinguish them from those
that are harmless would seem not inappropriate here, for where a person
is bitten by a snake it becomes at once a matter of vital importance to
determine, if possible, its true character. Most non-venomous serpents
will viciously bite when cornered, and while they may produce slight
wounds, with a small amount of bleeding, such injuries are entirely
devoid of danger, and need occasion no fear on the part of the victim.
There now follows a brief description of our venomous snakes, by means of
which it will be easy for any one to distinguish them from their innocent
relatives.

_True Rattlesnakes._--There are twelve species of these reptiles in the
United States, all of which, with but two exceptions, live west of the
Mississippi. They vary very greatly in color, but the common eastern
forms generally have alternate transverse yellow and brownish-black marks
over their bodies. All possess rattles. The body of the snake is thick in
proportion to its length, and the head, which is more or less
diamond-shaped, is much larger than, and is quite distinct from the neck.
The pupils of the eye are elliptical--a peculiarity which the pit-vipers
alone possess of all the North American snakes. Between the eye and nose
there is a comparatively deep depression or pit which gives to this group
of snakes their name. There are two large, exceedingly sharp fangs in the
front of the mouth, in the position of a dog's canine teeth, that are
folded up against the roof of the mouth when the snake is in
repose;--being brought forward in a position for stabbing as the serpent
strikes. The scales on the under surface of the body back of the anus do
not divide along the middle line into two rows, as in harmless snakes.

_Ground Rattlesnakes._--There are two species of the pygmy or
ground-rattlesnakes. They attain to a length of only about twenty inches,
and present the general characteristics of the true rattlesnakes, with
the exception that the rattle is small, consisting of but one single
button at the end of the tail. These serpents are exceedingly vicious,
and usually bite without warning. Contrary to the general opinion,
however, the wounds they inflict are rarely, or never, followed by
serious consequences in man. One species is southern. The other occurs
from Ohio to Nebraska, where it is called massasauga.

_Cotton-Mouth Moccasin._--The largest specimens of the cotton-mouth
moccasin attain to a length of about six feet. The full grown reptile is
of a dingy brownish-black color, but the young are pinkish, with coppery
bands running transversely across the body. With the exception that this
reptile has no rattles, it answers in its general peculiarities to the
description already given of its near relatives the rattlesnakes. The
cotton-mouth moccasin is semi-aquatic, being found around the edges of
streams and other bodies of water.

_The Copper-head, or Highland Moccasin._--This serpent is found from
Florida and Illinois to southern Massachusetts; also in parts of Texas.
The largest specimens have a length of about three feet. They resemble
the cotton-mouth moccasin in their general peculiarities, being, however,
somewhat lighter in color. The head has a coppery tinge, from which the
snake gets its name, while the body is of a brownish color, with
transverse Y-shaped bands of reddish-brown. Its favorite habitat is rocky
hill-sides and the banks of mountain water-courses.

_Coral-snakes._--The two coral-snakes resemble each other very closely,
and are long slender serpents, whose heads are quite small, and scarcely
differentiated from their bodies. The pupils are round, and the head has
no pits. They possess two short permanently erect fangs, which are by no
means so well developed as those of the viperine reptiles--though perhaps
capable of inflicting more deadly wounds than any of the latter,--with
the possible exception of the diamond-back rattlesnake of the extreme
southern portion of the country. Their coloration is exceedingly
beautiful, and when properly interpreted, entirely characteristic. From
the head to the tail their skins exhibit alternate rings, or encircling
bands of black, red and yellow--each band of the two former colors being
bordered by yellow; _in other words there are as many yellow stripes as
there are both black and red together._ Stress is laid upon the
characteristics just mentioned, for the reason that half a dozen species
of harmless serpents that greatly resemble them may, without exception,
be differentiated from the true coral-snakes by the fact that there are
as many _black bands as both red and yellow_. Where a snake has been
killed, it is of course quite easy to determine whether or not it is
venomous by a search for the fangs, which are never present in the
non-poisonous reptiles. Fortunately, the coral-snakes are only found in
the extreme southern portion of the United States, live under ground for
the most part, and are rarely encountered.

