Oenanthe crocata

Volume I — Special Symptomatology

( Water-hemlock.)

Botanical Description. — ''The (Enanthes are smooth aquatic plants, with compound umbels, variable involucres (often wanting), polyphyllian involucelles, white flowers on long pedicles inserted on the ray of the umbellule, hermaphrodite and sterile by abortion. They grow abundantly in the northern countries of the Old World, and some have been observed in America. The genus contains very numerous species ; and, as it has been limited by botanists up to the present day, we reckon a score which have been divided into two grand sections.

Genus (Enanthe (Linn.), perennial species, with fasciculated tubes, such as (E. crocata, which is the one now before us.

Synonyms. — (Enanthe mfranee. (Enanthe cl sucjaune. Breton, K/guis, Pembis, Pempes (the root having five fingers) pum bys, "Welsh. At Nantes, Pensagre. Navet du diable. The flowers are white, sometimes light rose, with a fascicle of tubers; in one variety the root is white, in another reddish-purple. Without enlarging on the chemical analysis let us merely state that the plant contains amongst other matters a fixed oil, a soluble oil, a resin, a yellow coloring matter; that one may ascribe to the first three the venomous action of the plant ; they exist in such abundance that in order to see them you have only to cut the root across, when the oils exude to the surface and soon lose by evaporation their aqueous parts and the highly scented volatile oil, whilst the yellow resinous juice encrusts the surface of the section.

Gray does not mention it in his botany, but it is pretty certain that it has been found in the United States. Dr. Kimball, of Sacketts Harbor, reported cases of poisoning with it, in American Observer of 1867. I have had specimens of the root sent me which clearly answered the above description. {Hale.)

Officinal Preparations. — Tincture of the root (with strong alcohol) ; dilutions.

Analogues. — Cicuta, JEthusa, Agaricus, Stramonium, Acid hydrocyanic,

Solanum.

Mind.

Disturbances of intellect; mad and furious as if drunk. Sudden and complete loss of consciousness. Madness, with convulsions — death.

He remembered nothing that had befallen him during the many days of his illness, nor what caused the sickness (in a case of poisoning).

Sensorium.

Violent vertigo, with falling; vertigo with nausea, vomiting, syncope and convulsions.

Head.

Puffs (flashes) of pungent heat on the head.

Apoplectic conditions, speechless and insensible, with face

puffed and livid, pupils dilated, respiration laborious,

limbs contracted, and tenesmus. Coma after the convulsions.

Face.

Bleeding from the nose. Eyes turned upward. Pupils dilated. Rose colored spots on the face.

Face swollen and livid, with bloody froth issuing from the mouth and nostrils.

Gastric Symptoms.

Burning heat in the throat and stomach, with disturbance of intellect; vertigo, cardialgia, nausea, followed by alvine evacuations.

Obstinate vomiting, continuing for days, not relieved by anything.

Extremities.

Numbness and feebleness of the limbs.

Tetanic contractions of the limbs.

Rose colored spots on the face, chest and arms.

Convulsive Symptoms.

Epileptiform convulsions in all the cases.

Terrible convulsions, followed by coma, or deep sleep.

Convulsions with vertigo, madness, nausea, vomiting, unconsciousness, eyeballs turned up, pupils dilated; tremblings, contractions of the lower jaw, lockjaw, trismus, contractions of the limbs.

Sudden convulsions, trismus, biting of the tongue, followed by unconsciousness and oblivion of the circumstances.

Convulsions with deathly syncope, coldness as if dead.

Convulsions with swollen and livid face; bloody froth from the mouth and nostrils; convulsive respirations, insensibility, feeble pulse, prostration — death. [For cases of poisoning, pathological anatomy, etc., see Vol. II. Therapeutics.]

Volume II — Special Therapeutics

This is one of the most poisonous and deadly of all the plants which have their home in the temperate zone. It is a native of Europe, and I think of the United States, although our botanical textbooks do not mention it as indigenous.

Cases of poisoning occur very often, owing to the ignorance of the people, who mistake it for harmless plants of the same family, which it closely resembles.

In the July number of the “British Journal of Homoeopathy” appeared an exhaustive study of the poisonous effects of (Enanthe, by Dr. Bloc. It first appeared in the “ Art Medicale,” and then in the “Dublin Medical Journal.”

Allen’s “Encyclopaedia of Materia Medica” gives a pathogenesis of this poison, but it has been but little used, except in some cases of epilepsy and puerperal convulsions.

We will give, in toto, the result of all the post-mortems which took place.

Exterior Aspect. — Very marked rigidity of the corpse ; the hand strongly bent, with the thumb applied forcibly to the palm of the hand; the nails bluish ; livid patches of small extent on the front of the trunk ; all the back part presented a tinge of deep purple except at the edge of the troughs, where the discoloration was redder, and the edges of parts submitted to pressure, where there was no discoloration ; the scrotum and penis equally livid ; the face too was injected and puffy; eyelids slightly apart ; conjunctiva rather congested ; pupils widely dilated ; lips, gums, and ears tinged purple ; tongue showing through the teeth and bitten at the tip ; froth issued from the nostrils.

