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Full text of "Medical Jurisprudence And Toxicology"

CANTHARIDES                                                         601

crystalline cantharidin taken by a medical student out of misplaced curiosity
produced poisonous symptoms, which persisted for 13 days. About 1 to 2
grains of crystalline cantharidin have proved fatal.

Fatal Period.—The usual fatal period is twenty-four to thirty-six hours.
A man,4 aged 54 years, died in 2 days after he had taken some pills contain-
ing a large dose of cantharides with a view to promoting success with his
bride, aged 23 years. Death has also occurred after several days.

Treatment.—Eliminate the poison by washing out the stomach. Give
demulcent drinks, but do not give oils or fats, as they dissolve cantharidin.
Inject morphine hypodermically to allay pain. Administer magnesium
sulphate to empty the bowel and treat the renal damage by hot fomentations
and starvation followed by large quantities of water.

Post-mortem Appearances.—The gj^e&^shining particles of powdered
cantharides may be found adherent to the mucous membrane of the stomach,
which is blood-stained, softened, inflamed and ulcerated, showing patches of
vesication or even gangrene. The same is the condition of the mucous mem-
brane of the intestines. The spleen is hyperaamic and congested. The
kidneys are congested and inflamed, frank blood may be present in the renal
pelvis, ureters and bladder. The bladder is injected and ecchymosed.
Lungs are cedematous, frothy blood-stained mucus is present in the air
passages. Haemorrhages on the surface of the heart are seen.

Chemical Analysis.—Organic mixtures containing cantharidin should be
shaken up with acidified chloroform and the chloroform layer sliould be
separated, filtered and allowed to evaporate spontaneously. The residue
contains cantharidin, which may be identified by the following test: —

If a small piece of lint is moistened with a drop of the residue mixed
with a drop of olive oil, and applied to the skin, a blister will be produced
on the skin after some time.

Medico-Legal Points.—Cantharides has produced poisonous symptoms
from its use as an aphrodisiac, or as a criminal abortifacient. It is rarely
used for suicidal and homicidal purposes. In his annual report for the year
1948, the Chemical Examiner, Bengal, cites a case in which a man committed
suicide by swallowing some liquor epispasticus.

Two fatal cases 5 of cantharidin poisoning have been reported in two
female clerks aged 19 and 27 years, following eating coconut ice in which
small quantity of cantharidin was deliberately introduced by a male
employee in a firm of chemists.

Accidental poisoning has occurred from its external application as a
vesicant, or from the use of a blistering paper (Charta epispastica). A
case6 is recorded in which an unmarried woman, aged 26 years, produced
dermatitis artefacta by the application of cantharides plaster over the front
of the neck and the chin doxvn to the sternum and over the backs of the
hands. The lesions' were markedly angular and showed definite blisters in
places.

The wings of the beetle resist putrefaction for a very long time; hence
their shining particles may be visible on the gastric or intestinal mucous
membrane by the aid of a lens many months after death has occurred.

Cantharidin is absorbed from the skin and the alimentary canal, and is
eliminated in the urine and faeces. Cantharides does not affect fowls, but
poisonous symptoms occur in a man, who eats the fowl that has been fed
with cantharides.

4.   Jour, Amer. Med, Assoc., Jan. 1, 1921, p. 50.

5.   L. C. Nickolls and Donald Teare, Brit Med. Jour., Dec. 11, 1954, p. 1384.

6.   Frederick Gardiner, Brit. Med. Jour., Feb. 15, 1930, p. 282.