Poisons

Citation preview

F.Bodin and

C.F.Cheinisse

Poisons

World University

Library

>.

$4.95 That over a million cases of acute poisoning are reported each year throughout the world is not surprising in view of the fact that about 50,000 poisonous products can now be purchased in shops. The increased poison risks have led to advisory Poison Centers being set up in many countries. A subject of such great importance and size demands the widest possible treatment.

The authors begin with these Centers and their organization. They then describe the analytical techniques of forensic toxicology ; criminal misuse of poisons is today rare and simple to detect, which leaves the analyst free for work on social abuses such as drug

trafficking or drunkenness. Social factors enter again with agricultural and industrial poisons, since their use requires safety precautions. The second haif of the book takes the most common poisons one by one, including the many products (such as bleaches, medicines or garden chemicals) found in any home. After an account of the physiological action

of poisons on the body, a useful chapter follows on the treatment of cases of poisoning, the most important advice here being to keep the subject breathing until expert medical help arrives, and not to give drinks, especially not miik. A final chapter discusses the pollution of food, water and the atmosphere.

With 15 color and 35 black and white photographs and 3 diagrams

==

World

University Library

The World University Library is an international series of books, each of which has been specially commissioned. The authors are leading scientists and scholars from all over the world who, in an age of increasing specialization, see the need for a broad, up-to-date presentation of their subject. The aim is to provide authoritative introductory books for students which will be ofinterest also to the general reader. Publication of the series takes place in Britain, France,

Germany, Holland, Italy, Spain, Sweden and the United States.

F. Bodin and C.F. Cheinisse

Poisons Translated

from the French

by Harold Oldroyd

World

University Library

McGraw-Hill Book Company New York Toronto

© F. Bodin and C. F. Cheinisse 1970 Translation © George Weidenfeld and Nicolson Ltd 1970 Library of Congress Catalog Card Number: 77-77024 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any

means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner

Photoset by BAS Printers Limited, Wallop, Hampshire, England Manufactured by LIBREX, Italy

Contents

—

Introduction World organisation against poisoning Forensic toxicology

Industrial toxicology Clinical toxicology Poisons and war How poisons act Different types of poisons

RS CSG SOC ~~] CO

Industrial chemicals Agricultural chemicals Substances used in the home Drugs and medicines Vegetable poisons Animal toxins Drug addiction

The treatment of acute poisoning

209

Contamination of the environment

228

Appendix:

234

The distribution of Poison Control Centres

Bibliography

245

Acknowledgments

248

Index

249

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9 The treatment of acute poisoning

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This chapter deliberately omits the treatment of chronic cases of poisoning, because these are normally dealt with by qualified medical practitioners, and by psychiatrists if the subject is an addict. The overwhelming majority of cases requiring emergency treatment are victims of acute poisoning. The action to be taken in a case of acute poisoning falls into two parts: first aid, emergency action which should be carried out at once, by anyone who is available; and more comprehensive treatment, which is the business of a doctor,

and preferably a hospital doctor with specialist knowledge of clinical toxicology and resuscitation techniques. First aid Very often the chance of survival of a person who has been poisoned depends on what first aid is given. Now the things to be avoided are very few indeed, while a few simple first-aid techniques are within the capabilities of anyone: but it is necessary to learn both of these beforehand, and not wait until a poisoning has occurred. If a case of poisoning is discovered simultaneously by

several persons, one of these should take no part in the actual first aid, but should be responsible for giving the alert, reporting where the case is, and how to get there, the type of

poisoning, and how serious it is; this report should be made to the nearest doctor, the police or ambulance service, or even to the fire brigade, who are usually equipped with breathing apparatus and have experience of dealing with persons in danger of suffocation. After taking these prelimi-

nary steps, the same person can beuseful in gathering as much

information

as possible about

the poison involved,

what time it was taken, the state of the patient, and — if ina

country where the Poisons Information Centre accepts calls from the general public — seek advice from it regarding the

210

action to take pending the arrival of help. It goes without saying that the telephone numbers of the nearest doctor — or of the works doctor if there is one — the police, ambulance and fire brigade, and the Poison Control Centre, whether

national

or regional,

should

be displayed

permanently in every place where poisons may be encountered, and especially in factories and industrial plant. Meanwhile the other rescuers should start applying first aid to the victim. There should not be more than four helpers, otherwise they will begin to get in each other’s way. If the victim has been overcome by gas or vapour in an enclosed space, the rescuers should not go in until they have the protection of respirators, so as to avoid the classic error of falling victim themselves. If no respirators are available, then only one rescuer should go in, holding his breath and tied

with a rope, and the others should stand by to drag him out again if necessary.

If it is, or seems to be, a case of some poison having been

swallowed, one of the helpers should carefully gather up what is left of the substance and its container and wrappings, which may be found on the bed-side table of the victim; he should count how many tablets are left, or estimate how much has been drunk from a bottle, and pass this information on as quickly as possible to the person who is acting as messenger. The first steps in first aid are always negative ones, telling the by-standers what not to do, before they do more harm than good. For instance it is so often bad to give milk to

drink that it is best to start by forbidding this altogether.A “patient in a coma, or even in a deep sleep, should not be

given anything at all to drink, in case it chokes him. For the same reason nothing should be done to try to make a patient

Pall

vomit if he has swallowed a caustic substance (acids, alkalis, oxidating agents, formol), if he is asleep, or especially, in a coma, if he is suffering from convulsions, and finally, if he has drunk petrol or any detergent likely to foam. Induced “vomiting is justified only if the poison is so virulent that getting it up takes priority over any other consideration. An example is white phosphorus, and then it is essential to make the patient vomit with as little delay as possible, by giving him a little salt solution, then touching the back of the inside

of the throat.

_The idea of a universal antidote should be abandoned entirely: there is no such thing. The use of any antidote, antagonist or chelate compound,

is a very delicate matter,

even dangerous, and should be left to a doctor, preferably a specialised toxicologist. Nevertheless, in cases where a strong oxidising agent has been swallowed — such as chloride bleach, hydrogen peroxide, or potassium permanganate solution — it is recommended to neutralise this as quickly as possible with an aqueous solution of sodium hyposulphite, in concentration between 2 and 10 per cent, according to the strength of the poison swallowed. As we have said earlier, no _ attempt should be made to neutralise a strong acid with a strong alkali (or vice versa), but it is the right thing to give the patient as much water as possible to dilute the poison. Finally, the most imperative need_in_first aid is often to

keep the patient breathing, and many lives might be saved if this were

kept in mind.

This means

that if the patient is

unconscious and vomits he should be placed in such a position that his head hangs down and to one side, so that the vomit is thrown out and does not block the respiratory passages. Any poisoned person who is having difficulty in breathing when he is found should at once be helped by the

212

9:1 These three photographs show the correct technique for giving the ‘kiss of life’. 1. Preparation : the person is held firmly with the head and neck ‘outstretched’. 2. Approach : with one hand one pinches the nose of the person, while with the other hand one presses down the lower jaw so that the tongue cannot retract. 3. Breathing into the mouth of the victim.

most direct method possible, mouth-to-mouth respiration, or the ‘kiss of life’. Everyone should be taught how to do this: it only takes a few minutes to learn, and there are organisations in every country which are equipped to teach it. The first-aider should be determined not to give in, even if the patient appears to be dead. Besides mouth-to-mouth respiration, success may sometimes be obtained by external cardiac massage, but this is dangerous unless carried out by a fully trained person, and should not be resorted to unless the pulse has stopped entirely. Medical treatment of acute poisoning In a large number of cases the first problem is one of transport. In fact a growing number of countries have developed a specialist service for the transport of people who are seriously ill, with ambulances, helicopters or planes ready-equipped with apparatus

9:2 The correct position for external cardiac massage. The subject is placed on the ground or on any hard surface. The hands of the rescuer are crossed, and the finger-tips make contact with the breast-bone—not at the sides of the chest. Pressure should be firm, but gentle and progressive, avoiding any distortion of the chest.