Nervous System. — An incision of the integuments of the cranium let out a great quantity of black and liquid blood. The veins of the pia mater, greatly distended,

form numerous arborescent patterns on the surface of the convolutions and in their intervals. The cerebral substance is strongly injected, especially the white matter. It is the same with the cerebral protuberance and the medulla oblongata. Serous effusion pretty abundant in the cellular tissue, under the arachnoid and the ventricles, and principally at the base of the cranium. The sinuses of the dura mater distended with a great quantity of fluid blood. As to the spinal cord, its membranous sheath is strongly injected, the vertebral tissues are full of black fluid blood, and the medullary substance is redder and more congested than usual. In one case (Jones, who died in an hour) we found beneath the pia mater an escape of blood which covered both hemispheres.

Respiratory System. — The epiglottis is the seat of a very deep discoloration, with considerable injection of the network of veins covering it. The glottis, the ventricles of the larynx, the larynx itself, the trachea and bronchi, even to their ultimate ramifications, present a deep red, and are coated with a thick layer of reddish frothy mucus. The lungs are dull and blackish. A great many small extravasations (pulmonary apoplexy) were noticed.

Circulating System. — Heart: bulk normal, but contained much black fluid blood.

Digestive Apparatus. — The papilla; at the base of the tongue turgid and vascular. The velum palati, tonsils, and pharynx coated with glairy mucus and deeply livid. (Esophagus the same. Stomach and intestines scarlet inside. Interior surface coated with viscous mucus, under which the mucous membrane is strongly injected and looks mammillated, owing to the numerous follicles which are prominent and swollen. There are also points of extravasation and black lines along the venous trunks of these organs.

The report of these six post-mortems contains the substance of many others, which, being made much less carefully, we omit as useless.

MORBID ANATOMY.

We report verbatim this chapter, as a resume of the alterations observed in several post-mortems, of which we have given but one, which was more extensive than the rest, and because it comprehends the post-mortems made on animals.

External Appearance. — Strongly pronounced rigidity of the body; hands strongly clenched, the thumb forcibly applied to the palm. Face livid, sometimes injected, but rarely ; pupils widely dilated ; reddish tinge of the body, especially marked on the parts lying undermost ; scrotum and penis livid ; abdomen tympaniti c.

Digestive System. — Trismus very difficult to get over (a constant symptom). Labial mucous membrane red, w7ith ecchymotic spots, varying from bright rose to gangrenous black ; bloody foam at the nose and mouth ; velum pendulum palati, the two columns and back of the fauces, red, injected, and also exhibiting brown spots; glairy ropy mucus almost always present. Tongue bitten at the tip (constant symptom). Papillae on the base of the tongue turgid and vascular. Gums purplish-red. (Esophagus, nothing exterior, vinous-red tinge on the interior ; ropy mucus, red and brown spots. Stomach. — When death supervened rapidly, nothing at all was found in the stomach. This is the exception. Most frequently it presents a more or less deep tint of red ; its mucous membrane is

mammillated, and its follicles prominent and tumid. The pyloric and cardiac orifices very bright red ; their mucous coat raised, cedematous, and can be raised with the handle of the scalpel. If the subject has been long ill there is softening of the parietes of the stomach, and wide ecchymotic spots capable of proceeding to perforation. The stomach is generally empty ; sometimes contains debris of the root, or a milky yellow juice, or else dirty-gray ; in which, with a lens, one can find little drops of the gum-resinous juice, or the fecular grains of the poison. It is sometimes tympanitic, and the contained gas has the scent of fried celery, which characterizes the (Enantlie. In the large intestines the vessels are injected, with broad ecchymotic spots, distended, and mostly empty. The small intestines almost always contain the debris of the poison under the appearance of a yellowish matter in the jejunum, browner in the ileum. Liver normal ; the gall-bladder flabby and mostly empty. Spleen and Pancreas. — -Nothing special. Kidneys. — Marked injection of the cortical coat ; very little urine in the renal pelvis.

Nervous System. — Effusion of bloody serum and sometimes of blood at the occipital foramen. On cutting the meninges the veins of the pia mater distended and highly arborescent at the edges of the convolutions ; apoplectic foci in the cerebral mass, which is strongly injected and speckled (piquet). The annular protuberance, medulla oblongata, and peduncles of the cerebrum and cerebellum inflamed, and present (especially the latter) a certain degree of softening. Serous effusion in the cellular tissue beneath the arachnoid, the ventricles, and at the base of the brain. The sinuses of the dura mater are distended with blood. Spinal Cord. — The integuments strongly injected ; the vertebral sinuses filled with blood, soft and fluid. Medullary substance red and congested.

Circulating System — Heart. — Bulk normal ; sometimes serous effusion, due to pericarditis. Heart always gorged with black blood, containing fibrinous clots ; left side generally bloodless ; there exist also brown spots on the parietes of both sides of the heart ; the large vessels contain black blood quite fluid.