_Treatment of Snake-Bite._--As soon as a person has been bitten by a
poisonous serpent, a tight bandage, or ligature of any kind, should be
applied above the wound if the injury has been received on any of the
extremities,--which is fortunately the case in the vast majority of
instances. The part bitten should be at once exposed, and search made for
the point of entrance of the fangs. It should be particularly noted as to
whether there are one or two wounds, as it is true in about one-half of
the cases that only one fang enters the flesh,--in which case, of course,
the probabilities of serious consequences resulting are largely
diminished. With a pocket-knife or other sharp instrument the wound
should be enlarged, and, if possible, someone should be persuaded to suck
the wound; this should not be done by one with decayed teeth, as under
such circumstances the poison might be absorbed and produce unpleasant
consequences. A doctor should be summoned as quickly as is possible, but
it must be confessed that in the present state of knowledge, unless he
should happen to possess--which he probably will not--some antitoxin for
the particular snake doing the damage, his services will likely be of no
great value.

     It has been asserted by some that very large doses of strychnine
     are directly antidotal to snake venom, but more recent experience
     does not tend to confirm this view; still there is no harm in
     making the trial, and if the services of someone capable of giving
     the injections can be secured, the treatment is certainly worth the
     trial. The immediate injection into the tissues around the wound of
     a one-per-cent. watery solution of chromic acid or potassium
     permanganate is thought to be of value by destroying the poison,
     but in order to be efficient it must be administered within a short
     time after the bite has been received. Should the patient's
     condition become serious, and the breathing finally stop,
     artificial respiration may be resorted to. As soon as the remedies
     suggested have been tried, it is time for us to go back to the
     ligature, which cannot be suffered to remain around the limb
     indefinitely, as by cutting off the blood-supply it will sooner or
     later produce death of the tissues. From time to time we should
     slowly loosen the bandage, thus allowing a little of the poison to
     pass into the body, and at the same time permit the entrance of a
     small quantity of blood into the tissues of the limb beyond the
     ligature; the bandage should of course be tightened at the end of a
     half a minute, and it should be alternately loosened and tightened
     every half hour until the patient is considered to be out of
     danger.

The reader cannot fail to have observed that nothing has been said
concerning the use of alcohol in the treatment of snake-bite, and the
matter is only here referred to for the purpose of condemning it as being
unsound in theory and bad in practice.

     The idea that this drug is of value in snake bite doubtless
     originally arose from the fact that those bitten by poisonous
     serpents were depressed, and, as in the past alcohol was considered
     the best of all stimulants, it is not surprising that its use was
     generally considered to be essential. As we now know, however, that
     alcohol is a depressant rather than a stimulant, and as numerous
     experiments carried out on animals have clearly shown that it does
     harm in snake bite rather than good, there is every reason why we
     should cease to endanger the lives of those already poisoned by
     adding to the trouble by using this drug. There is but little doubt
     that many more persons have been killed by the alcoholic treatment
     for snake bites than have died from the effects of snake venom.
     Inasmuch as there is a deep-rooted superstition among most people
     that alcohol is the panacea for snake bite--and such notions die
     hard--it may be well to say that all of the authenticated cases of
     this character that have occurred in this country have recently
     been collected, with the result that it was shown that only about
     one man in ten dies who is bitten by a venomous serpent, and it is,
     therefore, quite easy to understand why alcohol has maintained its
     reputation as being an antidote in such cases--the chances being
     nine to one in the victim's favor without any treatment whatever.

As soon as the patient's needs are attended to, it is well to find if the
snake that inflicted the wound was killed, and an examination of it
should at once be made as by determining the size and character of the
reptile an accurate forecast to the probable results may be made. In many
instances it will be found that the snake was not venomous, it having
made only a few scratches which are of no more consequence than the prick
of a brier. If it be found that the serpent inflicting the wound belongs
to one of the groups already referred to, the probabilities of a serious
result will depend upon the size and character of the snake, and also to
a considerable degree on whether one or both fangs entered the victim's
body. A full grown diamond-back rattlesnake, which may attain the extreme
length of eight feet, is perhaps the most dangerous of all the American
poisonous reptiles, though a fully grown coral-snake may be regarded as
almost, if not quite as, deadly. Next to these a large sized cotton-mouth
moccasin is perhaps most to be dreaded, to be followed, depending upon
their size, by the other varieties of rattlesnakes, the copperheads, and
finally the ground-rattler. The larger the serpent inflicting the wound
the greater is the result to be dreaded; naturally it also follows that
the larger the individual bitten the less the danger.