215$

for supervising and controlling the working of various vital organs, breathing equipment and so on. The presence in the vehicle of a specialist in resuscitation ensures that the patient gets every possible care and attention during his journey. It is obviously impossible to list all the methods of treatment for every kind of poisoning, but the treatments can be considered as being directed towards three objectives: 1 To keep the various functional systems of the body — respiration, blood circulation, and so on — working during the critical period while the poison is being dealt with. 2 To speed up the elimination of the poison from the body. 3 In certain special cases only, to apply an antidote in the strict sense, an antagonist or a chelate compound. The first principle has completely transformed the prognosis in certain types of poisoning, notably in cases of barbituric coma. If the patient is suffering from a poison which depresses respiration it is essential that the initial mouth-to-mouth first aid should be supplemented as quickly as possible by some form of breathing apparatus, of which many types exist. Most of them are based on the original model invented about fifteen years ago by the Dane Engstrom, and all of them pump air — with or without additional oxygen — down a narrow tube inserted into the trachea of the patient. If artificial respiration has to be continued for more than a few days, then this tube must be replaced by one that is inserted surgically into a slit in the trachea, so as to avoid ulceration of the lining of the trachea from prolonged contact. Artificial respiration gives no help, however, if the cause of oxygen lack is faulty circulation of blood through low blood pressure or heart failure. If a close watch is kept on the blood pressure it is possible to maintain a sufficient flow

216

of blood to the brain and kidneys — both of which are essential to survival — by administering certain drugs which cause contraction of the blood-vessels, or by increasing the total volume of blood by giving a transfusion of blood or plasma. Similarly, continuous monitoring of the heart beat by means of an electrocardiogram enables this to be kept within essential limits by giving drugs which either accelerate or slow down the cardiac rhythm. To some extent this technique can be used to circumvent such heart disorders as fibrillation and ventricular tachycardia. If the heart stops altogether, then artificial respiration must be supplemented instantly by assisted circulation, either by external cardiac massage or electrical stimulation of the heart or a combination of the two. As we have seen, the delicate physico-chemical equilibria of the body are liable to be very seriously disturbed by a wide range of poisons. Hence the patient must be kept under strict observation, in order to check any variations of the pH of the blood, of the concentration of various elements in the blood plasma, particularly sodium and potassium; of the total volume of blood, and of the counts of red and white corpuscles;

and

of the urea

content

of the blood,

which

gives an indication of whether the kidneys are functioning correctly. Very often it is possible to take remedial action before the defect has developed far enough to endanger the patient’s life. The word ‘observation’ has been used several times in the preceding paragraphs, and, in fact, the patient’s life may depend on the frequency and regularity of examinations and tests. The time available before a heart-stoppage has had irreversible

effects is about

two

or three minutes,

so that

even a pulse-reading every five minutes — a difficult thing to

217

guarantee in a ward with several patients — is not sufficient to give full protection. Similarly, a blood pressure reading every half-hour,

an

arduous

task

for doctor

or

nurse,

cannot

guard against a sudden collapse. It is for these reasons that modern practice makes more and more use of electronic monitoring equipment, which records all these things on dials, on a panel where they can be kept under continuous observation. The more sophisticated installations ring a bell or flash a light when any needle moves outside a safety zone which can be fixed by the doctor in charge of each case. Some, monitoring heart conditions, can even be set to react automatically to heart failure by supplying a rhythmic electrical stimulus which will keep the heart muscle contracting regularly. Equipment of this kind is built in two forms, the one light and portable, so that it can be taken to the bedside of the patient, or loaded on to a plane or truck, the other heavy, elaborate and expensive, for use at a Centre where every possible treatment must be available. The problem of eliminating the poison from the body varies according to its nature. Some poisons are eliminated through the urine, and so the patient is given copious perfusions so that the flow of urine is increased. Again, the

poison

may

be more

soluble

in either acid or alkaline

solution, and it may be possible to vary the pH of the blood plasma in that direction, though the permissible limits are rather narrow before the safety of the patient is endangered. As we have seen, volatile poisons are eliminated from the body with the breath, and so it helps to speed up this process with breathing apparatus. Some poisons find their way into the blood at a particular stage of the poisoning, and it may be possible to give a

218

9:3

Two kinds of electronic monitoring equipment.

The one shown below

(Electronique Marcel Dassault, France) is semi-fixed, stands on a console on

the wall and is connected by cable to a central apparatus. The one opposite (Sanborn, United States) is light and mobile, and is shown here standing

on the upper platform of a trolley. On the lower platform can be seen the defibrillator, which is used where a heart is being weakened by ventricular fibrillations. The electrical impulses restore the rhythm to normal

220

9-4 This is a central post for electronic monitoring (Electronique Marcel Dassault, France) which receives information from a number of individual posts, transforms these into graphic data (the electrocardiogram appears on the oscilloscope to the left) or into numerical form (with figures appearing on the window to the right of the oscilloscope, recording the various parameters that are being measured), records these data on paper (rapid writer for the electrocardiogram on extreme left, slow recorder

for the other data on extreme right), and finally commits them to memory. In addition, it sounds an alarm if any of the parameters goes outside the safety limits fixed by the doctor in charge. The illuminated dials on the desk below, just above the nurse’s shoulder, light up to show which

parameter has fired off the alarm, and which patient is involved, while at the same time sounding a buzzer.

221

blood transfusion, replacing the toxic blood with fresh. Finally, a poisoned kidney may need to be helped by extrarenal epuration (for example, peritoneal dialysis, or even an artificial kidney) to avoid the accumulation

in the body of

excretory products, particularly urea. All the same, unless there are good reasons for not doing so, there is no substitute for getting the poison out of the gut before it has time to be absorbed, either by induced vomiting,

stomach pump, or a purge. The last should be an inorganic salt such as sodium sulphate and never an oil-based purgative which might actually help the poison to be absorbed into the body. The idea that every poison has an antidote should be vigorously resisted. Genuine antidotes are rare, in the strict sense of substances which either compete with the poisons for the attraction of the cells or form stable compounds with the poison and so neutralise its effects. It is true that the poison can sometimes be converted by a chelate compound into a chemical form in which it is quickly eliminated, and that, while some antagonists have fallen into disrepute (for example the use of strychnine and amphetamine stimulants in cases of barbituric coma), others are still essential under

the right circumstances.

223

10 Contamination of the environment

The steady growth of industry all over the world is a threat to human health because of the poisonous substances that

are being continuously released into the environment. At the same time the constant need for more and more food calls for the use of more and more preservatives and pesticides, many of which are poisonous to man. This risk was negligible at the beginning of the twentieth century, and first began to be seriously studied by toxicologists in the 1950s. There is no doubt that the world-wide urge towards more industry, the exploitation of new forms of energy, and the increasing numbers of people everywhere mean that by the end of the century the very survival of man could be endangered. Contamination of foodstuffs has been touched upon in beyond the subject of this more about it here. Human

Bacterial contamination an earlier chapter, and book, so we shall not foodstuffs are exposed

scale

two

contamination

from

other

sources,

of food extends say any to large-

accidental

contamination from agricultural chemicals, and deliberate use of chemical additives. Among the sources of accidental contamination, undoubtedly the most widespread is the effect of organochlorine insecticides, not only on table vegetables, but also on the flesh of herbivorous

animals such as cattle, and on

their milk products. While these insecticides may be eaten along with the fruit and vegetables that have been sprayed, a more serious risk is that to infants and young children who are given what may be contaminated milk. So far the concentrations reached fall well below the danger mark, but in all the advanced countries the concentrations in samples of milk and milk products are constantly rising. Part of the poison is eliminated, but part of it is absorbed by fatty

224

tissues because these substances are mainly fat-soluble. Cases have already occurred where a sudden loss of weight has released a reservoir of organo-chlorine compounds which had accumulated in the fat, and given a concentration sufficient to cause poisoning. We can no longer ignore in this connection various hormones and antibiotics that are fed to fat-stock to make them grow more quickly and to increase the proportion of useful weight in the carcase. This growing practice has already led to poisoning cases among people who eat a lot of poultry, who may be sensitised to the antibiotic, or be affected by the oestrogens used in chemical caponisation in ways that they did not expect. Food additives may be grouped into three classes: Preservatives, substances intended to improve the taste or smell; and substances intended to alter the colour or consistency. Additives of the first group are obviously essential, especially in a world where hunger is an ever-present problem. It would be impossible to send food to under-developed countries without preservatives. Nevertheless those responsible for deciding on the preservatives to be used might give more consideration to the cumulative effects of small, but repeated doses of poisons. One example is boric acid and various borates, which are authorised in some countries for the preservation of fish, shell-fish, powdered eggs and butter. Recent research has shown that these compounds may accumulate in the cerebral tissues, and if their concentration rises above a certain level they may inhibit the utilisation of oxygen and of adrenalin. Similarly certain anti-oxidants such as thiourea, are used to keep fruit and fruit juices from turning brown, and oils and fats from going rancid; taken in

225

‘

small doses over a long period they have been shown capable of causing cancers of the liver and thyroid and are already prohibited in some countries. Additives of the other two classes are obviously not essential and their use is dictated purely by commercial considerations. A long time ago it was found that the public preferred its margarine to be dyed yellow, so that it looked more like butter, and some of the colorants used have been

shown to be cancer-forming. Though the public has now been educated into accepting white margarine, it still expects its butter to be yellow at all times of the year, although at certain seasons some kinds of milk are deficient in carotene pigments, and will not give butter of this colour naturally. For fear of being unable to sell its produce, a milk co-operative or butter factory is tempted to give the consumer the colour he wants. In August 1960 the Netherlands had an epidemic of poisoning involving several thousands of cases, mostly not serious, because the producer had the idea of improving his product by adding an emulsifier so that the margarine did not spit in the frying pan, an attractive publicity gimmick. Public authorities ought to get together more effectively in this field, placing tighter restrictions than at present exist on unnecessary additives to food. Legislation in different countries ought to be brought more into line: at present an additive permitted in France may be prohibited in Germany, and vice versa. Finally it is in the interests of the producers themselves — since additives cost money — to persuade the public to like pale butter and grey bacon, to present two common foodstuffs in their natural colours.