Respiratory System — Larynx, Epiglottis. — More or less deep coloring of the mucous lining, with more or less injections of the venous network which covers it. It contains a frothy, whitish fluid. Trachea. — Injection ; bronchial glands gorged. Lungs. — Bulk normal, generally crepitant, presenting some petechice and nucules of pulmonary apoplexy ; bronchi sometimes gorged with thick mucosities. The vessels are filled with black blood, liquid and ropy. Some obstruction was also ascertained at the back, but this, we think, was the result of incipient decomposition.

In short, the symptoms produced by poisoning with CEnanthe crocata are as follows, according to authors in general and Dr. Bloc in particular. The attack presents two forms : first, sudden ; second, consecutive.

1. Some minutes after swallowing it the subject utters a cry and falls a prey to convulsions. 2. These symptoms do not appear again for about an hour. Local Symptoms. — Some time after ingestion spots appear on the hands, face, and limbs ; at first rose-colored, then becoming deep-red, like the stings of Urtica urens. This eruption may extend over the whole body ; it is preceded and accompanied by a sharp itching. In about two days the redness abates, the eruption decreases, leaving a scurfy desquamation. But the progress of this eruption is not always so

gentle. The dermis is inflamed, the glands are gorged, and there appear shortly signs of a phlegmon, which runs its usual course, ending either by resolution or suppuration. Observe that this eruption sometimes shows itself in subjects who are poisoned, but especially from the application of the juice on the hands.

General Symptoms.— 1. Regarding the nervous system : shivering at the outset, and horripilation ; loss of consciousness and of memory ; agitation, brisk, shaking, and intermittent, or rather with remission ; acute cries ; delirium, more or less prolonged ; stupor, vertigo ; convulsive movements of the muscles of the face, jaws, and limbs; sometimes opisthotonos. Well-marked trismus, proceeding from mere cramp to impossibility of opening the jaws, or having them opened by force. Dilated pupils, contraction of the muscles of the eyelids, spasms of the muscles of inspiration, fainting fits, sometimes horrible convulsions, followed by general insensibility and death. We rarely observe hallucinations.

1. As to the alimentary canal : an acrid sensation, biting and burning on the tongue, mouth, and fauces ; sensation of constriction of the pharynx. Appearance of red and brown spots on the parts directly in contact with the poison. Bloody froth at the nose and mouth. Tongue projecting and almost always bitten. Acute, burning pain of the oesophagus, stomach, and intestines ; pressive pain in the epigastric and abdominal region. Nausea, efforts to vomit, with or without effect. Virulent smell of fried celery. Loss of appetite. Obstinate constipation or frequent stools.

2. As to the circulatory and respiratory symptoms : irregular beating of the heart ; small pulse, and threadlike ; respiration short, with long intervals, and sometimes appearing to cease entirely. Brisk expirations are made from time to time to expel masses of bloody mucus.

3. As to secretions: at first, cold clammy sweats, then dryness of skin. Excretion of urine: in general there is retention, and very little is passed each time.

Of all maladies epilepsy has most resemblance to poisoning by (Enanthe ; but epileptic attacks last on the average ten or twenty minutes, whereas the sufferings produced by the poison are of long duration, extending beyond eight hours and even for days and weeks. In epilepsy the trismus never lasts longer than the fit, and is not always present. In poisoning cases it not only appears during the general attack, but lasts very long, even so as to prevent emetic treatment, from impossibility of introducing liquid into the mouth, and they have to inject it by the nostrils with the’oesophagean catheter. Out of 124 poisoning cases whose phenomena have been recorded in this work, there were fifty-five deaths.

As a result of all the cases of poisoning and pathological effects, it is the opinion of other authors, and of Dr. Bloc himself, that (CEnanthe crocata, and especially the root, gives rise in man to all the symptoms of epilepsy. According to experiments on animals with the fresh juice, or aqueous or alcoholic extract, or even with the tincture in small doses, it provokes in them, also, symptoms analogous to those of epilepsy. The lesions of the dead body, ascertained by post-mortem examination, present in each case precisely the same alterations. From this similitude of symptoms ascertained during life, and of the organic lesions found after death, may we not hope that this plant can be administered beneficially to epileptic subjects? This is what we wished to try in the case of one of our dispensary patients. This young man, about 22, presented frequent epileptic vertigo,

and sometimes biting of the tongue and involuntary urine during the fit, with total oblivion of all that had happened during the crisis. We prescribed for four months (Enanthe, from the 6th dilution to the “ mother tincture,” in drops. Sometimes we observed retardation of the attack, which, from fortnightly became monthly, and retardation and diminution of the vertigo. But at other times the vertigo and fits reappeared as often and as intense as ever, though we could not positively prove that the strong doses produced aggravation. This patient left off coming. I ought to add that, having taken his medicine from a druggist’s shop where I was not quite sure that they had the mother tincture of (Enanthe crocata, and not from Messrs. Catalan, where I had verified its presence, I cannot feel certain as to this experiment.