Water pollution Anyone living in an industrial country, and

in a town with a river, is certain to have seen a mass of foam collecting below a sluice-gate, or against the pillars of a bridge. As more and more synthetic detergents are used, they inevitably pass into the waste water, which is discharged into the rivers, either directly by industrial works, or indirectly through the sewers by domestic users. We have already seen in chapter 8 that anionic detergents are not very poisonous if taken as a single massive dose, but we have little information about any effects that they may have in repeated small doses. Now these substances pass through any normal filters, and so concentrations of up to several milligrams per litre may pass into the drinking water.

10-1 The great increase in detergents of industrial and domestic origin in the streams and rivers of developed countries often causes the water to froth below large towns.

227

Cationic detergents are more obviously dangerous, because they are known to have toxic effects in heavy dosage, and they will certainly have long-term effects if small doses are taken over a long period. Some industrial firms, more concerned with their immediate profits than with the public health, discharge into rivers such products as phenols, toxic to man in small doses, and petroleum hydrocarbons, which by spreading as a thin film over the surface of the water prevent the normal purification of the water by aerobic micro-organisms. Finally, the ever-increasing use of organo-chlorine insecticides, which is now almost world-wide, means that they are carried down by rain water into streams and rivers and reach supplies of drinking water in concentrations that may already exceed several milligrams per litre. We have deliberately omitted any mention of radioactive contamination of water supplies, because the dangers to man from radioactivity require a separate study. All rivers and streams discharge their contaminated water into the sea. The volume of the oceans is immense, to be sure,

but the continuous cycle of rainfall and evaporation means that the concentration of dissolved matter in the sea is inevitably going to rise, as indeed the salinity of the oceans has risen steadily throughout geological time. Specialists have calculated the date at which they expect the detergent content of the oceans to rise enough to make them foam, assuming the present rate of discharge into the rivers, and they set this date as between 2020 and 2040: that is, within the lifetime of children being born today. A more immediate danger than the foaming will be the effect of this concentration of poisonous substances on the ocean plankton, which is the food of fishes, as well as an increasing concentration of

228

10:2 Measuring air pollution caused by traffic in Berlin. Air pollution caused by traffic can build up to dangerous levels in certain circumstances. Here the main components of the atmosphere being monitored are carbon monoxide, carbon dioxide, hydrocarbons, aldehydes and lead dust.

these substances in the flesh of fishes caught for human food. Atmospheric pollution All the waste fumes from industrial processes, and from domestic sources as well as from all the

internal combustion engines of the world, are discharged into the atmosphere, where winds and gaseous diffusion normally ensure that the concentration of poisonous gases does not rise to dangerous levels. All the same it must be emphasised that as long ago as 1936, at peak hours of the Paris traffic, the concentration

of carbon monoxide

rose to

15 per cent of the maximum permissible concentration of this poisonous gas. Moreover, this is not the only poisonous gas at present produced by the burning of motor spirit, which contains among other things the notorious tetraethyl lead. The concentration of sulphur dioxide in the atmosphere of towns can be estimated very precisely, provided that we know the tonnage of coal burned, and its sulphur content. For Paris we arrive at the figure of 80 million kilograms of sulphur dioxide per year, of which an appreciable fraction is washed down by rain in the form of sulphurous acid, and is responsible for much of the decay of stonework. As for solid particles of all kinds, the tonnage of these in suspension in the atmosphere of towns is staggering. In some industrial areas the annual solids deposit per square metre is more than 250 grams. There is a further danger in towns. Under certain meteorological conditions the air over the town may become trapped

under an invisible barrier and be completely cut off from the atmosphere outside. These conditions are often caused by a thermal inversion in the atmosphere, but in some localities they are semi-permanent, as a result of the lie of the land in relation to the prevailing winds. Such a situation, with a

mixture of fumes and fog, is the cause of the smog that is well known at times in both London and Los Angeles. In 1930, the valley of the Meuse in Belgium near Liège was affected by a dense fog which contained so many poisonous gases that many people died, and which affected first those people who were already suffering from respiratory deficiencies. Apart from spectacular disasters on this scale, it is well known in towns subject to smog that the deaths from respiratory complaints rise steeply at such times. But human activity does not only affect the atmosphere in towns: the whole atmosphere of the earth is involved. Here again, as was true of the oceans, the total volume is so great that one might think that poisonous vapours would be so diluted that they would soon become harmless. This is true for the gases that are poisonous in the strict sense, but it is not true for carbon dioxide, which is a by-product of all

+

201

10:3 These two photographs, taken in identical weather with the same exposure and the same film, show the Paris sky at times twenty-four hours apart. In the top photograph the sky is clear, and the distant buildings stand out sharply ; itis Sunday and the factories are shut. The bottom photograph was taken on a Monday, and industrial fumes and soot belch from a chimney, despite regulations to the contrary which have been in existence since 1935.

forms of complete combustion. In fact, between the end of the Mesozoic Period and the beginning of the Industrial Era, the earth’s atmosphere had reached a state of dynamic equilibrium between the oxygen set free by the photosynthetic activity of plants (which is actually the source from which all the oxygen of the atmosphere is derived), and the carbon dioxide produced by the respiration of all the animals and plants together. This is no longer true. By burning coal — fossil carbon of the Mesozoic — and petrol — a fossil hydrocarbon which is probably of animal origin — man has now begun to alter the composition of the earth’s atmosphere in the direction of an increased concentration of carbon dioxide. It is true that this is not a poison in the strict sense, but it is a contamination of

the human environment by a gas which, as its concentration rises, will set up a ‘greenhouse effect’, warming up the earth’s surface and producing incalculable results. Radioactive contamination The radioactive dangers that are present on earth have been mentioned previously. Nuclear activity imperils the whole of the human environment, acting on man through his food, through his drinking water, and through the air he breathes. Man has always been exposed to natural radiation, which is calculated to amount to 0-230 Rem per annum. In recent

iJ)

years this annual irradiation has risen by 39 per cent, to a total of 0-320 Rem per year. The greater part of this increase of 0-090 is accounted for by the medical use of x-rays (0-050), while 0-030 Rem per year comes from the wearing of luminous watches. Finally all the nuclear explosions that have been carried out by the great powers have resulted in an annual increase in radiation for every person on earth of 0-010 Rem. This increase may seem tiny, but we have to remember we are still only on the threshold of the nuclear

age; that the amount of radiation will get bigger, not less; and that the cumulative effect of repeated small doses of radiation does not have any threshold: every small increase is an added risk. In this field, too, certain biological mechanisms aggravate

the risks from concentration effects. Thus after the experimental nuclear explosions carried out by the USA there was found to be an increased radioactivity in the milk in certain areas. An investigation showed

that radio-strontium,

a by-

product of the explosions, was carried long distances by upper winds, and had been absorbed and concentrated by some of the plants forming part of the herbage on which the cows fed. Similarly, after some of the tests in the Pacific, a

process of selective absorption gave a significant rise in radioactive content in certain food-fishes, in waters a long way from the site of the explosions. Of course the danger from this source is almost negligible at the present time, but it is bound to get worse with the increasing use of nuclear energy in future and the release into the rivers of even faintly radioactive waste water. The dumping of waste radioactive materials in containers into the ocean depths will eventually be dangerous when marine corrosion has been at work on them.

233

There is no question of trying to halt the march of progress, or even some of its manifestations such as nuclear industry and the use of organo-chlorine pesticides. The business of toxicology should be to study the risks involved in this progress, to publicise them, and to play its part in minimising them. For if this is not done, man will find that he has attempted too much, and has been the architect of his own

destruction.

Appendix The distribution of Poison Control Centres Argentina A national Poison Control Centre was opened in 1962 at the Children’s Hospital in Buenos Aires, under the direction of Professor Astolfi, who holds the chair of Pharmacology at the Faculty of Medicine. During the first two years that it was in operation this Centre received more than 4,000 appeals by telephone, 850 of them involving adults. Even though this Centre is located in a hospital it confines itself to giving information and does not offer treatment. Australia

A national

Centre,

the National

Poisons

Service,

an

offshoot of the Department of Health in Canberra, plays the part of the National Clearing House in the usa, or of the Association Européenne des Centres de Lutte contre les Poisons. It therefore exercises a co-ordinating function between the nine Information Centres which are being set up in each of the nine States of the Commonwealth of Australia. These nine Centres will be located at hospitals

so that, in addition

to their information

service,

the

Centres can also call upon the hospitals for treatment. Note that in Australia the central co-ordinating body has come into existence in advance of the individual Centres, the reverse of what has happened in most other countries. Belgium Since 1963 Brussels has had a National Centre for the Treatment of Poisoning, a private organisation which receives a state subsidy and operates in premises provided for it by the Belgian Red Cross. Since 1965, this Centre, directed by Professor Govaerts, has been able to provide a 24-hour service by telephone in urgent cases. As for treatment, this is available for serious cases

by telephonic liaison between the Centre and the resuscitation services of a number of hospitals in the bigger towns. The Belgian Centre gives quite a remarkable service, despite the difficulties of having to use two languages, and while it still receives only a moderate number of appeals (3,500 in 1966), it has been conceived with an eye upon future demands and on the inevitable increase in the number of calls upon it. It classifies a very great

The information centre at ZUrich. The doctor answering a call has at hand all the tools of his trade : telephones, tape recorders to record questions and answers so that he does not have to make out the file card until the call is over, standard works of reference available on the desk or in a library near to the left of the photograph, and rotary card-index in the background containing full details of the toxicological properties of poisons.

a.

a

Ia,

CE. Geo»

Bim,

Bons

236

mass of information methodically and rationally, makes this information readily available to doctors and even to the general public (with campaigns for the prevention of risk of poisoning), and maintains regular contacts with the manufacturers of industrial products, both agricultural and domestic. Brazil Since 1962 there has been a Centro de Controle de Intoxicacoés at the Paediatric Clinic of the university hospital in Sao Paulo, which functions as a centre of diagnosis, treatment and research, exclusively for children less than eleven years old. This organisation maintains a close liaison with the other emergency services and resuscitation services of the same hospital, with the Department of Pharmacology, and the state laboratories of toxicology; but it does not seem to function as a general information service. Bulgaria The Centre for the Treatment of Poisons directed by Professor Monov, operates at the Pirogof Institute of Emergency Medicine in Sofia. The Centre offers both information and treatment, and also runs a laboratory that has two functions: identifying and estimating poisons in patients who have been admitted to hospital, and scientific research in toxicology.

Canada In spite of having the relatively small population of only sixteen million, Canada — intentionally or not — has copied the organisation of the United States, which has eleven times as many people. This has resulted in an extraordinary proliferation of Poison Control Centres (222 in 1963), so that any one of these can

hardly expect to receive more than a few calls upon it. There is no central organisation. The Centres came into existence by private enterprise all over the country, in hospitals, local universities, research institutes, health institutes and private clinics. They are loosely controlled by the Ministry of Health, but for information and advice they often turn to the central organisation of the United States. Bilingualism seems not to be a major problem since there

237

are so many Centres that each applicant can find a Centre that operates in his own language.

Colombia An Information Centre is being developed under the direction of Professor Alfonso Matallana, in the Department of Pharmacology of the Faculty of Medicine on the University of Valle, at Cali.

It does

not

undertake

treatment,

but places its

experience in toxicology at the disposal of the emergency service of the University Hospital of Valle.

Czechoslovakia An Information Centre for cases of acute poisoning operates under the direction of Professor Teisinger at the Clinic for Occupational Diseases in Prague. This organisation, which was set up by the Ministry of Health, does not undertake to give information to anyone but doctors. Its documentation is very complete and its staff (one doctor and one pharmacist) should have plenty of time to keep it in order, since they have very few enquiries (250 per year in 1965-66). Three secondary Centres exist, at Brno, Pilzen and Hraden Kralove. Czechoslovakia has no Treatment Centre specialising in poisoning cases which are dealt with by individual hospitals. Denmark

Although this country saw the initiation, in 1949, of the

first specialist service for the treatment of acute poisoning, it seems as if no further progress has been made since that date. Serious cases of poisoning throughout the country are referred to this service, directed by Dr Clemmesen, and attached to the psychiatric clinic at the Bispebjerg Hospital in Copenhagen. No toxicological Information Centre exists. East Germany At present there are two Centres in operation, one in East Berlin and one in Leipzig, under the aegis of the Institutes of Pharmacology and of Toxicology respectively of the two towns. During 1966 the Leipzig Centre received about sixty calls per month. Neither Centre gives treatment. Certain beds in the univer-

238

sity hospital in Leipzig are reserved for serious poisoning cases; in other towns such cases are treated by the normal medical and paediatric services, if necessary seeking advice by telephone from one of other of the two Centres. Finland The opening of a Toxicological Information Centre, which will probably be located at Helsinki, is under consideration. This is the only one contemplated and will supply information to the whole country. There is no Centre for specialised treatment, nor does one appear to be contemplated in the immediate future.

France Opened in 1959 on the initiative of Professors Gaultier and Fournier, the Poison Control Centre in Paris has the merit of being one of the rare examples of a complete and co-ordinated Centre. Under the authority of the Professor of Clinical Toxicology at the Faculty of Medicine in Paris it has at its disposal all the various weapons in the campaign against poisoning. The number of appeals to its services has grown steadily and has reached the order of 15,000 per annum, while the number of serious cases under treatment each year exceeds one thousand. The Centre at Lyons, opened in 1961 by Professor Roche, also

functions both as Information Centre and Treatment Centre. At Nancy

(Professor

Senault),

at Tours

(Professor

Vacher)

and

at

Marseilles (Dr Jouglard), the Centres limit themselves voluntarily to giving information only: those at Tours and at Nancy specialise in agricultural and domestic poisoning respectively. Since 1962 the activity of these Centres has been co-ordinated by a national organisation, le Groupement Français des Centres de Lutte contre les Intoxications, which — in contrast to the American equivalent — was set up by private enterprise. In Paris a national Information Centre keeps an eye on co-ordinating the documentation between the various French Centres and keeps them in touch with Centres abroad.

299

Great Britain As we have seen, this was the first country to have, in 1950, an organisation that offered both information and treatment. Many years later, within the structure of the National Health

Service, this purely private enterprise was rounded off by the creation of National Centres at Guy’s Hospital in London by Dr Goulding, and of a Regional Centre at Cardiff, Belfast and Edinburgh respectively. All four Centres, however, confine themselves to information, and none of them offers treatment.

Serious

cases of poisoning are referred to the resuscitation services of individual hospitals. Whereas in most countries the Poison Control Centres accept calls from the general public as well as from doctors, in theory at least the British Centres deal only with qualified doctors. This is a result

of the existence

of the British

National

Health

Service,

through which any person can apply to a doctor quickly and without payment, and he will decide whether or not to refer the case to the Poison Control Centre.

Holland Two Information Centres exist. Besides the one operated by the KNMP, which as we have seen was the earliest in the world, there is a national organisation, the National Vergiftigingen Centrum, operating in Utrecht under the direction of Dr Van Heyst, and within the framework of the RIV (the National Institute of Public Health). These two organisations naturally exchange information. Whereas the KNMP unit, originally set up for pharmaceutical use, now extends its services to doctors, the National Centre responds to every appeal, even those coming direct from the public. Actually few people make use of this facility: out of 663 telephone enquiries in 1965, 595 came from doctors, 60 from pharmacists and only 8 from members of the public.

Hungary Although no Information Centre exists in Hungary, there are two remarkably well equipped Treatment Centres in Budapest, one for adults and the other for children. These are enough for the whole country, thanks to the existence of a Medical Transport

240

Service which makes it possible to move sick people from even the most remote places quickly and under the best conditions, supervised by a doctor specialist in resuscitation techniques. Ireland A National Centre, operating on a small budget, is located at the Jervis Street Hospital in Dublin under the name of Poisons Information Service, and treatment is given by the resuscitation service of the same hospital in collaboration with the Centre. Alone in Europe, Ireland has chosen — probably because of its lack of funds — to allow telephone enquiries to be answered by a nonmedical person. During office hours a secretary answers; at other times this task devolves upon the duty nurse of the hospital. In both cases advice can be sought from a doctor. Israel Though no Centre, properly speaking, exists in Israel, a national organisation called the Israeli Poison File compiles the basic information in the shape of a file which is continually kept up to date and which is circulated to all hospitals. The idea of sending it to every doctor is under consideration. Italy An Italian group for the study of measures against poisoning, set up in 1966 and presided over by Professor Gerin, is considering the organisation of an information service by telephone. At present, treatment is carried out by the resuscitation services of the various hospitals, one of which — at Milan, under Professor Cavaciuti — specialises to some extent in poisoning cases.

Morocco A Treatment Centre forms part of the emergency and resuscitation unit at the Hôpital Averroes in Casablanca. The possibility of forming a telephonic Information Centre, no doubt at the same hospital, is under consideration.

New Zealand A National Information Centre has been in operation since 1964 at the Department of Pharmacology of the Medical School, University of Otago (Dunedin), under the direction of

241

Dr McQueen. The treatment of serious cases of poisoning is carried out by the emergency services of the Dunedin Hospital in collaboration with the Information Centre. Norway A single Information Centre, serving the whole country, is the Gift Kartoteket, housed by the Institute of Pharmacology in Oslo. This organisation, financed by the Ministry of Health, provides information only and functions only during office hours. Very fortunately for those people who fall victim to poisoning outside office hours, a duplicate file has been lodged with the duty staff of a nearby hospital (Ulleval Hospital, Professor Enger), so that there is a continuous service for telephone enquiries. Like in Great Britain, this service is restricted to qualified doctors.

Poland Three Information Centres, part of the Ministry of Health and Social Assistance, are in operation in the Institutes of Industrial Medicine in Lublin, Lodz and Zabrze. The Centre at Lodz is res-

ponsible for maintaining and keeping up to date a joint index, in which every entry that is added or altered by Lodz is at once passed on to the other two Centres. The Ministry contemplates setting up five other Centres in the near future. There is no Treatment Centre that specialises in handling poisoning cases, but the medical institutes of the three towns where the Information Centres are located are accustomed to doing so.

Portugal No Information Centre actually exists at the present time, though the Instituto de Medecina Legal of Coimbra is looking into the possibilities of founding one. In view of the lack of any official organisation, Dr Filipe Vaz has set up a private Information Centre, Centro de Intoxicaçoes, Informacao e Assisténcia Medicas, though this seems to receive very few enquiries. Finally the country has no service specialising in the treatment of poisoning cases.

Spain Although no telephone Information Centre exists, the University Hospital in Barcelona possesses a centre for clinical

242

toxicology and resuscitation which gives treatment to victims of acute poisonong.

Sweden The old-established Giftinformationscentralen is a national Information Centre directed by Dr Karlsson, and located at the Karolinska Sjukhuset in Stockholm, as part of the paediatric service of Professor Lind. In order to make the best use of its massive documentation, this very modern Centre operates a 1BM 360 computer. Although in its early days this service dealt only with doctors, the Centre nowadays gives information to the general public as well. There are no Swedish Centres for clinical toxicology, Serious cases are referred to the two resuscitation services in Stockholm, one for adults and one for children, both of which are remarkably well-used. Switzerland In 1966, the Swiss pharmaceutical society (Schweizerischer Apothekerverein) opened an Information Centre (Toxikologisches Informationszentrum)

in Zürich, and this works

in exemplary fashion, despite the difficulties caused by three languages. This Centre is directed by Professor Borbely. Switzerland has no Treatment Centre. Cases are dealt with by individual hospitals, making use if need be of information obtained by telephone from the Information Centre. USA The situation in the United States is exactly the reverse of that in the USSR in the following respect: instead of a single Centre under direct State control, the USA has an extraordinary proliferation of Centres attached to State Departments of Health, to townships, to hospitals, to Medical Schools of Universities, to regional or local Medical Associations, plus some that have sprung up on the private initiative of doctors or pharmacists — sometimes even set up by a nurse, or by a religious community. In some densely populated regions there is only one Centre, while certain towns of only minor importance have several Centres each. Some Centres, such as the one in New York which was set up in

243

1955 by Dr Jacobziner, and which is attached to the Municipal Department of Public Health, receive more than twenty thousand applications per annum; in the same period others may receive only ten or twenty. The quality of the advice given is very variable since the Federal authorities do not impose any standards upon the staff in charge of such Centres. Most of the Centres confine themselves to supplying information, and many States are without any specialist service for the treatment of poisoning cases. Superimposed upon all this apparent confusion there is, fortunately, a federal organisation which imposes a degree of coordination and effective circulation of information. In particular this National Clearing House for Poison Control Centers supplies to the Centres free, on demand, a copy of the very valuable file which it keeps constantly up to date. Another important part of the activity of the National Clearing House is the organisation of national campaigns against the risk of poisoning: educating the public by means of films, the press, posters, tracts, radio and television. Finally, there is a National Association which represents the Poison Control Centres collectively.

USSR A remarkably well organised Centre for both treatment and information operates under the direction of Professor Soukinin as part of the Sklifossovski Institute in Moscow, itself an emergency hospital. Besides the Information Service (which is at the disposal of doctors and lay public alike) and the hospital treatment service, there is a biochemical laboratory that specialises in the various techniques of toxicological analysis. In spite of the enormous distance that separates Moscow from the boundaries of the Soviet Union it does not seem that there are any other Centres. Medical emergencies have priority over the long-distance telephone cables, and there is an efficient system of air transport for serious cases, so that circumstances have favoured the concentration of resources in a single Centre.

244

West Germany Specialist services for the treatment of acute poisoning exist in West Berlin, Munich, Hamburg, Augsburg, Cologne

and

Mainz.

One

of these, the Centre

in West

Berlin,

operates an embryonic information service by telephone. It is noteworthy that the two German republics have stressed opposite aspects of the problem, one giving priority to information and the other to treatment. Yugoslavia Three Centres, in Belgrade, Zagreb and Ljubljana, modelled on the one in Paris, supply both information and treatment.

All

three

are

state-controlled,

and

deal

only

with

doctors.

Table 7 Principal Centres for toxicological information in the English-speaking parts of the world* Town

State and Country

Cleveland Dunedin Los Angeles Montreal New York

Ohio, USA New Zealand California, USA Canada NY, USA

number

CETS500 76 740 4 2121

WE 7 8511 212 566 8020

Philadelphia

Pennsylvania,

Seattle Winnipeg

Washington, USA Canada

*

Telephone

USA

MU

6 5187

LA 4 4300 15518311

English and Irish Centres are omitted because they give information only to qualified doctors.

Bibliography

245

J.M. Arena, Poisoning, C.C.Thomas, Springfield (IIl.), 1963. Written by a paediatrician, this book approaches poisoning with particular reference to children. Intended though it is for medical readers, it gives a broad survey without going into too many medical details. Sven Moeschlin, Poisoning: Diagnosis and Treatment, Grune & Stratton, London/New York, 1965. One of the few definitive and comprehensive works on clinical toxicology, this is an invaluable reference. T.A.Loomis, Essentials of Toxicology, Henry Kimpton, London/ Lea, Philadelphia, 1968.

In effect this is an introduction to toxicology as an academic and experimental discipline. C.H.Thienes and T.J.Haley, Clinical Toxicology (4th edn), Kimpton, London/Lea, Philadelphia,

1964.

This has the flavour of chemical and forensic toxicology with, today, more historical than contemporary comment. D.C.Trainor, A Handbook of Industrial Toxicology, Angus & Robertson, London,

1966.

In its small and succinct way, a very useful handbook of poisoning in relation to industry. H.Matthew and A.A.H.Lawson, Treatment of Common Acute Poisonings, E. & S. Livingstone Ltd, Edinburgh/Williams & Wilkins, Baltimore, 1967. A convenient if not exhaustive aide memoire for the practising doctor or casualty officer. J.D.P.Graham, The Diagnosis and Treatment of Acute Poisoning, Oxford U.P., London/New York, 1962. As a textbook of poisoning for the doctor and student, this gives a good account of poisoning in Britain; based on statistics and practical experience. E.Boyland and R.Goulding, Modern Trends in Toxicology,

246

Butterworth Press, London,

1968.

A work for the specialist, especially in the laboratory, not in the clinic. As the title implies, this highlights the modern approach. A.S.Curry, Poison Detection in Human Organs, C.C.Thomas, Springfield (IL), 1963. Written by one of the foremost analytical toxicologists of the present day, this is an essential guidebook for the practising laboratory specialist. P.M. North, Poisonous Plants and Fungi, Blandford Press, London,

1967. A conveniently small handbook of plant poisons in Britain which is very helpful for recognition but tends to take a sinister view, almost alarmist. A.A.Forsyth, British Poisonous Plants, H.M. Stationery Office, Bulletin No. 161, Ministry of Agriculture, Fisheries and Food, 1954. Despite its date, still a reliable reference, but orientated more to

veterinary rather than to medical practice. F.Lampe and R.Fagerstrom, Plant Toxicity and Dermatitis, Livingstone, Edinburgh/Williams & Wilkins, Baltimore, 1968. In the North American context, this is currently the outstanding work on plant poisoning. C.H.Gray, Laboratory Handbook of Toxic Agents, Royal Institute of Chemistry, London,

1961.

An invaluable guide, especially in an emergency, when accidents may have occurred with common chemical reagents used in the laboratory. R.H. Dreisbach, Handbook of Poisoning (Sth edn), Lange Medical Publications, Los Altos/Blackwell, London,

1966.

Everyman’s guide to acute poisoning; with this at hand, anyone can be an authority on toxicology. M.N.Gleason, Gosselin and Hodge, Clinical Toxicology of Com-

mercial Products, Baltimore, 1963.

Livingstone,

Edinburgh/Williams

&

Wilkins,

With a distinctly American bent, this presents a unique and extensive account on the toxicity of household products, etc. W.F. von Oettingen, Poisoning — A Guide to Clinical Diagnosis and Treatment, Saunders, London/Philadelphia, 1958. Excellent in its day, but now due for revision. C.J.Polson and R.N.Tattersall, Clinical Toxicology (2nd edn), English U.P., London,

1969.

A readable and anecdotal work full of fascinating case histories, but not so reliable as a reference. N.Irving Sax, Dangerous Properties of Industrial Materials, Chapman & Hall, London/Reinhold, New York, 1957. Indispensable as a reference for the industrial medical officer. E.H.Bensley and G.E.Joron, Handbook of Treatment of Acute Poisoning, Livingstone, Edinburgh/Williams & Wilkins, Baltimore, 1963. A small book, full of common sense on acute poisoning. Highly recommended for the casualty officer, general practitioner or consultant physician. E.Browning, Toxicity and Metabolism of Industrial Solvents, Elsevier, London/New York, 1965. An excellent, authoritative and most exhaustive reference on the

industrial hazards of solvents.

Acknowledgments

Acknowledgment

is due to the following for the illustrations (the number

refers to the page on which the illustration appears): 8, 28 Mansell Collection; 14 after Sunshine, Gavaerts and Gaultier Roche; 18, 19 American Association of Poison Control Centers; 31, 32, 33, 34, 35, 38, 42, 43, 136-7

Poisons Reference Service, Guy’s Hospital, London; 46 Wellcome Foundation; 51 Royal Society for the Prevention of Accidents; 84 Keystone; 88-9 Daily Telegraph; 93, 101, 117 Professor Keith Simpson;

100, 185, 186,

189, 197, 198-9, 226, 229 Paul Popper; 117 Department of Audio Visual Communication, St Mary’s Hospital Medical School, London; 144, 151, 168, 169, 173, 176 Pharmaceutical Society of Great Britain; 191 Zoological Society of London; 235 Centre d’Information Toxicologique de la SSPH Institut médicolégal de l'Université de Zürich. The publishers would like to thank Dr B. Widdop of the Poisons Reference Service, London, for invaluable advice on the illustrations, and for allowing

Ken Coton to photograph inside the Centre. Dr R. Goulding of the same Centre gave much encouragement in the early stages. The diagrams were drawn by Design Practitioners Ltd.

Index

249

abortions 62, 64, 69, 74, 145, 159, 170, 171 abrin

170

Academy of Sciences of the USA

thiono-phosphates)

122

accidents 62, 63, 66, 67, 93, 118, 128, 135, 160; to children

15, 57, 58, 62,

63, 69, 93, 134, 147-8; at work 25, 29, 39, 53, 54, 55, 62, 63, 69, 207, and see

industrial injuries; road 25, 40, 41, 57, 160, 207; therapeutic 62, 63 accumulators, manufacture of

50, 114 acetylene 105 acids 45,91, 104, 131, 142, 143, 145, 146, 211, 224; caustic 111; amino 164, 180 aconite (Aconitum nappelus or A. columbianum) 165-6 adrenaline 106, 150, 224 agriculture 11, 82, 106, 111,

112; agricultural workers 49 alcohol 11, 25-6, 36, 119, 132, 133, 141-2, 146, 150, 177, 205-7; and forensic medicine 40-1; ethyl 142; glycol 141; mono-ethyl-glycol 141-2; methol

141, 142;

poly-alcohols 148; consumption statistics 206; see also antabuse effect alcoholics 113, 132 alcoholism 67, 205-7 alkalis 54, 91, 111, 142, 145, 211 alkaloids 27, 155, 156, 163,

164, 165, 166, 196, 201, 203, and see strychnine, veratrine

alkyl-pyro-phosphates 129, and see tetraethylpyrophosphate alkyl-thio-phosphates (aryl-

129,

and see parathion, melathion, diazinone,

artificial silk industry

atropine 7, 156, 162, 163, 165, 166, 178, and see belladonna

aubergines 162 autopsy 36, 117

15, 134

American Association of Pharmacy 134 amino groups 117, 118 ammonia 53, 132-3 amphetamines 92, 203, 221

158 7, 106

anilines 45, 118, 119, 132; aminobenzene

45

anions, see detergents antabuse effect 174

132, 133, 150,

7, 92, 93, 145,

Balloon fish (Tetraodon) 179 bananas 162 Banting and Best, discoverers of insulin 187 barbiturates 10, 71, 92, 150; barbituric coma 92, 150,

and favism

158-9,210-11,215, 221; use of milk as 8, 1056,

146, 210 antifreezes 141-2 anti-malarial drugs 93, 158, 159, and see quinine, chloroquine apiol 159-60 apples 162 apricots 67 Arachnida 192-3; Black Widow Spider (Latrodectus mactans)

bacteria, see micro-organisms Badische Anilin und Soda Fabrik 45

215221 barium 141 beans 93, 164, 181;

antibiotics 109, 224 anticoagulants 138-9 antidotes

54, 107

Arum maculatum 167 aspirin (acetysalicylic acid) 69, 71, 154-5, 161 atomic bomb 85, 122

almonds 162 alpha-naphthyl-thio-urea (ANTU) 139-40 American Academy of

amphotericin

76, 102,

214, 215, 216

allergies 22, 160-1

anaesthetics

113,116 arsine, see gas, poison artificial respiration

chlorthion, endothion, demeton

Paediatrics

131, 193; marsh test for 8, 26~7; white (arsenious trioxide)

193;

scorpions 193 argyrism, see mercury poisoning arrows, poisoned 7, 79 arsenic 8, 26-7, 54, 112-3,

164;

St Ignatius’ bean, see strychnine; castor oil bean (Ricinus communis) 170, and see ricin beech nuts 162 bees, see insects

belladonna (Atropa belladonna)

156, 165, 167, 178,

179 benzene

49, 52, 54, 108, 122,

127 benzol (compounds)

benzyl carbides

45, 108

109

Bernard, Claude 7, 27, 98 betel nut 194, 202-3; Areca catechu 202; Chavica betle

202

250

biguanides

carotene pigments 225

158

bitter-sweet (Solanum dulcamara) 167 bleaches, chloride 71, 143-5,

146, and see hydrogen peroxide, potassium permanganate, potassium hypochlorite, hypochlorite of sodium, sodium hyposulphite Boccarmé case 27 bonito

179

Borgias

cassava, sweet (Manihot aipi)

163; bitter (Manihot utilissima)

163 castor oil plant, see beans cations, see detergents caustics 19, 95,97, 112, 132, y iar caustic potash 111 caustic soda 91, 111, 146 celluloid 104 cellulose

112

54, 107

calcium 143, 160 calcium cyanamide

133

chelate compounds 102, 117, 124, 211 chemical industry 10, 45-7, 79, 104 chemical warfare 11, 79, and see gas, poison chemicals, synthetic 11, 16, 45, 49, 71, 73, 74; industrial 97 passim cherries 162 chinchoua bark, see quinine chloramphenicol 158 chlordiazepoxide 70 chloride of lime 82

calcium phosphate

133

chlorine, see bleach, gas,

boron

131;

borates 224; boric acid 224 botulin 85, 86, 181; botulism 85, 181-2 breathalyser 41 Brieger 180 bronchitis

80, 109

bryony (Bryonia dioica) 167, 169 butane 102

Cannabis (indica) 202;

Indian hemp 202; marijuana 202, 207; hashish 202; pot 202 cancer 119, 122, 123, 225 capital punishment, by poisoning 86 caraway seeds 162 carbon 103; carbon dioxide

103-4,

229-31; carbon disulphide 54, 106-7;

carbon monoxide 98-9, and see gas, poison; carbon tetrachloride 107-8,

127 carbonyl chloride, see phosphene carcinogens 45, 118

poison chloroform 106 chloropicrin 138 chloroquine 159 chlorthion 129 cholinesterase 129, 131 Clostridium botulinum, see botulin coal, see gas, poison; coal tar 108 cobalt 102 cocaine 201-2, 207; derivation from coca (Erythroxylon coca) 201 codeine 71 coffee 193 colchicine (Colchicum autumnale) 165, 167 colocynth (Citrullus colocynthis)

178

Conium maculatum, see hemlock

copper 131 crime 25, 26, 29, 41, 112; statistics of criminal poisoning 58, 62, 63-4, 67 crimidine (chloro-dimethylamino-methyl-pyrimidine) 139 crude oil 109 curare 7 Cuvier 188, and see Lacépède

cyanides 99, 102, 133, 162 cyanogen 163 cyanosis 118-9, 142, 154 Cyclon B, see gas, poison cytotoxicity 91,92 DDT, see dichloro-diphenyltrichloroethane De la Pommeraie, Couty,

case 27 demeton 129 dermatitis 45, 119, 128 dermatology 22 detergents 71, 79, 109, 147-8, 211, 226-7; anionic 226; cation producing 148, 227 diabetes 157-8, and see insulin, sulphonamides, biguanides diazepam 70 diazinone 129 dichlorodiethylsulphide, see gas, poison dichloro-diphenyl-trichloroethane (DDT) 127-8 dicoumarin see vitamins digitalis (Digitalis purpurea), purple foxglove 7, 27, 140, 153, 165 diodontidae (Chilomycterus

Shoepfi) 183 diphosgene, see gas, poison disinfectants 148 diuretics 160 doctors

18, 20-3, 35-7, 40,

251

41, 48, 50-3, 64, 109, 134, 138, 152, 209, 211, 217;

cock fish (Pterois volitans)

190

works 45, 48, 62, 72, 74, 210; Werkärztliche

synacceia verrucosa 190; jelly fish (Coelenterates) Arbeitsgemeinschaft C.V. 190-2; (German association of hallucinatory 194 works doctors) 48 Flaubert 112 Draeger’s apparatus 52 fluorine 92 drugs 7, 11, 16, 27, 37, 41, 92; | food poisoning 62 forensic medicine 20, 25, 37 drug addiction 25, 29, 37, 157, 193-207, and see, forensic scientists 25, 27, 29, 35, 37, 39, 41, 107, 112 cannabis, cocaine, heroin, formol 131, 148, 211 morphine, opium fungi 163, 164, 171-8: dyes, manufacture of 45, 54, Death Cap (Amanita 107, 113, 178; nitrogenous 45 phalloides) 174; Destroying Angel (Amanita verosa) 174; Fool’s Mushroom Elapidae, see snakes electrocardiogram 216 (Amanita verna) 174; Parasol Mushroom (Lepiota electro-encephalograph 95 aelveola) 174; Entoloma electrolysis 54 lividum 174; Cortinarius electrons 210 orellanus 175; Panther Engstrôm 215 mushroom (Amanita endothion 129 pantherina) 175; Flyenzymes 99, 129, 180, and see agaric (Amanita muscaria) cholinesterase, glucose-6175; Clitocybe 175-6; phosphate-dehydrogenase

(G6PD) ephedrine (Ephedra vulgaris)

203 ergot of rye (claviceps purpurea)

164, 171, 204

explosions, see nuclear explosions explosives, manufacture of 11 favism, see beans fertilisers 125, 132-3, and see

nitrates; calcium phosphate fish, poisonous 183, 188-92; cat fish (Galeichthys felis) 188; rays 183, 188, 190; weever fish (trachinidae)

188-90; hog fish 190; scorpion fish 190;

C. rivulosa 177; C. oleavia 177; chanterelles (Canther-

ellus cibarius) 177; Inocybe 177; Boletus Satanus 177; Flap mushroom (Boletus edulis) 177; Pleurotus

oleanus

177; Scleroderma

177; Gyromitra

138, 228-31; coal 74, 98, 103, 228, 231; chlorine 79, 80, 82, 146; phosgene 80, 82, 83, 107; diphosgene

mustard, or yperite 80, 82, 92, 104; arsine 80, 82, 83; carbon monoxide 81, 98-9,

103, 104, 228; Cyclon B 81; nerve gases 82, and see Tabun; Sarin; Soman;

classification of war gases 82; delivery of war gases 83; see also tear gas, rodenticides gas chambers 79, 81, 86 gas masks 54, 55, 80, 81 Gaultier, Professor 16 Gautier, Armand 27

Geiger counter 52 Geneva Convention Gibonne case 27

79

glass making 120 glucochloral (chloralose) 139 r glucose 93 glucose-6-phosphatedehydrogenase (G6PD)

147, 164 glucosides 118 Grill (‘Aunt Carrie’) case 114 Grzymala, Professor 175

177;

Smooth Ink Cap (Coprinus atramentarius) 177; Psylocybe mexicana 204; Stropharia cubensis 204;

see also ergot of rye; Poison Control Centres,

hallucinogens, see Cannabis; lycergic acid hashish, see Cannabis hemlock 178; Great Hemlock (Conium maculatum) 86, 166; Lesser Hemlock

Information Centres

(Aretusa cinapium) 166 herbicides 177; and fungi-

ganglioplegic drugs 154;

cides 131-2; 2, 4-D 131 heroin 196, 200, 201, 207 Hippomane mancenilla 171 holly (Ilex aquifolium) 167 hormones 224

pentamethonium

dihydrallazine

80;

hydrogen cyanide 80, 81, 82, 86, 99-102; dichlorodiethylsulphide 80;

154;

154; see

also detergents, cations gas, poison 79 passim, 129,

252

hydrocarbons

45, 102, 108,

LOTO 150, 227 hydrocyanic acid

TS 19; 102, 133,

138 hydrofluoric acid 111, 142-3 hydrogen cyanide, poisoning by 99-102, 172, and see gas, poison

hydrogen peroxide 211 hydrogen sulphide 55, 172 hypertherminants 117 hypotensive drugs 153-4; reserpine (Rauwolfia serpentina) 154 icthyosarcotoxism

insulin

tiques et Etudes économiques 58, 64 iodine 161

mackerel 179 Madame Bovary malaria 127 malathion 129

47,

54, 55, 210; compensation

for 37,39, 55 industrial medicine 10, 20, 37, 45, 48, 50; in us 47;in USSR 47-8 industry 10-1, 98, 105, 112, 223; nuclear 233 insecticides 11, 113, 117, 164; effects as poisons 125-31; pyrethrum 125-6; vegetable 125-6; mineral 126; organic 127-30; organophosphorus 82; 227, 233

insects, poisonous 183, 192; Honey bee (Apis mellifera) 93, 192; wasp (Vespa germanica) 192; Fire ant (Solinopsis sacrissima) 192;

Blister beetle or Spanish fly (Lytta vesicatoria) 192;

Kat, Khat, Qat (Catha edulis) 203 kiss of life, see artificial respiration KNMP, Royal Dutch Society for the Advancement of Pharmacology 14 labelling of toxic products 49,

74, 135 Lacépède 188, and see Cuvier laevopromepazine 70 Lafarge trial 8 laquers 109 Lavoisier 104 laxatives 156-7, 193 lead 121, 124; white 49;

tetraethyl 109, 228; metallic 109, 112, 115; red 115 lead poisoning (saturnism) 49,

50, 114—S; ‘lead colic’ 115; lead paralysis 115; and Burton’s line 115

Processionary caterpillar

lead workers

192; Hylesia urticans

League of Nations 81, 195 legislation on poisoning 10, 11, 25, 35-6, 37; and

192;

Horse flies 192 inspectors, factory 45, 47, 48,

Diethylamid 25) 194,

204-5, 207

jaundice 91, 108; spirochaetal 138

49 industrial hygiene 48, 49 industrial injuries 37, 39, 53,

166

leukaemia 122, 123 LSD 25; see lycergic acid lupins 163 lysergic acid (Lyserg Saiire

USSR 48 Institut national des Statis-

179

Industrial Code (France)

alcohol 40-1 lethal dose (LD) 87 Lettuce, poison (Lactuca virosa)

157-8

International Congress of Industrial Hygiene 47 Interpol 194 Institutes of Industrial Medicine and Hygiene,

irradiation, see radioactive contamination

imipramine 95, 150, 152 Indian hemp, see Cannabis

organochloride

49, 52, 53, 134 isoniazid, anti-tubercular drug 158-9

52

112

Mandrake ( Mandragora officinarum) 166—7 marijuana, see Cannabis Marsh test 8 Meadow Saffron (Colchicum autumnale), see colchicine medicine 11, 13, 20, 22, 26, 69, 70-1, 72, 73, 120, 149-61

Meissner 140 meprobamate 70 mercury 30, 91, 112, 116, 124, 131; poisoning (argyrism) 116 metaldehyde 141 metallurgy 98, 104 metals 111, 112, 117, 121 methane 102, 103 methyl alcohol, see alcohol methylene blue 119 methyl bromide 138 microbial infections 178, and see Salmonella: Staphylococcus

micro-organisms anaerobic

180, 181:

227, and see

botulin milk, see antidotes mining 98, 123 mistletoe (Viscum album)

167

Mithridates, King 113, 114 monoamine oxidase inhibitors (MAOI) 150, 152

295

morphine

127-8, 129, 223-4, 227, 233;

37, 94, 195, 196,

200, 201 mortality rates, poisoning

57,

58-9, 62, 64-7, 68 moth-balls, see naphthalene, paradichlorobenzene mushrooms, see fungi mussels 180 mustard gas, see gas, poison mutations 120 mytilism 180

Nallyl-normorphine (Nalorphine) 94

naphthalene 127, 146-7 National Association of Drugstore Proprietors (Us)

hexa-chloro-cyclohexane (BHC) 127; lindane 127; dieldrin 128; aldrin 128; heptachlorine 128; see also dichloro-diphenyltrichlorethane (DDT)

organo-phosphorus compounds 127, 129-31; parathion 129 ouabain 7, 74 overdoses 10, 62, 149, 157,

158, 159 oversensitivity to drugs as a cause of poisoning 62,

92-3, 149, 158, 160-1

National Clearing House for Poison Control Centers

oxalates 162 oxidation 172; oxidating agents 211; anti-oxidants 224, and see thiourea

(us) 15, 68-9 neuroleptics 150, 152

paint 55, 114

134

nicotine

paraffin 142 paradichlorobenzene

27, 165; as

insecticide 125-6 Niemann 201 nitrates 104; as fertilisers nitric acid 111; drugs derived from 154 nitrogen 117; oxides of 104 nuclear energy 121, 232; explosions 232 nurses

nutmeg

18, 21, 22

162

occupational diseases 53-4, 116; compensation for 54, 55 opium

195, and see

heroin; morphine optical glass manufacture Orfila, Mathieu

114

8, 26, 92, 94;

Traité des Poisons, ou Toxicologie générale 26 organo-chlorine compounds

111

peas 163, 181; Paternoster (Abrus precatorius) 170, and see abrin

Pelletier 140, 152 penicillin 158, 160 peppers, red 162 pesticides 106, 125, 223, 233, and see insecticides petrol and petroleum products

194, 195; effects of,

and its derivatives 195-201: opium poppy (Papaver somniferum)

pastes and fillers, manufacture of 107 pathology, toxicological 20, 22, 91; agricultural

plastics, manufacture of 99,

121 plums

162

Poison Control Centres 10, 13 passim, 25, 64, 68, 71-2, 75, 76, 77, 116, 135, 148, 149, 210, 217; Information Centres 17, 21, 22,68; 73: 75, 209; Poznan Centre for Information on fungi 171, 175; Treatment Centres

17, 21, 75; in Belgium 20-1, 71, 127,

146, 147

152185

152 phosgene, see gas, poison phosphoramides 129; amide of octamethylpyrophosphoric acid (oMPA) 129 phosphorescent pigments, manufacture of 114 phosphorous compounds 91, 106; white phosphorus 211 photosynthesis 229 plague 138

109, 111, 142,

21122728 peyote (Echinocatus williamsii) 194, 203-4 pharmacists 18, 20, 21, 22, 69, 87, 150 pharmacology 7, 11, 20 phenobarbitone 92 phenol 117, 131, 227 phenyl-amino-propane group

73:;in Britain 15, 72; in Canada 15; in Denmark

15;in France 15, 22-3, 70-2, 75-7; in Holland 14; in Switzerland

18, 20; in

USA 15, 18, 65, 68-70, 134; in USSR 18; in the world, see Appendix, 234 passim; European Association of Poison Control Centres

16:

statistics of telephone calls to 58-9, 61-3 pollution, atmospheric 11, 223, 228-31; water 225-8; see also radioactive contamination polymyxine 158 porphyrism 115 Portier 190 pot, see Cannabis potassium 131, 155, 157, 183, 216; potassium perman-

ganate 211

procainamide 153 promethazine 70

254

catenella)

piscivorus) 184, Bothrops

48, 50

propane 102 protozon (Gonyaulax

resuscitation, centres

180

prussic acid, see hydrocyanic acid psychiatry, psychiatrists 20, 22, 150, 204 Public Health Service 11, 17, 20, 21, 57, 74 pyrethrum, see insecticides

15, 23,

149, 215; experts 23, 76, 77; techniques 20, 22, 92, 93, 95, 106, 116, 119, 139, 150, 153, 160, 209, 211 rhubarb 163 Richet 190 ricin 170

Rizzi 201 rocket fuel

145

rodenticides 114, 131, 135— 41; use of gas as 138; see

quinidine 153 quinine 159

also White hellebore; virus radioactive compounds

97,

120ff

radioactive contamination. 11, 52, 85, 86, 227, 231-3; irradiation

120, 121-2,

232; radioactive poisoning 120-4 radioactive tracers 120, 121 radiation 120-4, 232; ionising 120-1, 123; cosmic 120; sickness 122 radio-strontium 232 Raspail 8, 26 raticides, see rodenticides

rats 135ff; Brown rat (rattus decumanus or norvegicus) 135-8; Black rat (rattus rattus) 135; see also

rodenticides rattle snakes, see snakes rayon industry 107 rays 120-1; alpha 120; beta 120; gamma

120; X- 120,

232 refrigeration fluid, poisoning by 75-7 Registrar General’s Statistical Review for England and Wales 66 regulations, governing toxic chemicals 45; for protection of agricultural workers 133; for protection of workers in industry 47,

rotenone 125, 126 Roussin 27 rubber 106 rue (Ruta gravedens) rust remover 68

(Viperidae)

Vipera

184; vipers 183, 184-5:

184, Bitis 184,

Gaboon viper (Bitis gabonica)

184, Cerastes

184, 185, Horned viper (Cerastes carinata) 184: water snakes (Hydrophidae) 183, 185; Elapidae 183, 187: spectacled cobra (Naja tripudians) 187, King cobra (Naja burgarus) 187, Asp (Naja haje) 187, coral snakes (Elaps) 187

170

safety engineers 45, 47, 48, 53, 124; safety precautions, industrial 53-4 Salmonella 182 santonin 156 Sarin 82 saturnism, see lead poisoning Savin (Juneripus sabina) 171 Schmidt 180 scilla (squill)

okinawensis

140; extraction

from Scilla (Urginea) maritima 140, 165 Séguin 196 serranidae (groupers), Mycteroperca venenosa 183 Service des Transmissions de la Marine Nationale 75 sharks 183 sleeping pills 74 snake bites 184, 185; antisnake bite sera 187-8 snakes 183-8; rattle snakes (Crotalidae) 183-4, 185: Crotalus adamantus 184, C. atrox 184, C. confluetus 184, Sistrurus 184, C. terrificus 184, Water Mocassin (Ancistrodon

Société Suisse de Pharmacie 18 Socrates 86 sodium 155, 157, 216; fluoride 143; hyposulphite 145, 211; sulphate 221 solvents 45, 52,97; fats 105,

106, 146; industrial 105-11 Soman 82 sorrel 162 Staphylococcus 182-3 stimulants 92, 150, 152, 221 streptomycin 158 strychnine

27, 92, 139, 221;

compounds: glucochloral 131, metaldehyde 131; extraction from Nux vomica 139, 165; and St Ignatius’ bean (Strychnos ignatii) 165 suicide by poisoning 11, 16,

99, 112, 128, 138, 140, 149, 150 sulphonamides 158 sulphur 106, 228; ‘sulphide madness’ 107; sulphur dioxide

138, 228

sulphuric acid 91, 111, 146, 228 Sunshine, Dr 15 Tabun 82 tanning industry 113, 178; and mercury 116

46

Tardieu 27

76-7, 214

tares (Lolium temulentum) tea 193

165

tetanus 139, 182 tetraethylpyrophosphate (TEPP) 129 tetracyclines 158 thallium 114, 140-1 thiocarbamates 132 thiourea 224

thymo-analeptics

150, 152;

see also imipramine; monoamine oxidase inhibitors tobacco

125, 193, 196;

tobacco plant (Nicotiana tabacum)

165, and see

nicotine toluene 108 tomatoes 163 toxicological analysis 24-37 toxicologists 11, 21, 25, 29,

35:36; 31.438211]; 223 toxicology, science of 8, 26,

29,91, 95, 174, 233; clinical

10, 17, 25, 48,

chapter 5 passim, 209; forensic 25ff tranquillisers 11, 70, 92, 150,

193 transport, of poison cases 23,

trial by ordeal 7, 87, 170

trichlorethylene 71, 105, 106, 107, 127, 134, 148 triorthocresyl phosphate 111 tunny 179 typhus 127 United Nations Organisation Narcotics Commission 195 uranium 120, 121 varnishes

109

Vauquelin

26

veratrine 140, 166; and extraction from Hellebore (Veratrum album) 140 vermifuges 156; cheno-

podium oil (Chenopodium

dicoumarin 139, coumafene 139 vitriol, see sulphuric acid

washing-up liquid 68 water, dilution with, in treat-

ment for poisoning

gemeinschaft C.V., see doctors, works White Hellebore (Veratrum album) 166; and see veratrine

White Spirit 109, 142 wine

194

Wolff 180 World War, First 79, 80, 194, 47, 80, 81,

127, 129, 195, 204

(Aspidium filix) 156, and see santonin vipers, see snakes virus (Danyscz virus), used as rat poison 141 vitamins: Vitamin A 160;

Worm-seed (Artemesia maritima) see santonin

X-rays, see rays yew (Taxus baccata)

Vitamin B 102; Vitamin C

119; Vitamin D 160; Vitamin K 139; antivitamins K: coumarin

112,

119, 124, 145-6, 155, 211 water snakes, see snakes Werkarztliche Arbeits-

195; Second

ambrosoides) 156; Male fern, or Fern-root

299

zinc phosphide zoologists 178 139,

138

167

FE a

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CEE TE

ne 7

Drs. F. Bodin and C.F. Cheinisse work at the Poison Control Center of the toxicological clinic of the Fernand-Widal Hospital in Paris.

The jacket shows the poisonous fungus Amanita muscaria.

Printed in Italy

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